Test Catalog

Test Id : PBLI

Plasma Cell Assessment, Blood

Useful For
Suggests clinical disorders or settings where the test may be helpful

Detecting peripheral blood involvement by plasma cell proliferative disorders

 

Establishing the diagnosis of and determining prognosis for plasma cell proliferative disorders

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

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

Method Name
A short description of the method used to perform the test

Flow Cytometry

NY State Available
Indicates the status of NY State approval and if the test is orderable for NY State clients.

Yes

Reporting Name
Lists a shorter or abbreviated version of the Published Name for a test

Plasma Cell Assessment, B

Aliases
Lists additional common names for a test, as an aid in searching

Peripheral Blood Labeling Index

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

Specimen Type
Describes the specimen type validated for testing

Whole blood

Shipping Instructions

Specimen must arrive within 72 hours of collection.

Necessary Information

Date and time of collection are required.

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

Container/Tube:

Preferred: Green top (sodium heparin)

Acceptable: Lavender top (EDTA)

Specimen Volume: 10 mL

Collection Instructions:

1. Do not centrifuge.

2. Send whole blood specimen in original tube. Do not aliquot.

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

Forms

If not ordering electronically, complete, print, and send a Hematopathology/Cytogenetics Test Request (T726) with the specimen.

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

4 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 Type Temperature Time Special Container
Whole blood Ambient (preferred) 72 hours
Refrigerated 72 hours

Useful For
Suggests clinical disorders or settings where the test may be helpful

Detecting peripheral blood involvement by plasma cell proliferative disorders

 

Establishing the diagnosis of and determining prognosis for plasma cell proliferative disorders

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

Clinical Information
Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test

Plasma cell proliferative disorders are a group of hematologic neoplasms, all of which are derived from clonal plasma cells. These disorders exhibit a wide range of biologic activity ranging from monoclonal gammopathy of uncertain significance, a usually indolent disorder with a low rate of disease progression, to multiple myeloma, a disease that most often is aggressive with poor long-term survival. Detecting plasma cell immunoglobulin light chain restriction (ie, the presence of either predominately kappa or predominately lambda light chains) is an important element in assessing plasma cell clonality and, hence, establishing the diagnosis. Furthermore, a greater degree of peripheral blood involvement by these disorders is associated with more aggressive disease types and, therefore, is an adverse prognostic indicator.

 

Flow cytometric immunophenotyping (FCIP) is a recognized method for detecting plasma cell immunoglobulin light chain restriction. However, short comings of the traditionally performed technique include relative insensitivity and consistent underestimation of the number of clonal plasma cells present. Both short comings are likely attributable to limitations of the instruments and antibodies used, as well as the presence of intraclonal phenotypic heterogeneity, which creates difficulties in accurately detecting and enumerating all of the clonal plasma cells. For this reason, the FCIP plasma cell clonality assessment previously performed in our laboratory was supplemented with a slide-based immunofluorescence technique.

 

However, recent advances in flow cytometry have led to the development of more powerful instruments and antibody reagents that allow for the use of greater antibody combinations and increased resolution of the data. With these tools, the ability of FCIP to detect and enumerate plasma cell clones has been greatly enhanced, allowing us to discontinue the supplemental, labor-intensive, slide-based plasma cell evaluation in peripheral blood specimens.

 

The following algorithms are available:

-Amyloidosis: Laboratory Approach to Diagnosis

-Multiple Myeloma: Laboratory Screening

Reference Values
Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.

An interpretive report will be provided.

Interpretation
Provides information to assist in interpretation of the test results

In normal peripheral blood specimens, no clonal plasma cells are present (polytypic or too few to detect).

 

Plasma cells are CD38 and CD138 positive.

 

Normal (polyclonal, nonneoplastic) plasma cells are typically CD19-positive, whereas neoplastic (clonal) plasma cells typically are CD19-negative. CD19 expression is especially helpful in distinguishing clonal from nonclonal plasma cells when few analyzable cells are present.

 

CD45 may be expressed by both normal and neoplastic plasma cells. In some plasma cell proliferative disorders there are both CD45-positive and CD45-negative subsets within the clonal cell population.

 

The evaluation of these antigens aids in the identification of abnormal plasma cells, however, they will not be reported independently.

