Immunophenotyping of Acute Lymphoblastic Leukaemia through Flowcytometry in Children

  • Zulfania Zulfania Department of Physiology, Rehman Medical Institute, Peshawar, Pakistan
  • Hinna Hayat Department of Pathology, Rehman Medical Institute, Peshawar, Pakistan
  • Sadia Shaukat Department of Anatomy, Rehman Medical Institute, Peshawar, Pakistan
  • Rashid Mahmood Department of Physiology, Rehman Medical Institute, Peshawar, Pakistan
  • Yasir Ihtesham World Food Programme Office, Islamabad, Pakistan
  • Mushtaq Ahmad Mian Rehman Medical Institute, Peshawar, Pakistan
Keywords: Acute Lymphoblastic, Flowcytometry, Immunophenotyping, T-ALL, B-ALL


Background: Acute Lymphoblastic Leukaemia (ALL) is caused by both genetic and environmental factors. Immunophenotyping by flowcytometry is vital for WHO classification of acute leukaemia. The objective of this study was to determine the immunophenotyping of ALL in paediatric patients through flowcytometry and to determine the frequency of each type of ALL through flowcytometry. Methods: This study was conducted in Rehman Medical Institute, Peshawar. One year retrospective data from Laboratory reports of blood parameters and flowcytometry were evaluated. Frequencies for qualitative variables like age and gender, and mean and standard deviation were calculated for quantitative variables like haemoglobin level, total leukocyte count, and platelet count. Results: Out of 32 ALL patients 22 (68.7%) had B-ALL and 10 (31.3%) had T-ALL. Eleven (34%) patients were females and 21 (66%) were males, 4 (12.5%) were from age group 1–5 years, 15 (47%) had age group >5–10 years, and 13 (41%) had age group >10–15 years. In B-ALL the expression of CD markers CD10, cCD79a, CD19 and CD20 was 91%, 77%, 68% and 14% respectively. In T-ALL, cCD3 was expressed in 100%, CD7 in 20%; cCD79a, CD19, and CD20 were 0%. Conclusion: ALL is more common in male children with peak age >5–10 years. B-ALL is more frequent than T-ALL. Patients mostly present with low haemoglobin (Hb), high total leukocyte count (TLC) and low platelet count. CD10, CD19, cCD79a were the most expressed markers in B-ALL, and cCD3 was expressed in all patients of T-ALL.

Pak J Physiol 2020;16(3):3–6


Hayati H, Kebriaeezadeh A, Ehsani MA, Nikfar S, Sari AA, Troski M, et al. Treatment costs for pediatrics acute lymphoblastic leukemia; comparing clinical expenditures in developed and developing countries: A review article. Int J Pediatr 2016;4(12):4033–41.

Ahmad S, Kifayatullah, Shah KA, Hussain H, Anwar-ul-Haq, Abidullah, et al. Prevalence of acute and chronic forms of leukemia in various regions of Khyber Pakhtunkhwa, Pakistan: Needs much more to be done! Bangladesh J Med Sci 2019;18(2):222–7.

Ribera JM, Oriol A. Acute lymphoblastic leukemia in adolescents and young adults. Hematol Oncol Clin North Am 2009;23(5):1033–42.

Kumar A, Rathee R, Vashist M, Neelkamal SS, Gupta S. Acute Lymphocytic Leukemia: An epidemiological and hematological study from Haryana. Biosci Biotech Res Asia 2016;9(2). DOI : bbra/1069

Hassanzade J, Mohammadi R, Rajaeefard AR. Risk factors in childhood lymphoblastic leukemia in Shiraz-Iran: An epidemilogical study. J Gorgan Univ Med Sci 2012;14(4):119–24.

Ghasemi A, Banihashem A, Ghaemi N, Elmi S, Esmaeili H, Sayyar RE. Evaluation of bone mineral density in children with acute lymphoblastic leukemia (ALL) and non-Hodgkin’s lymphoma (NHL Int J Hematol Oncol Stem Cell Res 2016;10(3):153–60.

Shahverdi E, Shahriari M, Zare S, Rahiminejad MS, Soleimani FH, Maki M, et al. Common presenting signs and symptoms in children with acute lymphoblastic leukemia. Basic Clin Cancer Res 2020;12(1):26–33.

American Cancer Society. Cancer Facts & Figures 2020. Atlanta, Ga: American Cancer Society; 2020.

Yalyzhko M. Epidemiological features of leukemia in children. (Doctoral dissertation). Sumy State University. 2020.

