Lymphocyte subset panel with NK cells

Immunity

Report in 72Hrs

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No Fasting Required

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Flow cytometry for T, B, NK cells.

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Lymphocyte Subset Panel with NK Cells - Comprehensive Information Guide

Why is it done?
- Test Overview: This test measures the distribution and absolute counts of different lymphocyte subsets, including T cells (CD3+, CD4+, CD8+), B cells (CD19+), and natural killer (NK) cells (CD16+/CD56+). It uses flow cytometry to identify and quantify these immune cell populations in peripheral blood.
- Primary Indications: Evaluation of immunodeficiency disorders; Assessment of HIV infection status and progression; Monitoring immune reconstitution in patients on antiretroviral therapy; Investigation of recurrent infections; Evaluation of autoimmune conditions; Assessment of lymphoid malignancies; Evaluation of immunosuppressive therapy effects.
- Timing and Circumstances: Performed at initial diagnosis of suspected immune disorders; During baseline assessment before immunosuppressive therapy; Periodically in HIV-positive patients (typically every 3-6 months); When monitoring response to treatment; When investigating unexplained infections or lymphadenopathy; As part of pre-transplant evaluation.
Normal Range
- Reference Ranges (Adults):
  - CD3+ T cells (Total T cells): 700-2200 cells/μL or 60-85% of lymphocytes
  - CD4+ T cells (Helper T cells): 500-1500 cells/μL or 35-50% of lymphocytes
  - CD8+ T cells (Cytotoxic T cells): 250-900 cells/μL or 15-30% of lymphocytes
  - CD19+ B cells: 100-700 cells/μL or 5-20% of lymphocytes
  - CD16+/CD56+ NK cells: 150-1000 cells/μL or 5-20% of lymphocytes
  - CD4+/CD8+ Ratio: 1.0-3.0 (typically 1.5-2.0)
- Units of Measurement: Absolute counts in cells/μL (cells per microliter); Percentages of total lymphocytes (%); Ratios (unitless)
- Interpretation Guide:
  - Normal Results: All lymphocyte subsets within reference range; Indicates normal immune function and balanced cellular immune response
  - Low Values: Indicate lymphopenia or immunodeficiency; Suggests impaired immune function; May indicate disease progression or treatment effects
  - High Values: May indicate lymphocytosis, active infection, or lymphoid malignancy; Pattern of elevation helps determine specific condition
  - Abnormal Ratios: Inverted ratio (CD4+/CD8+ < 1.0) suggests viral infection, HIV disease, or certain malignancies
Interpretation
- CD4+ T Cell Interpretation:
  - > 500 cells/μL: Generally adequate immune function; Lower risk of opportunistic infections in HIV patients
  - 200-500 cells/μL: Intermediate immunodeficiency; Increased risk for certain infections; May warrant prophylactic treatment
  - < 200 cells/μL: Severe immunodeficiency; High risk for opportunistic infections (PCP, CMV, MAC); Requires prophylaxis and close monitoring
- CD8+ T Cell Interpretation:
  - Elevated CD8+: May indicate viral infection (HIV, CMV, EBV); Chronic immune activation; Response to malignancy
  - Decreased CD8+: Suggests immunodeficiency; Loss of viral control; Advanced HIV disease; Certain autoimmune conditions
- B Cell Interpretation:
  - Elevated B cells: May indicate B-cell lymphoproliferative disorder; Chronic stimulation; Early immune reconstitution in HIV
  - Decreased B cells: Suggests B-cell immunodeficiency; HIV disease progression; Hypogammaglobulinemia; Agammaglobulinemia syndromes
- NK Cell Interpretation:
  - Elevated NK cells: Active viral infection; Immune activation; Certain lymphoproliferative disorders; Normal variation
  - Decreased NK cells: NK cell deficiency; HIV disease; Severe immunodeficiency; Increased susceptibility to viral and malignant conditions
- CD4+/CD8+ Ratio Interpretation:
  - > 1.0: Normal balanced immune response; Indicates preserved CD4+ helper cell function
  - 0.5-1.0: Borderline; Suggests mild immune dysregulation; Increased CD8+ activation relative to CD4+ help
  - < 0.5: Significantly inverted; Characteristic of HIV infection, viral reactivation, chronic viral stimulation, or malignancy; Indicator of immune dysfunction
- Factors Affecting Results:
  - Acute infections (bacterial, viral, fungal); Recent vaccination or immunization; Medications (corticosteroids, immunosuppressants, antiretrovirals); Time of day (circadian variation); Stress; Smoking; Age variations; Sample handling and processing delays; Specimen integrity
Associated Organs
- Primary Organ Systems:
  - Immune System: Direct assessment of cellular immunity; Lymphocytes originate from bone marrow and thymus; Circulate through lymphoid organs
  - Lymphoid Organs: Thymus, spleen, lymph nodes, bone marrow; Tonsils and Peyer's patches; Secondary lymphoid tissues where lymphocytes mature and respond
  - Blood System: Lymphocytes transport through peripheral circulation; Test measures circulating populations
- Associated Medical Conditions:
  - HIV/AIDS: Progressive CD4+ depletion; Inverted CD4+/CD8+ ratio; Most common indication for testing
