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Forum Name: Miscellaneous Cancer Topics

Question: Hematology - Immunophenotyping tests?


 onesassieone - Mon Sep 22, 2008 11:44 pm

Background Info:
In 1990, after seeing my family doctor for a regular annual exam, my WBC came back on the higher side (13.5), specifically neutrophils. After undergoing several different blood tests and ruling out other diseases, my family doctor referred me to a oncologist/hematologist. My WBC count was at 18.8.

The oncologist/hematologist thought that I had a MPD(CML), after several months of testing and undergoing bone marrow and chromosomal analysis testing that was ruled out at that time. The oncologist/hematologist stated that the elevated WBC could be normal for me but my family doctor should "watch" my blood counts. My WBC count dropped to be within the 12-15 range for several years however recently went above 19.2 so my doctor referred me back to the same oncologist/hematologist at which time I was informed that there was a newer test called a JAK test which would be able to find things that previously were more challenging to find. I didn't hear back from the oncologist/hematologist with the results of the test so I assumed things were fine. However, 2 months later (last week) I was asked to come in for "immunophenotyping to further check on my lymphocytes".I attempted to contact the oncologist/hematologist to find out why this test is being requested and have not received a response. I have done some research on the internet and from the information I have found, immunophenotyping is used more to stage various types of leukemias rather than a diagnostic tool.
Is that correct?
How long does it typically take to receive results from immunophenotyping?
What could the JAK test shown that would have resulted in the request for the immunophenotyping test?
Do some people have higher than normal WBC?
Could a person be Philedelphia Chromosome negative and then years later be positive?
 Dr. Safaa Mahmoud - Thu Oct 16, 2008 11:55 am

User avatar Hello,

It would be more helpful if you can provide us more information about your history of (Psoriasis) from the initial diagnosis to the last follow up and your current status, what kind of treatments you have received and any associated complications.

Normal values for while blood cell and its elements are:
4,500-10,000 white blood cells/mcl.
Neutrophils: 40% to 60%
Lymphocytes: 20% to 40%
Monocytes: 2% to 8%
Eosinophils: 1% to 4%
Basophils: 0.5% to 1%
Band: 0% to 3%

Elevated Total Leukocytic count can be due to many causes including:
- Infections,
-systemic disease like Rh. Arthritis, Psoriasis, inflammtory bowel diseases and vasculitis as well as physical stress.
- Cancer.

Specific increase in one blood element is more indicative of certain medical conditions, e.g esiophilia in allergic people, and parasitic infection, monocytosis is commonly seen in bacterial infections, neutrophilia in most infections and tissue damage like inflammatory diseases.

Although a higher than 11,000 white cells/mcl of blood is considered high, in leukemias the white blood cell counts can reach 100,000.

Other tests known to be elevated in tissue damage and inflammatory conditions are ESR, LDH and CRP. .

When leukemia is suspected, Bone marrow Aspirate and Biopsy should be evaluated. Other symptoms like weak generalized condition, fever, headache and bony pains, which are very common in conditions like active inflammatory (tissue damage) and malignant diseases.

It is reassuring that your blood counts for more that 15 years are almost within the same range, thus the cause is more likely to be either benign or very indolent.

Regarding immunophenotyping, it is a technique to study specific proteins expressed by cells and mark them (cell markers). Thus it can define the type of leukemic cells accurately in a matter of a few hours using a technique named flow cytometry. Flow cytometry has become the preferred method for the lineage assignment (cell of origin) and maturation analysis (degree of differentiation) of malignant cells in acute leukemias and lymphomas.

According to the identified markers it can differentiate normal from abnormal cells, and classify these abnormal cells into specific subcategories.

Philadelphia chromosome is a specific abnormal chromosome that is associated with chronic myelogenous leukemia (CML) that develops from a translocation, or switching, of material between two previously normal chromosomes.

In CML, this abnormal chromosome results in the production of an abnormal protein that drives the bone marrow to produce more white blood cells. This overproduction of white blood cells made CML also considered a type of myeloproliferative disorder.

Cytoplasmic Janus protein tyrosine kinases (JAKs) are crucial components in the regulation of cellular survival, proliferation, differentiation and apoptosis.
Jak Kinases abnormalities to the contrary although have been found to be involved in the pathogenic pathway of many hematologic malignancies (it regulates hematopoietic cell differentiation), it is not diagnostic.

I would advise you to follow up with your doctor and to discuss with him all your concerns.

Hope you find this information useful.
Please keep us updated.
Best regards.

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