B Cell Analysis and Final Interpretation of Case Two

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The page below is a sample from the LabCE course Introduction to Flow Cytometry: Blood Cell Identification. Access the complete course and earn ASCLS P.A.C.E.-approved continuing education credits by subscribing online.

Learn more about Introduction to Flow Cytometry: Blood Cell Identification (online CE course)
B Cell Analysis and Final Interpretation of Case Two

The B cell analysis produced the following results (abnormal findings are highlighted in yellow):
  • CD19 = 81%
  • CD20 = 82%
  • HLA-DR = 83%
  • Kappa = 80%
  • Lambda = 1%
  • CD19+/CD5+ = 81%
  • CD10 = negative
  • CD45 = 99%

Two apparent abnormalities are present; the B cells are clonal because they express primarily Kappa light chains and the B cells are positive for CD5, which is not normally present on B cells.
If Kappa or Lambda is predominant and CD5 is co-expressed with CD19 (CD19/CD5 dual positive lymphocyte population), B-cell chronic lymphocytic leukemia (B-CLL) is a possible diagnosis. In order to confirm this finding, it is important to determine whether or not CD23 is present. The flow cytometry pattern can look identical for B-CLL and Mantle Cell Lymphoma (MCL), except CD23 is generally positive in B-CLL and negative in MCL, as shown in the decision tree on the right.
This particular case does have CD23 = 82%.
Therefore, the final interpretation of Case Two is B-CLL.