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B cell test interpretation

Discussion in 'Diagnostic Guidelines and Laboratory Testing' started by Learner1, Nov 6, 2017.

  1. Learner1

    Learner1 Forum Support Assistant

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    Can anyone help me understand this? It seems "normal" but I know that on other tests, just because one is in the normal range doesn't mean there isn't a problem.

    Thanks for any interpretive help.:)

    RESULTS: B Cell Immunophenotyping by Flow Cytometry:

    [ CD19 B cells (of Lymphs): 16.7% (Ref. Range: 6.0-19.0%)].
    [ Memory B cells (of CD19): 27% (Ref. Range: 8-48%)].
    [ Naive B cells (of CD19): 73% (Ref. Range: 48-95%)].
    [ Mature Memory B Cells (of CD19): 23% (Ref. Range: 8-48%)].
    [ Functional Mature Naive B Cells (of CD19): 77% (Ref. Range:
    48-95%)].
    [ Immature/Transitional B cells (of CD19) : 0.8% (Ref. Range:
    0.6-9.0%)].
    [ IgM IgD c-s mem B Cells of CD19+CD27+: 42% (Ref. Range: None Provided)].
    [ IgM IgD c-s mem B Cells (of CD19): 11.6% (Ref. Range: 6.0-30.0%)].
    [ Anergic Activated B cells (of CD19): 0.6% (Ref. Range: 0.0-10.0%)]
    [ IgG c-s mem B Cells (of CD19+CD27+): 13.2% (Ref. Range:
    10.0-80.0%)].
    [ IgA c-s mem B Cells (of CD19+CD27+): 20.1% (Ref.Range: 5.0-40.0%)].
    [ IgG:IgA (class-switched Memory B ratio): 0.7 (Ref. Range: 0.5-3.5)].
    [ Plasmablasts (of CD19): 0.1% (Ref. Range: 0.0-4.0%)].
    [ CD20 B Cells (of Lymphs): 16.6% (Ref. Range: 6.0-19.0%)].
    [ CD20+ B Cells (of CD19): 100% (Ref. Range: 90-100%)].
    [ BAFF-R+ B Cells (of CD19): 100% (Ref. Range: 90-100%)].
    [ BAFF-R Median Fluorescence Intensity: 33.67 (Ref. Range:
    25.00-75.00)]
     
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  2. Gingergrrl

    Gingergrrl Senior Member

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    I don't know how to interpret it and have never seen such a detailed B cell test! The one that I do to monitor B cells every four weeks (for Rituximab) is the "lymphocyte subset panel" but it is totally different than the test that you did above. Was your test ordered for possible Rituximab or another purpose? Can your doctor help you to interpret it? The only thing I know from my test is that there are two sets of numbers (for both B cells and T cells) and one is the "absolute" number and one is a percentage.
     
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  3. Learner1

    Learner1 Forum Support Assistant

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    I don't have an appointment with that doctor for 3 weeks... Just trying to be prepared;)

    I didn't know he ran it and haven't seen one before either...

    Just curious, thanks!
     
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  4. rodgergrummidge

    rodgergrummidge Senior Member

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    Such a specific and detailed panel! It would be good to know what the doc was investigating. Such a B-cell analysis might be informative if you had post-viral CFS? Are you post-viral? EBV? Other? If so, abnormal B-cell numbers or expression patterns could provide important clues. For example, if you had abnormal numbers/%, it might point toward latent viral infections which would be informative for diagnosis and/or treatment.

    Rodger
     
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  5. Gingergrrl

    Gingergrrl Senior Member

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    @Learner1 Was it our doc who ordered that panel for you or another doc? I think in my case w/Ritux, he is just checking that B cells are staying at zero between infusions which, so far, has been the case. But I am curious to hear more once you know it!
     
  6. Learner1

    Learner1 Forum Support Assistant

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    I have low IgG, IgM, and NK cells. Also 5 viral and 2 bacterial chronic infections. And celiac, Hashimotos, adrenergic, and muscarinic antibodies. And MCAS. And I'm on IVIG, antivirals and antibiotics.
     
