Test Catalog

Test ID: LCMS    
Leukemia/Lymphoma Immunophenotyping, Flow Cytometry, Varies

Testing Algorithm Delineates situations when tests are added to the initial order. This includes reflex and additional tests.

The testing process begins with a screening panel. The screening panel will be charged based on the number of markers tested (FIRST for first marker, ADD1 for each additional marker). The interpretation will be based on markers tested in increments of 2 to 8, 9 to 15, or 16 and greater. In addition, reflex testing may occur to fully characterize a disease state or clarify any abnormalities from the screening test. Reflex tests will be performed at an additional charge for each marker tested (FIRST if applicable, ADD1 if applicable).


In addition to reflexing flow cytometric panels, AML FISH testing for PML-RARA translocation t(15;17) may be added by the Mayo Clinic pathologist to exclude acute promyelocytic leukemia if there is morphologic suspicion or if blasts and promyelocytes are CD34-negative and HLA-DR-negative.


The triage panel is initially performed to evaluate for monotypic B cells by kappa and lambda light chain expression, increased numbers of blast cells by CD34 and CD45 expression along with side scatter gating, and increased plasma cells by CD45 expression and side scatter gating. The triage panel also includes antibodies to assess the number of CD3-positive T cells and CD16-positive/CD3-negative natural killer (NK) cells present. This triage panel also determines if there is an increase in the number of T cells that aberrantly coexpress CD16, an immunophenotypic feature of T-cell granular lymphocytic leukemia.


This panel, together with the provided clinical history and morphologic review, is used to determine what, if any, additional testing is needed for disease diagnosis or classification. If additional testing is required, it will be added per the algorithm to fully characterize a disease state with a charge per unique antibody tested.


If no abnormalities are detected by the initial panel, no further flow cytometric assessment will be performed unless otherwise indicated by specific features of the clinical presentation or prior laboratory results.


Additional FISH or molecular testing may be recommended by the Mayo pathologist to facilitate diagnosis. The referring physician or pathologist will be contacted to confirm the addition of any of these tests. Cytogenetic FISH Studies:

-CCND1/IGH translocation t(11;14), to exclude mantle cell lymphoma in cases of CD5+CD23- B-cell lymphoproliferative disorder.

-TCL-1 break-apart at 14q32, to exclude T-cell prolymphocytic leukemia in cases with CD4-positive T-cell lymphoproliferative disorder (phenotypic aberrancy or very tight CD4+ population with high CD4:CD8 ratio).

-MYC break-apart at 8q24, with or without IGH-BCL2 t(14;18) and BCL6 break-apart at 3q27, for suspected high grade B-cell lymphomas, based on morphologic assessment and immunophenotype (usually CD10-positive).


Molecular Genetic Studies:

-T-cell receptor gene rearrangement to examine clonality of T cells in cases showing phenotypically aberrant T-cell population.


Cytochemical Stains:

-Confirmatory cytochemical stains as needed.


The following algorithms are available in Special Instructions:

-Bone Marrow Staging for Known or Suspected Malignant Lymphoma Algorithm

-Acute Myeloid Leukemia: Testing Algorithm

-Acute Myeloid Leukemia: Relapsed with Previous Remission Testing Algorithm

-Acute Promyelocytic Leukemia: Guideline to Diagnosis and Follow-up

Specimen Type Describes the specimen type validated for testing


Ordering Guidance

This test is appropriate for hematopoietic specimens only. For solid tissue specimens, order LLPT / Leukemia/Lymphoma Immunophenotyping, Flow Cytometry, Tissue.


For bone marrow specimens being evaluated for possible involvement by a myelodysplastic syndrome (MDS) or a myelodysplastic/myeloproliferative neoplasm (MDS/MPN) including chronic myelomonocytic leukemia (CMML), order MYEFL / Myelodysplastic Syndrome by Flow Cytometry, Bone Marrow.


Bronchoalveolar lavage specimens submitted for evaluation for leukemia or lymphoma are appropriate to send for this test.


This test is not appropriate for and cannot support diagnosis of sarcoidosis, hypersensitivity pneumonitis, interstitial lung diseases, or differentiating between pulmonary tuberculosis and sarcoidosis (requests for CD4/CD8 ratios); specimens sent for these purposes will be rejected.

