Lymphoma Lab Tests and health information

The lymphoma tests can give you an accurate reading of your platelet count and white blood cell count to determine if they are low, which may indicate that lymphoma is present in the bone marrow and blood, with results sent confidentially online. Order from Ulta Lab Tests today! 

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A Complete Blood Count (CBC) Panel is used as a screening test for various disease states including anemia, leukemia, and inflammatory processes.

A CBC blood test includes the following biomarkers: WBC, RBC, Hemoglobin, Hematocrit, MCV, MCH, MCHC, RDW, Platelet count, Neutrophils, Lymphs, Monocytes, Eos, Basos, Neutrophils (Absolute), Lymphs (Absolute), Monocytes(Absolute), Eos (Absolute), Basos (Absolute), Immature Granulocytes, Immature Grans (Abs)

NOTE: Only measurable biomarkers will be reported.

Reflex Parameters for Manual Slide Review
  Less than  Greater Than 
WBC  1.5 x 10^3  30.0 x 10^3 
Hemoglobin  7.0 g/dL  19.0 g/dL 
Hematocrit  None  75%
Platelet  100 x 10^3  800 x 10^3 
MCV  70 fL  115 fL 
MCH  22 pg  37 pg 
MCHC  29 g/dL  36.5 g/dL 
RBC  None  8.00 x 10^6 
RDW  None  21.5
Relative Neutrophil %  1% or ABNC <500  None 
Relative Lymphocyte %  1% 70%
Relative Monocyte %  None  25%
Eosinophil  None  35%
Basophil  None  3.50%
Platelet  <75 with no flags,
>100 and <130 with platelet clump flag present,
Instrument Flags Variant lymphs, blasts,
immature neutrophils,  nRBC’s, abnormal platelets,
giant platelets, potential interference
The automated differential averages 6000+ cells. If none of the above parameters are met, the results are released without manual review.
CBC Reflex Pathway

Step 1 - The slide review is performed by qualified Laboratory staff and includes:

  • Confirmation of differential percentages
  • WBC and platelet estimates, when needed
  • Full review of RBC morphology
  • Comments for toxic changes, RBC inclusions, abnormal lymphs, and other
  • significant findings
  • If the differential percentages agree with the automated counts and no abnormal cells are seen, the automated differential is reported with appropriate comments

Step 2 - The slide review is performed by qualified Laboratory staff and includes: If any of the following are seen on the slide review, Laboratory staff will perform a manual differential:

  • Immature, abnormal, or toxic cells
  • nRBC’s
  • Disagreement with automated differential
  • Atypical/abnormal RBC morphology
  • Any RBC inclusions

Step 3 If any of the following are seen on the manual differential, a Pathologist will review the slide:

  • WBC<1,500 with abnormal cells noted
  • Blasts/immature cells, hairy cell lymphs, or megakaryocytes
  • New abnormal lymphocytes or monocytes
  • Variant or atypical lymphs >15%
  • Blood parasites
  • RBC morphology with 3+ spherocytes, RBC inclusions, suspect Hgb-C,
  • crystals, Pappenheimer bodies or bizarre morphology
  • nRBC’s

Before ordering this test consider The Complete Blood Count (CBC) with Differential and Platelets Blood Test (Test # 6399) which is a better value.

In Quest's internal studies of more than two thousand patient samples, no significant abnormalities were detected with manual differentials associated with test code 20253 that were not otherwise identified thru the test code 6399 CBC Reflex cascade.

This test is a CBC reflex test and it will include the components of the CBC (Includes Diff/PLT) with Smear Review based upon the test results of the following analytes if are above or below ranges as outlined in the test.

  • WBC 
  • Hemoglobin 
  • Hematocrit 
  • Platelet 
  • MCV 
  • MCH 
  • MCHC 
  • RBC 
  • RDW 
  • Relative Neutrophil % 
  • Relative Lymphocyte % 
  • Relative Monocyte % 
  • Eosinophil 
  • Basophil 
  • Platelet 

See individual tests

Comprehensive Metabolic Panel

The BUN/Creatinine ratio is useful in the differential diagnosis of acute or chronic renal disease. Reduced renal perfusion, e.g., congestive heart failure, or recent onset of urinary tract obstruction will result in an increase in BUN/Creatinine ratio. Increased urea formation also results in an increase in the ratio, e.g., gastrointestinal bleeding, trauma, etc. When there is decreased formation of urea as seen in liver disease, there is a decrease in the BUN/Creatinine ratio. In most cases of chronic renal disease the ratio remains relatively normal.

