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However, the execution of robust immune monitoring in clinical trials by flow cytometry is complex due to logistical challenges in sample preparation and reagent stability. These challenges are exacerbated when considering remote and rural communities in Australia, which are burdened by both an increased prevalence and a worse prognosis of many chronic and infectious pathologies. This is not unique to the Australian context as globally remote and rural communities are underrepresented in biomedical research studies, contributing to persistent health inequities. To address these challenges, we have harnessed the unique benefits of mass cytometry to develop and test a workflow that enables inclusion of remote communities in high\u2010parameter immune phenotyping studies. The stability of heavy\u2010metal conjugated antibodies and the lack of any signal derived from cellular autofluorescence allows samples stained for mass cytometry to be cryopreserved and stored long\u2010term. In this approach, whole blood (WB) samples are collected and stained fresh with dry\u2010format antibodies specific for 38 surface targets, then cryopreserved without washing. By removing the need for centrifugation, we enable staining and preservation of fresh samples in resource\u2010limited settings without access to specialized equipment. Samples are delivered to the central site, where neutrophils are removed and samples are barcoded with a 6\u2010channel cocktail, pooled and stained for an additional 8 intracellular targets, achieving 52\u2010plex coverage. In a pilot to demonstrate workflow feasibility, we characterized blood immune and myeloid cell populations from cancer patients recruited at 3 sites across Australia, including 26 patients recruited from Dubbo Base Hospital which is located approximately 400\u2009km from the state capital city, Sydney. We find consistency in immune phenotype between WB samples prepared with our simplified WB approach and matched PBMC samples prepared in parallel. This is the first time, to our knowledge, that a multi\u2010centre high\u2010parameter immune phenotyping study has included cancer patients from regional Australia. In summary, we show here that the preparation of samples for high\u2010dimensional mass cytometry can be simplified to be compatible with resource\u2010limited environments while conserving data quality.<\/jats:p>","DOI":"10.1002\/cyto.a.70026","type":"journal-article","created":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T11:47:39Z","timestamp":1775735259000},"page":"210-229","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Mass Cytometry\u2010Based Blood Cell Phenotyping Workflow Enabling Inclusion of Resource\u2010Limited and Rural Sites in Immune System Studies"],"prefix":"10.1002","volume":"109","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9186-2719","authenticated-orcid":false,"given":"Natalie J.","family":"Smith","sequence":"first","affiliation":[{"name":"Charles Perkins Centre and School of Medical Sciences, Faculty of Medicine and Health The University of Sydney  Camperdown New South Wales 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