Peris-Bonet R, Salmerón D, Martínez-Beneito MA, Galceran J, Marcos-Gragera R, Felipe S, et al. Childhood cancer incidence and survival in Spain. Ann Oncol 2010;21(suppl-3):iii103–10.

Norouzirad R, Khazaei Z, Mousavi M, Adineh HA, Hoghooghi M, Khabazkhoob M, et al. Epidemiology of common cancers in Dezful county, southwest of Iran. Immunopathol Persa 2017;4(1):e10.

Gupta N, Pawar R, Banerjee S, Brahma S, Rath A, Shewale S, et al. Spectrum and immunophenotypic profile of acute leukemia: A tertiary center flow cytometry experience. Mediterr J Hematol Infect Dis 2019;11(1):e2019017.

Munir AH, Khan MI. Pattern of basic hematological parameters in acute and chronic leukemias. J Med Sci 2019;27(2):125–9.

Shahni A, Saud M, Siddiqui S, Mukry SN. Expression of aberrant antigens in hematological malignancies: A single center experience. Pak J Med Sci 2018;34(2):457–62.

Salem DA, Abd El-Aziz SM. Flowcytometric immunophenotypic profile of acute leukemia: mansoura experience. Indian J Hematol Blood Transfus 2012;28(2):89–96.

Siegel DA, Henley SJ, Li J, Pollack LA, Van Dyne EA, White A. Rates and trends of pediatric acute lymphoblastic leukaemia ―United States, 2001–2014. MMWR Morb Mortal Wkly Rep 2017;66(36):950–4.

Greaves MF, Janossy G, Peto J, Kay H. Immunological defined subclass of acute lymphoblastic leukemia in children relationship to presenting features and prognosis. Br J Haematol 1981;48:179–97.

Kiem Hao T, Nhu Hiep P, Kim Hoa NT, Van Ha C. Causes of death in childhood acute lymphoblastic leukemia at Hue Central Hospital for 10 Years (2008–2018). Glob Pediatr Health 2020;7:2333794X20901930.

Kakaje A, Alhalabi MM, Ghareeb A, Karam B, Mansour B, Zahra B, et al. Rates and trends of childhood acute lymphoblastic leukaemia: an epidemiology study. Sci Rep 2020;10:6756.

Fadoo Z, Nisar I, Yousuf F, Lakhani LS, Ashraf S, Imam U, et al. Clinical features and induction outcome of childhood acute lymphoblastic leukemia in a lower/middle income population: A multi-institutional report from Pakistan. Pediatr Blood Cancer 2015;62(10):1700–8.

Yasmeen N, Ashraf S. Childhood acute lymphoblastic leukaemia; epidemiology and clinicopathological features. J Pak Med Assoc 2009;59(3):150–3.

Jaime-Pérez JC, García-Arellano G, Herrera-Garza JL, Marfil-Rivera LJ, Gómez-Almaguer D. Revisiting the complete blood count and clinical findings at diagnosis of childhood acute lymphoblastic leukemia: 10-year experience at a single center. Hematol Transfus Cell Ther 2019;41(1):57–61.

Pavithra P, Koulmane Laxminarayana SL, Manohar C, Belurkar S, Kairanna NV. Transition from morphologic diagnosis to immunophenotypic diagnosis of acute leukaemia —experience of establishing a new flow cytometry laboratory. J Hematopathol 2019;12(4):191–9.

Rajkumar NN, Vijay RH. Immunological subtypes of acute lymphoblastic leukemia-beyond morphology: experience from Kidwai State Cancer Institute, Bengaluru, India. J Assoc Physicians India 2017;65(7):14–17.

Hegde SS, Soundarya M, Harsha K. Study of the clinicopathological profile of paediatric haematological malignancies at a tertiary care centre. J Evol Med Dent Sci 2013; 2(43):8438–43.

Marks DI, Paietta EM, Moorman AV, Richards SM, Buck G, DeWald G, et al. T-cell acute lymphoblastic leukemia in adults: clinical features, immunophenotype, cytogenetics, and outcome from the large randomized prospective trial (UKALL XII/ECOG 2993) Blood 2009;114(25):5136–45.


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Zulfania Z, Hayat H, Shaukat S, Mahmood R, Ihtesham Y, Mian M. Immunophenotyping of Acute Lymphoblastic Leukaemia through Flowcytometry in Children. PJP [Internet]. 30Sep.2020 [cited 26Nov.2022];16(3):3-. Available from:

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