Home
HelpTest Code IABCS B-Cell Phenotyping Profile for Immunodeficiency and Immune Competence Assessment, Blood
Reporting Name
Immune Assessment B Cell Subsets, BUseful For
Screening for common variable immunodeficiency and hyper-IgM syndromes
Assessing B-cell subset reconstitution after stem cell or bone marrow transplant
Assessing response to B-cell-depleting immunotherapy
This test is not indicated for the evaluation of lymphoproliferative disorders (eg, leukemia, lymphoma, multiple myeloma).
Profile Information
| Test ID | Reporting Name | Available Separately | Always Performed |
|---|---|---|---|
| TBBS | QN Lymphocyte Subsets: T, B, and NK | Yes | Yes |
| IABC | Immune Assessment B Cell Subsets, B | No | Yes |
Testing Algorithm
When multiple specimen types are required to perform a panel of tests, the laboratory will perform the tests for which the appropriate specimen type was received. The laboratory will cancel those for which the appropriate specimen was not received. Be advised that this may change the degree of interpretation received with the report.
Performing Laboratory
Mayo Clinic Laboratories in Rochester
Specimen Type
Whole Blood EDTAOrdering Guidance
The IABCS is a panel test. This test requires two separate whole blood EDTA specimens at two different transport temperatures: one ambient and one refrigerate.
The TBBS / Quantitative Lymphocyte Subsets: T, B, and Natural Killer (NK) Cells, Blood is automatically performed, a separate order is not required.
If only an ambient EDTA specimen is received, only the TBBS / Quantitative Lymphocyte Subsets: T, B, and Natural Killer (NK) Cells, Blood will be performed. If only a refrigerate EDTA sample is received, this test will be canceled and converted to RBCS / Relative B-Cell Subset Analysis Percentage, Blood, which provides the relative B-cell subset values without quantitation.
This test is a screening test and further analyses will be required to complete a diagnostic workup for hyper-IgM (XHIM / X-Linked Hyper IgM Syndrome, Blood and CD40 / B-Cell CD40 Expression by Flow Cytometry, Blood).
Shipping Instructions
Testing performed Monday through-Friday. Specimens not received by 4pm (CST) on Friday may be canceled.
Samples arriving on the weekend and observed holidays may be canceled.
Collect and package specimens as close to shipping time as possible.
It is recommended that specimens arrive within 24 hours of collection.
Necessary Information
1. Date of collection is required.
2. Ordering healthcare professional name and phone number are required.
Specimen Required
Two separate EDTA whole blood specimens are required: 1 refrigerate and 1 ambient transport temperature.
For serial monitoring, it is recommended that specimens are collected at the same time of day.
Specimen Type: Whole blood for TBBS / Quantitative Lymphocyte Subsets: T, B, and Natural Killer (NK) Cells, Blood
Container/Tube: 4 mL Lavender top (EDTA)
Specimen Volume: 3 mL
Collection Instructions:
1. Send whole blood specimen in original tube. Do not aliquot.
2. Label specimen as TBBS.
3. Ship ambient.
Specimen Stability Information: Ambient <52 hours
Specimen Type: Whole blood for IABC / B-Cell Phenotyping Screen for Immunodeficiency and Immune Competence Assessment, Blood
Container/Tube: Lavender top (EDTA)
Specimen Volume:
≤14 years: 4 mL
>14 years: 10 mL
Collection Instructions:
1. Send whole blood specimen in original tube. Do not aliquot.
2. Label specimen IABC.
3. Ship refrigerate.
Specimen Stability Information: Refrigerated <48 hours
Specimen Minimum Volume
TBBS: 1 mL; IABC: > 14 years: 5 mL; ≤ 14 years: 3 mL
Specimen Stability Information
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Whole Blood EDTA | Varies | 48 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 Friday
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
86356 x7 - Mononuclear cell antigen, quantitative
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| IABCS | Immune Assessment B Cell Subsets, B | 90416-9 |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| 30296 | CD19+ % of total Lymphocytes | 8117-4 |
| 3321 | CD45 Total Lymph Count | 27071-0 |
| 3316 | % CD3 (T Cells) | 8124-0 |
| 29094 | CD20+ % of total Lymphocytes | 8119-0 |
| 3322 | CD3 (T Cells) | 8122-4 |
| 30298 | CD27+ % of CD19+ B cells | 89358-6 |
| 3319 | % CD4 (T Cells) | 8123-2 |
| 30300 | CD27+ IgM+ IgD+ % of CD19+ B cells | 89352-9 |
| 3325 | CD4 (T Cells) | 24467-3 |
| 30302 | CD27+ IgM- IgD- % of CD19+ B cells | 89350-3 |
| 3320 | % CD8 (T Cells) | 8101-8 |
| 30304 | CD27+ IgM+ IgD- % of CD19+ B cells | 89348-7 |
| 3326 | CD8 (T Cells) | 14135-8 |
| 30306 | IgM+ % of CD19+ B cells | 89346-1 |
| 3318 | % CD19 (B Cells) | 8117-4 |
| 30308 | CD38+ IgM- % of CD19+ B cells | 89344-6 |
| 30310 | CD38+ IgM+ % of CD19+ B cells | 89341-2 |
| 3324 | CD19 (B Cells) | 8116-6 |
| 4054 | % CD16+CD56 (NK cells) | 8112-5 |
| 30312 | CD21+ % of CD19+ B cells | 89356-0 |
| 30314 | CD21- % of CD19+ B cells | 89355-2 |
| 4055 | CD16+CD56 (NK cells) | 20402-4 |
| 3327 | 4/8 Ratio | 54218-3 |
| 30297 | CD19+ | 8116-6 |
| 29095 | CD20+ | 9558-8 |
| 6657 | Comment | 80722-2 |
| 30299 | CD27+ | 89353-7 |
| 30301 | CD27+ IgM+ IgD+ | 89351-1 |
| 30303 | CD27+ IgM- IgD- | 89349-5 |
| 30305 | CD27+ IgM+ IgD- | 89347-9 |
| 30307 | IgM+ | 89345-3 |
| 30309 | CD38+ IgM- | 89343-8 |
| 30311 | CD38+ IgM+ | 89357-8 |
| 30313 | CD21+ | 25164-5 |
| 30315 | CD21- | 89354-5 |
| 30316 | Interpretation | 80722-2 |
Interpretation
Quantitative Lymphocyte Subsets: T, B, and natural killer:
When the CD4 count falls below 500 cells/mcL, patients who are HIV-positive can be diagnosed with AIDS and can receive antiretroviral therapy.
