Flow Cytometry Rotation

Goals and Objectives

 

 

Laboratory: Immunogenetics, Department of Pathology

Director: Nicole Suciu-Foca, PhD

Associate Director: Adriana I. Colovai, PhD

Recommended rotation length: 2 weeks

 

 

I. General Considerations

 

The goal of this rotation is an understanding of the principles and procedures of flow cytometry with emphasis on clinical applications. The faculty will assist the fellow in achieving the objectives through recommended readings, assigned service responsibilities, and weekly didactic sessions during which the principles and practical applications of flow cytometry are reviewed in detail. Fellows are expected to review and prepare for the weekly didactic session with the faculty.

 

 

II. Core Competencies

 

Patient Care

1)            Participate in the analysis of patient specimens using flow cytometry

2)            Understand the value of flow cytometry as a diagnostic tool

3)            Learn how to interpret flow cytometry results and to correlate those findings with other laboratory and clinical data

4)            Understand the criteria for selection of cell markers based on clinical indications

5)            Learn to function as a laboratory consultant to the referring physicians.

 

Medical Knowledge 

1)      Cellular Immunology

i)         Understand the principles of structural and functional evaluation of hematopoietic cells

ii)       Understand the principles and stages of lymphocyte development

iii)      Understand the importance of immunophenotypic characterization of normal and aberrant hematopoietic cell population

iv)     Understand the basic function, protein structure, and cell expression of cell markers currently used for clinical diagnosis

 

2)      Flow Cytometry as diagnostic tool

i)         Understand the importance of immunophenotyping in detecting abnormal cell subsets in patients with hematopoietic malignancies

ii)       Understand the principles of multi-color flow cytometry 

iii)      Learn the normal pattern of cell marker expression and the abnormalities most commonly detected in patients with leukemia, lymphoma or immunodeficiency

iv)     Learn the immunophenotypic features of hematopoietic stem/progenitor  cells

v)       Understand the effects of drugs that deplete target cell populations, such as Rituximab and Campath, and the uses of flow cytometry to monitor the efficacy of those drugs

vi)     Understand the importance of multicolor flow cytometry as a highly sensitive technique in the detection of minimal residual disease

 

Practice-based learning and improvement

1)      Understand the organization and function of the Immunognenetics/ Flow Cytometry laboratory

2)      Understand the criteria for the selection of relevant cell markers based on the patient’s clinical presentation 

3)      Gain hands on experience in the laboratory procedures, including:

a.       Lymphocyte isolation from tissue samples

b.      Assessment of cell viability

c.       Staining of whole specimens (peripheral blood and bone marrow) and of lymphocytes isolated from tissue samples

d.      Run and analyze stained specimens on the flow cytometer

e.       Understand cell gating procedures and learn to identify normal and aberrant cell populations

f.        Learn to interpret positive and negative results for individual cell markers

g.       Prepare the flow cytometry data report

h.       Discuss the findings of the flow cytometric analysis in context of morphology, cytogenetics and molecular data available for individual patients

4)      Understand the objectives of the Quality Control/Quality Assurance plan of the Flow Cytometry laboratory and the plan implementation policies

5)      Develop an efficient method for collecting and studying the relevant scientific literature and reach the ability to critically evaluate and compare published literature

6)      Demonstrate an investigative and analytical thinking approach in the field of Cellular Immunology and Flow Cytometry

 

 

Interpersonal and communication skills

1)      Communicate effectively and maintain cordial relationships with laboratory personnel, residents, fellows and attending physicians

2)      Develop the skills to discuss laboratory results, additional or alternative tests required for individual patients

3)      Develop the ability to communicate effectively with patients, patients' families and health care providers when discussing flow cytometry results

 

Professionalism

1)      Attend all laboratory activities planned for this rotation

2)      Reliably complete each assigned task

3)      Thoroughly complete all case analyses

4)      Maintain correct and cordial communication with laboratory personnel, residents, fellows and attending physicians

 

System-Based Practice

1)      Become familiar with the standards for Flow Cytometry laboratories set forth by the College of American Pathologists and New York State Department of Health

2)      Understand the clinical indications for flow cytometry testing

3)      Become familiar with the educational resources available for clinical use of flow cytometry  

4)      Become informed about professional organizations (e.g. Clinical Cytometry Society, CAP etc), specialized journals, and consensus conferences in the field of Clinical Flow Cytometry

5)      Participate in the evaluation of quality control and proficiency testing results

6)      Understand the need for cost effective laboratory utilization and resource allocation

 

 

III. Areas of Assignment

 

Week 1.

The fellow will become familiar with the technical aspects of flow cytometry, including staining procedures, instrumentation, reagents and cell analysis. Quality control procedures will be emphasized.

 

Week 2.

The fellow will learn specific protocols used for immunophenotyping of hematopoietic cells. The fellow should become proficient in analyzing flow cytometry data and will undertake service responsibilities, such as resolving individual cases. At the end of the rotation, the fellow will present to the laboratory faculty and supervisors a summary of flow cytometry results obtained during the rotation on two patients. Flow cytometry data will be presented in the context of laboratory, histology, molecular and clinical information available. 

 

 

IV. Key References:

1.      Smith, B. R., et al. Curriculum content and evaluation of resident competency in clinical pathology (laboratory medicine): a proposal. Human Pathology (2006) 37,934-968.

2.      Abbas KA, Lichtman AH, and Pober JS. Cellular and Molecular Immunology, Fourth Edition. WB Saunders Co., New York, 2000.

3.      Paul, W .E., ed. Fundamental Immunology, Fourth Edition. Lippincott Raven, Philadelphia, 1999.

4.      Hahn, A.B., Land, G.A., and Strothman, R.M., eds. The American Society for Histocompatibility and Immunogenetics Laboratory Manual, Fourth Edition, ASHI, 2000.

5.      Flow Cytometry in Hematopathology: A Visual Approach to Data Analysis and Interpretation (Current Clinical Pathology) by Doyen T. Nguyen, Lawrence W. Diamond, and Raul C. Braylan. Humana Press, Second Edition, 2007.