Test Catalog

Test Id : TYRBS

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Tyrosinemia Follow Up Panel, Blood Spot

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Overview

Test Catalog

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

Monitoring of individuals with tyrosinemia type 1 (HT-1)

 

Diagnosis of HT-1 when used in conjunction with testing for urine organic acids, liver function, alpha-fetoprotein, and molecular genetic analysis of the fumarylacetoacetate hydrolase (FAH) gene

Genetics Test Information
Provides information that may help with selection of the correct genetic test or proper submission of the test request

This test assists in the diagnosis of tyrosinemia type 1 (HT-1) and monitoring of the effectiveness of 2-[2-nitro-4-trifluoromethylbenzoyl]-1,3-cycohexanedione (NTBC; nitisinone) and dietary therapy in patients with HT-1.

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

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.

Yes

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

Tyrosinemia Follow Up Panel, BS

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

Hereditary tyrosinemia, type I

HT-1

Tyr-1

Tyr type 1

Hepatorenal tyrosinemia

NTBC

Nitisinone

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

Specimen Type
Describes the specimen type validated for testing

Whole blood

Necessary Information

Patient's age and reason for testing are required.

ORDER QUESTIONS AND ANSWERS

Question ID Description Answers
BG722 Reason for Referral Follow up of a known patient
Rule out Tyrosinemia Type I
Monitoring of treatment
Follow up of an abnormal newborn screen.

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

Submit only 1 of the following specimen types:

 

Preferred:

Specimen Type: Blood spot

Supplies: Card-Blood Spot Collection (Filter Paper) (T493)

Container/Tube:

Preferred: Blood Spot Collection Card

Acceptable: Whatman Protein Saver 903 Paper, PerkinElmer 226 filter paper, Munktell filter paper, or blood collected in tubes containing EDTA and dried on filter paper

Specimen Volume: 2 Blood spots

Collection Instructions:

1. An alternative blood collection option for a patient older than 1 year is a fingerstick. For detailed instructions, see How to Collect Dried Blood Spot Samples.

2. At least 2 spots should be complete (ie, unpunched).

3. Let blood dry on filter paper at room temperature in a horizontal position for a minimum of 3 hours.

4. Do not expose specimen to heat or direct sunlight.

5. Do not stack wet specimens.

6. Keep specimen dry.

Specimen Stability Information: Ambient (preferred) 7 days/Refrigerated 14 days/Frozen 90 days

Additional Information:

1. For collection instructions, see Blood Spot Collection Instructions

2. For collection instructions in Spanish, see Blood Spot Collection Card-Spanish Instructions (T777)

3. For collection instructions in Chinese, see Blood Spot Collection Card-Chinese Instructions (T800)

 

Acceptable:

Specimen Type: Whole blood

Container/Tube: Lavender top (EDTA)

Specimen Volume: 2 mL

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

Specimen Stability Information: Refrigerate 6 days

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

Blood Spots: 1

Whole Blood: 0.5 mL

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

Blood spot specimen that shows serum rings or has multiple layers Reject
Insufficient specimen Reject
Unapproved filter papers 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
Whole blood Varies

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

Monitoring of individuals with tyrosinemia type 1 (HT-1)

 

Diagnosis of HT-1 when used in conjunction with testing for urine organic acids, liver function, alpha-fetoprotein, and molecular genetic analysis of the fumarylacetoacetate hydrolase (FAH) gene

Genetics Test Information
Provides information that may help with selection of the correct genetic test or proper submission of the test request

This test assists in the diagnosis of tyrosinemia type 1 (HT-1) and monitoring of the effectiveness of 2-[2-nitro-4-trifluoromethylbenzoyl]-1,3-cycohexanedione (NTBC; nitisinone) and dietary therapy in patients with HT-1.

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

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

Tyrosinemia type 1 (hepatorenal tyrosinemia, HT-1) is an autosomal recessive condition caused by a deficiency of the enzyme fumarylacetoacetate hydrolase. HT-1 primarily affects the liver, kidneys, and peripheral nerves causing severe liver disease, renal tubular dysfunction, and neurologic crises. If left untreated, most patients die of liver failure in the first years of life, and all are at risk of developing hepatocellular carcinoma (HCC). The incidence of HT-1 is approximately 1 in 100,000 live births.

