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HelpOrder Code PCPRO Plasma Cell DNA Content and Proliferation, Bone Marrow
Reporting Name
Plasma Cell Proliferation, MarrowUseful For
Establishing a diagnosis of a plasma cell proliferative disorder
Providing prognostic information for newly diagnosed multiple myeloma and other plasma cell proliferative disorders
Assessing response to therapy and detecting disease relapse and progression in treated plasma cell proliferative disorder patients
Determining plasma cell DNA content and proliferation
Testing Algorithm
When this test is ordered, flow cytometry interpretation will always be performed at an additional charge.
For more information see:
Performing Laboratory
Mayo Clinic Laboratories in Rochester
Specimen Type
Bone MarrowOrdering Guidance
This test can be ordered at diagnosis or follow-up of a plasma cell neoplasm (plasma cell proliferative disorder).
If reflex fluorescence in situ hybridization (FISH) testing is desired, order MSMRT / Mayo Algorithmic Approach for Stratification of Myeloma and Risk-Adapted Therapy Report, Bone Marrow.
For follow-up of a plasma cell neoplasm (plasma cell proliferative disorder), order MSMRD / Myeloma Stratification and Risk-Adapted Therapy with Reflex to Measurable/Minimal Residual Disease, Bone Marrow, could be considered.
Necessary Information
Include patient's disease state (untreated, treated, monoclonal gammopathy of undetermined significance, stable).
Specimen Required
Specimen Type: Redirected bone marrow
Preferred: Yellow top (ACD solution A or B)
Acceptable: Lavender top (EDTA) or green top (sodium heparin)
Specimen Volume: 4 mL
Specimen Stability Information: 3 days
Specimen Minimum Volume
2 mL
Specimen Stability Information
| Specimen Type | Temperature | Time |
|---|---|---|
| Bone Marrow | Ambient (preferred) | |
| Refrigerated | ||
Special Instructions
Reference Values
Plasma Cell Clonality:
Normal bone marrow
No monotypic clonal plasma cells detected
DNA Index:
Normal polytypic plasma cells
DNA index (G0/G1 cells): Diploid 0.95-1.05
Day(s) Performed
Monday through Saturday
CPT Code Information
88182-Flow cytometry, cell cycle or DNA analysis
88184-Flow cytometry; first cell surface, cytoplasmic or nuclear marker
88185 x 5-Flow cytometry; additional cell surface, cytoplasmic or nuclear marker (each)
88187-Flow cytometry interpretation, 2 to 8 Markers (added as FCINT)
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| PCPRO | Plasma Cell Proliferation, Marrow | 93363-0 |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| CK056 | Monotypic Plasma Cells: | 93362-2 |
| CK057 | Monotypic PC per Total Events | 93021-4 |
| CK058 | Monotypic Plasma Cells S-phase | 93361-4 |
| CK059 | Monotypic Plasma Cells DNA Index | 93360-6 |
| CK060 | Monotypic Plasma Cells DNA Ploidy | 93359-8 |
| CK061 | Polytypic PC per Total Events | 93358-0 |
| CK062 | Polytypic PC per All Plasma Cells | 93020-6 |
| CK063 | Final Diagnosis | 50398-7 |
Method Description
Flow cytometric immunophenotyping of bone marrow is performed using the following antibodies; CD19, CD38, CD45, CD138, cytoplasmic kappa and lambda immunoglobulin, and DAPI (4',6-diamidino-2-phenylindole). Plasma cell clonality is detected through demonstrating CD38 and CD138 positivity along with immunoglobulin light chain restriction (ie, the presence of either predominately kappa or lambda immunoglobulin light chains) and abnormality of CD19 and/or CD45 expression. DNA index of clonal plasma cells and their proliferation activity is determined through staining of double-stranded DNA using DAPI.
Plasma cells (monoclonal/monotypic and polyclonal/polytypic) are detected by immunoglobulin light chain restriction, surface immunophenotype, and DNA content. If present, the light chain expressed by the monotypic plasma cells is indicated. The percentage of clonal plasma cells estimated by flow cytometry is affected by specimen processing and antigen loss with specimen aging. Manual differential counting remains the accepted standard for determining the bone marrow plasma cell percentage. The percentage of monotypic plasma cells in S-phase of the cell cycle is determined by quantitative DNA analysis. The DNA index is a calculated value. The presence of more than 1 value indicates the presence of cell populations with differing DNA contents within the monotypic plasma cells.(Sidana S, Jevremovic D, Ketterling RP, et al. Rapid assessment of hyperdiploidy in plasma cell disorders using a novel multi-parametric flow cytometry method. Am J Hematol. 2019;94[4]:424-430)
Reject Due To
| Gross hemolysis | Reject |
| Fully clotted | Reject |
Method Name
Flow Cytometry/DNA Content/Cell Cycle Analysis
Additional Tests
| Test ID | Reporting Name | Available Separately | Always Performed |
|---|---|---|---|
| FCINT | Flow Cytometry Interp, 2-8 Markers | No, (Bill Only) | Yes |
Forms
If not ordering electronically, complete, print, and send a Hematopathology/Cytogenetics Test Request (T726) with the specimen.