Test Catalog

Test Id : BTKS

Bruton Tyrosine Kinase (BTK) Genotype, Full Gene Sequence, Blood

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

Confirming a diagnosis of X-linked agammaglobulinemia (XLA) in male patients with a history of recurrent sinopulmonary infections, profound hypogammaglobulinemia, and less than 1% peripheral B cells, with or without abnormal Bruton tyrosine kinase (Btk) protein expression by flow cytometry


Evaluating for the presence of BTK variants in female relatives (of male XLA patients) who do not demonstrate carrier phenotype by Btk flow cytometry

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
BTKSP BTK, Full Gene Sequence No Yes
BTKSQ BTK, Full Gene Sequencing No Yes

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

Polymerase Chain Reaction (PCR) followed by DNA Sequence Analysis

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

BTK, Full Gene Sequence

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

B-cell progenitor kinase

Bruton agammaglobulinemia tyrosine kinase

Agammaglobulinemia Tyrosine Kinase

Dominant-negative kinase-deficient Brutons tyrosine kinase

Bruton's tyrosine kinase (BTK)

Tyrosine-Protein Kinase BTK

Specimen Type
Describes the specimen type validated for testing

Whole Blood EDTA

Ordering Guidance

The preferred test for confirming a diagnosis of X-linked agammaglobulinemia in males and identifying carrier females is BTKFP / Bruton Tyrosine Kinase (BTK) Genotype and Protein Analysis, Full Gene Sequence and Flow Cytometry, Blood.


For cases where the differential diagnosis remains broad, BTK may be evaluated as part of a larger genetic panel, see BCLGP / B-Cell Deficiency Primary Immunodeficiency Disorder Panel (34 genes), Next-Generation Sequencing, Varies.


Testing for familial variants/known mutations is available; see FMTT / Familial Mutation, Targeted Testing, Varies.

Necessary Information

1. Bruton Tyrosine Kinase (BTK) Genotype Patient Information (T620) is required, see Special Instructions. Testing may proceed without the patient information however it aids in providing a more thorough interpretation. Ordering providers are strongly encouraged to complete the form and send it with the specimen.

2. Include physician name and phone number with specimen.

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

Multiple whole blood EDTA genotype tests can be performed on a single specimen after a single extraction. See Multiple Whole Blood EDTA Genotype Tests in Special Instructions for a list of tests that can be ordered together.


Patient Preparation: A previous bone marrow transplant from an allogenic donor will interfere with testing. Call 800-533-1710 for instructions for testing patients who have received a bone marrow transplant.

Container/Tube: Lavender top (EDTA)

Specimen Volume: 3 mL

Collection Instructions: Send specimen in original tube. Do not aliquot.

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


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 in Special Instructions:

-Informed Consent for Genetic Testing (T576)

-Informed Consent for Genetic Testing-Spanish (T826)

2. Bruton Tyrosine Kinase (BTK) Genotype Patient Information (T620) is recommended, see Special Requirement

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

0.35 mL

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

All specimens will be evaluated at Mayo Clinic Laboratories for test suitability.

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
Whole Blood EDTA Refrigerated (preferred)

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

Confirming a diagnosis of X-linked agammaglobulinemia (XLA) in male patients with a history of recurrent sinopulmonary infections, profound hypogammaglobulinemia, and less than 1% peripheral B cells, with or without abnormal Bruton tyrosine kinase (Btk) protein expression by flow cytometry


Evaluating for the presence of BTK variants in female relatives (of male XLA patients) who do not demonstrate carrier phenotype by Btk flow cytometry

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

X-linked agammaglobulinemia (XLA) is a humoral primary immunodeficiency affecting males in approximately 1 in 200,000 live births. XLA is caused by variants in the Bruton tyrosine kinase gene (BTK),(1) which results in a profound block in B-cell development within the bone marrow and a significant reduction, or complete absence, of mature B cells in peripheral blood.(2) Approximately 85% of male patients with defects in early B-cell development have XLA.(3) Due to the lack of mature B cells, XLA patients have markedly reduced levels of all major classes of immunoglobulins in the serum and are, therefore, susceptible to severe and recurrent bacterial infections. Pneumonia, otitis media, enteritis, and recurrent sinopulmonary infections are among the key diagnostic clinical characteristics of the disease. The spectrum of infectious complications also includes enteroviral meningitis, septic arthritis, cellulitis, and empyema, among others. The disease typically manifests in male children younger than 1 year.


BTK, the only gene associated with XLA, maps to the X chromosome at Xq21.3-Xq22 and consists of 19 exons spanning 37.5 kb genomic DNA.(4) BTK encodes a nonreceptor tyrosine kinase of the Btk/Tec family. The Btk protein consists of 5 structural domains (PH, TH, SH3, SH2, and TK). Variants causing XLA have been found in all domains of the BTK gene, as well as noncoding regions of the gene. Over 800 unique variants in BTK have been detected by full gene sequencing and are listed in BTKbase, a database for BTK variants (http://structure.bmc.lu.se/idbase/BTKbase/).(5)  Missense variants account for approximately 33% of unique variants, nonsense variants 13%, frameshift 25%, in-frame deletions and insertions 4%, large deletions 3% to 5%, and intronic and complex variants make up the remainder. Patients with a large deletion spanning the BTK gene may also impact the adjacent TIMM8A gene (also known as DDP) resulting in both XLA and deafness-dystonia-optic neuropathy syndrome (DDS or Mohr-Tranebjaerg syndrome). Genotype-phenotype correlations have not been completely defined for BTK, but it is clear that nonsense and frameshift variants are overrepresented 4-fold compared with substitutions, which indicates that the latter may be tolerated without causing a phenotype or with a milder phenotype or later age at presentation. Some individuals present within the first 2 years of life, enabling an early diagnosis. Others present with milder phenotypes, resulting in diagnosis later in childhood or in adulthood.(5) Delayed diagnoses can be partly explained by the variable severity of XLA, even within families in which the same variant is present. While the disease is considered fully penetrant, the clinical phenotype can vary considerably depending on the nature of the specific BTK variant.(5) Lyonization of this gene is not typical and only 1 case of XLA in a female has been reported so far due to skewed lyonization in a carrier female. Therefore, females with clinical features that are identical to XLA should be evaluated for autosomal recessive agammaglobulinemia when deemed clinically appropriate(6) and for XLA, if a male parent is affected with the disease.


