T-lymphocyte count

Alternative names
T cell counts; CD4 count; CD3 count; T (thymus derived) lymphocyte count

This is a blood test that measures the number of T-lymphocytes (a type of white blood cell).

How the test is performed

Blood is drawn from a vein on the inside of the elbow or the back of the hand. The puncture site is cleaned with antiseptic, and an elastic band is placed around the upper arm to apply pressure and restrict blood flow through the vein. This causes veins below the band to fill with blood.

A needle is inserted into the vein, and the blood is collected in an air-tight vial or a syringe. During the procedure, the band is removed to restore circulation. Once the blood has been collected, the needle is removed, and the puncture site is covered to stop any bleeding.

For an infant or young child, the area is cleansed with antiseptic and punctured with a sharp needle or a lancet. The blood may be collected in a pipette (small glass tube), on a slide, onto a test strip, or into a small container. Cotton or a bandage may be applied to the puncture site if there is any continued bleeding.

In the laboratory, the white blood cells are separated from the other blood cells. A stain or other substance that “labels” the cells is added to help identify which type of white blood cells are present.

B and T lymphocytes look the same under an ordinary microscope. However, they may be differentiated with an electron microscope. B or T lymphocytes may also be counted using immunofluorescence or by flow cytometry. T cells can also be differentiated by the E rosette test (Blood is mixed with sheep red blood cells. The T cells will cling to the sheep cells and produce a distinctive rosette pattern).

How to prepare for the test
No special preparation is necessary.

For infants and children:
The preparation you can provide for this test depends on your child’s age and experience. For specific information regarding how you can prepare your child, see the following topics:

  • Infant test or procedure preparation (birth to 1 year)  
  • Toddler test or procedure preparation (1 to 3 years)  
  • Preschooler test or procedure preparation (3 to 6 years)  
  • Schoolage test or procedure preparation (6 to 12 years)  
  • Adolescent test or procedure preparation (12 to 18 years)

How the test will feel
When the needle is inserted to draw blood, some people feel moderate pain, while others feel only a prick or stinging sensation. Afterward, there may be some throbbing.

Why the test is performed
A T-cell count of may be helpful in the diagnosis of immunodeficiency diseases and lymphocytic diseases. It is also used to monitor the response to therapy for these types of diseases.

Lymphocytes are white blood cells that are part of the immune system. T lymphocytes (T-cells) act directly (cellular immunity) to fight diseases or organisms, stimulate B lymphocytes (helper T-cells), or suppress some B lymphocyte functions (suppressor T-cells).

Normal Values

Lymphocytes make up 16-45% of white blood cells. Of those lymphocytes, about half are T cells, a quarter are B cells, and another quarter are natural killer cells.

  • Helper T-cells, also known as absolute CD4+ or T4 count: more than 400 per microliter, or 32-68% of lymphocytes  
  • Suppressor T-cells, also known as absolute CD8+ or T8 count: 150-1000 per microliter

There are several ways to count T cells and the normal range may vary with the method used.

What abnormal results mean
Greater-than-normal T-cell levels may indicate:

  • Infectious mononucleosis (sometimes)  
  • Multiple myeloma  
  • Acute lymphocytic leukemia

Less-than-normal T-cell levels may indicate:

  • Congenital T-cell deficiency (rare)  
  • Congenital immunodeficiency disorders  
  • Acquired immunodeficiency disorders  
  • Leukemias  
  • Cancer  
  • Hodgkin’s  
  • Acute viral infection  
  • Waldenstrom’s macroglobulinemia  
  • AIDS  
  • Side effect of radiation therapy  
  • Effect of aging

What the risks are
Risks associated with having blood drawn are slight:

  • Excessive bleeding  
  • Fainting or feeling light-headed  
  • Hematoma (blood accumulating under the skin)  
  • Infection (a slight risk any time the skin is broken)  
  • Multiple punctures to locate veins

Note: This test is often performed on people with altered immune systems. Therefore, the risk for infection may be somewhat greater than when blood is drawn from a person with a normal immune system.

Special considerations
This test can be affected by:

  • Stress  
  • Surgery  
  • Chemotherapy medications  
  • Corticosteroids  
  • Immunosuppressive medications  
  • X-rays

A flow cytometric measurement is more accurate than manual counts.

People with decreased T lymphocytes may not react to diagnostic skin tests.

Veins and arteries vary in size from one patient to another and from one side of the body to the other. Obtaining a blood sample from some people may be more difficult than from others.

Johns Hopkins patient information

Last revised: December 2, 2012
by Arthur A. Poghosian, M.D.

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