Clinics and Departments

Laboratory Services

Lab Dept:

Chemistry

Test Name:

NEUTROPHIL OXIDATIVE BURST

General Information

Lab Order Codes:

NOXB

Synonyms:

Neutrophil Chemiluminescence Assay; Chemiluminescence

CPT Codes:

88184 – Flow cytometry, cell surface, cytoplasmic,or nuclear marker, technical component only; first marker

Test Includes:

Functional assay that measures the oxidation (and resultant fluorescence) of dihydrorhodamine 123 (DHR 123) due to oxygen radical generation during the oxidative burst. The DHR 123 is preloaded into the cells, PMA is added to stimulate the neurtophils, and the neutrophil fluorescence is quantitated as the blood is analyzed on a flow cytometer.

Logistics

Test Indications:

Chronic Granulomatous Disease (CGD), recurrent infections. Diagnosis of X-linked CGD in male patients <40 years of age or autosomal recessive CGD in male and female patients. Identification of X-linked CGD female carriers.

Lab Testing Sections:

Chemistry - Sendouts

Referred to:

Mayo Medical Laboratories (MML Test# NOXB/82560)

Phone Numbers:

MIN Lab: 612-813-6280

STP Lab: 651-220-6550

Test Availability:

Sunday – Thursday ONLY

Turnaround Time:

1 – 3 days

Special Instructions:

Specimen must arrive with 48 hours of collection. A control sample is required in addition to the patient sample.

Specimen

Specimen Type:

Whole blood

Container:

Green top (Na Heparin) tube obtained from the lab

Draw Volume:

5 mL (Minimum: 1 mL) Na heparinized whole blood

Processed Volume:

Same as Draw Volume

Collection:

Routine venipuncture

Special Processing:

Lab Staff: Do Not centrifuge. Send specimen in original collection container. Lab must also collect a 5 mL Na Heparin “control” sample from a normal, unrelated person at the same time. Clearly label patient and normal control samples on specimen labels. Ship specimens at room temperature as priority delivery.

Patient Preparation:

None

Sample Rejection:

Specimen is more that 48 hours old; hemolyzed; clotted; mislabeled or unlabeled specimens

Interpretive

Reference Range:

Normal

Interpretation: Absent oxidative burst is consistent with CGD.

Carriers for X-linked CGD will 2 neutrophil populations: 1 population will have a normal oxidative burst and the second will demonstrate no oxidative burst.

Carriers of autosomal recessive CGD will have a normal oxidative burst and can only be identified by genetic testing.

Critical Values:

N/A

Limitations:

This test should not be used to identify carriers for autosomal recessive forms of CGD. Genetic testing should be used to identify carriers of autosomal recessive CGD. Genetic testing should also be performed for females who do not show typical carrier pattern for X-linked CGD, but have male offspring or relatives with a confirmed diagnosis (flow cytometry and genetic testing) of X-linked CGD.

In males, this test is typically not indicated in patients >40 years of age.

Before ordering this test, the clinician should investigate potential local causes of infection such as foreign bodies, skin maceration, repeated trauma, or congenital cysts, as well as assess the patient’s environment for evidence of repeated infection. An investigation into allergic rhinitis and asthma is also recommended. If all the common causes are absent, the differential includes cystic fibrosis (even in adults), ciliary immobility syndrome, autoimmune disease such as Wegener granulomatosis, common variable immune deficiency (CVID), and finally CGD.

Clinical consultation by specialists in immune deficiency is recommended.

Methodology:

Flow cytometry

References:

Mayo Medical Laboratories May 2010



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