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Test Code TBFLW Quantitative Lymphocyte Subsets: T, B, and Natural Killer (NK) Cells, Blood

Important Note

  • Specimen must be received in lab by 16:30 on the day of collection.
  • Please forward to lab in a Stat bag.

Additional Codes

Epic: LAB3245

Mayo: TBBS

Reporting Name

QN Lymphocyte Subsets: T, B, and NK

Useful For

Serial monitoring of CD4 T-cell count in patients who are HIV-positive

 

Follow-up and diagnostic evaluation of primary immunodeficiencies, including severe combined immunodeficiency

 

Immune monitoring following immunosuppressive therapy for transplantation, autoimmunity, and other immunological conditions where such treatment is utilized

 

Assessment of immune reconstitution post hematopoietic cell transplantation

 

Early screening of gross quantitative anomalies in lymphocyte subsets in infection or malignancies

 

Absolute quantitation of circulating B cells for diagnosis of patients with chronic lymphocytic leukemia as indicated in the 2008 International Workshop on Chronic Lymphocytic Leukemia guidelines

Performing Laboratory

Mayo Clinic Laboratories in Rochester

Specimen Type

Whole Blood EDTA

Specimen Required


Ordering Guidance


This assay should not be used for diagnosing lymphocytic malignancies or evaluation of lymphocytosis of unknown etiology. For such cases, order LCMS / Leukemia/Lymphoma Immunophenotyping, Flow Cytometry, Varies, which includes a hematopathology review.

 

This assay can be used for absolute quantitation of B cells in patients with chronic lymphocytic leukemia.

 

While this assay can be used to follow patients on B-cell-depleting therapy, like Rituximab or Ofatumumab, it may be more reasonable and financially viable to use CD20B / CD20 on B Cells, Blood (includes CD45, CD19 and CD20 markers).



Shipping Instructions


It is recommended that specimens arrive within 24 hours of collection. Collect and package specimen as close to shipping time as possible.



Necessary Information


Date and time of collection is required.



Specimen Required


Container/Tube: Lavender top (EDTA)

Specimen Volume: 3 mL

Collection Instructions: Send specimen in original tube. Do not aliquot.

Additional Information: For serial monitoring, it is recommended that specimen collection be performed at the same time of day.


Specimen Minimum Volume

1 mL

Specimen Stability Information

Specimen Type Temperature Time Special Container
Whole Blood EDTA Ambient 52 hours PURPLE OR PINK TOP/EDTA

Reference Values

The appropriate age-related reference values will be provided on the report.

Day(s) Performed

Monday through Sunday

Test Classification

This test was developed using an analyte specific reagent. Its performance characteristics were determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the US Food and Drug Administration.

CPT Code Information

86355

86357

86359

86360

LOINC Code Information

Test ID Test Order Name Order LOINC Value
TBBS QN Lymphocyte Subsets: T, B, and NK 80721-4

 

Result ID Test Result Name Result LOINC Value
3321 CD45 Total Lymph Count 27071-0
3316 % CD3 (T Cells) 8124-0
3322 CD3 (T Cells) 8122-4
3319 % CD4 (T Cells) 8123-2
3325 CD4 (T Cells) 24467-3
3320 % CD8 (T Cells) 8101-8
3326 CD8 (T Cells) 14135-8
3318 % CD19 (B Cells) 8117-4
3324 CD19 (B Cells) 8116-6
4054 % CD16+CD56 (NK cells) 8112-5
4055 CD16+CD56 (NK cells) 20402-4
3327 4/8 Ratio 54218-3
6657 Comment 80722-2

Clinical Reference

1. Carmichael KF, Abayomi A: Analysis of diurnal variation of lymphocyte subsets in healthy subjects and its implication in HIV monitoring and treatment. 15th Intl Conference on AIDS, 2004, Abstract B11052

2. Dimitrov S, Benedict C, Heutling D, et al: Cortisol and epinephrine control opposing circadian rhythms in T-cell subsets. Blood 2009 May 21;113(21):5134-5143

3. Dimitrov S, Lange T, Nohroudi K, Born J: Number and function of circulating antigen presenting cells regulated by sleep. Sleep. 2007 Apr;30(4):401-411

