Test Catalog

Test Id : PPFWE

Protoporphyrins, Fractionation, Washed Erythrocytes

Useful For
Suggests clinical disorders or settings where the test may be helpful

Preferred test for analysis of erythrocyte protoporphyrin fractions

 

Preferred test for evaluating patients with possible diagnoses of erythropoietic protoporphyria and X-linked dominant protoporphyria

 

Establishing a biochemical diagnosis of erythropoietic protoporphyria, or X-linked dominant protoporphyria

Testing Algorithm
Delineates situations when tests are added to the initial order. This includes reflex and additional tests.

This test should not be ordered in conjunction with PEWE / Porphyrins Evaluation, Washed Erythrocytes.

 

The following algorithms are available in Special Instructions:

-Porphyria (Acute) Testing Algorithm

-Porphyria (Cutaneous) Testing Algorithm

Special Instructions
Library of PDFs including pertinent information and forms related to the test

Method Name
A short description of the method used to perform the test

High-Performance Liquid Chromatography (HPLC) with Fluorescence Detection

NY State Available
Indicates the status of NY State approval and if the test is orderable for NY State clients.

Yes

Reporting Name
Lists a shorter or abbreviated version of the Published Name for a test

Protoporphyrins, Fractionation, RBC

Aliases
Lists additional common names for a test, as an aid in searching

EPP (Erythropoietic Protoporphyria)

Erythropoietic Protoporphyria

Free Protoporphyrin

Zinc Protoporphyrin

X-linked Dominant Protoporphyria (XLDPP or XDP)

Testing Algorithm
Delineates situations when tests are added to the initial order. This includes reflex and additional tests.

This test should not be ordered in conjunction with PEWE / Porphyrins Evaluation, Washed Erythrocytes.

 

The following algorithms are available in Special Instructions:

-Porphyria (Acute) Testing Algorithm

-Porphyria (Cutaneous) Testing Algorithm

Specimen Type
Describes the specimen type validated for testing

Washed RBC

Ordering Guidance

This test is for assessment for protoporphyria, an erythropoietic porphyria. The preferred test for lead toxicity in children is blood lead. For more information see PBDV / Lead, Venous with Demographics, Blood or PBDC / Lead, Capillary, with Demographics, Blood. The preferred screening test for suspicion of a hepatic porphyria is urine porphyrins. For more information see PQNRU / Porphyrins, Quantitative, Random, Urine.

Necessary Information

1. Volume of packed cells and total volume of erythrocyte suspension (red cells + saline) are required and must be sent with specimen.

2. Include a list of medications the patient is currently taking.

Specimen Required
Defines the optimal specimen required to perform the test and the preferred volume to complete testing

All porphyrin tests on erythrocytes can be performed on 1 tube.

 

Patient Preparation: Patient should abstain from alcohol for 24 hours.

Collection Container/Tube:

Preferred: Green top (sodium heparin)

Acceptable: Dark blue top (metal free heparin) or green top (lithium heparin)

Submission Container/Tube: Plastic vial

Specimen Volume: Washed erythrocyte suspension

Collection Instructions: Collect and process whole blood specimen as follows:

1. Transfer entire specimen to a 12-mL graduated centrifuge tube.

2. Centrifuge specimen for 10 minutes at 2000 rpm.

3. Record volume of packed cells and the total volume of the specimen.

4. Discard supernatant plasma.

5. Wash packed erythrocytes 2 times by resuspension of at least an equal amount of cold 0.9% saline, mix, and centrifuge for 5 minutes at 2000 rpm, discarding supernatant after each washing.

6. Resuspend packed cells to the original total volume with 0.9% saline. Invert specimen gently to mix.

7. Transfer washed erythrocytes into a plastic vial and freeze.

Special Instructions
Library of PDFs including pertinent information and forms related to the test

Forms

Specimen Minimum Volume
Defines the amount of sample necessary to provide a clinically relevant result as determined by the Testing Laboratory

1 mL

Reject Due To
Identifies specimen types and conditions that may cause the specimen to be rejected

Other Cell suspension not available

Specimen Stability Information
Provides a description of the temperatures required to transport a specimen to the performing laboratory, alternate acceptable temperatures are also included

Specimen Type Temperature Time Special Container
Washed RBC Frozen (preferred) 14 days
Refrigerated 14 days

Useful For
Suggests clinical disorders or settings where the test may be helpful

Preferred test for analysis of erythrocyte protoporphyrin fractions

 

Preferred test for evaluating patients with possible diagnoses of erythropoietic protoporphyria and X-linked dominant protoporphyria

 

Establishing a biochemical diagnosis of erythropoietic protoporphyria, or X-linked dominant protoporphyria

Testing Algorithm
Delineates situations when tests are added to the initial order. This includes reflex and additional tests.

