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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 HIV-positive patients
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 chronic lymphocytic leukemia patients as indicated in the 2008 International Workshop on Chronic Lymphocytic Leukemia guidelines
Performing Laboratory
Mayo Clinic Laboratories in Rochester
Specimen Type
Whole Blood EDTAAdvisory Information
This assay should not be used for diagnosing lymphocytic malignancies or evaluation of lymphocytosis of unknown etiology, though the latter may be identified through this assay in a screening assessment. In such cases, LCMS / Leukemia/Lymphoma Immunophenotyping, Flow Cytometry, Varies will be recommended, which includes a hematopathology review. However, this assay can be used for absolute quantitation of B cells in CLL patients as indicated above.
Shipping Instructions
It is recommended that specimens arrive within 24 hours of draw. Draw and package specimen as close to shipping time as possible.
Necessary Information
Date of draw is required.
Specimen Required
For serial monitoring, we recommend that specimen draws be performed at the same time of day.
Container/Tube: 4 mL Lavender top (EDTA)
Specimen Volume: 3 mL
Collection Instructions: Send specimen in original tube. Do not aliquot.
Specimen Minimum Volume
1 mL
Testing Algorithm
See Newborn Screen Follow-up for Severe Combined Immunodeficiency Syndrome (SCID) in Special Instructions.
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) and Time(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 U.S. Food and Drug Administration.CPT Code Information
86355-B cells, total count
86357-Natural killer (NK) cells, total count
86359-T cells, total count
86360-Absolute CD4/CD8 count with ratio
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, Bangkok, Thailand, 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;30:401-411
4. Kronfol Z, Nair M, Zhang Q, et al: Circadian immune measures in healthy volunteers: relationship to hypothalamic-pituitary-adrenal axis hormones and sympathetic neurotransmitters. Pyschosom Med 1997;59:42-50
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;3:144-151
6. Paglieroni TG, Holland PV: Circannual variation in lymphocyte subsets, revisited. Transfusion 1994;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;111:5446-5456
8. Hanson CA, Kurtin PJ, Dogan A: The proposed diagnostic criteria change for chronic lymphocytic leukemia: unintended consequences? Blood 2009;113:6495-6496
9. Hillmen P, Cheson BD, Catovsky D, et al: Letter to Editor. Blood 2009;113:6497-6498
10. US Department of Health and Human Services. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Available at http://aidsinfo.nih.gov/guidelines
11. Thompson MA, Aberg JA, Hoy JF, et al: Antiretroviral treatment of adult HIV infection: 2012 recommendations of the International Antiviral Society-USA panel. JAMA 2012;308:387-402
Method Description
Quantitive Lymphocyte Subsets: T, B, and Natural Killer (NK)
The T, B, and 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, 1980:77:4914-4917; US Department of Health and Human Services: Guidelines for performance of CD4+ T-cell determinations in persons with human immunodeficiency virus infection. MMWR Morb Mortal Wkly Rep 1997;46 no. RR-2 pp 1-29)
Analytic Time
Same day/1 dayReject Due To
| Gross hemolysis | Reject |
| Gross lipemia | Reject |
| Other | Specimen in aliquot tube |
Method Name
Flow Cytometry