4. Kronfol Z, Nair M, Zhang Q, Hill EE, Brown MB: Circadian immune measures in healthy volunteers: relationship to hypothalamic-pituitary-adrenal axis hormones and sympathetic neurotransmitters. Pyschosom Med. 1997 Jan-Feb;59(1):42-50

5. Malone JL, Simms TE, Gray GC, et al: Sources of variability in repeated T-helper lymphocyte counts from HIV 1-infected patients: total lymphocyte count fluctuations and diurnal cycle are important. J AIDS. 1990;3(2):144-151

6. Paglieroni TG, Holland PV: Circannual variation in lymphocyte subsets, revisited. Transfusion. 1994 Jun (6);34:512-516

7. Hallek M, Cheson BD, Catovsky D, et al: Guidelines for the diagnosis and treatment of chronic lymphocytic leukemia: a report from the International Workshop on CLL updating the National Cancer Institute Working Group 1996 guidelines. Blood. 2008 Jun 15;111:5446-5456

8. Hanson CA, Kurtin PJ, Dogan A: The proposed diagnostic criteria change for chronic lymphocytic leukemia: unintended consequences? Blood. 2009 Jun 18;113(25):6495-6496

9. Hillmen P, Cheson BD, Catovsky D, et al: Response: Letters regarding Blood. 2008;111:5446-5456 by Hanson et al and Mulligan et al. . Blood. 2009 Jun;113(25):6497-6498. doi: 10.1182/blood-2009-04-165324

10. Panel on Antiretroviral Guidelines for Adults and Adolescents: Guidelines for the use of antiretroviral agents in adults and adolescents living with HIV. Department of Health and Human Services; Updated January 20, 2022. Accessed April 4, 2022. Available at https://clinicalinfo.hiv.gov/sites/default/files/guidelines/documents/guidelines-adult-adolescent-arv.pdf

11. Thompson MA, Horberg MA, Agwu AL, et al: Primary care guidance for persons with human immunodeficiency virus: 2020 update by the HIV Medicine Association of the Infectious Diseases Society of America. Clin Infect Dis. 2021 Dec 6;73(11):e3572-e3605. Erratum in: Clin Infect Dis. 2021 Dec 08

12. Panel on Opportunistic Infections in Adults and Adolescents with HIV. Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV: recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. Department of Health and Human Services; Updated February 17, 2022. Accessed April 4, 2022. Available at https://clinicalinfo.hiv.gov/en/guidelines

Method Description

Quantitive Lymphocyte Subsets: T, B, and Natural Killer:

The T, B, and natural killer (NK)-cell surface marker assay uses monoclonal antibodies to identify the various membrane antigens, and flow cytometry to enumerate the number of cells expressing these differentiation antigens. CD14 is used to exclude monocytes, thereby improving accuracy and enhancing the purity of the lymphocyte population. The results are reported as the percent of lymphocytes that are total T cells (CD3+), CD3+CD4+ T cells, CD3+CD8+ T cells, natural killer (CD16+56+, CD3-), and B-lymphocytes (CD19+), and the absolute number of each cell type per mL of blood. The assay is a 7-color no-wash procedure and the absolute counts are calculated from internal bead standards. In addition, the total lymphocyte count and the CD4:CD8 ratio are reported.(Hoffman RA, Kung PC, Hansen WP, Goedstien G: Simple and rapid measurement of human T lymphocytes and their subclasses in peripheral blood. Proc Natl Acad Sci USA. 1980 Aug:77(8):4914-4917; Mandy FF, Nicholson JK, McDougal JS; CDC. Guidelines for performing single-platform absolute CD4+ T-cell determinations with CD45 gating for persons infected with human immunodeficiency virus. Centers for Disease Control and Prevention. MMWR Recomm Rep. 2003 Jan 31;52(RR-2):1-13)

Report Available

Same day/1 to 2 days

Reject Due To

Gross hemolysis Reject
Gross lipemia Reject

Method Name

Flow Cytometry

Secondary ID

9336
Inova Laboratories Additional Information:

Samples must arrive to ICL Monday - Friday before 17:00 so that it can make the Mayo courier pickup.