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  7. Learner1

    Learner1 Forum Support Assistant

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    Its the back up immunologist I found near me, in case I get into trouble, not our doc.

    Not sure what he's driving at. He agrees I need IVIG, but wasn't totally following the rest of my diagnoses and treatment.

    Edited to add:
    I found this paper which discusses B cells and categorizing common variable immune deficiency, which is a heterogeneous disease. I'm puzzling over it and comparing to my results, but it seems to match up with the B cell test. Lots to learn...

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2922984/#!po=48.6667
     
    Last edited: Nov 7, 2017
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  8. Lalia

    Lalia

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    Hi @Learner1 - just wondering what your doctors interpretation of these B cell results ended up being? And what the purpose of running such detailed testing was? My doc ran an ‘immunophenotyping’ panel which showed the B cell CD19 percentage and absolute numbers, and they were super low. In the bottom 1% of the population. I know it’s linked with autoimmunity, but trying to understand more and wondering if I should ask for this level of detail...
     
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  9. Learner1

    Learner1 Forum Support Assistant

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    The immunologist I saw who was not very clever said it was normal. He only inderstood immunodeficiency but didn't understand autoimmunity or my infections and said he was failing me as a doctor.

    However, I dug through a bunch of B cell papers and, from what I could make out, I have a tendency to autoimmunity.

    I found the attached along the way, which might be useful to you.

    Hope your immunologist is more clever...did he/she test your immunoglubulins with subclasses or NK cells?
     

    Attached Files:

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  10. Lalia

    Lalia

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    Yes, my NK cells were right in the middle of the range, IGG, IGA, IGM and all IGG subclasses were on the low end but still well within range. It was just my B cells that were super low, and that lines up with my Antinuclear Abs which are 1:2560. We’re now testing for specific liver/ kidney/ gut abs because of my symptoms.

    Thanks for the B cell paper! I’ll have a read thru now :)
     
  11. Learner1

    Learner1 Forum Support Assistant

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    Here are some antibodies others have had tested.
     

    Attached Files:

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  12. Markus83

    Markus83

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    Where do you have this from? I have elevated B cells since 15 years or so, but no hint for viral infections (at least herpes family is negative). So the source of your claim would be interesting for me.
     
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  13. Lalia

    Lalia

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    @rodgergrummidge I’m curious about this comment too - does this mean having low B cells could point to a latent viral infection? A virus triggered my decent into poor health, and EBV is the only thing that’s shown up in my bloodwork as a past infection (not active). I may be reading too much into your comment, will do some research to see if there’s anything linking the B cells with latent viral infections.
     
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  14. Lalia

    Lalia

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    @Learner1 thank you so much for this!! I’ve been trying to build my own list (which was taking forever) and here’s all the info in one doc - you’re fantastic.

    There are a lot of antibodies on this list tho - in terms of testing is it best to narrow the list down based on symptoms? And does knowing what antibodies you’re creating, help inform treatment options? Sorry if these are silly questions, I’m just trying to understand why it’s important to know the type of antibodies you’re creating.

    I’ll do some more research today, I’m due to have another round of bloodwork done next week and would like my doctor to expand my antibody testing. But I’m conscious he’ll think I’m nuts if I send him this list and ask to test for everything. Thank you again for sharing this awesome list :)
     
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  15. Learner1

    Learner1 Forum Support Assistant

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    The list was collected by other patients around here. From what I've experienced, my doctor dors the tests he suspects may provide usable results. In my case, he was looking to gather as many autoimmune antivisies as he could in order to justify a higher IVIG dose to my insurance.

    It's nor necessary to find every one you have, but it definitely helps to know you have certain bad actors to determine a treatment plan that works.
     
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  16. Gingergrrl

    Gingergrrl Senior Member

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    I am still trying to understand this as well! My B-cells are at zero (because I am doing Rituximab and this is the goal) but in a "normal" person, do low B-cells equal autoimmunity and high B-cells equal infection (or is this not the case)? Did you figure it out from any of the papers that you have been reading @Lalia?
     
