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HelpTest Code MONOF Monocyte Repartition by CD14/CD16, Blood
Ordering Guidance
If cytogenetic tests are also desired an additional specimen should be submitted. It is important that the specimen be obtained, processed, and transported according to instructions for the other required test.
Shipping Instructions
Specimens must be refrigerated and received within 3 days of collection.
Specimen Required
Container/Tube:
Preferred: Yellow top (ACD solution A or B)
Acceptable: Lavender top (EDTA)
Specimen Volume: 3 mL
Collection Instructions: Send whole blood specimen in original tube. Do not aliquot.
Secondary ID
610018Useful For
Aiding in the diagnosis and monitoring of chronic myelomonocytic leukemia
Method Name
Immunophenotyping
Reporting Name
Monocyte Repartition by CD14/CD16,BSpecimen Type
Whole bloodSpecimen Minimum Volume
1 mL
Specimen Stability Information
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Whole blood | Refrigerated | 72 hours |
Reject Due To
| Gross hemolysis | Reject |
Clinical Information
Chronic myelomonocytic leukemia (CMML) is a myelodysplastic syndrome/myeloproliferative neoplasm (MDS/MPN) overlap syndrome characterized by peripheral blood monocytosis (absolute monocyte count ≥1.0 x 10(9)/L, ≥10% of the total white blood cell count) persisting for 3 months or greater. It could be very challenging to distinguish CMML from a reactive monocytosis or from a MPN (such as primary myelofibrosis or polycythemia vera) with monocytosis. Monocytes can be classified into 3 subsets: classical MO1 (CD14+/CD16-), intermediate MO2 (CD14+/CD16+), and non-classical MO3 (CD14-/CD16+) monocytes, with MO1 constituting the major monocyte population (85%) in healthy individuals. Recent reports using multiparametric flow cytometry have demonstrated a characteristic increase in classical monocytes (≥94%) in CMML patients, thus distinguishing them from other causes of reactive and clonal monocytosis with greater than 90% sensitivity and specificity.(1) This panel is designed to analyze the repartition of monocytes in these patients and to give a semiquantitative value for the MO1 compartment. This value will aid in the differential diagnosis and monitoring of CMML.
Reference Values
% Monocytes of WBC: 1.0-6.6%
MO1 (classical monocytes): <94.0%
Interpretation
An interpretive report describing the classical monocytes (MO1) fraction as either increased or normal will be provided. See Cautions.
Cautions
Typically, an expanded classical monocytes (MO1) fraction has been seen in patients with chronic myelomonocytic leukemia (CMML).(1,2,3) However, it is not diagnostic of CMML. It can be seen in patients with other myeloid neoplasms (eg, myelodysplastic syndrome, myeloproliferative neoplasm, myelodysplastic/myeloproliferative neoplasm, not otherwise specified) or in reactive conditions. A normal MO1 fraction does not rule out a diagnosis of CMML because it may be seen in CMML patients with autoimmune or inflammatory states or post-therapy.
Correlation of these flow cytometry results with bone marrow aspirate and biopsy findings, clinical history, and other laboratory features is required for a definitive diagnosis.
Supportive Data
Clinical Sensitivity and Sensitivity:
Thirty-two patients with untreated chronic myelomonocytic leukemia (CMML) were tested. Twenty-five of these patients had a percent classical monocyte (%MO1) result of greater than or equal to 94% (abnormal result), which correlated to a sensitivity of 78%.
One hundred one patients with non-CMML hematologic malignancies were also tested. Ninety of these patients had a %MO1 result of less than 94% (normal result), which correlated to a specificity of 89%.
In addition, 30 healthy donors also had a %MO1 result of less than 94% (normal result).
Clinical Reference
1. Selimoglu-Buet D, Wagner-Ballon O, Saada V, et al. Characteristic repartition of monocyte subsets as a diagnostic signature of chronic myelomonocytic leukemia. Blood. 2015;125(23):3618-3626. doi:10.1182/blood-2015-01-620781
2. Pophali PA, Marinelli LM, Ketterling RP, et al. High level MYC amplification in B-cell lymphomas: is it a marker of aggressive disease? Blood Cancer J. 2020;10(1):5. doi:10.1038/s41408-019-0271-z
3. Patnaik MM, Timm MM, Vallapureddy R, et al. Flow cytometry based monocyte subset analysis accurately distinguishes chronic myelomonocytic leukemia from myeloproliferative neoplasms with associated monocytosis. Blood Cancer J. 2017;7(7):e584. doi:10.1038/bcj.2017.66
Specimen Retention Time
14 daysPerforming Laboratory
Mayo Clinic Laboratories in Rochester
Test Classification
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
88184-Flow cytometry; first cell surface, cytoplasmic or nuclear marker
88185 x 7-Flow cytometry; additional cell surface, cytoplasmic or nuclear marker (each)
88187-Flow Cytometry Interpretation, 2 to 8 markers
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| MONOF | Monocyte Repartition by CD14/CD16,B | 101146-9 |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| 610019 | % Monocytes of WBC | 101147-7 |
| 610020 | MO1 (Classical Monocytes) | 101148-5 |
| 610023 | Final Diagnosis | In Process |
Day(s) Performed
Monday through Saturday