When the CD4 count falls below 200 cells/mcL, prophylaxis against Pneumocystis jiroveci pneumonia is recommended.
Immune Assessment B Cell Subsets:
The assay provides quantitative information on the various B-cell subsets (percentage and absolute counts in cells/microliter). Each specimen is evaluated for B-cell subsets with respect to the total number of CD19+ B cells present in the peripheral blood mononuclear cell population, compared to the reference range. In order to verify that there are no CD19-related defects, CD20 is used as an additional pan-B-cell marker (expressed as percentage of CD45+ lymphocytes).
The B-cell panel assesses the following B-cell subsets:
CD19+=B cells expressing CD19 as a percent of total lymphocytes
CD19+ CD27+=total memory B cells
CD19+ CD27+ IgD+ IgM+=marginal zone or non-switched memory B cells
CD19+ CD27+ IgD- IgM+=IgM-only memory B cells
CD19+ CD27+ IgD- IgM-=class-switched memory B cells
CD19+ IgM+=IgM B cells
CD19+ CD38+ IgM+=transitional B cells
CD19+ CD38+ IgM-=plasmablasts
CD19+ CD21-=CD21 low ("immature") B cells
CD19+ CD21+=mature B cells
CD19+ CD20+=B cells coexpressing both CD19 and CD20 as a percent of total lymphocytes
Clinical Reference
1. Warnatz K, Denz A, Drager R, et al. Severe deficiency of switched memory B cells (CD27+ IgM- IgD-) in subgroups of patients with common variable immunodeficiency: a new approach to classify a heterogeneous disease. Blood. 2002;99(5):1544-1551
2. Brouet JC, Chedeville A, Fermand JP, Royer B. Study of the B cell memory compartment in common variable immunodeficiency. Eur J Immunol. 2000;30(9):2516-2520
3. Wehr C, Kivioja T, Schmitt C, et al. The EUROclass trial: defining subgroups in common variable immunodeficiency. Blood. 2008;111(1):77-85
4. Alachkar H, Taubenheim N, Haeney MR, et al. Memory switched B-cell percentage and not serum immunoglobulin concentration is associated with clinical complications in children and adults with specific antibody deficiency and common variable immunodeficiency. Clin Immunol. 2006;120(3):310-318
5. Lee WI, Torgerson TR, Schumacher MJ, et al. Molecular analysis of a large cohort of patients with hyper immunoglobulin M (hyper IgM) syndrome. Blood. 2005;105(5):1881-1890
6. Ramirez NJ, Posadas-Cantera S, Caballero-Oteyza A, Camacho-Ordonez N, Grimbacher B. There is no gene for CVID - novel monogenetic causes for primary antibody deficiency. Curr Opin Immunol. 2021;72:176-185. doi:10.1016/j.coi.2021.05.010
7. Salzer U, Chapel HM, Webster ADB, et al. Mutations in TNFRSF13B encoding TACI are associated with common variable immunodeficiency in humans. Nat Genet. 2005;37(8):820-828
8. Salzer U, Grimbacher B. TACI deficiency - a complex system out of balance.Curr Opin Immunol. 2021;71:81-88. doi:10.1016/j.coi.2021.06.004
9. Carmichael KF, Abayomi A. Analysis of diurnal variation of lymphocyte subsets in healthy subjects in the Caribbean, and its implication in HIV monitoring and treatment. Afr J Med Med Sci. 2006;35(1):53-57
10. Dimitrov S, Benedict C, Heutling D, et al. Cortisol and epinephrine control opposing circadian rhythms in T-cell subsets. Blood. 2009;113(21);5134-5143
11. Dimitrov S, Lange T, Nohroudi K, Born J. Number and function of circulating antigen presenting cells regulated by sleep. Sleep 2007;30(4):401-411
12. 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(1):42-50
13. 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
14. Paglieroni TG, Holland PV. Circannual variation in lymphocyte subsets, revisited. Transfusion. 1994;34(6):512-516
15. U.S. Department of Health and Human Services: Recommendations for prophylaxis against Pneumocystis carinii pneumonia for adults and adolescents infected with human immunodeficiency virus. MMWR Morb Mortal Wkly Rep. 1994;43(RR-3):1-21
16. 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
17. Kumanovics A, Sadighi Akha AA. Flow cytometry for B-cell subset analysis in immunodeficiencies. J Immunol Methods. 2022;509:113327. doi:10.1016/j.jim.2022.113327
18. Sadighi Akha AA, Csomos K, Ujhazi B, Walter JE, Kumanovics A: Evolving approach to clinical cytometry for immunodeficiencies and other immune disorders. Clin Lab Med. 2023;43(3):467-483. doi:10.1016/j.cll.2023.05.002
Report Available
3 to 4 daysMethod Name
Flow Cytometry