Complementary Roles of Peripheral Blood Film, Bone Marrow Examination, and Flow Cytometry in the Diagnosis of Suspected Leukemia

Introduction: Leukemia comprises a heterogeneous group of hematologic malignancies requiring timely and accurate diagnosis for appropriate classification and clinical management. In routine practice, diagnostic evaluation commonly involves peripheral blood film examination, bone marrow morphology, and flow cytometry, although these modalities are not always applied uniformly. Objective: To evaluate the complementary roles and real-world utilization of peripheral blood film, bone marrow examination, and flow cytometry in the diagnostic assessment of suspected leukemia. Methods: This retrospective observational study analyzed laboratory records from two tertiary diagnostic centers in Dhaka, Bangladesh. A total of 43 cases evaluated for suspected, known, or follow-up leukemia were included. Demographic characteristics, specimen types, availability of diagnostic modalities, flow cytometry technical parameters, immunophenotypic findings, and diagnostic impressions were summarized using descriptive statistics. Results: The mean age of the study population was 42.6 ± 21.7 years, with a slight female predominance (55.8%). Peripheral blood film findings were suggestive of acute leukemia in 51.2% of cases, while bone marrow morphology was suggestive in 58.1%. Flow cytometry was performed in 86.0% of cases, and all three diagnostic modalities were documented in 86.0%. Among flow cytometry–evaluated cases, the mean blast percentage was 61.9 ± 30.1, with acute myeloid leukemia supported in 19 cases and indeterminate findings in 15. Myeloperoxidase positivity was observed in 61.3%, CD33 in 80.0%, CD13 in 71.0%, CD34 in 70.6%, and lymphoid marker co-expression in 54.3%. Conclusion: Flow cytometry demonstrated a central role in routine leukemia diagnostics, particularly when morphological findings were inconclusive. Integrated application of peripheral blood film examination, bone marrow morphology, and flow cytometry remains essential for robust diagnostic evaluation in suspected leukemia. Medicine Today 2026, Vol.38 (2): 270-275