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Serum creatinine is useful in the evaluation of kidney function and in monitoring renal dialysis. A serum creatinine result within the reference range does not rule out renal function impairment: serum creatinine is not sensitive to early renal damage since it varies with age, gender and ethnic background. The impact of these variables can be reduced by an estimation of the glomerular filtration rate using an equation that includes serum creatinine, age and gender.

See individual tests

Hepatitis B Surface Antibody, Qualitative  (anti-HBs)

Detects only the IgM antibody to the hepatitis B core antigen. Used to detect acute infections; sometimes present in chronic infections as well as used to detect previous exposure to HBV; it can also develop from successful vaccination so it is used to determine the need for vaccination (if anti-HBs is absent) or to determine if a person has recovered from an infection and is immune (cannot get the infection again).

Clinical Significance

The detection of anti-HBs is indicative of a prior immunologic exposure to the antigen or vaccine. To determine immune status as ≥10 mIU/mL as per CDC guidelines, please order Hepatitis B Surface Antibody, Quantitative.

Hepatitis B Surface Antibody, Quantitative (anti-HBs

Detects antibody produced in response to HBV surface antigen. It is used to detect previous exposure to HBV; it can also develop from successful vaccination so it is used to determine the need for vaccination (if anti-HBs is absent) or to determine if a person has recovered from an infection and is immune (cannot get the infection again).

Clinical Significance

This assay is used to determine immune status for Hepatitis B as ≥10 mIU/mL as per CDC Guidelines.

Hepatitis B Surface Antigen with Reflex Confirmation: Positive samples will be confirmed

IMPORTANT:  NOTE THIS IS A REFLUX TEST - The price charged for this test is only for the Hepatitis B Surface Antigen. ADDITIONAL CHARGE OF $39 WILL OCCUR FOR THE REFLUX CONFIRMATION if the Hepatitis B Surface Antigen is positive.

Hepatitis B surface antigen (HBsAG) Detects protein that is present on the surface of the virus.  It is used to screen for, detect, and help diagnose acute and chronic hepatitis B virus (HBV) infections; earliest routine indicator of acute hepatitis B and frequently identifies infected people before symptoms appear; undetectable in the blood during the recovery period; it is the primary way of identifying those with chronic infections, including "hepatitis B virus (HBV) carrier" state.

Clinical Significance

Surface antigen usually appears in the serum after an incubation period of 1 to 6 months following exposure to Hepatitis B virus and peaks shortly after onset of symptoms. It typically disappears within 1 to 3 months. Persistence of Hepatitis B surface antigen for greater than 6 months is a prognostic indicator of chronic Hepatitis B infection.

Hepatitis C AB with reflex to HCV RNA, QN, PCR


If Hepatitis C Antibody is reactive, then Hepatitis C Viral RNA, Quantitative, Real-Time PCR will be performed at an additional charge of $179.00

For the detection of active HCV infection in HCV antibody positive individuals.

Clinical Significance

Hepatitis C Virus (HCV) is a major cause of hepatitis. The clinical symptoms of an HCV infection are variable. Infection with HCV results in a chronic infection in 50 to 80% of cases. The "window" between HCV acquisition and seroreactivity is highly variable; up to six months.


Hepatitis C Viral RNA, Quantitative, Real-Time PCR]

If the HCV RNA test is positive, then the person has a current infection. If no HCV viral RNA is detected, then the person either does not have an active infection or the virus is present in very low numbers.

Useful in monitoring therapy and/or disease progression. Reportable range is 15 to 100,000,000 IU/mL (1.18-8.00 Log IU/mL).


