Beryllium Lymphocyte Proliferation Test
What is a beryllium lymphocyte proliferation test (BeLPT)?
How is a BeLPT done?
Who should have a BeLPT?
Will the BeLPT tell me whether or not I have CBD?
What do the values on the test result mean?
I have a 2.5 SI on my National Jewish Health test result. Is this considered almost abnormal?
Does a very high SI value on my test result mean I have CBD?
Do I need to fast (not eat) prior to my blood test?
Will taking prednisone affect my test result?
Is there a program that will pay for my test?
Will my insurance company and/or employer have access to my test results?
Can I have a normal test and still have beryllium sensitization or CBD?
What is the false positive rate for the blood BeLPT?
What is the false negative rate for the blood BeLPT?
Can you test urine for beryllium sensitization? Or hair?
Is medical screening with the blood BeLPT recommended?
What is a beryllium lymphocyte proliferation test (BeLPT)?
The beryllium lymphocyte proliferation test (BeLPT) is a blood test that measures beryllium sensitization, which is an “allergic” reaction to beryllium. The test is very specific, meaning that if your blood reacts to beryllium, nothing other than beryllium could have caused this reaction. It means that your immune system has seen beryllium as a “foreign invader,” and has built an “army” of cells in the bloodstream that are prepared to react to beryllium wherever they see it in the body.
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How is a BeLPT done?
To perform the test, a specimen of blood is drawn from a vein in your arm. In the laboratory, the white blood cells are separated from the rest of the blood cells and mixed with a beryllium solution. If your immune system is sensitized to beryllium, these cells will multiply. If your immune system is not sensitized to beryllium, the cells will not multiply. In normal (non-sensitized) individuals, cells do not multiply.
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Who should have a BeLPT?
National Jewish Health recommends that individuals who are or have been exposed to any form of beryllium dust or fume (including pure beryllium metal, copper-, aluminum-, nickel- and magnesium-beryllium alloys; ceramics, and composite materials) have a BeLPT. This includes:
- Individuals who work directly with beryllium or have in the past,
- Individuals who have ever been in buildings where beryllium dust or fume was created by others (this is called “bystander exposure”),
- Individuals who have disturbed beryllium dust in some manner (such as through janitorial work, building maintenance, or construction),
- Family members of workers who wore beryllium-contaminated clothing or shoes home from work,
- Short-term employees, including summer students, since beryllium sensitization and CBD can develop within a few months of exposure,
- Any person with lung disease (especially scarring lung diseases) who has current or past exposure to beryllium. CBD can be mistaken for asthma, sarcoidosis, pulmonary fibrosis, chronic bronchitis, COPD or other lung ailments. The blood BeLPT helps correct mistakes in diagnosis.
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Will the BeLPT tell me whether or not I have CBD?
The blood BeLPT only determines beryllium sensitivity; it does not indicate whether or not you have CBD. An abnormal blood response to beryllium does means that you are beryllium sensitized, and most people with beryllium sensitization will eventually develop CBD 1. The BeLPT test result is either normal (no sensitization) or abnormal (beryllium sensitized). Additional testing is needed to determine whether or not you have disease.
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What do the values on the test result mean?
The test is performed in two parts: one part ensures your blood cells are alive and normal when they arrive at the laboratory, and the other part tests the blood cells for their reaction to beryllium.
Part 1: To ensure that your white blood cells are acting normally, we test them for their ability to respond to two different substances that are known to make nearly everyone’s cells multiply. One is an antigen and the other is a mitogen. If your cells react normally to these “positive controls,” the cells are then tested to see if they will react to a beryllium solution.
Part 2: The test for the reaction to beryllium is like having six tests in one. We use three different concentrations of beryllium sulfate and check the cells at two different points in time. If your cells multiply in two or more of these six beryllium conditions, the test is interpreted as abnormal (“positive”).
Result: Your cells’ responses to the mitogen, antigen, and beryllium are reported. Each laboratory that performs the BeLPT sets it own values to determine whether cell responses are normal or abnormal. For a more in depth explanation of National Jewish Health test results, please click on the link for My Test.
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I have a 2.5 SI on my National Jewish Health test result. Is this considered almost abnormal?
In the National Jewish Health laboratory, tests with all values 2.5 and less are considered normal. A value of 2.5 does not increase the likelihood that an individual will have an abnormal test in the future. In our laboratory, two of the six measurements must be greater than 2.5 for the test to be abnormal.
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Does a very high SI value on my test result mean I have CBD?
National Jewish Health has not found that high abnormal values are linked to disease. A person who has a 12.8 is no more likely to have CBD that a person who has a 5.8. Further testing is needed to determine whether or not an individual has CBD.
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Do I need to fast (not eat) prior to my blood test?
No, your test results are not affected by food or drink.
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Will taking prednisone affect my test result?
We are able to perform the test in people who are taking prednisone. National Jewish Health sees many patients who are on immunosuppressive drugs, such as corticosteroids like prednisone, who have abnormal BeLPTs. Although definitive research has not been done, it is preferable that you discontinue medicines that suppress the immune system 3 months prior to a BeLPT. This should be done only if your doctor considers it safe to reduce or stop your medicines. If you were on an immunosuppressive drug when your blood BeLPT was done, and you have doubts about the validity of your test results, we suggest you meet with your personal physician to determine if you should discontinue your medication and have a repeat test.
