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The page below is a sample from the LabCE course Introduction to Flow Cytometry: Blood Cell Identification (retired 6/6/2018). Access the complete course and earn ASCLS P.A.C.E.-approved continuing education credits by subscribing online.

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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.