Test ID: NOXB
Neutrophil Oxidative Burst, Blood
Secondary ID 
A test code used for billing and in test definitions created prior to November 2011
NY State Approved Indicates the status of NY State approval and if the test is orderable for NY State clients.
Useful For Suggests clinical disorders or settings where the test may be helpful
Diagnosis of X-linked chronic granulomatous disease (CGD) in male patients <40 years of age or autosomal recessive CGD in male and female patients
Identification of X-linked CGD female carriers
Profile Information A profile is a group of laboratory tests that are ordered and performed together under a single Mayo Test ID. Profile information lists the test performed, inclusive of the test fee, when a profile is ordered and includes reporting names and individual availability.
| Test ID | Reporting Name | Available Separately | Always Performed |
|---|---|---|---|
| NOXB1 | Neutrophil Oxidative Burst | No | Yes |
| NOXB2 | NOXB Control Tube | No | Yes |
Method Name A short description of the method used to perform the test
Flow Cytometry
Reporting Name A shorter/abbreviated version of the Published Name for a test; an abbreviated test name
Aliases Lists additional common names for a test, as an aid in searching
Chronic Granulomatous Disease (CGD)
NBT (Nitroblue Tetrazolium) Assay
Neutrophil function
Nitroblue Tetrazolium (NBT) Assay
Oxidative burst
Specimen Type Describes the specimen type needed for testing
WB Sodium Heparin
Specimen Required Defines the optimal specimen. This field describes the type of specimen required to perform the test and the preferred volume to complete testing. The volume allows automated processing, fastest throughput and, when indicated, repeat or reflex testing.
Specimens must arrive within 48 hours of draw. Send specimens Sunday through Thursday only. Draw and package specimens as close to shipping time as possible. Ship overnight in an Ambient Mailer-Critical Specimens Only (Supply T668).
Ordering physician name and phone number are required.
A whole blood sodium heparin specimen and a control specimen are required.
Patient
Specimen Type: Whole blood
Container/Tube: Green top (sodium heparin)
Specimen Volume: 5 mL
Collection Instructions: Send specimen in original tube.
Normal Control
Specimen Type: Whole blood
Container/Tube: Green top (sodium heparin)
Specimen Volume: 5 mL
Collection Instructions:
1. Label clearly on outermost label normal control.
2. Send specimen in original tube.
Specimen Minimum Volume Defines the amount of specimen required to perform an assay once, including instrument and container dead space. Submitting the minimum specimen volume makes it impossible to repeat the test or perform confirmatory or perform reflex testing. In some situations, a minimum specimen volume may result in a QNS (quantity not sufficient) result, requiring a second specimen to be collected.
Reject Due To Identifies specimen types and conditions that may cause the specimen to be rejected
| Hemolysis | Mild OK; Gross reject |
| Lipemia | Mild OK; Gross reject |
| Icterus | NA |
| Other | NA |
Specimen Stability Information Provides a description of the temperatures required to transport a specimen to the laboratory. Alternate acceptable temperature(s) are also included.
| Specimen Type | Temperature | Time |
|---|---|---|
| Control | Ambient | 72 hours |
| WB Sodium Heparin | Ambient | 72 hours |
Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
Chronic granulomatous disease (CGD) is a diverse group of hereditary (X-linked and autosomal recessive) immunodeficiencies with impaired neutrophil function. The X-linked form of CGD is caused by mutations in the CYBB gene encoding the gp91phox protein. The other 3 forms of CGD are autosomal recessive and due to mutations in the p22phox, p47phox and p67phox-encoding genes. The majority (70%) of CGD is X-linked, and patients are diagnosed in childhood and early adulthood. However, female carriers can become phenotypically symptomatic, particularly when they get older. Patients with CGD frequently present with recurrent bacterial infections, particularly of the skin, subcutaneous areas, or regional lymph nodes. Sinopulmonary infections also are common. The majority of infections in CGD are due to Staphylococcus aureus, Pseudomonas cepacia, Serratia marcescens, nocardia, and aspergillus.
Normal neutrophil function is dependent on a number of properties including migration toward the site of infection, phagocytosis, and microbicidal activity. While most patients with recurrent infections have normal neutrophils, a persistent infection that fails to respond to appropriate medical treatment or infection with an organism that is unusual in an otherwise normal host suggest a possible neutrophil function defect. Measuring the neutrophil oxidative burst indirectly assesses microbicidal activity.
Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.
Normal
Interpretation Provides information to assist in interpretation of the test results
Absent oxidative burst is consistent with chronic granulomatous disease (CGD).
Carriers for X-linked CGD will have 2 neutrophil populations: 1 population will have a normal oxidative burst and the second will demonstrate no oxidative burst.
Carriers of autosomal recessive CGD will have a normal oxidative burst and can only be identified by genetic testing (contact Mayo Medical Laboratories for referral testing information).
Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
This test should not be used to identify carriers for autosomal recessive forms of chronic granulomatous disease (CGD). Genetic testing should be used to identify carriers of autosomal recessive CGD. Genetic testing should also be performed for females who do not show typical carrier pattern for X-linked CGD, but have male offspring or relatives with a confirmed diagnosis (flow cytometry and genetic testing) of X-linked CGD.
In males, this test is typically not indicated in patients >40 years of age. For questions about appropriate test selection, contact Mayo Medical Laboratories.
Before ordering this test, the clinician should investigate potential local causes of infection such as foreign bodies, skin maceration, repeated trauma, or congenital cysts, as well as assess the patient's environment for evidence of repeated infection. An investigation into allergic rhinitis and asthma is also recommended. If all the common causes are absent, the differential includes cystic fibrosis (even in adults), ciliary immobility syndrome, autoimmune disease such as Wegener granulomatosis, common variable immune deficiency, and finally CGD.
Clinical consultation by specialists in immune deficiency is recommended. For Mayo Clinic patients, referral to the Immune Deficiency Clinic in Adult and Pediatric Allergy is suggested.
Clinical Reference Provides recommendations for further in-depth reading of a clinical nature
Hampton MB, Kettle AJ, Winterbourn CC: Inside the neutrophil phagosome: oxidants, myeloperoxidase, and bacterial killing. Blood 1998;92:3007-3017
Method Description Describes how the test is performed and provides a method-specific reference
Neutrophil oxidative burst is a functional assay that measures the oxidation (and resultant fluorescence) of dihydrorhodamine 123 (DHR 123) due to oxygen radical generation during the oxidative burst. The DHR 123 is preloaded into the cells, PMA (phorbol 12-myristate 13-acetate) is added to stimulate the neutrophils, and the neutrophil fluorescence is quantitated as the blood is analyzed on a flow cytometer. (O'Gorman MR, Corrochano V: Rapid whole-blood flow cytometry assay for diagnosis of chronic granulomatous disease. Clin Diagn Lab Immunol 1995;2[2]:227-232)
Day(s) and Time(s) Test Performed Outlines the days and times the test is performed. This field reflects the day and time the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time required before the test is performed. Some tests are listed as continuously performed, which means assays are performed several times during the day.
Monday through Friday
Do not send specimen after Thursday. Specimen must be received by 10 a.m. on Friday.
Analytic Time Defines the amount of time it takes the laboratory to setup and perform the test. This is defined in number of days. The shortest interval of time expressed is "same day/1 day," which means the results may be available the same day that the sample is received in the testing laboratory. One day means results are available 1 day after the sample is received in the laboratory.
Maximum Laboratory Time Defines the maximum time from specimen receipt at Mayo Medical Laboratories until the release of the test result
Performing Laboratory Location The location of the laboratory that performs the test
Test Classification Provides information regarding the medical device classification for laboratory test kits and reagents. Tests may be classified as cleared or approved by the US Food and Drug Administration (FDA) and used per manufacturer's instructions, or as products that do not undergo full FDA review and approval, and are then labeled as an Analyte Specific Reagent (ASR), Investigation Use Only (IUO) product, or a Research Use Only (RUO) product.
CPT Code Information Provides guidance in determining the appropriate Current Procedural Terminology (CPT) code(s) information for each test or profile. The listed CPT codes reflect Mayo Medical Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.
88184
LOINC® Code Information Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the result codes returned for this test or profile.
| Result ID | Reporting Name | LOINC Code |
|---|---|---|
| 82560 | Neutrophil Oxidative Burst | 30903-9 |
| 21593 | Reviewed by | In Process |
| 21592 | Interpretation | 59462-2 |
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