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Time Sensitive

Ordering Recommendation

Evaluate for primary immunodeficiencies, including severe combined immunodeficiency, and monitor immune reconstitution following transplantation.

Mnemonic

TIMMUNPAN

Methodology

Quantitative Flow Cytometry

Performed

Sun-Sat

Reported

1-3 days

New York DOH Approval Status

This test is New York DOH approved.

Specimen Required

Patient Preparation
Collect

Lavender (EDTA), pink (K2EDTA), or green (sodium or lithium heparin). Hemogard tubes are preferred for laboratory automation and safety.

Specimen Preparation

Transport 4 mL whole blood. (Min: 0.5 mL)

Storage/Transport Temperature

CRITICAL ROOM TEMPERATURE.

Unacceptable Conditions

Clotted or hemolyzed specimens.

Remarks

Specimens must be analyzed within stability times provided. Some medication may affect immunophenotyping results and should be provided on the patient test request form.

Stability

EDTA: Ambient: 72 hours; Refrigerated: Unacceptable; Frozen: Unacceptable; Heparin: Ambient: 48 hours; Refrigerated: Unacceptable; Frozen: Unacceptable
New York State Clients: Same as the above.

Reference Interval

Test Number
Components
Reference Interval
  Absolute CD19
Age Reference Interval (cells/µL)
0-6 days 140-2000
1 week-1 month 180-3500
2-4 months 520-2300
5-8 months 130-6300
9-14 months 110-7700
15-23 months 160-3700
2-4 years 180-1300
5-9 years 100-800
10-15 years 120-740
16-64 years 91-610
65 years or older 74-510

  % Natural Killer Cells
Age Reference Interval (Percent)
0-6 days 8-62
1 week-1 month 3-23
2-4 months 2-20
5-8 months 2-36
9-14 months 1-64
15-23 months 1-96
2-4 years 2-25
5-9 years 2-31
10-15 years 4-51
16-64 years 4-26
65 years or older 5-28

  Absolute Natural Killer Cells
Age Reference Interval (cells/µL)
0-6 days 500-3100
1 week-1 month 140-1900
2-4 months 97-2000
5-8 months 68-3900
9-14 months 71-3500
15-23 months 55-4000
2-4 years 61-510
5-9 years 70-590
10-15 years 92-1200
16-64 years 78-470
65 years or older 74-620

  Absolute CD3
Age Reference Interval (cells/µL)
0-6 days 1400-6800
1 week-1 month 1900-8400
2-4 months 2200-9200
5-8 months 1400-11500
9-14 months 2400-8300
15-23 months 700-8800
2-4 years 850-4300
5-9 years 770-4000
10-15 years 850-3200
16-64 years 570-2400
65 years or older 660-2200

  % CD3
Age Reference Interval (Percent)
0-6 days 38-88
1 week-1 month 55-90
2-4 months 49-97
5-8 months 49-95
9-14 months 56-87
15-23 months 36-92
2-4 years 52-92
5-9 years 55-97
10-15 years 52-90
16-64 years 62-87
65 years or older 62-89

  Absolute CD4
Age
Reference Interval (cells/µL)
0-6 days 1000-4800
1 week-1 month 1500-6000
2-4 months 1600-6500
5-8 months 1000-7200
9-14 months 1300-7100
15-23 months 400-7200
2-4 years 500-2700
5-9 years 400-2500
10-15 years 400-2100
16-64 years 430-1800
65 years or older 490-1600

  Absolute CD8
Age
Reference Interval (cells/µL)
0-6 days 200-2700
1 week-1 month 300-2700
2-4 months 300-3400
5-8 months 200-5400
9-14 months 400-4100
15-23 months 200-2800
2-4 years 200-1800
5-9 years 200-1700
10-15 years 300-1300
16-64 years 210-1200
65 years or older 150-1050

  % CD4
Age Reference Interval (Percent)
0-6 days 26-62
1 week-1 month 39-69
2-4 months 37-69
5-8 months 27-81
9-14 months 25-86
15-23 months 16-91
2-4 years 25-66
5-9 years 26-61
10-15 years 20-65
16-64 years 32-64
65 years or older 35-68

