Test Id : PBGDW
Porphobilinogen Deaminase, Washed Erythrocytes
Useful For
Suggests clinical disorders or settings where the test may be helpful
Confirmation of a diagnosis of acute intermittent porphyria using washed erythrocyte specimens
Genetics Test Information
Provides information that may help with selection of the correct genetic test or proper submission of the test request
This test is for diagnosis of acute intermittent porphyria.
Testing Algorithm
Delineates situations when tests are added to the initial order. This includes reflex and additional tests.
The following algorithms are available:
-Porphyria (Acute) Testing Algorithm
Method Name
A short description of the method used to perform the test
Enzymatic End Point/Spectrofluorometric
NY State Available
Indicates the status of NY State approval and if the test is orderable for NY State clients.
Reporting Name
Lists a shorter or abbreviated version of the Published Name for a test
Aliases
Lists additional common names for a test, as an aid in searching
Acute Intermittent Porphyria (AIP)
Hydroxymethylbilane Synthase (HMBS)
Uroporphyrinogen I Synthase
Uroporphyrinogen Synthase
Testing Algorithm
Delineates situations when tests are added to the initial order. This includes reflex and additional tests.
The following algorithms are available:
-Porphyria (Acute) Testing Algorithm
Specimen Type
Describes the specimen type validated for testing
Washed RBC
Ordering Guidance
This test is for diagnosis of acute intermittent porphyria. Porphobilinogen deaminase, also known as uroporphyrinogen I synthase, is commonly confused with uroporphyrinogen III synthase, the enzyme deficient in congenital erythropoietic porphyria (CEP). For CEP cases, order UPGC / Uroporphyrinogen III Synthase (Co-Synthase), Erythrocytes.
Necessary Information
1. Volume of packed cells and total volume of specimen (red cells + saline) are required and must be sent with specimen.
2. Patient's age is required
3. Include a list of medications the patient is currently taking.
ORDER QUESTIONS AND ANSWERS
| Question ID | Description | Answers |
|---|---|---|
| BG575 | Total cell Suspension | |
| BG576 | Packed cell volume |
Specimen Required
Defines the optimal specimen required to perform the test and the preferred volume to complete testing
Patient Preparation: Patient must not consume any alcohol for 24 hours before specimen collection. This is essential as ethanol induces porphobilinogen deaminase activity, which may lead to a false-normal result.
Collection Container/Tube:
Preferred: Green top (sodium heparin)
Acceptable: Lavender top (EDTA) or green top (lithium heparin)
Submission Container/Tube: Plastic vial
Specimen Volume: Entire 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 at 4 degrees C 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.
Special Instructions
Library of PDFs including pertinent information and forms related to the test
Forms
1. New York Clients-Informed consent is required. Document on the request form or electronic order that a copy is on file. The following documents are available:
-Informed Consent for Genetic Testing (T576)
-Informed Consent for Genetic Testing-Spanish (T826)
2. If not ordering electronically, complete, print, and send a Biochemical Genetics Test Request (T798) with the specimen.
Specimen Minimum Volume
Defines the amount of sample necessary to provide a clinically relevant result as determined by the testing laboratory. The minimum volume is sufficient for one attempt at testing.
1 mL of washed and resuspended erythrocytes
Reject Due To
Identifies specimen types and conditions that may cause the specimen to be rejected
| Cell suspension not available | Reject |
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 | |
| Ambient | 48 hours | ||
| Refrigerated | 14 days |
Useful For
Suggests clinical disorders or settings where the test may be helpful
Confirmation of a diagnosis of acute intermittent porphyria using washed erythrocyte specimens
Genetics Test Information
Provides information that may help with selection of the correct genetic test or proper submission of the test request
This test is for diagnosis of acute intermittent porphyria.
Testing Algorithm
Delineates situations when tests are added to the initial order. This includes reflex and additional tests.
The following algorithms are available:
-Porphyria (Acute) 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. Acute intermittent porphyria (AIP) is caused by diminished erythrocyte activity of porphobilinogen deaminase (PBGD), also known as uroporphyrinogen I synthase or hydroxymethylbilane synthase (HMBS).
Onset of AIP typically occurs during puberty or later. Individuals may experience acute episodes of neuropathic symptoms. Common symptoms include severe abdominal pain, peripheral neuropathy, and psychiatric symptoms. Crises may be precipitated by a broad range of medications (including barbiturates and sulfa drugs), alcohol, infection, starvation, heavy metals, and hormonal changes. AIP is inherited in an autosomal dominant manner. At-risk family members of patients with a biochemical diagnosis of AIP should undergo appropriate testing. Timely diagnosis is important as acute episodes of AIP can be fatal. Treatment of AIP includes the prevention of symptoms through avoidance of precipitating factors. More than 80% of individuals with a deficiency variant in the HMBS gene remain asymptomatic throughout their lives.