A diagnosis of XLA should be suspected in males with 1) early-onset bacterial infections, 2) marked reduction in all classes of serum immunoglobulins, and 3) absent B cells (CD19+ cells). The decrease in numbers of peripheral B cells is a key feature, though this also can be seen in a small subset of patients with common variable immunodeficiency (CVID). Conversely, some BTK variants can preserve small numbers of circulating B cells and, therefore, all 3 of the criteria mentioned above need to be evaluated.


The preferred approach for confirming a diagnosis of XLA in males and identifying carrier females requires testing for the Btk protein expression on B cells by flow cytometry and genetic testing for a BTK variant. Patients can be screened for the presence of Btk protein by flow cytometry (BTK / Bruton Tyrosine Kinase [Btk], Protein Expression, Flow Cytometry, Blood); however, normal results by flow cytometry do not rule out the presence of a BTK variant with normal protein expression but aberrant protein function. The diagnosis is confirmed only in those individuals with appropriate clinical history who have a varaint identified within BTK by gene sequencing or who have male family members with hypogammaglobulinemia with absent or low B cells.

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.

An interpretive report will be provided.

Provides information to assist in interpretation of the test results

A patient-specific interpretive report is provided.

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

Rare alterations (ie, polymorphisms) could potentially lead to false-negative or false-positive results. If results obtained do not match clinical findings, additional testing should be considered. Any error in the diagnosis or in the pedigree provided to the laboratory could lead to an erroneous interpretation of results.


Patients who have received a heterologous blood transfusion within the preceding 6 weeks, or who have received an allogeneic hematopoietic stem cell transplant, can have inaccurate genetic test results due to presence of donor DNA.


This method will not detect variants that occur in intronic (other than exon-intron boundaries) and regulatory regions of the Bruton tyrosine kinase gene (BTK) gene or large rearrangement-type variants. This assay is not designed to detect large deletions.

If the full gene sequencing does not match the clinical impression, flow cytometry should be performed to assess expression of Btk protein (BTK / Bruton Tyrosine Kinase [Btk], Protein Expression, Flow Cytometry, Blood). Large deletions or rearrangements will affect protein expression, and the absence of Btk protein on monocytes can be determined by flow cytometry.


Btk protein and genetic tests are not meant for patients with hematological neoplasias on kinase inhibitor therapy, including but not restricted to the selective Btk inhibitor, Ibrutonib. This test is only meant for the assessment of patients with a suspected monogenic primary immunodeficiency, X-linked agammaglobulinemia, caused by germline variants in the Bruton tyrosine kinase gene.

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

1. Tsukada S, Saffran DC, Rawlings DJ, et al: Deficient expression of a B cell cytoplasmic tyrosine kinase in human X-linked agammaglobulinemia. Cell. 1993 Jan 29;72(2):279-290

2. Noordzij JG, de Bruin-Versteeg S, Comans-Bitter WM, et al: Composition of precursor B-cell compartment in bone marrow from patients with X-linked agammaglobulinemia compared with healthy children. Pediatr Res. 2002 Feb;51(2):159-168

3. Conley ME, Broides A, Hernandez-Trujillo V, et al: Genetic analysis of patients with defects in early B-cell development. Immunol Rev. 2005 Feb;203:216-234

4. Lindvall JM, Blomberg KE, Valiaho J, et al: Bruton's tyrosine kinase: cell biology, sequence conservation, mutation spectrum, siRNA modifications, and expression profiling. Immunol Rev. 2005 Feb;203:200-215

5. Valiaho J, Smith CI, Vihinen M: BTKbase: the mutation database for X-linked agammaglobulinemia. Hum Mutat. 2006 Dec;27(12):1209-1217

6. Takada H, Kanegane H, Nomura A, et al: Female agammaglobulinemia due to the Bruton tyrosine kinase deficiency caused by extremely skewed X-chromosome inactivation. Blood 2004 Jan 1;103(1):185-187

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

Genomic DNA is first extracted from whole blood, followed by Bruton tyrosine kinase gene (BTK) amplification by polymerase chain reaction (PCR). The PCR product is purified from unincorporated primers and nucleotides by enzymatic digestion and sequenced in both directions using sequencing primers and fluorescent dye-terminator chemistry. Sequencing products are separated on an automated sequencer and trace files are analyzed for variations in the exons and intron/exon boundaries of all 19 exons using specialized mutation detection software and visual inspection.(Unpublished Mayo method)

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.


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.

28 to 42 days

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

Whole Blood: 2 weeks Extracted DNA: 2 months

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


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.


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
BTKS BTK, Full Gene Sequence 94241-7
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.
BTKSQ BTK, Full Gene Sequencing Bill only; no result
29305 BTK Full Gene Result 82939-0
45486 BTK Full Gene Interpretation 69047-9
45487 Reviewed By 18771-6

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