@article{LIU2026, 
author = {Meifang LIU and Mei JIANG and Zige WANG and Qing ZHU and Qianbin DAI and Zhewen LE and Rui ZHAO},
title = {Integration of flow cytometry in the bone marrow cell morphology laboratory teaching},
year = {2026},
journal = {Experimental Technology and Management},
volume = {43},
number = {9},
pages = {218-225},
keywords = {flow cytometry, bone marrow cells, morphological analysis, immunophenotyping, experimental teaching},
url = {https://www.sciopen.com/article/10.16791/j.cnki.sjg.2026.09.027},
doi = {10.16791/j.cnki.sjg.2026.09.027},
abstract = {ObjectiveConventional laboratory teaching in bone marrow cytomorphology has two major limitations: limited accuracy in qualitative cell recognition and an excessive emphasis on morphological features at the expense of immunophenotypic characterization. These limitations hinder students’ development of an integrated morphology-immunophenotype diagnostic framework, an increasingly indispensable competency in the era of precision medicine. To address these gaps, this study integrated flow cytometry (FCM) into the cytomorphology laboratory curriculum, thereby establishing a novel morphology-immunophenotype integrated teaching model. This approach enables students not only to recognize cellular morphology at the microscopic level but also to quantitatively evaluate the immunophenotypes of corresponding cell subsets at the molecular level. By bridging the gap between clinical practice and classroom instruction, this model fosters systematic diagnostic reasoning and multimodal analytical skills essential for the evaluation of hematologic diseases.MethodsThis teaching practice was implemented in the Clinical Hematology Laboratory course. Bone marrow samples were obtained from patients with diseases such as acute promyelocytic leukemia (APL) and acute B-lymphoblastic leukemia (B-ALL) after informed consent was obtained. The integrated experimental workflow comprised four modules: (1) Morphological analysis—Bone marrow smears were prepared, stained with Wright–Giemsa stain, and examined under light microscopy (×1000 oil immersion) to assess cell size, nuclear-to-cytoplasmic ratio, chromatin pattern, granules, and Auer bodies. (2) Flow cytometry (FCM)—EDTA-anticoagulated bone marrow specimens were labeled with multicolor antibody panels (e.g., CD45 KO, CD34 APC, CD13 PE, CD33 PC5.5, and CD117 PC7), incubated, subjected to red blood cell lysis, and analyzed using a Navios EX flow cytometer equipped with 488, 638, and 405 nm lasers. Data acquisition (≥104 CD45+ events) and analysis using Kaluza software, including hierarchical gating and multiparametric phenotyping, were performed. (3) Integrated case-based learning—Students compared morphological findings with FCM immunophenotyping results obtained from the same patient samples, focusing on their complementary diagnostic value (e.g., APL: atypical promyelocytes vs. SSChi/CD45dim/HLA-DR–/CD33++; B-ALL: lymphoblasts vs. CD19+/CD10+/CD34+/TdT+/cIgM–/κ–/λ–). (4) Clonality and minimal residual disease (MRD) demonstration—FCM data were used to illustrate light chain restriction, aberrant antigen expression, and MRD detection (sensitivity, 0.01%). The entire process was designed to help students translate morphological observations into immunophenotypic definitions and vice versa.ResultsThe integrated teaching approach yielded several key outcomes. (1) Complementarity in disease diagnosis—In the APL case, morphology revealed characteristic abnormal promyelocytes with Auer bodies, whereas FCM rapidly identified an SSChi/CD45dim/ HLA-DR–/CD33++ immunophenotype, providing actionable evidence for targeted therapy with all-trans retinoic acid. In the B-ALL case, morphology showed homogeneous lymphoblasts, whereas FCM precisely identified the B-cell lineage (CD19+/CD22+/CD10+) and early precursor stage (CD34+/TdT+/cIgM–), and further demonstrated clonality through the absence of κ/λ light chain expression, thereby distinguishing malignant proliferation from benign lymphocytosis. (2) nhanced diagnostic precision—FCM detected MRD at levels as low as 0.01% residual leukemia cells in post-treatment B-ALL samples, a sensitivity far beyond that of morphological assessment alone. (3) Integrated diagnostic model—A “genetic aberration → immunophenotypic alteration → morphological manifestation” pathway was established, enabling students to understand, for example, how the CD34–/HLA-DR–/CD33++ FCM pattern corresponds to hypergranular promyelocytes in APL and how the CD19+/CD10+/CD34+/TdT+/κ–/λ– phenotype explains the morphology of immature lymphoblasts in B-ALL. (4) Student skill development—Through hands-on practice in multicolor panel design, spectral compensation, gating strategies, and correlative analysis, students developed the ability to differentiate morphologically similar cells (e.g., reactive versus neoplastic lymphocytes) and to trace the origin of abnormal cells using multiparametric FCM data. This dual-perspective approach substantially enhanced their systematic diagnostic reasoning.ConclusionsBy integrating FCM, a clinically established but pedagogically underrepresented technology, into traditional bone marrow cytomorphology laboratory teaching, this reform breaks down the “knowledge silos” between morphology and immunophenotyping. Morphology provides insight into cellular architecture, maturation stages, and pathognomonic structures (e.g., Auer bodies), whereas FCM provides objective, quantitative, and clonal immunophenotypic evidence. Together, they establish a comprehensive diagnostic framework spanning macroscopic features to molecular signatures. This teaching model not only enables students to interpret molecular events observed in flow cytometry plots within the context of microscopic morphology but also fosters the integrated analytical skills required for precision medicine. The proposed framework is replicable, technology-integrated, and effectively bridges laboratory teaching with clinical practice, offering a scalable approach to experimental education reform in medical laboratory science.}
}