Ordering Recommendation

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
B SUBSETS
Methodology

Flow Cytometry

Performed

Sun-Sat

Reported

1-3 days

New York DOH Approval Status
Specimens from New York clients will be sent out to a New York DOH approved laboratory, if possible.
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.

Storage/Transport Temperature

Refrigerated.

Unacceptable Conditions

Clotted or hemolyzed specimens.

Remarks
Stability

Ambient: Unacceptable; Refrigerated: 48 hours; Frozen: Unacceptable

Reference Interval
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

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.

Compliance Statement A: For laboratory developed tests using a manufacturer labeled ASR as the reagent providing the specificity of the assay. Analyte Specific Reagent. This test was developed and its performance characteristics determined by ARUP Laboratories. The U. S. Food and Drug Administration has not approved or cleared this test; however, the FDA has determined that such clearance or approval is not necessary.

Note
Hotline History
N/A
CPT Codes

86355; 86356 x6

Components
Component Test Code* Component Chart Name LOINC
3002217 CD20+ 9558-8
3002218 CD20+ %
3002219 Activated CD21low CD38-
3002220 Activated CD21low CD38- %
3002225 Plasmablasts CD38+IgM- 89343-8
3002226 Plasmablasts CD38+IgM- % 89344-6
3002227 CD19+ B cells 8116-6
3002228 CD19+ B cells % 8117-4
3002231 Non switched CD27+IgD+IgM+ 89351-1
3002232 Non switched CD27+IgD+IgM+ % 89352-9
3002233 Class-switched CD27+IgD-IgM- 89349-5
3002234 Class-switched CD27+IgD-IgM- % 89350-3
3002235 Total Memory CD27+ 89353-7
3002236 Total Memory CD27+ % 89358-6
3002237 Transitional CD38+IgM+ 89357-8
3002238 Transitional CD38+IgM+ % 89341-2
* 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
  • CVID
  • Memory B-cells
B Cell Subset Analysis