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  17. Lalia

    Lalia

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    @Gingergrrl from what I understand, it’s the B cells that produce the autoantibodies and drive autoimmunity. So high B cells = AI and low B cells = more susceptible to infection. And in CFS there tend to be issues with how the B cells mature (too many naive B cells). *I may have misunderstood this or be over-simplifying* Did you have B cell testing or IGG testing before starting treatment?

    I still don’t understand how I can have such a high AI marker, with low B cells. But my results have always shown that dense fine speckled pattern, and like @kangaSue said, the experts don’t agree on what that means, aside from the fact that it doesn’t indicate a connective tissue disease (like lupus). There are a fair few references that indicate that pattern could be an inflammatory marker, so a possible explanation is that I started with a B cell deficiency + infections = inflammatory autoantibodies (?)

    I found this paper on CVID-like B cell deficiency and severe autoimmunity being caused by lack of the protein (PRKCD) to be interesting. The lack of protein interrupted B cell signaling. Seems like a severe case, the child in question had severe infections from birth: http://www.bloodjournal.org/content/121/16/3112?sso-checked=true

    From the B cell paper Learner1 posted, I thought the following was interesting...

    ‘Impairment of B cell function leads to recurrent infections or a propensity to AI or allergy’ (and we know AI/ allergies/ MCAS all play together - I’m still trying to understand how that works).

    ‘CFS patients may have some kind of unusual or unrecognized AI disease or be unable to control lymphotropic viral infections due to defects in B or T memory cells.’

    So, a whole bunch of rambling from me tonight. Time to go to bed and try again tomorrow :)
     
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  18. Gingergrrl

    Gingergrrl Senior Member

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    I basically understood that part but I was not sure if someone could have the proper number of B-cells (not too low or too high) but that the ones they had were producing pathogenic autoantibodies = autoimmunity. Sort of like Mastocytosis is too many mast cell but but MCAS is the proper number but they are behaving badly.

    I actually did not have B-cell testing prior to Rituximab so I do not know how many B cells (absolute or percentage) I had at that time. I might have done the testing four years ago when I first saw my doctor but would have to search for it (and it would not reflect what was going on now anyway). I did have IGG testing and it was normal. My IgM was always elevated and we did further testing to rule out MGUS or cancer. My IgA was normal and my IgE was elevated (but often is in people with allergies/MCAS).

    I'm not sure either and am curious what you learn about it.

    That is really interesting (and I have not had a chance to read any of the articles you sent me but hope to one day)! It makes sense that impairment of B-cells (even if you have the correct number) could correlate with AI and allergies. I wish I understood it all better, too.

    Not rambling at all and very interesting and helpful!
     
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  19. Lalia

    Lalia

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    Yes, you could have the proper amount of B cells but the autoimmunity is because they’re behaving badly. I think you start out with naive B cells (these attack your body) and most of them are supposed to turn into mature B cells (these attack pathogens etc). But if there’s a disconnect in that developmental process, you end up with too many naive B cells = autoimmunity. *I think*

    http://www.igliving.com/magazine/ar...immune-Disease-A-Complicated-Relationship.pdf

    This paper explains it better “Three quarters of newly formed B cells are autoreactive, which is just a way of saying that most new B cells are destined to attack the organs of the body instead of infectious invaders. But at various points in their development these autoreactive cells are destroyed. Failure at any of these developmental check points leads to autoimmunity. One reason people with immune deficiencies may also have autoimmunity, may be that in addition to B cell dysfunction they may have defective elimination of autoreactive B cells.”
     
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  20. Gingergrrl

    Gingergrrl Senior Member

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    In a normal person, at any given point in time, are they supposed to have the majority of their B cells be "mature" and only a small percentage be "naive"? Also, are there tests which show the different types of B cells that someone has? In my case, I have zero from Rituximab (for now) but I was just wondering if this can even be tested?
     

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