Hepatitis A Antibody, Total; Hepatitis B Surface Antibody, Qualitative; Hepatitis B Surface Antigen with Reflex Confirmation; Hepatitis B Core Antibody, Total; Hepatitis C Antibody with Reflex to HCV, RNA, Quantitative, Real-Time PCR

Hepatitis B Surface Antigen with Reflex Confirmation: Positive samples will be confirmed based on the manufacturer's FDA approved recommendations at an additional charge (CPT code(s): 87341).

If Hepatitis C Antibody is reactive, Hepatitis C Viral RNA, Quantitative, Real-Time PCR will be performed at an additional charge (CPT code(s): 87522).

Increased CRP levels are found in inflammatory conditions including: bacterial infection, rheumatic fever, active arthritis, myocardial infarction, malignancies and in the post-operative state. This test cannot detect the relatively small elevations of CRP that are associated with increased cardiovascular risk.

Direct Antiglobulin Test (DAT) with Reflex to Anti C3 and Anti IgG


If DAT (Coombs, Direct) is positive, Anti C3d and Anti IgG will be performed at an additional charge of $64.00

Reference Range(s)


Clinical Significance

The DAT (Direct Coomb's test) is positive if red cells have been coated, in vivo, with immunoglobulin, complement, or both. A positive result can occur in immune-mediated red cell destruction, autoimmune hemolytic anemia, a transfusion reaction or in patients receiving certain drugs.


Early Sjogren's Syndrome Profile


Carbonic Anhydrase VI (CA VI) IgG Antibodies, Carbonic Anhydrase VI (CA VI) IgA Antibodies, Carbonic Anhydrase VI (CA VI) IgM Antibodies
Parotid Specific Protein (PSP) IgG Antibodies, Parotid Specific Protein (PSP) IgA Antibodies, Parotid Specific Protein (PSP) IgM Antibodies
Salivary Protein 1 (SP-1) IgG Antibodies, Salivary Protein 1 (SP-1) IgA Antibodies, Salivary Protein 1 (SP-1) IgM Antibodies


Clinical Significance

Sjogren's syndrome (SS) is a systemic autoimmune disease in which loss of salivary gland and lachrymal gland function is associated with hypergammaglobulinemia, autoantibody production, mild kidney and lung disease and eventually lymphoma. SS involves dry eyes and dry mouth without systemic features that may be either primary or secondary to another autoimmune disease, such as SLE. Patients with SS and picked up at a late stage in their disease, after the salivary glands and lachrymal glands are already destroyed, because they are asymptomatic until that time. At this point, only symptomatic treatment can be offered for abnormal lachrymal and salivary gland function. The diagnosis for SS is currently at a crossroad with the American College of Rheumatology providing which requires characteristic autoantibodies (SS-A/SS-B) or minor salivary gland biopsy. Since lip biopsies are not frequently performed in clinical practice, there is increased emphasis placed on autoantibodies in diagnosis. The current Ro and La antibodies can delay the diagnosis by over 6 years.Recently novel antibodies identified to salivary gland protein 1 (SP-1), carbonic anhydrase 6 (CA6) and parotid secretory protein (PSP) using western blot methodology. Further studies have shown that the isotype differentiation of the markers adds to the sensitivity of diagnosis of SS. These autoantibodies occurred earlier in the course of the disease than antibodies to Ro or La. In addition antibodies to SP-1, CA-6 and PSP were found in patients meeting the criteria for SS who lacked antibodies to Ro or La. Furthermore, in patients with idiopathic xerostomia and xerophthalmia for less than 2 years, 76% had antibodies to SP-1 and/or CA6 while only 31% had antibodies to Ro or La.
Antibodies to different isotypes (IgG, IgM & IgA of SP-1, CA6 and PSP are useful markers for identifying patients with SS at early stages of the disease or those that lack antibodies to either Ro or La.

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Recently, inhibitors of anaplastic lymphoma kinase (ALK) have been used successfully in treating patients harboring gene fusions between echinoderm microtubule-associated protein-like 4 (EML4) and ALK. This is a reverse transcription PCR-based exon scanning approach to encompass fusion variants spanning nearly the entire EML4 gene.