Cautions
Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances

No significant cautionary statements

Clinical Reference
Recommendations for in-depth reading of a clinical nature

1. Chakraborty R, Muchtar E, Kumar SK, et al: Risk stratification in myeloma by detection of circulating plasma cells prior to autologous stem cell transplantation in the novel agent era. Blood Cancer J. 2016 Dec;6(12):e512. doi: 10.1038/ bcj.2016.117

2. Chakraborty R, Muchtar E, Kumar SK, et al: Serial measurements of circulating plasma cells before and after induction therapy have an independent prognostic impact in patients with multiple myeloma undergoing upfront autologous transplantation. Haematologica. 2017 Aug;102(8):1439-1445

3. Evans LA, Jevremovic D, Nandakumar B, et al: Utilizing multiparametric flow cytometry in the diagnosis of patients with primary plasma cell leukemia. Am J Hematol. 2020 Jun;95(6):637-642. doi: 10.1002/ajh.25773

4. Gonsalves WI, Jevremovic D, Nandakumar B, et al: Enhancing the R-ISS classification of newly diagnosed multiple myeloma by quantifying circulating clonal plasma cells. Am J Hematol. 2020 Mar;95(3):310-315. doi: 10.1002/ajh.25709

5. Ravi P, Kumar SK, Roeker L, et al. Revised diagnostic criteria for plasma cell leukemia: results of a Mayo Clinic study with comparison of outcomes to multiple myeloma. Blood Cancer J. 2018 Nov;8(12):116

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

Method Description
Describes how the test is performed and provides a method-specific reference

The plasma cell immunoglobulin light chain restriction assessment is performed by 6-color flow cytometry using a single assay tube containing antibodies to kappa Ig light chain, lambda Ig light chain, CD19, CD38, CD45, and CD138. CD38 and CD138 are used to gate on the plasma cells and anti-kappa and anti-lambda are used to identify cytoplasmic Ig light chains. The flow cytometric screen will report the presence or absence of a detectable plasma cell population with immunoglobulin light chain restriction (clonality).(Unpublished Mayo method)

PDF Report
Indicates whether the report includes an additional document with charts, images or other enriched information

No

Day(s) Performed
Outlines the days the test is performed. This field reflects the day that the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time before the test is performed. Some tests are listed as continuously performed, which means that assays are performed multiple times during the day.

Specimens processed: Monday through Sunday

Results reported: Monday through Friday

Report Available
The interval of time (receipt of sample at Mayo Clinic Laboratories to results available) taking into account standard setup days and weekends. The first day is the time that it typically takes for a result to be available. The last day is the time it might take, accounting for any necessary repeated testing.

1 to 2 days

Specimen Retention Time
Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded

Not retained

Performing Laboratory Location
Indicates the location of the laboratory that performs the test

Rochester

Fees
Several factors determine the fee charged to perform a test. Contact your U.S. or International Regional Manager for information about establishing a fee schedule or to learn more about resources to optimize test selection.

  • Authorized users can sign in to Test Prices for detailed fee information.
  • Clients without access to Test Prices can contact Customer Service 24 hours a day, seven days a week.
  • Prospective clients should contact their Regional Manager. For assistance, contact Customer Service.

Test Classification
Provides information regarding the medical device classification for laboratory test kits and reagents. Tests may be classified as cleared or approved by the US Food and Drug Administration (FDA) and used per manufacturer instructions, or as products that do not undergo full FDA review and approval, and are then labeled as an Analyte Specific Reagent (ASR) product.

This test was developed using an analyte specific reagent. Its performance characteristics were determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the US Food and Drug Administration.

CPT Code Information
Provides guidance in determining the appropriate Current Procedural Terminology (CPT) code(s) information for each test or profile. The listed CPT codes reflect Mayo Clinic Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.

CPT codes are provided by the performing laboratory.

88184-Flow cytometry, cell surface, cytoplasmic

88185 x 5-Each additional marker

88187-Flow cytometry, interpretation; 2 to 8 markers

LOINC® Information
Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the order and results codes of this test. LOINC values are provided by the performing laboratory.

Test Id Test Order Name Order LOINC Value
PBLI Plasma Cell Assessment, B 86900-8
Result Id Test Result Name Result LOINC Value
Applies only to results expressed in units of measure originally reported by the performing laboratory. These values do not apply to results that are converted to other units of measure.
30388 Blood Plasma Cell Light Chain 86900-8
26838 # Monotypic PCs per 150,000 events 19099-1
26839 PC Event Interpretation 69052-9

Test Setup Resources

Setup Files
Test setup information contains test file definition details to support order and result interfacing between Mayo Clinic Laboratories and your Laboratory Information System.

Excel | Pdf

Sample Reports
Normal and Abnormal sample reports are provided as references for report appearance.

Normal Reports | Abnormal Reports

SI Sample Reports
International System (SI) of Unit reports are provided for a limited number of tests. These reports are intended for international account use and are only available through MayoLINK accounts that have been defined to receive them.

SI Normal Reports | SI Abnormal Reports