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HelpTest Code TBBS Quantitative Lymphocyte Subsets: T, B, and Natural Killer (NK) Cells, Blood
Reporting Name
QN Lymphocyte Subsets: T, B, and NKT and B Cell
T Cell
T and B
Useful 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 EDTAOrdering 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 (eg, Rituxan, Riabni) or ofatumumab (eg, Kesimpta), 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 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 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 |
|---|---|---|
| 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 |
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, 2004, Abstract B11052
2. Dimitrov S, Benedict C, Heutling D, Westermann J, Born J, Lange T. Cortisol and epinephrine control opposing circadian rhythms in T-cell subsets. Blood. 2009;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(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. Psychosom Med. 1997;59(1):42-50
5. Malone JL, Simms TE, Gray GC, Wagner KF, Burge JR, Burke DS. 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;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 chronic lymphocytic leukemia updating the National Cancer Institute Working Group 1996 guidelines. Blood. 2008;111(12):5446-5456
8. Hanson CA, Kurtin PJ, Dogan A. The proposed diagnostic criteria change for chronic lymphocytic leukemia: unintended consequences? Blood. 2009;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 February 27, 2024. Accessed August 19, 2024. Available at https://clinicalinfo.hiv.gov/sites/default/files/guidelines/documents/adult-adolescent-arv/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;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 August 19, 2024. Available at https://clinicalinfo.hiv.gov/en/guidelines
Report Available
Same day/1 to 2 daysMethod Name
Flow Cytometry
Testing Algorithm
For information see Newborn Screen Follow-up for Severe Combined Immunodeficiency Syndrome (SCID).