Clinical Significance

FISH, B-Cell Chronic Lymphocytic Leukemia Panel - This test is performed to detect the rearrangements of 6q21(SEC63),6q23(MYB),ATM(11q22.3),centromere 12(D12Z3), 13q14.3(DLEU),13q34(LAMP1) and TP53(17p13.1) regions,by FISH (fluorescence in situ hybridization). This assay is useful for prognostic assessment for chronic lymphocytic leukemia/ small lymphocytic lymphoma(CLL/SLL).


Clinical Significance

A galectin-3 test may be ordered for the identification of individuals with chronic heart failure at elevated risk of disease progression.

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Elevations of IgG, A and/or M are seen in generalized hypergammaglobulinemia, chronic inflammatory conditions and in lymphoproliferative diseases such as multiple myeloma, lymphoma and leukemias. Decreased levels are found in immunodeficiency states, generalized hypogammaglobulinemia and in unrecognized pediatric patients.

Lactate Dehydrogenase (LD) (LDH)

Elevations in serum lactate dehydrogenase occur from myocardial infarction, liver disease, pernicious and megaloblastic anemia, pulmonary emboli, malignancies, and muscular dystrophy

Lactate Dehydrogenase Isoenzymes

Clinical Significance

Diagnostic aid for myocardial infarction. Also for malignancies, anemias, and acute liver and muscle injury.



LD 1, LD 2, LD 3, LD 4, LD 5



Reference Range(s)

  • LD 119-38 %
  • LD 230-43 %
  • LD 316-26 %
  • LD 43-12 %
  • LD 53-14 %

Alternative Name(s)

LD Isoenzymes without Total LD,LDI

CD20 antigen is expressed on the surface of >90% of B-cell non-Hodgkin's Lymphomas (NHL). Binding to CD20 antigen is necessary for the antitumor effect of Rituxan®.

The localization of lymphocytes, a specific type of WBCs (or white blood cells), in one or more lymph nodes is what is referred to as lymphoma – a cancer.  In both the lymphatic and blood circulatory systems, lymphocytes travel all over the body.  Tissue fluids are drained and carried all over the body as lymph and then back to the blood circulatory system via the lymphatic system, which is a network of lymph nodes and vessels (or lymphatics).  In areas such as the groin, neck, chest, armpits, and abdomen, lymph nodes are found in chains or individually. As the lymph fluid goes through the nodes (tiny lymphoid tissue organs whose job it is to filter lymph), abnormal cells and microorganisms are destroyed. Natural killer cells, T-lymphocytes and B-lymphocytes are some of the lymphocytes and macrophages contained in lymph nodes.         

The immune system is controlled by T-lymphocytes.  When it comes to immune responses, these lymphocytes decide when a response is necessary, its scale or severity, in addition to triggering it.  Furthermore, they counteract a variety of foreign bodies attacking the body.  B-lymphocytes work to create antibodies that are activated when an individual gets a vaccine against hepatitis, mumps or measles, or any other diseases. 10 to 15 percent of all the lymphocytes in the bloodstream are of the natural killer (or NK) variety, another type of lymphocytes.  Abnormal cells that have been attacked by viruses and cancerous cells are usually attacked and killed by NK cells.    

In the case of lymphoma, any of these cells may be involved either singly or as a combination.  The occurrence of abnormal cells in the lymph nodes, one or more, or lymphoid tissues could signal the onset of lymphoma.  The uncontrollable reproduction of these cells means that their number exceeds that of normal cells in the affected node causing the node to grow in size before the abnormal cells start spreading to other nodes in the lymphatic system.  The abnormal cells may also travel to the tonsils, thymus, bone marrow, adenoids and spleen, and other organs closely related to the lymphatic system.     

T-cell lymphomas are less common than B-cell lymphomas.  

Symptoms of Lymphoma  

The lymph nodes in the groin, neck, and armpits may swell painlessly and/or the spleen becomes enlarged in people with lymphoma.  Increased levels of abnormal lymphocytes may also be discovered in the blood of affected individuals.  Additional signs and symptoms of lymphoma include:    

  • Episodes of chills and fever 
  • Fatigue 
  • Instances of night sweats  
  • Significant loss of weight, up to 10 percent or higher, for no apparent reason  
  • Diminished appetite 
  • Pain in the neck or flank 
  • Itchiness  

The individual’s breathing may be affected if the lymph node in question is located in the chest area.  If the affected lymph node is in the abdomen, abdominal pain may be experienced.  Since the above symptoms may be mild in nature, diagnosing lymphoma may, at times, be quite hard.  While some people may experience a low-grade fever, others may not have any noticeable signs.  The physician, or individual suffering from lymphoma, may not be able to feel or see the swollen lymph node even though it is there.   

