Test Id : F822B
Hemophilia A F8 Gene, Intron 22 Inversion Known Mutation, Whole Blood
Useful For
Suggests clinical disorders or settings where the test may be helpful
First-tier molecular testing for male patients affected with severe hemophilia A, when a familial intron 22 inversion has been previously identified
Determining hemophilia A carrier status for at-risk female patients, ie, individuals with a family history of severe hemophilia A due to F8 intron 22 inversion
Genetics Test Information
Provides information that may help with selection of the correct genetic test or proper submission of the test request
This test detects the intron 22 inversion within the F8 gene. The intron 22 inversion variant accounts for approximately 45% of variants associated with severe hemophilia A.
Intron 22 inversion known variant analysis can only be performed for individuals when an intron 22 inversion has already been identified in the family. For testing options, see Ordering Guidance.
Reflex Tests
Lists tests that may or may not be performed, at an additional charge, depending on the result and interpretation of the initial tests.
| Test Id | Reporting Name | Available Separately | Always Performed |
|---|---|---|---|
| CULFB | Fibroblast Culture for Genetic Test | Yes | No |
| CULAF | Amniotic Fluid Culture/Genetic Test | Yes | No |
| MATCC | Maternal Cell Contamination, B | Yes | No |
| _STR1 | Comp Analysis using STR (Bill only) | No, (Bill only) | No |
| _STR2 | Add'l comp analysis w/STR (Bill Only) | No, (Bill only) | No |
Testing Algorithm
Delineates situations when tests are added to the initial order. This includes reflex and additional tests.
Maternal cell contamination testing will be performed for all cord blood specimens. A maternal whole blood sample with an order for MATCC / Maternal Cell Contamination, Molecular Analysis, Blood is required to perform this test. See Additional Testing Requirements.
The following algorithms are available:
Method Name
A short description of the method used to perform the test
Inverse Shifting-Polymerase Chain Reaction (IS-PCR)
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
Hemophilia A
HA
Factor VIII gene
F8
Intron 22 inversion
Testing Algorithm
Delineates situations when tests are added to the initial order. This includes reflex and additional tests.
Maternal cell contamination testing will be performed for all cord blood specimens. A maternal whole blood sample with an order for MATCC / Maternal Cell Contamination, Molecular Analysis, Blood is required to perform this test. See Additional Testing Requirements.
The following algorithms are available:
Specimen Type
Describes the specimen type validated for testing
Whole blood
Ordering Guidance
If a familial variant has not been identified in a severely affected hemophilia A patient, order F8INV / Hemophilia A F8 Gene, Intron 1 and 22 Inversion Mutation Analysis, Whole Blood.
For evaluation of a patient with bleeding symptoms and no known personal history of a bleeding disorder consider ALBLD / Bleeding Diathesis Profile, Limited, Plasma or the specific factor assays.
Additional Testing Requirements
Due to the complexity of testing non-peripheral blood, consultation with the laboratory is required for all cord blood samples. Order this test on the cord blood specimen (only 1 specimen tube required) and order MATCC / Maternal Cell Contamination, Molecular Analysis, Blood on the maternal specimen.
Necessary Information
Hemophilia A Patient Information (T712) is required. Testing may proceed without the patient information, however, the information aids in providing a more thorough interpretation. Ordering providers are strongly encouraged to fill out the form and send with the specimen.
Specimen Required
Defines the optimal specimen required to perform the test and the preferred volume to complete testing
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:
Preferred: Lavender top (EDTA)
Acceptable: Yellow top (ACD) or blue top (3.2% sodium citrate)
Specimen Volume: 4 mL
Collection Instructions:
1. Invert several times to mix blood.
2. Send whole blood specimen in original tube. Do not aliquot.
Special Instructions
Library of PDFs including pertinent information and forms related to the test
Forms
1. Hemophilia A Patient Information (T712) is required.
2. 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)
3. If not ordering electronically, complete, print, and send a Coagulation Test Request (T753) 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
Reject Due To
Identifies specimen types and conditions that may cause the specimen to be rejected
| Gross hemolysis | OK |
| Gross lipemia | OK |
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 | Ambient (preferred) | 7 days | |
| Refrigerated | 7 days | ||
| Frozen | 7 days |
Useful For
Suggests clinical disorders or settings where the test may be helpful
First-tier molecular testing for male patients affected with severe hemophilia A, when a familial intron 22 inversion has been previously identified
Determining hemophilia A carrier status for at-risk female patients, ie, individuals with a family history of severe hemophilia A due to F8 intron 22 inversion
Genetics Test Information
Provides information that may help with selection of the correct genetic test or proper submission of the test request
This test detects the intron 22 inversion within the F8 gene. The intron 22 inversion variant accounts for approximately 45% of variants associated with severe hemophilia A.
Intron 22 inversion known variant analysis can only be performed for individuals when an intron 22 inversion has already been identified in the family. For testing options, see Ordering Guidance.
Testing Algorithm
Delineates situations when tests are added to the initial order. This includes reflex and additional tests.
Maternal cell contamination testing will be performed for all cord blood specimens. A maternal whole blood sample with an order for MATCC / Maternal Cell Contamination, Molecular Analysis, Blood is required to perform this test. See Additional Testing Requirements.
The following algorithms are available:
Clinical Information
Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
Hemophilia A (HA) is caused by a deficiency of clotting factor VIII (FVIII). HA is an X-linked recessive bleeding disorder that affects approximately 1 in 5000 male individuals. Male patients are typically affected with bleeding symptoms, whereas female carriers generally do not have bleeding symptoms but are at risk of having affected sons. Rarely, approximately 10% of female carriers have FVIII activity levels below 35% and are at risk for bleeding.
