LEUKEMIA/LYMPHOMA IMMUNOPHENOTYPING BY FLOW CYTOMETRY, BLOOD OR BONE MARROW

Code
000.0000
Name
LEUKEMIA/LYMPHOMA IMMUNOPHENOTYPING BY FLOW CYTOMETRY, BLOOD OR BONE MARROW
Category
None
Department
Send-Out
Start Date
Expiration Date
Synonyms
CPT Codes
88184 First marker, AND 88185 Each additional marker, AND 88187 interpretation for 2-8 markers, OR 88188 for 9-15 markers, OR 88189 for 16 or more
Site
SBMF
Reference Test
25219
ATLAS Test Code

Specimen Information

Type

Whole blood or bone marrow: Pale Yellow top (ACD) tube AND Lavender top (EDTA) tube
Tissue: Tissue culture media (e.g., RPMI 1640)
Fluid: Plastic container with tightly fitting lid

Volume

Blood: 7.0 mL ACD, 5.0 mL EDTA*, and 3-5 fresh smears
Bone marrow: 3.0 mL ACD, 3.0 mL EDTA, and 3-5 fresh smears
Tissue: 100 mg fresh tissue suspended in tissue culture media
Fluid: 10-100 mL fresh fluid

Transport Info

Blood or bone marrow: Room temperature
Tissue or fluid: Refrigerated

*Results of current complete blood count (CBC) and smear must be included if unable to send EDTA tube*

Fasting Required?
False
Patient Instructions

Form required:
Flow Cytometry Leukemia/Lymphoma Immunophenotyping Patient Information Sheet

Reference Range

See Report

Methodology

Flow Cytometry

Clinical Significance

Determination of the maturation and lineage of cells is used to establish a definitive diagnosis of leukemia or another hematopoietic neoplasm.

Lymphoid neoplasms, which include the majority of non-Hodgkin’s lymphomas and both the acute and chronic leukemias, are derived from clonally expanded, developmentally arrested cells of B- or T-lymphocyte lineage. Studies have indicated that lymphoid neoplasms often exhibit the characteristics of normal cells at various stages of lymphoid development. An early and critical step in lymphoid cell development is the rearrangement of genes encoding antigen receptors—immunoglobulins or T-cell receptors—in B- and T-cells, respectively. Rearrangement of the antigen receptor genes is required for the production of immunoglobulin or T-cell receptor and is a mechanism that provides for a vast repertoire of diverse antigen receptor types within the immune system. As neoplastic counterparts of normal B and T lymphocytes, the lymphoid neoplasms also show evidence of rearrangement of their antigen receptor genes. Because the lymphoid neoplasms are derived from a single cell, the identical rearrangement pattern is faithfully reproduced throughout the clonal descendants of the original neoplastic cell. In B-cell neoplasms, this is usually detected using flow cytometry and analysis of Kappa and Lambda light chains expression. Normal B-lymphocytes will secrete immunoglobulin with either Kappa or Lambda light chains. In normal populations, this is seen as a standard 60% Kappa bearing B-cells to 40% Lambda bearing B-cells. When a neoplastic cell undergoes clonal expansion, this 60:40 ratio is upset. In many Chronic Lymphoid Leukemias, populations of almost 100% Kappa or Lambda cells can be seen. In other more discrete populations, Kolmogorov-Smirnov analysis of the data is necessary to determine if a clonal population exists. Leukocyte immunophenotyping by flow cytometry is the principle method by which the maturation and lineage of a cell can be determined. Leukemias represent abnormal proliferations of hematopoietic cells that are arrested at a discrete state of differentiation. Since leukemic cells do not show abnormal morphological changes in the same manner as other tumors, a definitive diagnosis of a leukemia or another hematopoietic neoplasm can be made only by the finding of a shift in the distribution or maturity of a cell population. Utilizing monoclonal antibodies to cellular antigens, an immunophenotype can be established for each population of cells present in the specimen, and the percentage of each population determined.

Back