CD3/CD4/CD8

Immunity

Report in 12Hrs

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No Fasting Required

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Evaluate immune system function, especially in HIV, immunodeficiency, autoimmune, and transplant settings

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CD3/CD4/CD8 Test Information Guide

Section 1: Why is it done?
- Measures the absolute and relative counts of CD3 (total T cells), CD4 (helper T cells), and CD8 (cytotoxic T cells) in the blood to assess immune system function
- Monitors progression and treatment response in HIV/AIDS patients by tracking CD4 cell counts
- Evaluates immune system disorders and suspected immunodeficiencies
- Assesses immune reconstitution after organ or stem cell transplantation
- Evaluates suspected severe combined immunodeficiency (SCID) and other primary immunodeficiency disorders
- Monitors patients undergoing immunosuppressive therapy or chemotherapy
- Investigates recurrent, opportunistic, or unusual infections suggesting immune compromise
- Typically performed at initial HIV diagnosis, during antiretroviral therapy initiation, and at regular intervals during treatment
Section 2: Normal Range
- CD3 (Total T Cells): 800-3,000 cells/mm³ (or 0.8-3.0 × 10⁹/L); represents 60-85% of total lymphocytes
- CD4 (Helper T Cells): 500-1,500 cells/mm³ (or 0.5-1.5 × 10⁹/L); represents 30-60% of total T cells or 20-40% of lymphocytes
- CD8 (Cytotoxic T Cells): 300-1,000 cells/mm³ (or 0.3-1.0 × 10⁹/L); represents 15-40% of total T cells or 10-20% of lymphocytes
- CD4/CD8 Ratio: 1.0-2.5 (normal range indicates balanced immune response)
- Normal results indicate intact immune system with adequate T-cell populations to fight infections and maintain immune surveillance
- Abnormal results may show decreased counts (lymphocytopenia) suggesting immunodeficiency or increased counts (lymphocytosis) suggesting infection, inflammation, or malignancy
- Results are expressed in absolute cell counts per cubic millimeter (cells/mm³) or in 10⁹ cells per liter (× 10⁹/L)
- Slight variations in normal ranges may exist between laboratories and different assay methodologies
Section 3: Interpretation
- Decreased CD4 Count (<500 cells/mm³): Indicates significant immunodeficiency; in HIV patients, increases risk of opportunistic infections; counts below 200 cells/mm³ indicate AIDS diagnosis
- Severely Decreased CD4 Count (<50 cells/mm³): Indicates severe immunosuppression requiring prophylaxis against opportunistic infections such as Pneumocystis pneumonia and cytomegalovirus
- Decreased CD3 Count: Suggests T-cell lymphocytopenia; may occur in immunodeficiency syndromes, HIV/AIDS, immunosuppressive therapy, or during acute viral infections
- Decreased CD8 Count: May indicate impaired antiviral immunity; can occur in immunodeficiency disorders or certain viral infections
- Increased CD4 Count (>1,500 cells/mm³): May indicate active immune response to infection or other stimuli; in HIV patients, suggests good immune reconstitution on antiretroviral therapy
- Increased CD8 Count: Suggests active viral infection, immune activation, or certain malignancies
- Inverted CD4/CD8 Ratio (<1.0): Indicates CD8 cells exceed CD4 cells; common in HIV infection, chronic viral infections, or certain autoimmune conditions; suggests immune activation or dysregulation
- Factors Affecting Results: Recent acute infections, medications (chemotherapy, immunosuppressants), stress, time of day (circadian variations), recent vaccination, menstrual cycle, and laboratory technique variations
- Serial measurements are more clinically significant than single measurements; trends in CD4 count are more predictive of disease progression than absolute values
Section 4: Associated Organs
- Primary Organ System: Immune system, including bone marrow (production), thymus gland (T-cell maturation), lymph nodes, and spleen
- HIV/AIDS: Progressive destruction of CD4 T cells leading to severe immunosuppression and opportunistic infections
