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Test Id : LRBA

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Lipopolysaccharide-Responsive Beige-Like Anchor Protein (LRBA) Deficiency, Blood

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Overview

Test Catalog

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

Aiding in the diagnosis of lipopolysaccharide-responsive beige-like anchor protein (LRBA) deficiency

 

This test is not useful for identifying a carrier status for LRBA deficiency.

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

The human lipopolysaccharide-responsive beige-like anchor protein (LRBA) gene is on chromosome 4.

 

Assessment of 109 patients with LRBA deficiency has shown 93 homozygous and 16 compound heterozygous alterations in the gene.

 

Alterations in the LRBA gene have been observed throughout the length of the gene and include the following main categories: Nonsense; missense; insertions, deletions, indels, and splice site alterations.

Highlights

The test determines the percentage and intensity of expression of lipopolysaccharide-responsive beige-like anchor (LRBA) protein on T cells and B cells in peripheral blood.

 

It can be used as a screening step prior to genetic testing for LRBA; to confirm the finding of an established disease-causing alteration in LRBA at the protein level; and to examine the effect of reported genetic variants of undetermined significance on LRBA protein expression.

 

It can help distinguish LRBA deficiency from conditions with overlapping clinical manifestations, including immune dysregulation and autoimmunity, such as immune dysregulation, polyendocrinopathy, enteropathy, X-linked (IPEX)-like syndromes; early onset hypogammaglobulinemia; common variable immune deficiency; inflammatory bowel disease; and autoimmune lymphoproliferative syndrome.

Method Name
A short description of the method used to perform the test

Flow Cytometry

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

LRBA Deficiency, B

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

LPS-Responsive Beige-Like Anchor Protein

LRBA

LRBA Deficiency

Specimen Type
Describes the specimen type validated for testing

Whole Blood EDTA

Ordering Guidance

This flow cytometry test is complementary to genetic testing.

Shipping Instructions

Specimens are required to be received in the laboratory weekdays and by 4 p.m. on Friday. Collect and package specimen as close to shipping time as possible.

 

It is recommended that specimens arrive within 24 hours of collection.

 

Samples arriving on the weekend and observed holidays may be canceled.

Necessary Information

Ordering physician name and phone number are required.

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

Container/Tube: Lavender top (EDTA)

Specimen Volume: 3 mL

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

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

1 mL

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

Gross hemolysis Reject
Gross lipemia Reject
Gross icterus 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 EDTA Ambient 48 hours PURPLE OR PINK TOP/EDTA

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

Aiding in the diagnosis of lipopolysaccharide-responsive beige-like anchor protein (LRBA) deficiency

 

This test is not useful for identifying a carrier status for LRBA deficiency.

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

The human lipopolysaccharide-responsive beige-like anchor protein (LRBA) gene is on chromosome 4.

 

Assessment of 109 patients with LRBA deficiency has shown 93 homozygous and 16 compound heterozygous alterations in the gene.

 

Alterations in the LRBA gene have been observed throughout the length of the gene and include the following main categories: Nonsense; missense; insertions, deletions, indels, and splice site alterations.

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

Lipopolysaccharide-responsive beige-like anchor protein (LRBA) deficiency is a rare autosomal recessive primary immunodeficiency disease (also known as inborn errors of immunity) caused by homozygous or compound heterozygous loss-of-function variants in the LRBA gene. It has a wide spectrum of clinical manifestations, including immune dysregulation and autoimmunity, inflammatory bowel disease, early-onset hypogammaglobulinemia, recurrent infections and organomegaly.

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.

The appropriate reference values will be provided on the report.

Interpretation
Provides information to assist in interpretation of the test results

The results are reported as the percentage and MFI (mean fluorescence intensity) of lipopolysaccharide-responsive beige-like anchor protein (LRBA) expression in T cells and B cells.

 

The majority of genetically confirmed cases of LRBA deficiency led to the absence of LRBA expression. Therefore, the lack of LRBA expression in T and B cells is consistent with LRBA deficiency. In this case, genetic analysis of LRBA to confirm the diagnosis and to identify the underlying variant will be recommended.

 

In addition, there are reported cases of LRBA deficiency where the protein is expressed but at lower intensity. Therefore, the expression of LRBA at diminished intensity could be due to a disease-causing LRBA variant, which would have to be confirmed or ruled out by genetic and functional analysis.

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

No significant cautionary statements

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

1. Lopez-Herrera G, Tampella G, Pan-Hammarstrom Q, et al: Deleterious mutations in LRBA are associated with a syndrome of immune deficiency and autoimmunity. Am J Hum Genet. 2012 Jun 8;90(6):986-1001

2. Gamez-Diaz L, August D, Stepensky P, et al: The extended phenotype of LPS-responsive beige-like anchor protein (LRBA) deficiency. J Allergy Clin Immunol. 2016 Jan;137(1):223-230

3. Habibi S, Zaki-Dizaji M, Rafiemanesh H, et al: Clinical, Immunologic, and Molecular Spectrum of Patients with LPS-Responsive Beige-Like Anchor Protein Deficiency: A Systematic Review. J Allergy Clin Immunol Pract. 2019 Sep-Oct;7(7):2379-86.e5

4. Serwas NK, Kansu A, Santos-Valente E, et al: Atypical manifestation of LRBA deficiency with predominant IBD-like phenotype. Inflamm Bowel Dis. 2015 Jan;21(1):40-47

5. Revel-Vilk S, Fischer U, Keller B, et al: Autoimmune lymphoproliferative syndrome-like disease in patients with LRBA mutation. Clin Immunol. 2015 Jul;159(1):84-92

6. Kiykim A, Ogulur I, Dursun E, et al: Abatacept as a Long-Term Targeted Therapy for LRBA Deficiency. J Allergy Clin Immunol Pract. 2019 Nov-Dec;7(8):2790-2800.e15

7. Tesch VK, Abolhassani H, Shadur B, et al: Long-term outcome of LRBA deficiency in 76 patients after various treatment modalities as evaluated by the immune deficiency and dysregulation activity (IDDA) score. J Allergy Clin Immunol. 2020 May;145(5):1452-1463

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

The lipopolysaccharide-responsive beige-like anchor (LRBA) protein expression assay is performed on EDTA whole blood. Samples are fixed, permeabilized and stained with antibodies specific for CD45, CD14, CD19, CD3, and CD56 along with either the LRBA antibody (unconjugated) or isotype control (unconjugated). A secondary reporter antibody is added to allow the assessment of LRBA and isotype control expression. Samples are then analyzed on a flow cytometer. LRBA expression is evaluated on the following populations: T-cells: (CD45+CD14negCD3+) and B-cells: (CD45+CD14negCD3negCD19+).(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.

2 to 4 days

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

4 days

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.

  • 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 using an analyte specific reagent. Its performance characteristics were 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.

86356 x 2

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
LRBA LRBA Deficiency, B In Process
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.
608960 %CD3+LRBA+ In Process
608964 MFI CD3+LRBA+ In Process
608961 %CD19+LRBA+ In Process
608965 MFI CD19+LRBA+ In Process
608968 LRBA Interpretation 69052-9

Test Setup Resources

Setup Files
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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