Received flow cytometry report with positive Cd45 marker but every other marker is negative with no signs of clonality. I checked that Cd45 positive expression is associated with lymphoma. Can someone help in deciphering the report, doctor appointment is still not fixed.
I am male, 33 years old
Thank you
Per pubmed.ncbi.nlm.nih.gov/942... with my emphasis, "CD45 (lymphocyte common antigen) is a receptor-linked protein tyrosine phosphatase that is expressed on all leucocytes, and which plays a crucial role in the function of these cells." That's why it's called "lymphocyte common antigen".
The important phrases are "no evidence of blasts/atypical cells" and "no definitely evidence of monoclonal restriction", which I think should be "definitely no evidence of monoclonal restriction". The last part of the sentence "no evidence of atypical cells in the lymphocytes, could not be assessed due to degenerative changes are noted in the morphology" needs explaining, however.
In summary, you have "mild leukocytosis with lymphocytosis", that is a slightly high White Blood Cell count, from "both B and T lymphocytosis", i.e. slightly high B and T cell counts. If you had a B or T cell leukaemia/lymphoma, either the B or T cell count would be raised and you'd have evidence of a monoclonal restriction, i.e. lots of cloned/cancerous lymphocytes.
So your flow cytometry test shows absolutely no evidence of any cancerous lymphocytes, but there's mention of having a bone marrow biopsy to confirm. Given you have no symptoms and your other blood counts are fine, I don't know what a bone marrow biopsy would offer other than peace of mind. I'm not a doctor, let alone a haematologist, so to help you decide if you really want that bone marrow biopsy, I suggest you might like to ask a haematologist how the presence of lymphoma/leukaemia cells in your bone marrow could cause higher counts of normal B and T lymphocytes in your blood, but no cancerous lymphocytes.
You noted a month ago that you "don't have any symptoms, had a blood test two years back as part of a regular checkup with slightly elevated lymphocytes (around 45%). This blood test was also just part of regular checkup, no symptoms." As I said in my previous reply to you, "Keep in mind that blood count reference ranges only includes 95% of the healthy population. 5% have healthy results above or below the reference range." You just might have slightly higher B and T cell counts, or maybe there is some other cause driving those higher counts, perhaps your diet? Are you taking any immune system boosting supplements, such as mushroom extracts, for example Shitake, Turkey Tail or Chaga mushrooms? Also has your doctor checked if you have any inflammation, illnesses or perhaps prescriptions that could be causing your lymphocytosis? For example, have you had C Reactive Protein (CRP) test?
Neil
Neil, these Flow Cytometry results don't make sense to me. The Chronic Lymphoproliferative Disorder ( CLPD ) Panel was only positive for CD45, yet it was gaited for CD45 & CD19. It looks like there were no T or B cells in the analyzed sample because all of the B cell markers (CD19, CD20, CD22, CD23, FMC7) & T cell markers (CD3, Cd4, CD5 and CD8) were scored as negative. Were there only neutrophils in the sample? They would be positive for CD45, but negative for any of the other tested markers. I guess I've never seen the a Flow Cytometry report expressed in this way. What do you make of it? What am I missing?
The first dot diagram
Removed by Admin, as it included your name
The CD marker report doesn't make sense to me either, particularly given it's a Chronic Lymphoproliferative Disorder ( CLPD ) Panel and B and T cells are specifically mentioned. I wondered whether they only report CD markers above predefined thresholds?
Thank you both, I wish I could explain the negative markers but will have to wait for my doctor appointment. I have attached 3 images 2x2 dot graphs which show different CD markers, wonder if that could help. Thanks again for all your patience
I've deleted all three of your replies as you've missed crossing out your name in multiple places. Please blot out your name everywhere on the plots before you repost them 
Thanks, I missed it
Why would anybody do a bone marrow biopsy to rule out a lymphoproliferative disorder? If there was a lympho proliferative disorder the flow cytometry should prove the presence of monoclonal cells in the blood, no? I would ask more questions before I let anybody drill my bones based on this result.