  % CD8
Age Reference Interval (Percent)
0-6 days 5-37
1 week-1 month 7-35
2-4 months 6-41
5-8 months 10-35
9-14 months 7-58
15-23 months 7-40
2-4 years 9-49
5-9 years 13-47
10-15 years 14-40
16-64 years 15-46
65 years or older 10-46

  % CD19
Age Reference Interval (Percent)
0-6 days 3-30
1 week-1 month 3-60
2-4 months 8-33
5-8 months 4-54
9-14 months 3-77
15-23 months 8-45
2-4 years 8-39
5-9 years 4-33
10-15 years 7-24
16-64 years 6-23
65 years or older 5-21

  CD4:CD8 Ratio
Age Reference Interval
0-6 days 1.00-2.60
1 week-1 month 1.30-6.30
2-4 months 1.70-3.90
5-8 months 1.60-3.80
9-14 months 1.30-3.90
15-23 months 0.90-3.70
2-4 years 0.90-2.90
5-9 years 0.90-2.60
10-15 years 0.90-3.40
16-64 years 0.80-3.90
65 years or older 0.80-6.17

Interpretive Data

The CD4 cells are Helper T-cells expressing both CD3 and CD4. The CD8 cells are Cytotoxic T-cells expressing both CD3 and CD8. The B-cells express CD19, but not CD3. The NK-cells express either CD16 or CD56 (or both) but not CD3. CD3, CD4, CD8, CD19 and NK-cell percentages are reported as a percent of total lymphocytes. CD4 T-cell levels are a criterion for categorizing HIV-related clinical conditions by the CDC's classification system for HIV infection. The measurement of CD4 T-cell levels has been used to establish decision points for initiating P. jirovecii prophylaxis, antiviral therapy and to monitor the efficacy of treatment. The Public Health Service (PHS) has recommended that CD4 T-cell levels be monitored every 3 to 6 months in all HIV-infected persons.

This test was developed and its performance characteristics determined by ARUP Laboratories. It has not been cleared or approved by the US Food and Drug Administration. This test was performed in a CLIA certified laboratory and is intended for clinical purposes.

Compliance Category

Modified FDA

Note

This assay is designed for enumerating the percent and absolute cell counts of lymphocyte subsets in lysed whole blood. Whole blood is added to fluorochrome-labeled antibodies that bind specifically to cell surface antigens on lymphocytes. After incubation, lysing and fixation, percent and absolute counts are enumerated utilizing an internal quantitation standard. Additional CBC data is not required.

During HIV infection, antiviral therapy is often initiated when the absolute CD4 count drops below 500 cells/µL. When the absolute CD4 count drops below 200 cells/µL, therapeutic prophylaxis against PCP and other opportunistic infections may be initiated. When the absolute CD4 count drops below 100 cells/µL, prophylaxis against Mycobacterium avium complex is recommended.

For longitudinal studies involving serial monitoring, specimen collections should be performed at the same time of day.

Hotline History

N/A

CPT Codes

86355; 86357; 86359; 86360

Components

Component Test Code* Component Chart Name LOINC
0095618 Lymphocyte Subset Panel 5 Information 48767-8
0095700 Absolute CD19 15195-1
0095701 % Natural Killer Cells 32519-1
0095702 Absolute Natural Killer Cells 20604-5
0095902 Absolute CD3 8122-4
0095903 % CD3 20599-7
0095906 Absolute CD4 24467-3
0095911 Absolute CD8 14135-8
2012857 % CD4 8123-2
2012858 % CD8 32518-3
2012859 % CD19 20593-0
2012860 CD4:CD8 Ratio 54218-3
* Component test codes cannot be used to order tests. The information provided here is not sufficient for interface builds; for a complete test mix, please click the sidebar link to access the Interface Map.

Aliases

  • CD3, CD4, CD8, CD19 absolute count, NK cells absolute count
  • Helper T-Cell count
  • Helper T-cells, Cytotoxic T-cells and NK-cells count
  • Immune Status-Flow Cytometry
  • Immunosuppressive therapy monitoring for immunocompromised
  • P. jiroveci prophylaxis
  • T-Cell Immunodeficiency Profile
Lymphocyte Subset Panel 5 - Total Lymphocyte Enumeration