The biochemical diagnosis of AIP is made by demonstrating increased urinary excretion of porphobilinogen (PBG) and is most accurate during an acute episode. In addition, the diagnosis of AIP can be confirmed through the measurement of PBGD enzyme activity in erythrocytes, although 5% to 10% of affected individuals exhibit normal erythrocyte PBGD activity. In addition, molecular genetic confirmation (CGPH / Custom Gene Panel, Hereditary, Next-Generation Sequencing, Varies; specify gene list ID: IEMCP-WCJKC9) is available on a clinical basis and can be particularly helpful in identifying asymptomatic family members at risk of acute symptoms.
The workup of patients with a suspected porphyria is most effective when following a stepwise approach. See Porphyria (Acute) Testing Algorithm or call 800-533-1710 to discuss testing strategies.
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.
Reference ranges have not been established for patients who are younger than 16 years of age.
> or =7.0 nmol/L/sec
6.0-6.9 nmol/L/sec (indeterminate)
<6.0 nmol/L/sec (diminished)
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, 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
A normal result does not rule-out acute intermittent porphyria; 5% to 10% of affected individuals will have normal erythrocyte porphobilinogen deaminase activity. Additionally, enzyme activity may be increased during an acute attack; therefore, the enzyme level should be assessed when the patient is asymptomatic.
Clinical Reference
Recommendations for in-depth reading of a clinical nature
1. Tortorelli S, Kloke K, Raymond K. Disorders of porphyrin metabolism. In: Dietzen DJ, Bennett MJ, Wong ECC, eds. Biochemical and Molecular Basis of Pediatric Disease. 4th ed. AACC Press; 2010:307-324
2. Nuttall KL, Klee GG. Analytes of hemoglobin metabolism-porphyrins, iron, and bilirubin. In: Burtis CA, Ashwood ER, eds. Tietz Textbook of Clinical Chemistry. 5th ed. WB Saunders Company; 2001:584-607
3. Anderson KE, Sassa S, Bishop DF, Desnick RJ. Disorders of heme biosynthesis: X-linked sideroblastic anemia and the porphyrias. In: Valle DL, Antonarakis S, Ballabio A, Beaudet AL, Mitchell GA. eds. The Online Metabolic and Molecular Bases of Inherited Disease. McGraw-Hill; 2019. Accessed April 19,2024. Available at https://ommbid.mhmedical.com/content.aspx?bookid=2709§ionid=225540906
Method Description
Describes how the test is performed and provides a method-specific reference
Measurement of porphobilinogen deaminase (PBGD) activity is based on the measurement of the rate of synthesis of uroporphyrin from porphobilinogen (PBG) in incubated, lysed erythrocytes. Low yield of uroporphyrin from PBG indicates a deficiency of PBGD.(Ford RE, Ou CN, Ellefson RD. Assay for erythrocyte uroporphyrinogen I synthase activity, with porphobilinogen as substrate. Clin Chem. 1980;26(8):1182-1185; Bustad HJ, Kallio JP, Vorland M, et al. Acute Intermittent Porphyria: An Overview of Therapy Developments and Future Perspectives Focusing on Stabilisation of HMBS and Proteostasis Regulators. Int J Mol Sci. 2021;22(2):675. doi:10.3390/ijms22020675)
PDF Report
Indicates whether the report includes an additional document with charts, images or other enriched information
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.
Tuesday
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.
Specimen Retention Time
Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded
Performing Laboratory Location
Indicates the location of the laboratory that performs the test
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 account representative. 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. It 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.
CPT codes are provided by the performing laboratory.
82657
LOINC® Information
Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the order and results codes of this test. LOINC values are provided by the performing laboratory.
| Test Id | Test Order Name | Order LOINC Value |
|---|---|---|
| PBGDW | PBG Deaminase, RBC | 2812-6 |
| Result Id | Test Result Name |
Result LOINC Value
Applies only to results expressed in units of measure originally reported by the performing laboratory. These values do not apply to results that are converted to other units of measure.
|
|---|---|---|
| 31944 | PBG Deaminase, RBC | 2812-6 |
| 31945 | Interpretation | 59462-2 |
| BG575 | Total cell Suspension | 94496-7 |
| BG576 | Packed cell volume | 94497-5 |
| 606471 | Reviewed By | 18771-6 |