  - Primary Immunodeficiency Syndromes: DiGeorge syndrome (22q11 deletion); Severe combined immunodeficiency (SCID); Common variable immunodeficiency (CVID); Selective IgA deficiency; NK cell deficiencies
  - Autoimmune Disorders: Systemic lupus erythematosus (SLE); Rheumatoid arthritis; Sjögren's syndrome; Inflammatory bowel disease
  - Lymphoid Malignancies: Chronic lymphocytic leukemia (CLL); Lymphomas; Multiple myeloma; Acute lymphoblastic leukemia (ALL)
  - Chronic Viral Infections: Cytomegalovirus (CMV); Epstein-Barr virus (EBV); Hepatitis B and C; Human T-lymphotropic virus (HTLV)
  - Infections and Opportunistic Infections: Pneumocystis pneumonia (PCP); Tuberculosis; Cryptococcal meningitis; Toxoplasmosis; Recurrent infections
  - Drug-Induced Immunosuppression: Chemotherapy-induced; Corticosteroid effects; Post-transplant immunosuppression; Biologic agent effects
  - Ataxia-Telangiectasia and Other Genetic Syndromes: Wiskott-Aldrich syndrome; Ataxia-telangiectasia; Hyper-IgM syndrome
- Potential Complications:
  - Associated with Low CD4+/CD8+ Ratios:
  - Opportunistic infections (PCP, CMV, MAC, cryptococcal meningitis); Certain malignancies (Kaposi's sarcoma, lymphomas); Immune reconstitution inflammatory syndrome (IRIS); Mortality risk if untreated
  - Associated with Lymphoproliferative Disorders:
  - Complications related to specific malignancy; Tumor lysis syndrome; Leukostasis complications; Organ infiltration
Follow-up Tests
- Recommended Follow-up Testing:
  - For HIV Patients:
    - HIV viral load (RNA copies); Repeat CD4+ count and lymphocyte subset panel (typically every 3-6 months); Genotypic resistance testing if CD4+ not rising on therapy; Prophylaxis assessment based on CD4+ levels
  - For Immunodeficiency Disorders:
    - Immunoglobulin levels (IgG, IgA, IgM); Specific antibody responses to vaccination; T cell proliferation assays; Neutrophil function tests; Complement levels and function; Genetic testing for suspected primary immunodeficiency
  - For Lymphoproliferative Disorders:
    - Flow cytometry with additional markers (CD23, FMC7, surface immunoglobulin); Bone marrow biopsy and aspiration; Cytochemical stains; Cytogenetics and FISH studies; Molecular genetic testing; Imaging studies (CT, PET scan)
  - For Post-Transplant Monitoring:
    - Serial lymphocyte subsets; Immunoglobulin levels; Immunization response studies; Thymic function assessment
- Monitoring Frequency:
  - HIV Patients: Every 3-6 months for untreated disease; Every 3-6 months after initiation of therapy; Every 6-12 months once virally suppressed and CD4+ > 500 cells/μL
  - Immunodeficiency Patients: Baseline and annually or as clinically indicated; More frequently if recurrent infections occurring
  - Malignancy Patients: At diagnosis; Periodically during treatment (monthly to every 3 months); During remission monitoring; As clinically indicated
- Complementary Tests:
  - Complete Blood Count (CBC): Assess overall white blood cell count and lymphocyte percentage; Evaluate for cytopenias
  - Immunoglobulin Panel: Humoral immunity assessment; Evaluate antibody production capacity; Screen for hypogammaglobulinemia
  - Bacterial and Viral Serology: CMV antibodies/antigen; EBV antibodies; Hepatitis B and C; Tuberculosis testing; Toxoplasma serology
  - Extended Flow Cytometry Panels: Activation markers; Regulatory T cells; B cell subsets; Naive vs memory cell populations
  - Thymic Function Tests: T cell receptor excision circle (TREC) analysis; Thymic volume imaging
Fasting Required?
- Fasting Requirement: NO
- Fasting Not Required: The lymphocyte subset panel can be performed on either fasting or non-fasting patients; Food intake does not affect lymphocyte counts or subset distribution; Test is based on flow cytometric analysis of immune cells in blood, which is not influenced by nutritional status
- Patient Preparation:
  - Blood Draw Timing: Preferably drawn in morning (circadian lymphocyte variation); Consistent timing if serial testing; Patient should be seated or supine for 5 minutes before draw
  - Medications: Do NOT discontinue regular medications; Inform provider of recent corticosteroids, immunosuppressants, or chemotherapy; These should not prevent testing but results should be interpreted in context
  - Recent Vaccinations: Notify laboratory if vaccinated within 4 weeks; Live vaccines may temporarily affect lymphocyte counts; Testing can proceed but results interpretation should account for vaccination timing
  - Stress and Lifestyle: Avoid intense exercise or physical stress immediately before blood draw; Emotional stress may temporarily affect results; Adequate sleep night before testing is recommended
  - Specimen Collection: EDTA (ethylenediaminetetraacetic acid) tube or lithium heparin tube required (purple or green top); Label specimen clearly with patient identifier, date, and time of collection; Process promptly (ideally within 24 hours for optimal results); Handle gently to avoid hemolysis or cellular damage
  - Special Considerations: Smoking should be avoided 30 minutes before testing if possible; Avoid excessive caffeine on morning of test; Severe infections or acute illness may affect results; Discuss with provider if acutely ill

How our test process works!