Test Id : BAFS
Bile Acids, Fractionated and Total, Serum
Useful For
Suggests clinical disorders or settings where the test may be helpful
Measuring tauro- and glycol-conjugated and unconjugated bile acid constituents in serum specimens
Monitoring patients receiving bile acid therapy, such as cholic acid, deoxycholic acid, or ursodeoxycholic acid
Aiding in the evaluation of liver function; evaluation of liver function changes before the formation of more advanced clinical signs of illness such as icterus
Determining hepatic dysfunction as a result of chemical and environmental injury
Indicating hepatic histological improvement in chronic hepatitis C patients responding to interferon treatment
Indicating intrahepatic cholestasis of pregnancy
This assay is not useful for the diagnosis of peroxisomal biogenesis disorders or inborn errors of bile acid metabolism.
Highlights
Bile acids are elevated in individuals with liver dysfunction.
This bile acid test can be used in the diagnosis of intrahepatic cholestasis of pregnancy.
Fractionated bile acids, including tauro- and glycol-conjugates of cholic acid, chenodeoxycholic acid, deoxycholic acid, and ursodeoxycholic acid are individually summed and reported.
Testing Algorithm
Delineates situations when tests are added to the initial order. This includes reflex and additional tests.
For information see Bile Acid-Associated Tests Ordering Guide
Method Name
A short description of the method used to perform the test
Liquid Chromatography Tandem Mass Spectrometry (LC-MS/MS)
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
Bile Acid
Total Bile acids
Fractionated bile acids
Testing Algorithm
Delineates situations when tests are added to the initial order. This includes reflex and additional tests.
For information see Bile Acid-Associated Tests Ordering Guide
Specimen Type
Describes the specimen type validated for testing
Serum
Ordering Guidance
This test is useful in diagnosing intrahepatic cholestasis of pregnancy and does not support the assessment of either peroxisomal biogenesis disorders or inborn errors of bile acid metabolism.
For diagnostic testing for peroxisomal biogenesis disorders, order BAIPD / Bile Acids for Peroxisomal Disorders, Serum.
Specimen Required
Defines the optimal specimen required to perform the test and the preferred volume to complete testing
Patient Preparation:
Fasting: 12 to 14 hours, required
Supplies: Sarstedt Aliquot Tube, 5 mL (T914)
Collection Container/Tube:
Preferred: Serum gel
Acceptable: Red top
Submission Container/Tube: Plastic vial
Specimen Volume: 0.5 mL
Collection Instructions: Centrifuge and aliquot serum into a plastic vial.
Special Instructions
Library of PDFs including pertinent information and forms related to the test
Forms
If not ordering electronically, complete, print, and send a Gastroenterology and Hepatology Test Request (T728) 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.
0.3 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 |
|---|---|---|---|
| Serum | Refrigerated (preferred) | 90 days | |
| Ambient | 90 days | ||
| Frozen | 90 days |
Useful For
Suggests clinical disorders or settings where the test may be helpful
Measuring tauro- and glycol-conjugated and unconjugated bile acid constituents in serum specimens
Monitoring patients receiving bile acid therapy, such as cholic acid, deoxycholic acid, or ursodeoxycholic acid
Aiding in the evaluation of liver function; evaluation of liver function changes before the formation of more advanced clinical signs of illness such as icterus
Determining hepatic dysfunction as a result of chemical and environmental injury
Indicating hepatic histological improvement in chronic hepatitis C patients responding to interferon treatment
Indicating intrahepatic cholestasis of pregnancy
This assay is not useful for the diagnosis of peroxisomal biogenesis disorders or inborn errors of bile acid metabolism.
Testing Algorithm
Delineates situations when tests are added to the initial order. This includes reflex and additional tests.
For information see Bile Acid-Associated Tests Ordering Guide
Clinical Information
Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
Bile acids are formed in the liver from cholesterol, conjugated primarily to glycine and taurine, stored and concentrated in the gallbladder, and secreted into the intestine after the ingestion of a meal. In the intestinal lumen, the bile acids serve to emulsify ingested fats to promote digestion. During the absorptive phase of digestion, approximately 90% of the bile acids are reabsorbed.
The efficiency of the hepatic clearance of bile acids from portal blood maintains serum concentrations at low levels in normal persons. An elevated fasting level of bile acids due to impaired hepatic clearance is a sensitive indicator of liver disease. Following meals, serum bile acid levels have been shown to increase only slightly in normal persons, but they are markedly elevated in patients with various liver diseases, including cirrhosis, hepatitis, cholestasis, portal-vein thrombosis, Budd-Chiari syndrome, cholangitis, Wilson disease, and hemochromatosis. No increase in bile acids will be noted in patients with intestinal malabsorption. Metabolic hepatic disorders involving organic anions (eg, Gilbert disease, Crigler-Najjar syndrome, and Dubin-Johnson syndrome) do not cause abnormal serum bile acid concentrations.
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.
Total cholic acid: < or =5.00 nmol/mL
Total chenodeoxycholic acid: < or =6.00 nmol/mL
Total deoxycholic acid: < or =6.00 nmol/mL
Total ursodeoxycholic acid: < or =2.00 nmol/mL
Total bile acids: < or =19.00 nmol/mL
Interpretation
Provides information to assist in interpretation of the test results
Total bile acids are metabolized in the liver and can serve as a marker for normal liver function. Increases in serum bile acids are seen in patients with acute hepatitis, chronic hepatitis, liver sclerosis, liver cancer, and intrahepatic cholestasis of pregnancy.
Cautions
Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
This test does not measure sulfated bile acids.
Clinical Reference
Recommendations for in-depth reading of a clinical nature
1. Marschall HU. Management of intrahepatic cholestasis of pregnancy. Expert Rev Gastroenterol Hepatol. 2015;9(10):1273-1279
2. Ducroq DH, Morton MS, Shadi N, et al. Analysis of serum bile acids by isotope dilution-mass spectrometry to assess the performance of routine total bile acid methods. Ann Clin Biochem. 2010;47(Pt 6):535-540
3. Piechota J, Jelski W. Intrahepatic cholestasis in pregnancy: Review of the literature. J Clin Med. 2020;9(5):1361. doi:10.3390/jcm9051361
4. Society for Maternal-Fetal Medicine (SMFM). Lee RH, Mara Greenberg, Metz TD, Pettker CM. Society for Maternal-Fetal Medicine Consult Series #53: Intrahepatic cholestasis of pregnancy: replaces consult #13, April 2011. Am J Obstet Gynecol. 2021;224(2):B2-B9. doi:10.1016/j.ajog.2020.11.002
Method Description
Describes how the test is performed and provides a method-specific reference
Bile acid concentrations in serum are measured by liquid chromatography tandem mass spectrometry stable isotope dilution analysis. Serum is mixed with isotopically labeled internal standards of selected bile acids and then subjected to protein precipitation. Sample preparation is semi-automated using a liquid handler. Reverse-phase liquid chromatography is performed using mobile phases to separate free bile acids, their respective tauro- and glyco-conjugates, and 2 bile acid precursors.(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.
Monday through 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.
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.
82542
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 |
|---|---|---|
| BAFS | Bile Acids, Fractionated and Tot, S | 43130-4 |
| 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.
|
|---|---|---|
| 35796 | Total Cholic acid | 30518-5 |
| 35797 | Total Chenodeoxycholic acid | 30519-3 |
| 35798 | Total Deoxycholic acid | 30520-1 |
| 35799 | Total Ursodeoxycholic acid | 55159-8 |
| 35800 | Total bile acids | 14628-2 |