 

Affected individuals can show a partial response to dietary restriction of phenylalanine and tyrosine, but dietary treatment in conjunction with the administration of 2-(2-nitro-4-trifluoromethylbenzoyl)-1,3 cyclohexanedione (NTBC; nitisinone), an inhibitor of the proximal tyrosinemia pathway, is very effective when initiated in newborns. Outcome data are promising, and to date, newborn patients treated with NTBC have not developed acute liver disease, neurologic crises, or HCC.

 

According to treatment guidelines established in 2017, monitoring of blood NTBC concentration and succinylacetone (SUAC) levels along with measuring the dietary intake of amino acids, including tyrosine and phenylalanine are part of an individualized surveillance plan for patients with HT-1.(1) Monthly analysis of SUAC, NTBC concentration, and amino acids is suggested for the first year of life with the same compounds being monitored every 3 months to age 5 years and every 6 months thereafter.

 

The analytes encompassed in this assay satisfy the recommendations for diagnosis and monitoring of HT-1. In particular, for NTBC, the current guidelines recommend 40 nmol/mL to 60 nmol/mL plasma concentration, which corresponds to a target range for NTBC in dried blood spots of 17 nmol/mL to 26 nmol/mL based on a blood to plasma conversion factor of 2.34.(2)

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.

TYROSINE:

<4 weeks 40-280 nmol/mL

> or =4 weeks 25-150 nmol/mL

 

PHENYLALANINE:

27-107 nmol/mL

 

METHIONINE

11-45 nmol/mL

 

SUCCINYLACETONE:

< or =1.0 nmol/mL

 

NITISINONE:

< or =0.5 nmol/mL

Interpretation
Provides information to assist in interpretation of the test results

Quantitative results with reference values are reported without added interpretation. When applicable, reports of abnormal results may contain an interpretation based on available clinical information.

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

Bornaprine (Sormodrem) may, at least in theory, interfere with accurate measurement of 2-(2-nitro-4-trifluoromethylbenzoyl)-1,3 cyclohexanedione (NTBC, nitisinone).

 

In rare cases of tyrosinemia type 1, tyrosine or succinylacetone may not be elevated (3).

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

1. Chinsky JM, Singh R, Ficiciolglu C, et al. Diagnosis and treatment of tyrosinemia type I: a US and Canadian consensus group review and recommendations. Genet Med. 2017;19(12). doi:10.1038/gim.2017.101

2. Laeremans H, Turner C, Andersson T, et al. Inter-laboratory analytical improvement of succinylacetone and nitisinone quantification from dried blood spot samples. JIMD Rep. 2020;53(1):90-102

3. Blackburn PR, Hickey RD, Nace RA, et al. Silent tyrosinemia type I without elevated tyrosine or succinylacetone associated with liver cirrhosis and hepatocellular carcinoma. Hum Mutat. 2016;37(10):1097-1105. doi:10.1002/humu.23047

4. Sniderman King L, Trahms C, Scott CR: Tyrosinemia Type I. In: Adam MP, Feldman J, Mirzaa GM, et al, eds: GeneReviews [Internet]. University of Washington, Seattle; 2006. Updated May 25, 2017. Accessed December 26, 2023. Available at: www.ncbi.nlm.nih.gov/books/NBK1515/

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

A 3-mm disk is punched out of the dried blood spot into a 96-well plate. The amino acids and nitisinone are extracted by the addition of acetonitrile and known concentrations of isotopically labeled amino acids as internal standards. The extract is moved to another 96-well plate, dried under a stream of nitrogen, and derivatized by the addition of n-butanol hydrochloric acid. Analytes are measured by liquid chromatography tandem mass spectrometry. The concentrations of the analytes are established by computerized comparison of ion intensities of these analytes to that of the respective internal standards.(Unpublished Mayo method)

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 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.

3 to 5 days

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

1 year

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.

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  • 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.

84510

84030

82542

80299

82131

82542 only (if appropriate for government payers)

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
TYRBS Tyrosinemia Follow Up Panel, BS 94573-3
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.
607553 Tyrosine 35571-9
607554 Phenylalanine 29573-3
607555 Methionine 47700-0
607556 Succinylacetone 53231-7
607557 Nitisinone 85098-2
607552 Reviewed By 18771-6
BG722 Reason for Referral 42349-1

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 | PHP Pdf | CMS 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