Hi LeoPa, doc told me not to go ahead with it as there are no clinical symptoms, I think labs just write it as a precautionary measure.
Sounds like good advice from your doctor ☺️
Any chance you have subclinical infection? Covid exposure, Epstein Barr, herpes, long standing diabetes, other disease states. "Benign lymphoproliferative disorders may be associated with infections, autoimmune disorders, hyper-sensitivity reactions, and unknown causes. Most of these disorders are self-limiting; however, some are associated with significant morbidity and mortality." Or if you are a serious athlete; some have low grade elevation. I'll mention I had small spikes intermittently the decades before my diagnosis. It's difficult to take a single test out of context of an entire chart, including all the other labwork. I would want to see if a CBC with segs/bands/granulocytes, indicating the body's response to infectious agents potentially inducing a lymphocytosis. And what country is this report being generated from? I too am unfamiliar with this layout. Other than it's a generalized test.
Hi SofiaDeo, I am not aware of any infection (no covid or diabetes), though my TSH is a bit high at 4.13 but normal T3 and T4 levels (maybe will check free T4 in my next blood test to rule out hypothyroidism). Doc said they prepare test a bit differently where CD45 should be positive as it represents all cells and other CD markers are negative because they didn't have any significance or abnormality going on. My recent CBC is normal and within reference range, only shows relative lymphocytosis (lymphocytes 45% and 2.8 absolute, total leukocytes: 6.2, abs neutrophils: 3.2), doc would like to follow it again in few weeks on it. Planning to work on my weight as have moderately high cholesterol and liver enzymes.
Dear all, thank you all for your help. I checked with my doc and he said labs prepare the report a bit differently in my country for doctors. He said CD45 should always be positive since it represents all WBC, they would be concerned if it was negative. For rest of CD markers, they only report them relevant if there is something abnormal found in them, hence they are all negative because there was nothing significant to report. So hopefully it is fine as they didn't find any monoclonal restriction. Doc told me currently not to go with bone marrow or biopsy as there are no symptoms.
I did a recent blood test again and my WBC counts normal now but will keep an eye if there is some low grade inflammation or infection going on. I am obese so maybe that could be the reason, have moderate high cholesterol and liver enzymes, doc think all related to my weight.
I will look for some professional help to keep my anxiety in check. Can't thank all the people here enough for their patience in resolving my queries.
FWIW, I have been reading articles lately that indicate when weight gets nearer normal, a number of health issues skew towards normal if not outright resolve. IMO if you are eating a Western Diet with fast food, frozen and processed items (other than plain, frozen simple ingredients) with lots of high carb/high glycemic index items, "metabolic syndrome" and other metabolic abnormalities occur. Hopefully much of this will go away if you seriously address your weight. It's very difficult to change eating habits, and enjoy new eating patterns like we enjoyed the old "bad" ones, but it can be done.
Adult onset diabetes and atherosclerosis weren't seen/reported in the medical literature until the advent of using sugar as a main ingredient instead of sparingly, as a spice. Isolated populations that had a low incidence of these diseases developed them within generations of changing their ancestral diet. Modern hybridized wheat contains less protein & other nutrients and more gluten to irritate the digestive tract, than the wheat nature evolved (einkorn). But manufacturers wanted a wheat easier to remove from the chaff, so hybridization became popular. The plethora of chemicals like stabilizers, preservatives, emulsifiers, colorings, flavorings, etc. out there affect out gut biome. Just because they may not be overt poisons, so our governments allow them in foodstuffs, doesn't mean we should be eating them. Especially "natural" this or that.....there are poisons in nature. And don't get me started on GMO's! Canola oil, xanthan gum, now add palm oil to the list (possibly carcinogenic if it's not counterfeit. And the counterfeit stuff is often colored to pass as genuine with a known carcinogen.) A lot of these things aren't necessarily "bad" except they are now in every. single. food. item. What may innocuous at low ingestion rate causes problems if one eats it at virtually every meal.
Sorry, rant over Happy that you may only have an intermittent lymphocytosis, instead of an abnormal flow cytometry indicating disease/cancer.
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