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HelpTest Code TBFLW Quantitative Lymphocyte Subsets: T, B, and Natural Killer (NK) Cells, Blood
Reporting Name
QN Lymphocyte Subsets: T, B, and NKUseful 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 EDTASpecimen 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 |
Special Instructions
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 daysReject Due To
| Gross hemolysis | Reject |
| Gross lipemia | Reject |
Method Name
Flow Cytometry
Secondary ID
9336Samples must arrive to ICL Monday - Friday before 17:00 so that it can make the Mayo courier pickup.