Flowers- I agree with all of Maryalice's astute comments and would like to add one comment of my own to the discussion. When we are evaluating B-cell malignancies we routinely run the following two four color tubes (in addition to others not directly pertinent to this discussion) mK/mL/CD5/CD19; and pL/pK/CD20/CD38. We find as Maryalice suggests that the different sets of light reagents can allow you to make a diagnosis when one set of reagents might not. We use one monoclonal set and one polyclonal set and we switch the fluorochrome- light chain combinations between the two tubes becasue we find that the PE reagents tend to pull the light chain positve cells away from the 45 degree line of non-specificity slightly better than the FITC reagents. Also as Maryalice points out CLL's have characteristically dim surface immunoglobulin staining. The other common small, mature B lineage CD5+ malignancy is mantle cell which characteristically has bright immunoglobulin staining. This distinction is not adequate alone to make the diffirential diagnosis, but it is helpful. Richard McFarland Instructor Division of Hematopathology and Immunology Department of Pathology UT Southwestern Medical Center at Dallas Dallas, Texas
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