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HelpTest Code ALPS Alpha Beta Double-Negative T Cells for Autoimmune Lymphoproliferative Syndrome, Blood
Reporting Name
ALPS ScreenUseful For
Diagnosing autoimmune lymphoproliferative syndrome, primarily in patients younger than 45 years
Performing Laboratory
Mayo Clinic Laboratories in Rochester
Specimen Type
Whole Blood EDTAShipping Instructions
Testing is performed Monday through Friday. Specimens not received by 4pm (CST) on Friday may be canceled.
Collect and package specimen as close to shipping time as possible. It is recommended that specimens arrive within 24 hours of collection.
Samples arriving on the weekend and observed holidays may be canceled.
Necessary Information
Ordering healthcare professional name and phone number are required.
Specimen Required
Container/Tube: Lavender top (EDTA)
Specimen Volume: 3 mL
Collection Instructions: Send whole blood specimen in original tube. Do not aliquot.
Additional Information: For serial monitoring, it is recommended that specimens are collected at the same time of day.
Specimen Minimum Volume
0.5 mL
Specimen Stability Information
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Whole Blood EDTA | Ambient | 72 hours | PURPLE OR PINK TOP/EDTA |
Reference Values
Alpha beta TCR+DNT cells
2-18 years: <2% CD3 T cells
19-70+ years: <3% CD3 T cells
Reference values have not been established for patients that are younger than 24 months of age.
Alpha beta TCR+DNT cells
2-18 years: <35 cells/mcL
19-70+ years: <35 cells/mcL
Reference values have not been established for patients that are younger than 24 months of age.
Alpha beta TCR+DNT B220+ cells
2-18 years: <0.4% CD3 T cells
19-70+ years: <0.3% CD3 T cells
Reference values have not been established for patients that are younger than 24 months of age.
Alpha beta TCR+DNT B220+ cells
2-18 years: <7 cells/mcL
19-70+ years: <6 cells/mcL
Reference values have not been established for patients that are younger than 24 months of age.
TCR = T-cell receptor
DNT = Double negative T cell
Day(s) Performed
Monday through Friday
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
86356 x2
86359
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| ALPS | ALPS Screen | 101414-1 |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| 23973 | %alpha/beta-TCR DNT | 34962-1 |
| 23974 | alpha/beta-TCR DNT | 34963-9 |
| 28904 | % TCR+DNT B220+ | 88052-6 |
| 28905 | Absolute TCR+DNT B220+ | 88053-4 |
| 23975 | Interpretation | 69052-9 |
Interpretation
The presence of increased circulating T cells (CD3+) that are negative for CD4 and CD8 (double-negative T cells: DNT) and positive for the alpha/beta T-cell receptor (TCR) is required for the diagnosis of autoimmune lymphoproliferative syndrome (ALPS).
The laboratory finding of increased alpha beta TCR+DNT cells is consistent with ALPS only with the appropriate clinical picture (nonmalignant lymphadenopathy, splenomegaly, and autoimmune cytopenias). Conversely, there are other immunological disorders, including common variable immunodeficiency (CVID), which have subsets for patients with this clinical picture, but no increase in alpha beta TCR+DNT cells.
If the percent of the absolute count of either the alpha beta TCR+DNT cells or alpha beta TCR+DNT B220+ cells is abnormal, additional testing is indicated. All abnormal alpha beta TCR+DNT cell results should be confirmed (for ALPS) with additional testing for defective in vitro lymphocyte apoptosis followed by confirmatory genetic testing (ALPSG / Autoimmune Lymphoproliferative Syndrome [ALPS] Gene Panel, Varies).
Clinical Reference
1. Oliveira JB, Bleesing JJ, Dianzani U, et al. Revised diagnostic criteria and classification for the autoimmune lymphoproliferative syndrome (ALPS): report from the 2009 NIH International Workshop. Blood. 2010;116(14):e35-40
2. Consonni F, Gambineri E, Favre C. ALPS, FAS, and beyond: from inborn errors of immunity to acquired immunodeficiencies. Ann Hematol. 2022;101(3):469-484. doi:10.1007/s00277-022-04761-7
3. Bleesing JJ, Brown MR, Dale JK, et al. TCR alpha beta+ CD4-CD8-T-cells in humans with the autoimmune lymphoproliferative syndrome express a novel CD45 isoform that is analogous to urine B220 and represents a marker of altered O-glycan biosynthesis. Clin Immunol. 2001;100(3):314-324
4. Bleesing JJ, Janik JE, Fleisher TA. Common expression of an unusual CD45 isoform on T-cells from patients with large granular lymphocyte leukemia and autoimmune lymphoproliferative syndrome. Br J Haematol. 2003;120(1):93-96
5. Lopez-Nevado M, Gonzalez-Granado LI, Ruiz-Garcia R, et al. Primary immune regulatory disorders with an autoimmune lymphoproliferative syndrome-like phenotype: Immunologic evaluation, early diagnosis and management. Front Immunol. 2021;12:671755. doi:10.3389/fimmu.2021.671755
Report Available
3 to 4 daysMethod Name
Flow Cytometry
Forms
If not ordering electronically, complete, print, and send a Benign Hematology Test Request Form (T755) with the specimen.