Hodgkin Disease/Lymphoma   

The presence of Reed-Sternberg cells, big unique cells, characterizes Hodgkin disease/lymphoma.  

People between the ages of twenty and forty years, as well as those over the age of 55, have a higher prevalence of Hodgkin lymphoma.  Each year, around 9,000 individuals in the US are diagnosed with this disease, with 1,300 deaths, according to the ACS (or American Cancer Society).    

A variety of theories have attempted to explain the cause of Hodgkin Lymphoma.  The involvement of a virus, or other infectious agent, has been mentioned in a number of them.  According to other theories, cell mutations are to blame.  Specific causes are yet to be identified, even though research is still ongoing.  Similarly, there has been no clear explanation as to why males appear to be more vulnerable to HL.    

Based on the cells that are present as well as the abnormal lymph node structure, Hodgkin Lymphoma can be further divided.  A depletion of lymphocytes, a higher number of small lymphocytes, or a combination of various types of cells or fibrosis (occurrence of bands of scarring) may be seen in lymph nodes.  With HL,  a benign, mostly mixed, reactive cell population forms the majority of the cells in the lymph nodes, while Reed-Sternberg cells (tumor cells) are the minority.                                      

Non-Hodgkin Lymphoma  

About 4 percent of all newly diagnosed cancer cases in the US are Non-Hodgkin lymphoma.  This lymphoma is slightly more common in Caucasians and men than in women.  Individuals with a compromised immune system, those with HIV/AIDS, as well as those at an advanced age, face a higher risk of developing this disease.   

While around 20,000 people die from the disease annually, around 72,000 are diagnosed in a similar period according to the American Cancer Society.  Since the 1970s, the occurrence of the disease is almost double.  While cases relating to women account for the highest increase, the main reason for the upward trend is yet to be discovered.  Since the late nineties, however, non-Hodgkin lymphoma related deaths have been on the decrease.    

The systems used to classify the many different types of non-Hodgkin lymphoma have evolved as understanding about them grows.  Some of the changes in the classification systems used are attributed to the introduction of new methods of evaluating the cells involved in the disease.   

Many doctors have adopted the REAL (or Revised European American Lymphoma) classification proposed by the International Lymphoma Study Group back in the nineties.  The main function that the cell should be providing was the main focus of this classification.  For instance, while cell to cell interactions are left to T-lymphocytes, the main function of B-lymphocytes is to produce antibodies.  These characteristics are combined with genetic and phenotypic studies of the cells under the WHO (or World Health Organization) classification system – which is also the latest system.  Having been adopted by many healthcare professionals as the current standard, the World Health Organization classification added to the REAL classification.    

Non-Hodgkin Lymphoma Types  

Due to the various classification systems and changes made to them over the years, non-Hodgkin lymphoma classification can be somewhat confusing.  Natural Killer and T- cell lymphomas are less common in the US than B-cell non-Hodgkin lymphomas.  Around 15 percent of non-Hodgkin lymphomas affect T-lymphocytes, with approximately 85 percent involving mature B-lymphocytes.  

The following are some of the most common B-cell lymphomas types:   

* DLBCL (or Diffuse Large B-cell Lymphoma).  Of all non-Hodgkin lymphoma cases in the US, DLBCL constitutes about a third. While this disease mostly occurs in older individuals, it can affect anyone and is considered to grow swiftly.  

* Follicular Lymphoma.  About a fifth of all lymphoma cases in the US are of this type.  Over time, about a third of all Follicular lymphomas turn into the fast-growing DLBCL type described above, even though they are generally known to grow slower.  

* B-cell chronic lymphocytic lymphoma / small lymphocytic lymphoma (or CLL/ SLL).  

Characterized by small lymphoma cells, CLL/SLL is a slowly progressing disease.  The lymphoma cells are mostly small-sized.  While SLL generally involves the lymph nodes, CLL is predominantly found in the bone marrow; however, both of these are considered the same disease and combined make up about 24 percent of all lymphomas.   

