Mayo Test Catalog, (Sorted By Test Name) - Mayo Medical ...

to lectin mitogens occur in a variety of primary and secondary immunodeficiency diseases including
diseases that affect T lymphocytes, B lymphocytes, and T and B lymphocytes.(2) Specific antigen
recognition involves T-cell receptor recognition of specific peptide in the context of the appropriate MHC
molecule on an antigen-presenting cell. T cells activate and proliferate in response to specific antigenic
stimulus. The recall antigens (eg, Candida albicans and tetanus toxoid) are used to assess antigen-specific
T-cell responses. The absolute counts of lymphocyte subsets are known to be influenced by a variety of
biological factors, including hormones, the environment, and temperature. The studies on diurnal
(circadian) variation in lymphocyte counts have demonstrated progressive increase in CD4 T-cell count
throughout the day, while CD8 T cells and CD19+ B cells increase between 8:30 a.m. and noon, with no
change between noon and afternoon. Natural killer (NK) cell counts, on the other hand, are constant
throughout the day.(3) Circadian variations in circulating T-cell counts have been shown to be negatively
correlated with plasma cortisol concentration.(4-6) In fact, cortisol and catecholamine concentrations
control distribution and, therefore, numbers of naive versus effector CD4 and CD8 T cells.(4) It is
generally accepted that lower CD4 T-cell counts are seen in the morning compared with the evening (7),
and during summer compared to winter.(8) These data, therefore, indicate that timing and consistency in
timing of blood collection is critical when serially monitoring patients for lymphocyte subsets.
Useful For: Evaluating patients suspected of having diminished cellular immune function Evaluating
patients with primary and secondary immunodeficiency diseases that affect T lymphocytes, including
combined immunodeficiency diseases (eg, severe combined immunodeficiency, cellular
immunodeficiency diseases, and some patients with humoral immunodeficiency diseases (eg, common
variable immunodeficiency) Evaluating functional T-cell recovery post-hematopoietic stem cell
transplant or immunosuppressive therapy for solid-organ transplantation or in other clinical contexts
Interpretation: Diminished responses to lectin mitogens and/or antigens may be consistent with a
primary or secondary immunodeficiency disease. Abnormal results are not specific for a particular
disease, and the magnitude of the abnormality is not necessarily related to the degree of
immunodeficiency. In the case of antigen-specific proliferative responses, it is possible to have low or
absent responses if a long interval has passed since the original or booster vaccination (tetanus toxoid).
Reference Values:
LYMPHOCYTE PROLIFERATION TO ANTIGENS
Viability of lymphocytes at day 0: > or =75.0%
Maximum proliferation of Candida albicans as % CD45: > or =5.7%
Maximum proliferation of Candida albicans as % CD3: > or =3.0%
Maximum proliferation of tetanus toxoid as % CD45: > or =5.2%
Maximum proliferation of tetanus toxoid as % CD3: > or =3.3%
LYMPHOCYTE PROLIFERATION TO MITOGENS
Viability of lymphocytes at day 0: > or =75.0%
Maximum proliferation of phytohemagglutinin as % CD45: > or =49.9%
Maximum proliferation of phytohemagglutinin as % CD3: > or =58.5%
Maximum proliferation of pokeweed mitogen as % CD45: > or =4.5%
Maximum proliferation of pokeweed mitogen as % CD3: > or =3.5%
Maximum proliferation of pokeweed mitogen as % CD19: > or =3.9%
Clinical References: 1. Fletcher MA, Urban RG, Asthana D, et al: Lymphocyte proliferation. In
Manual of Clinical Laboratory Immunology. 5th edition. Edited by NR Rose, EC de Macario, JD Folds,
et al. Washington DC. ASM Press, 1997, pp 313-319 2. Bonilla FA, Bernstein IL, Khan DA, et al:
Practice parameter for the diagnosis and management of primary immunodeficiency. Ann Allergy
Asthma Immunol 2005;94:S1-S63 3. Carmichael KF, Abayomi A: Analysis of diurnal variation of
lymphocyte subsets in healthy subjects and its implication in HIV monitoring and treatment. 15th Intl
Conference on AIDS, Bangkok, Thailand, 2004, Abstract B11052 4. Dimitrov S, Benedict C, Heutling
D, et al: Cortisol and epinephrine control opposing circadian rhythms in T-cell subsets. Blood
2009;113:5134-5143 5. Dimitrov S, Lange T, Nohroudi K, Born J: Number and function of circulating
antigen presenting cells regulated by sleep. Sleep 2007;30:401-411 6. Kronfol Z, Nair M, Zhang Q, et
al: Circadian immune measures in healthy volunteers: relationship to hypothalamic-pituitary-adrenal
axis hormones and sympathetic neurotransmitters. Psychosom Med 1997;59:42-50 7. Malone JL,
Simms TE, Gray GC, et al: Sources of variability in repeated T-helper lymphocyte counts from HIV
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