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Is there a program that will pay for my test?
If you are a current or former Department of Energy employee, you may qualify for free testing. Many private insurance companies will cover the cost of the test, as will Medicare. Because plans vary in coverage, you should contact your insurance company for benefit information. For information on Department of Energy programs, please see www.dol.gov.
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Will my insurance company and/or employer have access to my test results?
If your employer or insurance company pays for your BeLPT, most likely you will have to sign a waiver allowing an authorized representative to see the results of your test. If you file a workers’ compensation or Department of Labor claim for beryllium sensitization or CBD, you may need to release your test results to the claim examiner before your claim can be processed. Under federal law (HIPAA), no one may access your test results unless you give them permission by signing a release of medical information.
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Can I have a normal test and still have beryllium sensitization or CBD?
National Jewish Health physicians have diagnosed CBD in individuals who have granulomas in their lungs but normal blood BeLPTs. In such instances, the lung cells usually react to beryllium when the BeLPT is performed using cells washed from the lungs.
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What is the false positive rate for the blood BeLPT?
If a person has an abnormal (“positive”) blood BeLPT, there is a greater likelihood that it will again be abnormal when it is repeated. Of people who have two abnormal blood BeLPTs, the chances of the test becoming consistently normal again in the future is less than very low. These rates vary some among the laboratories that perform the BeLPT.
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What is the false negative rate for the blood BeLPT?
A “false negative” test means that the test was read as being normal (“negative”) when a person has beryllium sensitization or chronic beryllium disease. It is estimated that this occurs rarely. Although a normal blood BeLPT is reassuring, it is not a 100 percent guarantee that you do not have beryllium sensitization or CBD. The test should be repeated if there is a strong suspicion that you have CBD. In some instances, it may be necessary to do other tests to determine if you have beryllium sensitization or CBD, in which case your physician should contact our medical staff to discuss options.
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Can you test urine for beryllium sensitization? Or hair?
While it is possible to test for beryllium in urine, it is not helpful in determining if you have beryllium sensitization or CBD. A urine test can determine if someone is or has been recently exposed to beryllium, but it does not detect beryllium sensitization. Beryllium tests on hair can also detect past beryllium exposure but cannot detect beryllium sensitization or “allergy.”
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Is medical screening with the blood BeLPT recommended?
The BeLPT is the best test currently available to detect beryllium related health effects. It is more sensitive than medical evaluation, spirometry, chest x-ray and CT scan. Studies have shown the blood BeLPT identifies approximately 70 to 94% of cases of beryllium sensitization and CBD 2-7. When used to test exposed individuals in a workforce over a period of time, it has been shown to detect new cases of beryllium sensitization and CBD over time 1-5. It is currently the most sensitive, least invasive, and most cost-effective screening tool for detecting beryllium sensitization among exposed individuals.
Because CBD is generally easiest to treat and control when detected in its early stages, regular medical screening with the blood BeLPT enables earlier detection, treatment, and outcomes for affected individuals. Individuals with abnormal blood tests have the opportunity to undergo additional clinical evaluation for CBD before symptoms of disease become apparent. Some individuals are diagnosed with beryllium sensitization and can be closely monitored for progression to CBD. Others may be diagnosed with “asymptomatic CBD,” which means that they do not yet have symptoms of the disease, such as respiratory symptoms or gas exchange abnormalities. Although treatment for symptomatic CBD is not recommended by most physicians, it does permit a doctor to follow a patient more closely and begin treatment promptly should it become necessary.
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References:
- Newman LS, Mroz MM, Balkissoon RC, Maier LA. Beryllium sensitization progresses to chronic beryllium disease: a longitudinal study of disease risk. Am J Respir Crit Care Med 2004; published ahead of print on September 16, 2004 as doi:10.1164/rccm.200402-190OC.
- Kreiss K, Mroz MM, Zhen B, Martyny JW, Newman LS. Epidemiology of beryllium sensitization and disease in nuclear workers. Am Rev Respir Dis 1993; 148:985-991.
- Kreiss K, Wasserman S, Mroz MM, Newman LS. Beryllium disease screening in the ceramics industry: Blood test performance and exposure-disease relations. J Occup Med 1993; 35:267-274.
- Kreiss K, Mroz MM, Newman LS, Martyny J, Zhen B. Machining risk of beryllium disease and sensitization with median exposures below 2 mg/m3. Am J Indust Med 1996; 30:16-25.
- Mroz MM, Kreiss K, Lezotte DC, Campbell PA, Newman LS. Re-examination of the blood lymphocyte transformation test in the diagnosis of chronic beryllium disease. J Allergy Clin Immunol 1991; 88:54-60.
- Kreiss K, Miller F, Newman LS, Ojo-Amaize EA, Rossman MD, Saltini C. Chronic beryllium disease: From the work place to cellular immunology, molecular immunogenetics, and back. Clin Immunol Immunopath 1994; 71:123-129.
- Rossman MD. Differential diagnosis of chronic beryllium disease. In: Rossman MD, Preuss OP, Powers MB, eds. Beryllium: Biomedical and Environmental Aspects. Baltimore: Williams & Wilkins, 1991;167-175.