Bleeding, the most common clinical symptom in individuals with HA, correlates with FVIII activity levels. FVIII activity levels below 1% are associated with severe disease, 1% to 5% activity with moderate disease, and 5% to 40% with mild disease. In male patients with severe deficiency, spontaneous bleeding may occur. In individuals with mild HA, bleeding may occur only after surgery or trauma.
FVIII is encoded by the factor VIII (F8) gene. Approximately 98% of patients with a diagnosis of HA are found to have a variant in F8 (ie, intron 1 and 22 inversions, point mutations, insertions, and deletions). The intron 22 inversion variants account for approximately 45% of variants associated with severe HA. These inversions are typically not identified in patients with mild or moderate HA.
Intron 22 inversion known variant analysis is only recommended for individuals when an intron 22 inversion has already been identified in the family.
If a familial mutation has not been identified in a severely affected HA patient, the F8 gene intron 1 and 22 inversion analysis (F8INV / Hemophilia A F8 Gene, Intron 1 and 22 Inversion Mutation Analysis, Whole Blood) should be ordered.
If the intron 22 inversion analysis is negative, the tested individual has not inherited the familial mutation.
It is recommended that the F8 variant be confirmed in the affected male patient or obligate female carrier prior to testing at-risk individuals. Affected male patients are identified by FVIII activity (F8A / Coagulation Factor VIII Activity Assay, Plasma) and clinical evaluation, while obligate female carriers are identified by family history assessment. If the intron inversion assays do not detect an inversion in these individuals, additional analysis (ie, F8 sequencing) may be able to identify the familial variant. Of note, not all women with an affected son are germline carriers of a F8 variant, as de novo variants in F8 do occur. Approximately 20% of mothers of isolated cases do not have an identifiable germline F8 variant. Importantly, there is a small risk for recurrence even when the familial F8 variant is not identified in the mother of the affected patient due to the possibility of germline mosaicism.
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.
Interpretation
Provides information to assist in interpretation of the test results
The interpretive report will include assay information, background information, and conclusions based on the test results.
Cautions
Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
Obtaining a medical genetics or hematology (coagulation) consultation prior to ordering is advisable. Consultations with the Mayo Clinic Special Coagulation Clinic, Molecular Hematopathology Laboratory, or Thrombophilia Center are available for DNA diagnosis cases. This may be especially helpful in complex cases or in situations where the diagnosis is atypical or uncertain.
Intron 22 inversion known variant analysis is only recommended for individuals when an intron 22 inversion has already been identified in the family.
This assay detects only F8 intron 22 inversion variants. Thus, a negative result does not exclude the presence of other variants in F8.
The intron 22 inversion variant targeted by this assay is found in approximately 45% of individuals with severe hemophilia A; if an intron 22 inversion has not been already identified in the family, the assay may be uninformative.
Test results should be interpreted in the context of clinical findings, family history, and other laboratory data. Errors in the interpretation of results may occur if the information provided is inaccurate or incomplete.
Clinical Reference
Recommendations for in-depth reading of a clinical nature
1. Antonarakis SE, Rossiter JP, Young M, et al: Factor VIII gene inversions in severe hemophilia A: results of an international consortium study. Blood. 1995 Sep;86(6):2206-2212
2. Rossiter JP, Young M, Kimberland ML, et al: Factor VIII gene inversions causing severe hemophilia A originate almost exclusively in male germ cells. Hum Mol Genet. 1994 Jul;3(7):1035-1039
3. Castaldo G, D'Argenio V, Nardiello P, et al: Haemophilia A: molecular insights. Clin Chem Lab Med. 2007;45(4):450-461
4. Johnsen JM, Fletcher SN, Huston H, et al: Novel approach to genetic analysis and results in 3000 hemophilia patients enrolled in the My Life, Our Future initiative. Blood Adv. 2017 May;1(13):824-834. doi:10.1182/bloodadvances.2016002923
5. Pruthi RK: Hemophilia: A practical approach to genetic testing. Mayo Clin Proc. 2005 Nov;80(11):1485-1499
Method Description
Describes how the test is performed and provides a method-specific reference
Genomic DNA from whole blood or cord blood is digested with restriction enzyme, ligated with T4 DNA ligase, and amplified by polymerase chain reaction with primers specific for the F8 intron 22 inversion mutations.(Rosetti LC, Radic CP, Larripa IB, De Brasi CD: Developing a new generation of tests for genotyping hemophilia-causative rearrangements involving int22h and int1h hotspots in the factor VIII gene. J Thromb Haemost 2008;6:830-836; Meijer P, Verbruggen, Spannagi M: Clotting factors and inhibitors: Assays and interpretation. In: Kottke-Marchant K, ed. Laboratory Hematology Practice. Wiley Blackwell Publishing; 2012: 435-446)
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.
Weekly
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.
81403
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 |
|---|---|---|
| F822B | HA F8 Intron 22 Inversion KM, B | 91679-1 |
| 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.
|
|---|---|---|
| 35139 | HA F8 Int22 KM Reason for Referral | 42349-1 |
| 35007 | HA F8 Intron 22 Inversion KM, B | 91679-1 |
| 35008 | F822B Interpretation | 69047-9 |
| 35009 | HA F8 Int22 KM Reviewed By | 18771-6 |