Recommendations when to order or not order the test. May include related or preferred tests.
Assess B cell subsets of immunodeficiencies. Support the diagnosis of common variable immune deficiency (CVID) and assist in predicting the clinical phenotype. Assess B cell reconstitution after bone marrow or hematopoietic stem cell transplantation. Not recommended for rituximab monitoring; refer to B-cell CD20 Expression (0092099).
Mnemonic
Unique test identifier.
B SUBSETS
Methodology
Process(es) used to perform the test.
Flow Cytometry
Performed
Days of the week the test is performed.
Sun-Sat
Reported
Expected turnaround time for a result, beginning when ARUP has received the specimen.
1-3 days
New York DOH Approval Status
Indicates test has been approved by the New York State Department of Health.
This test is New York DOH approved.
Specimen Required
Patient Preparation
Collect
Lavender (K2EDTA) or Pink (K2EDTA).
Specimen Preparation
Transport 4 mL whole blood. (Min: 2 mL) Specimens must be analyzed within 48 hours of collection.
Normal range/expected value(s) for a specific disease state. May also include abnormal ranges.
Test Number
Components
Reference Interval
CD20+
Age
Cells/µL
0-15 years
N/A
16 years and older
110-450
CD20+ %
Age
Percent
0-15 years
N/A
16 years and older
96.0-100.0
Activated CD21low CD38-
Age
Cells/µL
0-7 days
0-80
8 days-1 month
0-20
2-4 months
0-50
5-8 months
0-50
9-14 months
0-40
15-23 months
10-60
2-4 years
10-60
5-9 years
10-40
10-15 years
10-30
16 years and older
3-26
Activated CD21low CD38- %
Age
Percent
0-7 days
0.5-22.0
8 days-1 month
0.4-2.2
2-4 months
0.5-2.9
5-8 months
0.4-3.3
9-14 months
0.5-4.5
15-23 months
1.0-5.7
2-4 years
1.7-5.4
5-9 years
2.3-10.0
10-15 years
2.7-8.7
16 years and older
1.2-9.0
Plasmablasts CD38+IgM-
Age
Cells/µL
0-7 days
0-10
8 days-1 month
0-30
2-4 months
0-40
5-8 months
0-60
9-14 months
0-30
15-23 months
10-40
2-4 years
10-50
5-9 years
0-30
10-15 years
0-20
16 years and older
1-8
Plasmablasts CD38+IgM- %
Age
Percent
0-7 days
0.2-3.2
8 days-1 month
0.2-2.7
2-4 months
0.4-3.3
5-8 months
0.2-4.0
9-14 months
0.4-5.5
15-23 months
0.5-3.0
2-4 years
0.6-4.0
5-9 years
0.6-5.3
10-15 years
0.6-6.5
16 years and older
0.4-4.1
CD19+ B cells
Age
Cells/µL
0-7 days
200-800
8 days-1 month
700-1800
2-4 months
700-2400
5-8 months
700-2800
9-14 months
400-2900
15-23 months
600-1900
2-4 years
400-1700
5-9 years
300-600
10-15 years
200-600
16 years and older
110-450
CD19+ B cells %
Age
Percent
0-7 days
6.2-25.0
8 days-1 month
10.0-31.0
2-4 months
18.0-38.0
5-8 months
16.0-34.0
9-14 months
14.0-28.0
15-23 months
16.0-34.0
2-4 years
14.0-29.0
5-9 years
10.0-24.0
10-15 years
9.4-23.0
16 years and older
6.4-22.0
Non switched CD27+IgD+IgM+
Age
Cells/µL
0-7 days
10-40
8 days-1 month
20-50
2-4 months
20-200
5-8 months
30-120
9-14 months
20-140
15-23 months
30-170
2-4 years
20-180
5-9 years
20-100
10-15 years
20-70
16 years and older
5-46
Non switched CD27+IgD+IgM+ %
Age
Percent
0-7 days
2.6-12.0
8 days-1 month
1.7-6.5
2-4 months
2.5-8.7
5-8 months
2.8-7.4
9-14 months
3.0-11.0
15-23 months
4.1-14.0
2-4 years
2.7-20.0
5-9 years
5.2-20.0
10-15 years
4.6-18.0
16 years and older
2.4-15.0
Class-switched CD27+IgD-IgM-
Age
Cells/µL
0-7 days
10-30
8 days-1 month
10-90
2-4 months
10-170
5-8 months
20-140
9-14 months
10-100
15-23 months
30-180
2-4 years
20-220
5-9 years
40-140
10-15 years
30-110
16 years and older
11-61
Class-switched CD27+IgD-IgM- %
Age
Percent
0-7 days
1.0-7.2
8 days-1 month
1.5-7.1
2-4 months
0.3-9.0
5-8 months
1.6-7.0
9-14 months
1.4-12.0
15-23 months
3.9-14.0
2-4 years
4.7-21.0
5-9 years
11.0-30.0
10-15 years
8.7-26.0
16 years and older
5.1-22.0
Total Memory CD27+
Age
Cells/µL
0-7 days
20-70
8 days-1 month
30-100
2-4 months
40-230
5-8 months
50-270
9-14 months
40-190
15-23 months
50-330
2-4 years
50-390
5-9 years
60-230
10-15 years
50-200
16 years and older
23-110
Total Memory CD27+ %
Age
Percent
0-7 days
3.6-14.0
8 days-1 month
3.1-11.0
2-4 months
3.2-12.0
5-8 months
5.3-12.0
9-14 months
4.1-21.0
15-23 months
9.5-27.0
2-4 years
7.8-37.0
5-9 years
18.6-47.0
10-15 years
13.3-48.0
16 years and older
10.0-33.0
Transitional CD38+IgM+
Age
Cells/µL
0-7 days
0-210
8 days-1 month
50-570
2-4 months
130-940
5-8 months
100-300
9-14 months
20-210
15-23 months
30-200
2-4 years
20-200
5-9 years
10-40
10-15 years
10-60
16 years and older
1-17
Transitional CD38+IgM+ %
Age
Percent
0-7 days
1.2-42.0
8 days-1 month
4.1-44.0
2-4 months
11.0-38.0
5-8 months
7.2-20.0
9-14 months
3.6-13.0
15-23 months
3.3-17.0
2-4 years
3.1-12.0
5-9 years
4.6-8.3
10-15 years
1.4-13.0
16 years and older
0.7-5.9
Interpretive Data
Background information for test. May include disease information, patient result explanation, recommendations, details of testing, associated diseases, explanation of possible patient results.
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, referenceintervals 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.
Compliance Category
Analyte Specific Reagent (ASR)
Note
Additional information related to the test.
Hotline History
N/A
CPT Codes
The American Medical Association Current Procedural Terminology (CPT) codes published in ARUP's Laboratory Test Directory are provided for informational purposes only. The codes reflect our interpretation of CPT coding requirements based upon AMA guidelines published annually. CPT codes are provided only as guidance to assist clients with billing. ARUP strongly recommends that clients confirm CPT codes with their Medicare administrative contractor, as requirements may differ. CPT coding is the sole responsibility of the billing party. ARUP Laboratories assumes no responsibility for billing errors due to reliance on the CPT codes published.
* 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.
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