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Test ID TBNY T, B and NK Lymphocyte Quantitation, New York, Blood

Reporting Name

T, B and NK Lymphocyte QN, New York

Useful For

Only orderable by New York clients

 

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

Specimen Type

Whole Blood EDTA


Ordering Guidance


This assay should not be used for diagnosing lymphocytic malignancies or evaluation of lymphocytosis of unknown etiology. In 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
TBNY T, B and NK Lymphocyte QN, New York 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 Information

Lymphocytes in peripheral blood (circulation) are heterogeneous and can be broadly classified into T cells, B cells, and natural killer (NK) cells. There are various subsets of each of these individual populations with specific cell-surface markers and function. This assay provides absolute (cells/mcL) and relative (%) quantitation for the main categories of T cells, B cells, and NK cells, in addition to a total lymphocyte count (CD45+).

 

Each of these lymphocyte subpopulations have distinct effector and regulatory functions and are maintained in homeostasis under normal physiological conditions. Each of these lymphocyte subsets can be identified by a combination of 1 or more cell surface markers. The CD3 antigen is a pan-T cell marker, and T cells can be further divided into 2 broad categories, based on the expression of CD4 or CD8 coreceptors. B cells can be identified by expression of CD19, while NK cells are typically identified by the coexpression of CD16 and CD56.

 

The absolute counts of lymphocyte subsets are known to be influenced by a variety of biological factors, including hormones, the environment, and temperature. The studies on diurnal (circadian) variation in lymphocyte counts have demonstrated progressive increase in CD4 T-cell count throughout the day, while CD8 T cells and CD19+ B cells increase between 8:30 a.m. and noon with no change between noon and afternoon. NK-cell counts, on the other hand, are constant throughout the day.(1) Circadian variations in circulating T-cell counts have been shown to be negatively correlated with plasma cortisol concentration.(2-4) In fact, cortisol and catecholamine concentrations control distribution and, therefore, numbers of naive versus effector CD4 and CD8 T cells.(2) It is generally accepted that lower CD4 T-cell counts are seen in the morning compared to the evening(5) and during summer compared to winter.(6) These data therefore indicate that timing and consistency in timing of blood collection is critical when serially monitoring patients for lymphocyte subsets.

 

Abnormalities in the number and percent of T (CD3+, CD4+, CD8+), B (CD19), and NK (CD16+CD56) lymphocytes have been described in a number of different disease conditions. In patients who are infected with HIV, the CD4 count is measured for AIDS diagnosis and for initiation of antiviral therapy. The progressive loss of CD4 T-lymphocytes inpatients infected with HIV is associated with increased infections and complications. The Public Health Service has recommended that all patients who are HIV-positive be tested every 3 to 6 months for the level of CD4 T-lymphocytes.

 

Lymphocyte subset quantitation is also very useful in the evaluation of patients with primary immunodeficiencies of all ages, including follow-up for newborn screening for severe combined immunodeficiency and immune monitoring following immunosuppressive therapy for transplantation, autoimmunity, or any other relevant clinical condition where immunomodulatory treatment is used.

 

It is also helpful as a preliminary screening assay for gross quantitative anomalies in any lymphocyte subset, whether related to malignancies or infection.

 

The 2008 guidelines for diagnosis and treatment of chronic lymphocytic leukemia (CLL) from the International Workshop on Chronic Lymphocytic Leukemia(7) recommend changing the diagnostic criteria for CLL from an absolute lymphocyte count greater than 5 x 10(9)/L to a circulating B-cell count greater than 5 x 10(9)/L(8,9) previously defined in the 1996 National Cancer Institute guidelines for CLL. This flow cytometric assay enables accurate quantitation of circulating B cells using a single platform technology with absolute quantitation through the use of flow cytometry beads.

Interpretation

HIV treatment guidelines from the US Department of Health and Human Services and the International Antiviral Society-USA Panel recommend antiviral treatment in all patients with HIV infection, regardless of CD4 T-cell count.(10,11) Additionally, antibiotic prophylaxis for Pneumocystis jiroveci infection is recommended for patients with CD4 count less than 200 cells/mcL. For other opportunistic infections, see the 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.(12)

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. Afr J Med Med Sci. 2006 Mar;35(1):53-57

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, et al: Circadian immune measures in healthy volunteers: relationship to hypothalamic-pituitary-adrenal axis hormones and sympathetic neurotransmitters. Psychosom Med. Jan-Feb 1997;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):144-151

6. Paglieroni TG, Holland PV: Circannual variation in lymphocyte subsets, revisited. Transfusion. 1994 Jun;34(6):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(12):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

Report Available

3 to 4 days

Method Name

Fluorescent Flow Cytometry

Mayo Clinic Laboratories | Pediatric Catalog Additional Information:

mcl-newborn