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Understanding your results

Flow Cytometry on a — Bone Marrow Sample

Flow cytometry identifies what type of cancer cell is in your bone marrow. Without it, your team knows there is disease — but not which subtype. That distinction decides your treatment protocol.

Medically reviewed by Dr. Muralidhar Muddusetty, Surgical Oncologist, MBBS (AIIMS) · MS Surgery (AIIMS) · DNB Surg Onc · MRCS (Edinburgh) · Last reviewed September 2026

  • Not a second procedure — Flow cytometry uses the liquid marrow drawn during your aspiration. No extra needle is needed.
  • Reads the cell surface — It identifies proteins on the outside of each cell — the markers that tell the laboratory exactly what type of cell it is.
  • Subtype drives treatment — Two people with leukaemia may need entirely different protocols depending on what flow cytometry shows.
  • Results go to your haematologist — The report is interpreted by your treating team, who will explain what it means for your care.
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Flow cytometry on a bone marrow sample identifies the exact type of cancer cell present by reading the proteins on each cell's surface. The result — called an immunophenotype — tells your haematologist which subtype of leukaemia or lymphoma you have, and that subtype determines your treatment protocol.

How does flow cytometry work, step by step?

  1. The aspirate is collected

    During your bone marrow procedure, a small amount of liquid marrow is drawn into a syringe. This liquid portion — the aspirate — is what flow cytometry uses.

  2. The sample goes directly to the laboratory

    The cells must be alive for the test to work. The sample is sent immediately, unlike a tissue biopsy which can be processed later.

  3. Antibodies are added to the cells

    The laboratory adds specially made antibodies that attach to specific proteins on the surface of cells. Each antibody carries a fluorescent tag.

  4. The cells pass through a laser beam

    The labelled cells flow in a fine stream through a laser. Each cell is read individually — thousands of cells per second.

  5. The machine records the protein pattern

    The fluorescent tags glow when the laser hits them. The machine records which proteins each cell carries. This pattern is the immunophenotype.

  6. Your haematologist interprets the result

    The pattern is compared against known profiles for different cancer subtypes. Your treating haematologist receives the report and will discuss what it means for you.

What should you know about this test?

  • Flow cytometry uses the liquid aspirate from your bone marrow — it is not a second or separate procedure.
  • No special preparation is needed beyond what your bone marrow procedure already requires.
  • The sample cannot be stored the way tissue can — timing matters, and the team plans for this.
  • Results are sent directly to your treating haematologist, not issued to you as a self-service report.
  • Ask your haematologist when the result is expected and when they will discuss it with you.
  • If the aspirate volume was insufficient, your team may need to repeat the procedure to get a usable sample.

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What does flow cytometry actually measure?

Every cell in your body carries proteins on its surface. The combination of proteins on a cell is like a fingerprint — it identifies what type of cell it is and whether it is behaving normally.

Flow cytometry reads those surface proteins, called CD markers. A normal lymphocyte carries a predictable set of CD markers. A lymphocyte that has turned cancerous carries an abnormal set — and the specific abnormality tells the laboratory which disease it is.

The same principle applies to T-cell diseases, myeloid diseases, plasma cell diseases and others. The protein pattern identifies the subtype, not just the broad category.

Why does the subtype matter so much for treatment?

Two patients who both have acute leukaemia may need entirely different treatment protocols depending on what their flow cytometry shows. Some subtypes respond to targeted therapies that do not work at all in other subtypes.

NCCN and ESMO guidance for haematological cancers is built around immunophenotype. Protocols are not assigned by cancer name alone — they are assigned by the specific subtype the flow cytometry identifies.

This is why your team will not confirm a final treatment plan until the flow result is available. It is not a delay — it is precision.

How long do flow cytometry results take?

A standard panel usually produces a result within a few days of the sample reaching the laboratory. More complex panels, or samples that need additional testing, can take longer.

Your haematologist will tell you when to expect the result and schedule a time to discuss it. If you have not heard within the expected window, ask the team for an update rather than waiting in uncertainty.

The results go directly to your treating haematologist. They will explain what the immunophenotype shows and what it means for the next step in your care.

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Common questions

Frequently asked questions

Is flow cytometry the same as a bone marrow biopsy?

They are two different tests done during the same procedure. The biopsy is a small core of solid bone marrow tissue sent to a pathologist to examine the structure and cellularity of the marrow. Flow cytometry uses the liquid aspirate to read the proteins on individual cells. Both results together give a more complete picture than either one alone.

Can flow cytometry be done on a blood sample instead of bone marrow?

For some conditions, yes. In diseases where abnormal cells appear in significant numbers in the bloodstream, a peripheral blood sample can sometimes be used. Your haematologist decides which sample is most informative for your situation. Bone marrow is used when the disease is primarily in the marrow, or when a blood sample alone would not give enough information.

What does it mean if the flow cytometry shows abnormal cells?

It means the laboratory found cells carrying an abnormal protein pattern that matches a known disease profile. The specific pattern tells your haematologist which subtype it is — which is the information needed to choose the right treatment. Your haematologist will explain what the result means for your care plan at your next appointment.

Is flow cytometry used to check whether treatment is working?

Yes. Repeat flow cytometry after treatment can detect very small numbers of remaining abnormal cells — a measurement called minimal residual disease, or MRD. This helps your team judge how well treatment is working and whether any change in approach is needed. Whether and when MRD testing is done depends on your specific diagnosis and protocol.

Will my family members need this test?

Flow cytometry on bone marrow is done to investigate and monitor disease in a person who already has an indication for the test. It is not a screening test for family members. If there is a concern about a family member's health, they should be assessed by their own doctor, who will decide which investigations are appropriate.

What should I ask when the result is discussed with me?

Ask what subtype the flow cytometry identified, what that subtype means for your treatment options, and whether any further testing is needed before a final plan is confirmed. Ask for the result in writing, or bring a family member with you — these conversations carry a lot of information and are difficult to recall in full afterwards.

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