B Cell Subset Analysis

Overview

  • EPIC Code:
  • MISC
  • Soft Test Code:
  • MSOT
  • Send Out Test Code:
  • 3002216
Alternate Names
  • B Subsets
  • CVID
  • Memory B Cell
  • Memory B-cells
Clinical Significance

This panel identifies B cell dysregulation.  B cells start development in the bone marrow (stem-cell, pro-B, pre-B), then transition to the spleen and lymph nodes where some mature by acquiring CD27 and switching immunoglobulin class from IgD and IgM to IgG or IgA. Class-switched B cells may further progress to plasmablasts and finally plasma cells.  Different disorders may block different parts of this pathway, disrupting immunoglobulin production.
This panel can also be used to monitor B cell reconstitution after bone marrow transplantation or targeted B cell depletion therapy.
This panel can assist in the diagnosis and subclassification of Common Variable Immune Deficiency (CVID). CVID is a heterogeneous group of disorders characterized by low antibody production, defective antibody responses, and recurrent infections. Most cases of CVID have a severe reduction in class switched memory B cells (CD27+, IgD-, IgM-) that correlates with granulomatous disease.  Many also have an expanded population of CD21low, CD38low B cells that correlates with splenomegaly. Increased transitional B cells (CD38+, IgM+) in CVID correlates with lymphadenopathy. Most CVID patients have a low percentage of plasmablasts (CD38+, IgM-) that has a correlation with autoimmune cytopenia.
Class switched memory B cells are also low in ALPS, but are typically increased in SLE and infection.
Please note, reference intervals for CD20+ B cells were not established for patients less than 16 years of age. For all other B cell subsets, reference intervals for populations younger than 16 years are adopted from literature. Piatosa B, Wolska-Kusnierz B, Pac M, Siewiera K, Galkowska E, Bernatowska E. B cell subsets in healthy children: Reference values for evaluation of B cell maturation process in peripheral blood. Cytometry Part B 2010; 78B: 372381.


Specimen Collection & Preparation

Specimen Requirements

4.0 mL Whole Blood in a Lavender Top Tube - EDTA

Alternate Specimen

4.0 mL Whole Blood in a Pink Top Tube - EDTA 

TransportAndStorage

Unacceptable Ambient
48 hours Refrigerated
Unacceptable Frozen

Collection Instructions

Draw and send to Parkview Lab Monday thru Thursday Only, 

Specimen must be at testing laboratory (ARUP) within 48 hours of collection. 

Clinical Interpretation

Reference Range:

Refer to Interpretive Results


Methodology:
  • Flow Cytometry (FC)

Clinical Significance

This panel identifies B cell dysregulation.  B cells start development in the bone marrow (stem-cell, pro-B, pre-B), then transition to the spleen and lymph nodes where some mature by acquiring CD27 and switching immunoglobulin class from IgD and IgM to IgG or IgA. Class-switched B cells may further progress to plasmablasts and finally plasma cells.  Different disorders may block different parts of this pathway, disrupting immunoglobulin production.
This panel can also be used to monitor B cell reconstitution after bone marrow transplantation or targeted B cell depletion therapy.
This panel can assist in the diagnosis and subclassification of Common Variable Immune Deficiency (CVID). CVID is a heterogeneous group of disorders characterized by low antibody production, defective antibody responses, and recurrent infections. Most cases of CVID have a severe reduction in class switched memory B cells (CD27+, IgD-, IgM-) that correlates with granulomatous disease.  Many also have an expanded population of CD21low, CD38low B cells that correlates with splenomegaly. Increased transitional B cells (CD38+, IgM+) in CVID correlates with lymphadenopathy. Most CVID patients have a low percentage of plasmablasts (CD38+, IgM-) that has a correlation with autoimmune cytopenia.
Class switched memory B cells are also low in ALPS, but are typically increased in SLE and infection.
Please note, reference intervals for CD20+ B cells were not established for patients less than 16 years of age. For all other B cell subsets, reference intervals for populations younger than 16 years are adopted from literature. Piatosa B, Wolska-Kusnierz B, Pac M, Siewiera K, Galkowska E, Bernatowska E. B cell subsets in healthy children: Reference values for evaluation of B cell maturation process in peripheral blood. Cytometry Part B 2010; 78B: 372381.


Production Schedule

Sites Performed
  • ARUP Lab
Days Performed
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Departments
  • Sendouts - Miscellaneous
Turn Around Time

1 to 3 days


Coding & Compliance

CDM

00913333


CPT Coding

86355; 86356 x6