This test should not be ordered in conjunction with PEWE / Porphyrins Evaluation, Washed Erythrocytes.

 

The following algorithms are available in Special Instructions:

-Porphyria (Acute) Testing Algorithm

-Porphyria (Cutaneous) Testing Algorithm

Clinical Information
Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test

The porphyrias are a group of inherited disorders resulting from enzyme defects in the heme biosynthetic pathway. Depending on the specific enzyme involved, various porphyrins and their precursors accumulate in different specimen types. The patterns of porphyrin accumulation in erythrocytes and plasma, and excretion of the heme precursors in urine and feces allow for the detection and differentiation of the porphyrias.

 

Testing protoporphyrin fractions is most informative for patients with a clinical suspicion of erythropoietic protoporphyria (EPP) or X-linked dominant protoporphyria (XLDPP). Clinical presentation of EPP and XLDPP is identical with onset of symptoms typically occurring in childhood. Cutaneous photosensitivity in sun-exposed areas of the skin generally worsens in the spring and summer months. Common symptoms may include itching, edema, erythema, stinging or burning sensations, and occasionally scarring of the skin in sun-exposed areas. Although genetic in nature, environmental factors exacerbate symptoms, significantly impacting the severity and course of disease.

 

EPP is caused by diminished ferrochelatase resulting in significantly increased free protoporphyrin levels in erythrocytes, plasma, and feces.

 

XLDPP is caused by gain-of-function variants in the C-terminal end of ALAS2 gene and results in elevated erythrocyte levels of free and zinc-complexed protoporphyrin, and total protoporphyrin in plasma and feces.

 

Other possible causes of elevated erythrocyte zinc-complexed protoporphyrin may include:

-Iron-deficiency anemia, the most common cause

-Chronic intoxication by heavy metals (primarily lead) or various organic chemicals

-Congenital erythropoietic porphyria (CEP), a rare autosomal recessive porphyria caused by deficient uroporphyrinogen III synthase

-Hepatoerythropoietic porphyria (HEP), a rare autosomal recessive porphyria caused by deficient uroporphyrinogen decarboxylase

 

Typically, the workup of patients with a suspected porphyria is most effective when following a stepwise approach. See Porphyria (Acute) Testing Algorithm and Porphyria (Cutaneous) Testing Algorithm in Special Instructions or call 800-533-1710 to discuss testing strategies.

 

There are 2 test options:

-PPFE / Protoporphyrins, Fractionation, Whole Blood

-PPFWE / Protoporphyrins, Fractionation, Washed Erythrocytes

The whole blood option is easiest for clients but requires that the specimen arrive at Mayo Clinic Laboratories within 7 days of collection. When this cannot be ensured, washed frozen erythrocytes, which are stable for 14 days, should be submitted.

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.

FREE PROTOPORPHYRIN

<20 mcg/dL

 

ZINC-COMPLEXED PROTOPORPHYRIN

<60 mcg/dL

Interpretation
Provides information to assist in interpretation of the test results

Abnormal results are reported with a detailed interpretation that may include an overview of the results and their significance, a correlation to available clinical information provided with the specimen, differential diagnosis, and recommendations for additional testing when indicated and available.

Cautions
Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances

Patients must abstain from alcohol for at least 24 hours. Alcohol suppresses enzyme activity potentially leading to false-positive results.

