Light Scatter	CD45/14	CD5/20

CD3/23	CD19/Kappa	CD19/Lambda

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Explaination and interpretation of Flow cytometry results
Explaination of other results seen ( hematology,etc) and facts about this patient's disease

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• The patient's peripheral blood demonstrates a very homogeneous population of cells by light scatter properties (see light scatter).  The cell appear to be small and exhibit little 90 degree light scatter (complexity).

 
• The CD45/14 contour plot reveals that all of the cells within the set light scatter gates are high intensity CD45 positive (a characteristic of lymphocytes). There are no monocytes/promonocytes present (see CD45/14).

 
• The CD5/20 contour plot reveals that very few cells express CD5 (T cells) only (9%).  The majority (90%) of cells express both CD5 and CD20 (B cell). There were no cells that expressed only CD20 (classic B cells).  Very few normal B cells express both CD5 and CD20. However, it is a normal (albeit, small event) as the cells go through maturation. The expression of CD5 by a large numbers of B cells is characteristic of chronic lymphocytic leukemia (CLL) and mantel cell lymphoma.  The reason is that these cells express CD5 is that they are at that stage of B cell maturation which coexpresses the CD5 antigen. Therefore, at this point a CLL/Mantel cell lymphoma is suspected.  (see CD5/20).
  
  
  
• The CD3/23 contour plot again confirms that there are no T cells(CD3), only B cells (CD23). The CD23 positivity also excludes mantel cell lymphoma since they are usually CD23 negative (see CD3/CD23).

 
• Finally the CD19/kappa and CD19/lambda contour plots confirms the monoclonality and diagnosis of CLL.  All of the cells coexpress CD19 (B cells) and surface immunoglobulin of the kappa light chain phenotype, while virtually no cells express CD19 and lambda. In addition, to the the monoclonality, the intensity of expression of surface immunoglobulin also gives useful and confirming information. CLL cells are known to express surface immunoglobulin dimly or sometimes not at all, again these results are consistent with this (see CD19/Kappa, CD19/lambda).
  
  
• These results are diagnostic of CLL.  It should be noted that occasionally a patient may exhibit a higher than normal number of B cells which dual express CD5.  This occurs most often in very young children, but may occur in adults as well. Therefore, clonal expression (or no expression) of kappa and lambda light chains is still required.

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