Additional Testing Requirements

For bone marrow testing, if cytogenetic tests are desired along with this test request, an additional specimen should be submitted. It is important that the specimen be obtained, processed, and transported according to instructions for the other test.

Shipping Instructions

Specimen must arrive within 48 hours of collection for spinal fluid, 72 hours for fluids, or 96 hours for peripheral blood and bone marrow.

Necessary Information

The following information is required:

1. Pertinent clinical history including reason for testing or clinical indication

2. Clinical or morphologic suspicion

3. Specimen source

4. Date and time of collection

5. For spinal fluid specimens: spinal fluid cell and differential counts are required.

Specimen Required Defines the optimal specimen required to perform the test and the preferred volume to complete testing

Submit only 1 of the following specimens:


Specimen Type: Whole blood


Preferred: Yellow top (ACD solution A or B)

Acceptable: Green top (sodium heparin) or lavender top (EDTA)

Specimen Volume: 6 mL

Slides: Include 5 to 10 unstained blood smears, if possible.

Collection Instructions:

1. Send specimen in original tube. Do not aliquot.

2. Label specimen as blood.

Specimen Stability Information: Ambient <96 hours/Refrigerated < or =96 hours


Specimen Type: Bone marrow


Preferred: Yellow top (ACD solution A or B)

Acceptable: Green top (sodium heparin) or lavender top (EDTA)

Specimen Volume: 1 to 5 mL

Slides: Include 5 to 10 unstained bone marrow aspirate smears, if possible.

Collection Instructions:

1. Submission of bilateral specimens is not required.

2. Label specimen as bone marrow.

Specimen Stability Information: Ambient <96 hours/Refrigerated < or =96 hours


Specimen Type: Fluid

Sources: Serous effusions, pleural fluid, pericardial fluid, abdominal (peritoneal) fluid

Container/Tube: Body fluid container

Specimen Volume: 20 mL

Collection Instructions:

1. If possible, fluids other than spinal fluid should be anticoagulated with heparin (1 U/mL of fluid).

2. The volume of fluid necessary to phenotype the lymphocytes or blasts in serous effusions depends upon the cell count in the specimen. Usually 20 mL of pleural or peritoneal fluid is sufficient. Smaller volumes can be used if there is a high cell count.

3. Label specimen with fluid type.

Specimen Stability Information: Refrigerated <72 hours/Ambient < or =72 hours


Specimen Type: Spinal fluid

Container/Tube: Sterile vial

Specimen Volume: 1 to 1.5 mL

Collection Instructions:

1. An original cytospin preparation (preferably unstained) must be included with the spinal fluid specimen so correlative morphologic evaluation can occur.

2. The volume of fluid necessary to phenotype the lymphocytes or blasts in spinal fluid depends upon the cell count in the specimen. A cell count should be determined and submitted with the specimen. Usually 1 to 1.5 mL of spinal fluid is sufficient. Smaller volumes can be used if there is a high cell count. If cell count is <10 cells/mcL, a larger volume of spinal fluid may be required. When cell counts drop below 5 cells/mcL, the immunophenotypic analysis may not be successful.

3. Label specimen as spinal fluid.

Specimen Stability Information: Refrigerated <48 hours/Ambient < or =48 hours

Special Instructions Library of PDFs including pertinent information and forms related to the test


1. Hematopathology Patient Information (T676) in Special Instructions

2. If not ordering electronically, complete, print, and send 1 of the following forms with the specimen:

-Hematopathology/Cytogenetics Test Request (T726)

-Benign Hematology Test Request (T755)

Specimen Minimum Volume Defines the amount of sample necessary to provide a clinically relevant result as determined by the Testing Laboratory

Blood: 3 mL
Bone Marrow, Spinal Fluid: 1 mL
Fluid from Serous Effusions: 5 mL

Reject Due To Identifies specimen types and conditions that may cause the specimen to be rejected

Gross hemolysis Reject

Specimen Stability Information Provides a description of the temperatures required to transport a specimen to the performing laboratory, alternate acceptable temperatures are also included

Specimen TypeTemperatureTimeSpecial Container