Clinical Reference
Recommendations for in-depth reading of a clinical nature

1. Tortorelli S, Kloke K, Raymond K: Chapter 15: Disorders of porphyrin metabolism. In Biochemical and Molecular Basis of Pediatric Disease. Fourth edition. Edited by DJ Dietzen, MJ Bennett, ECC Wong. AACC Press 2010, pp 307-324

2. Nuttall KL, Klee GG: Analytes of hemoglobin metabolism-porphyrins, iron, and bilirubin. In Tietz Fundamentals of Clinical Chemistry. Fifth edition. Edited by CA Burtis, ER Ashwood. Philadelphia, WB Saunders Company, 2001, pp 584-607

3. Anderson KE, Sassa S, Bishop DF, Desnick RJ: Disorders of Heme Biosynthesis: X-Linked Sideroblastic Anemia and the Porphyrias. In The Online Metabolic and Molecular Bases of Inherited Disease. Edited by D Valle, AL Beaudet, B Vogelstein, et al. New York, McGraw-Hill. Accessed August 2, 2019. Available at http://ommbid.mhmedical.com/content.aspx?bookid=971&Sectionid=62638866

4. Whatley SD, Ducamp S, Gouya L, et al: C-terminal in the ALAS2 gene lead to gain of function and cause X-linked dominant protoporphyria without anemia or iron overload. Am J Hum Genet 2008 Sep;83(3):408-414

Special Instructions
Library of PDFs including pertinent information and forms related to the test

Method Description
Describes how the test is performed and provides a method-specific reference

Extraction followed by fractionation by high-performance liquid chromatography. Zinc protoporphyrin and free protoporphyrin are separately quantitated.(Smith RM, Doran D, Mazur M, Bush B: High-performance liquid chromatographic determination of protoporphyrin and zinc protoporphyrin in blood. J Chromatogr 1980 Mar 14;181[3-4]:319-327; Gou EE, Balwani M, Bissell DM, et al: Pitfalls in Erythrocyte Protoporphyrin Measurement for Diagnosis and Monitoring of Protoporphyrias. Clin Chem. 2015 Dec;61[12]:1453-6. doi: 10.1373/clinchem.2015.245456)

PDF Report
Indicates whether the report includes an additional document with charts, images or other enriched information

No

Day(s) Performed
Outlines the days the test is performed. This field reflects the day that the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time before the test is performed. Some tests are listed as continuously performed, which means that assays are performed multiple times during the day.

Monday, Wednesday, Friday

Report Available
The interval of time (receipt of sample at Mayo Clinic Laboratories to results available) taking into account standard setup days and weekends. The first day is the time that it typically takes for a result to be available. The last day is the time it might take, accounting for any necessary repeated testing.

2 to 3 days

Specimen Retention Time
Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded

2 weeks

Performing Laboratory Location
Indicates the location of the laboratory that performs the test

Rochester

Fees
Several factors determine the fee charged to perform a test. Contact your U.S. or International Regional Manager for information about establishing a fee schedule or to learn more about resources to optimize test selection.

  • Authorized users can sign in to Test Prices for detailed fee information.
  • Clients without access to Test Prices can contact Customer Service 24 hours a day, seven days a week.
  • Prospective clients should contact their Regional Manager. For assistance, contact Customer Service.

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 instructions, or as products that do not undergo full FDA review and approval, and are then labeled as an Analyte Specific Reagent (ASR) product.

This test was developed, and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the US Food and Drug Administration.

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 Clinic Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.

CPT codes are provided by the performing laboratory.

82542

LOINC® Information

Test Id Test Order Name Order LOINC Value
PPFWE Protoporphyrins, Fractionation, RBC 94490-0
Result Id Test Result Name Result LOINC Value
Result LOINC Value Tooltip
31932 Zinc-Complexed Protoporphyrin 2895-1
31933 Free Protoporphyrin 94491-8
INTP6 Interpretation 59462-2
BG571 Total cell suspension 94496-7
BG572 Packed cell volume 94497-5

Test Setup Resources

Setup Files
Test setup information contains test file definition details to support order and result interfacing between Mayo Clinic Laboratories and your Laboratory Information System.

Excel | Pdf

Sample Reports
Normal and Abnormal sample reports are provided as references for report appearance.

Normal Reports | Abnormal Reports

SI Sample Reports
International System (SI) of Unit reports are provided for a limited number of tests. These reports are intended for international account use and are only available through MayoLINK accounts that have been defined to receive them.

SI Normal Reports | SI Abnormal Reports