- Severe Combined Immunodeficiency (SCID): Rare genetic disorder with marked decrease in CD3, CD4, and CD8 T cells; associated with absent or hypoplastic thymus
- DiGeorge Syndrome (22q11 Deletion): Thymic hypoplasia resulting in T-cell deficiency; associated with abnormalities of thymus, heart, and parathyroid glands
- Opportunistic Infections: Pneumocystis jirovecii pneumonia (PCP), cytomegalovirus (CMV), tuberculosis, toxoplasmosis, candidiasis, and cryptococcal meningitis in severely immunocompromised patients
- Lymphomas and Malignancies: Increased risk of non-Hodgkin lymphoma, Hodgkin lymphoma, and Kaposi sarcoma in immunocompromised patients
- Autoimmune Disorders: Abnormal CD4/CD8 ratios and altered T-cell function associated with systemic lupus erythematosus, rheumatoid arthritis, and other autoimmune conditions
- Organ Transplant Rejection: Abnormal T-cell counts may indicate inadequate immunosuppression or excessive immunosuppression after organ transplantation
- Complications of Severe Immunodeficiency: Recurrent infections affecting lungs (pneumonia), gastrointestinal tract (chronic diarrhea), central nervous system (meningitis), and systemic organs
Section 5: Follow-up Tests
- HIV Viral Load (HIV RNA PCR): Measures HIV replication level; essential complement to CD4 count for assessing HIV disease progression and treatment efficacy
- Complete Blood Count (CBC): Assesses overall white blood cell count and differential; identifies cytopenias from bone marrow involvement or medications
- T-Cell Subset Analysis (Extended Panel): May include CD4+/CD45RA+ (naïve), CD4+/CD45RO+ (memory), CD8+/CD45RA+, and regulatory T cells for more detailed immune assessment
- B-Cell Count (CD19/CD20): Evaluates B-cell population; combined with T-cell counts helps diagnose primary immunodeficiency disorders
- Natural Killer (NK) Cell Count: Assesses NK cell function; important for comprehensive immune evaluation in immunodeficiency syndromes
- Opportunistic Infection Screening: When CD4 <200 cells/mm³: toxoplasmosis serology, tuberculosis testing (TST/IGRA), Cryptococcal antigen, CMV and other viral serologies
- Metabolic Panel: Monitors kidney and liver function, especially in patients on antiretroviral therapy or with opportunistic infections
- Immunoglobulin Levels (IgG, IgM, IgA): Assesses humoral immune function; abnormalities suggest combined or B-cell immunodeficiency
- Chest X-ray: When CD4 <200 cells/mm³ or with respiratory symptoms; screens for PCP prophylaxis need and active infections
- Monitoring Frequency: Every 3-6 months in stable HIV patients; every 1-3 months in newly diagnosed or during treatment changes; more frequently if CD4 <200 cells/mm³
Section 6: Fasting Required?
- Fasting Required: No
- No fasting requirement exists for CD3/CD4/CD8 testing; test can be performed at any time of day regardless of food or fluid intake
- Timing Considerations: T-cell counts have circadian variations; consistent collection time (e.g., morning) recommended for serial monitoring to minimize variation
- Medications: No medications need to be held before testing; antiretroviral medications, immunosuppressants, and other drugs should be continued as prescribed
- Sample Collection: Standard blood draw using ethylenediaminetetraacetic acid (EDTA) anticoagulated tube (lavender-top tube); no special collection procedures required
- Recent Activities to Consider: Recent infections, vaccinations (delay test 4 weeks if possible), or recent chemotherapy may affect T-cell counts; report to healthcare provider
- Physical Preparation: No special physical preparation needed; standard precautions for blood drawing apply; ensure adequate hydration for easier venipuncture
- Sample Stability: Sample should be processed within 24-48 hours; delayed processing may reduce cell viability and affect results; keep sample at room temperature

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