The following are some of the main types of T-cell lymphomas:  

* Precursor T-lymphoblastic lymphoma (leukemia). Depending on where the affected cells are located, in the bone marrow or the blood, this disease can be considered to be leukemia or lymphoma.  Of all lymphoma cases, about 1 percent fall under this category.   

* Peripheral or Mature T-cell lymphomas.  4 to 5 percent of all lymphomas fall under the different known categories of mature T-cell lymphomas.    

* Sezary Syndrome, Mycosis Fungoides, and Other Types Of Cutaneous T-Cell Lymphomas.  These types of lymphomas are different from other types because, unlike the rest, they start on the skin instead of internal organs or lymphoid tissue.  This means that even though they are quite uncommon, they very unique.  Of all non-melanoma skin cancer cases, this specific group makes up less than 1 percent. Five percent of all lymphomas are skin lymphomas.  

Lymphoma Testing  

When it comes to testing, the main goal is to distinguish the condition from other conditions and recognize and keep track of complications, if any, in addition to diagnosing and staging the lymphoma.  To diagnose lymphoma a few blood tests can be used.  

Lab Testing  

The examination of affected lymphoid tissue and lymph nodes by a pathology specialist is the gold standard when it comes to testing for both non-Hodgkin and Hodgkin lymphomas.  Using a fine needle aspiration procedure or biopsy obtained from the affected lymph tissue or node, the sample is evaluated microscopically.     

The following lab tests may also be used:  

CBC (or Complete Blood Count).  To rule out leukemia and other non-lymphoma conditions and to test for the presence of anemia, a CBC may be administered.  The CBC can identify low platelet or low white blood cell counts that may indicate whether lymphoma is present in the blood and/or bone marrow   

* Biopsy and Evaluation of The Bone Marrow.  The cells in the bone marrow are examined using this test.  Lymphoid aggregates and/or abnormal lymphoid cells may be found with lymphoma.  

Blood Smear Test.  The quality of platelets, white and red blood cells, and that of lymphoma cells, or any other abnormal cells, where present, is examined under this test.   

* Immunophenotyping.  By testing for specific identifying markers inside or on the membrane of cells, this test can be used to spot affected cells.  Usually listed numerically, these commonly used identifying factors are referred to as CD (or clusters of differentiation).  Classification of the cells is possible by creating a list of the clusters of differentiation present on the cells.  Immunohistochemistry and flow cytometry are a couple of the ways in which this test can be conducted.   

* Chromosome Analysis Test.  To establish whether bits of chromosomes have moved, chromosome analysis evaluates the chromosomes in the cancer cell nucleus. For lymphomas, this test is rarely used.   

* Molecular Genetic Analysis Tests.  To establish whether the cells under consideration belong to one clone, molecular genetic analysis can be used to look for genetic changes by examining the DNA of the cancerous cell.  

* Body fluids, including cerebrospinal fluid, can be analyzed if the lymphoma is thought to have spread to other parts of the body.  

Beta-2 Microglobulin Test.  The prognosis may be predicted with the help of the Beta-2 Microglobulin test.  

Serum Creatinine Test.  If a disease referred to as nephritic syndrome, affecting the kidneys, is linked with Hodgkin lymphoma, serum creatinine levels may be higher than normal.  

* Studies of Serum Chemistry.  The prognosis may also be determined with the help of serum chemistry studies such as LDH (or lactate dehydrogenase).  

Hepatitis B Test.  * Since rituximab therapy is linked with negative side effects in individuals suffering from hepatitis B, a hepatitis B test is used to determine the suitability of the treatment.  

* HIV (Human Immunodeficiency Virus) Test.  The lymphoma outcome in HIV patients may be improved by using an antiretroviral treatment. 

Non-laboratory Tests. 

The following non-laboratory tests may be used primarily to help stage and monitor lymphoma: 

* MRI (or magnetic resonance imaging). 

* Exploratory surgery (only necessary on occasion). 

* Physical examination. 

* CT (or computed tomography) scans. 

* PET (or positron emission tomography) scans. 

* Chest X-ray.