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Example of a CoA Report Chart for Characterization of a Healthy Human Peripheral Blood sample

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Customer:………………………………………………………………………………………..   Donor Sample#: Deidentified ………………………………………

Address Line 1:………………………………………………………………………………….             Age:……years

Address Line 2:…………………………………………………………………………………     SEX:…………………….                                                                                                 

Lab Director:…………………………………………………………………………………….              Sample Collection Date: …..-…..-…………  

Leukemia/Lymphoma Phenotyping Evaluation by Flow Cytometry:

Leukemia/Lymphoma Phenotype & Impression               

Sample type: Peripheral blood

Impression: No abnormal myeloid, B cell, T cell or NK cell population identified

 Differential:

 Lymphocytes (23%)

 Monocytes (2%)

 Granulocytes (75%)

 Blasts (0.07%) 

Lymphocytes:

 B-cell (16%)

 T-cell (61%)

 NK-cell (19%)

 Kappa/Lambda ratio: 1.5, Polytypic

 CD4/CD8 ratio:  Normal at 1.7

 Subset NK-cells: (80%) of NK-cells

 Positive:   CD2, CD7(dim), CD16, CD56, CD57 partial

 Negative: CD3, CD5, CD8

 Phenotypic abnormality. dim CD7, of uncertain significance remaining NK-cells normal

 Viability: (90%)

 Disclaimers: None

 Markers run: CD1, CD2, CD3, CD4, CD5, CD7, CD8, CD10, CD11c, CD13, CD14(Mo2), CD14(MY4), CD16,

 CD19, CD20, CD23, CD33, CD34, CD38, CD45, CD56, CD64, CD117, HLA-DR, Kappa, Lambda, MPO                                                                            

These results have been reviewed and approved by (name, function):……………………………………………………………………………………………………

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