CD4 Percentage interpretation

[Gokhan_Tr]

Hello everyone,

This is G from Turkey, I have one but a bit complicated question regarding the CD4 count and percentage and the way do it here. Hope I can explain it properly.

So I have just got my CD4 Percentage results, and they don't do CD4 count here. The test is run with Flow Cytometry method (or whatever that is). And they mark two gates as Forward SCatter (FSC) and Side SCatter (SSC) and put two percentages. And in the comment area they say X% of the T-Lymphocytes are identified as CD4.

So I was wondering how to get my cd4 out of this. My doctor said you have to use the second gate percentage with total White Blood Cells, and the first with the total number of lymphocytes.

But I couldn't find anything online about how to understand this. I'd be really glad if someone can explain.

Here are my details:
WBC: 5.600
%LYM: %41,3
#LYM: 2.300
Gate1: %35,5
(which says in the upper part: According to the marking In the %43,6 cell population of the total in Lymphocytes Area - which doesn't make any sense in any language I know)

Gate2: %15,1
(according to marking of the positive population in the lypmphosytes in the SSC graph.)

And as a comment it says: %15,1 CD4 positivity within T-Lymphocytes.

The math they have given me is:
WBC Count (5600) x %15,1= 845 (CD4 Count) or #Lym (2300) x %35,5=820 (CD4 count).

I am completely blocked to figure this out and I haven't found anything but lab research which didn't make any sense to me.

Diagnosed: 26.02.2016 with VL:15.000 and CD4: 260
Treatment: Stribild since 14.04.2016
As of 11.11.2016 Undetecable VL, and 820 CD4 (I guess).

Thanks a lot, and sorry for a long message, would appreciate any feedback.

[Wade]

Hi Gorkan and Welcome ,
The fact that you are UD is more important than any of those numbers, but it does sound like your CD4s are 820.
Congratulations on your great lab results 

Best, Wade

[Gokhan_Tr]

Thanks a lot @Wade

I am trying to get over the suspicion period, I think I made my mind in some disturbing way to look for problems with my results. I know I need to go get some mental help (which I am trying), But being here and starting to share helps A LOT!

Again thank you very much, and I wish great results for everyone.

[bocker3]

The CD4 count is a calculated result and is simple to do from the report you have (I am assuming that you have copied the report accurately here).

#LYM x %CD4 = CD4 count  or you could do (WBC x %LYM) x %CD4

2300 x 15.1% = 347  or (5600 x 41.3%) x 15.1% = 349 

Your CD4's seem to be recovering, based on what you have indicated from February results- this is exactly what should be happening.

Of course, as Wade pointed out, at this point the result that really matters is your UD VL!!  Congrats on that.

Mike

[Wade]

There now you have the real answer !

 ( Bocker understands labs better than anyone here  )

[Gokhan_Tr]

Mike thanks a lot for the explanation and your answer.

Can I ask couple of more things in order to clear my mind? (I could also call or contact anyone in anywhere if you can suggest any other way)

The math you have shown uses the 15,1% second gate ratio, so what is 35,5%?

And the last thing I am curious about is: is there a difference between total lymphocytes and  T-Lymphocytes, cause 15,1% is used for T-Lymphocyte zone (as it says in the reports.

I also checked the first report I got, CD4 percentage was 30% and LYM count was 876. So How come the percentage gets so low while LYM count increases?

Sorry for keep asking but I am just trying to figure out why there was a mistake like that :-(

Thanks.

[CaveyUK]

I'll leave the lab interpretation to others but....jeeeeeez....what a convoluted and confusing way to give a patient their numbers!!!

[bocker3]

What mistake are you referring to here?

Listen -- I have no idea why you are receiving the report that you have been getting -- it seems way to complex for the average patient to deal with.  Heck, it's even complicated for me and I am a trained Clinical Laboratory Scientist (who hasn't worked in a lab for over 15 yrs, just to be clear).  These results should be summarized for you.  Referencing Forward Scatter, Side Scatter and Gates are not needed here - it is providing you way too much information that you can't interpret and is only causing stress.

Going by what you presented -- 15.1% was the CD4 percentage.  I used that in the calculation, because that is what is used to calculate the total CD4 count.  The other percentage is most likely the CD8%, but it could be the CD3% -- I'd have to do a little refresher reading, and I don't really have the desire to do that right now.  However -- the other percentage has NOTHING to do with calculating the CD4 count (again, assuming that you have provided all the names/numbers accurately).

The formula is quite simple and laid out in my earlier posting.

I don't know why your CD4% has changed so much and anything I said would be mere speculation.  The things you SHOULD BE FOCUSED ON here are:

1.  You have an UD VL -- your meds are doing what they should do.
2.  You have adequate CD4 cells -- no need for any prophylaxis.
3.  You have an UD VL (repeating it because it is the MOST important thing here)

My final thought for you -- PUT DOWN THE LAB REPORT and go live your life.  If there was anything amiss, your doctor would be taking action.  My guess is that he/she is quite pleased with your response to your meds and with your immune systems recovery to this point.

Mike

[Gokhan_Tr]

Mike thanks. I completely agree that it is way too complicated as you stated, and that is why I became a little bit obsessed with it, and looked for ways to get an explanation.

I'll see what the doc will say, and I already asked for her to do the first test I have had (when I was diagnosed - which provides both the count and the percentage).

The things in Turkey are not as reachable as in anywhere else in the world when it comes to HIV and Testing. You can reach any lab to get tested (for primary tests etc.) but then it gets chaotic, what they do is just to give these test results and as you mentioned good luck finding out what that is.

PS: mistake is that they haven't performed the first test I had (where it shows both the count and the percentage).

Thanks again.