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Test Id : HSMWB

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Hepatosplenomegaly Panel, Blood

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Overview

Test Catalog

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

As a component of the initial evaluation of a patient presenting with hepatosplenomegaly

 

This test is not useful for the identification of carriers.

 

This test should not be used as a monitoring for patients with confirmed diagnoses.

Highlights

This is a screening test for a select number of lysosomal and lipid storage disorders, including cerebrotendinous xanthomatosis, Gaucher disease, and Niemann-Pick disease types A, B (also known as acid sphingomyelinase deficiency), and C.

 

The above conditions may all have hepatosplenomegaly as a presenting sign, making this test a helpful component of a patient's initial evaluation.

 

Although Fabry disease does not have hepatosplenomegaly as a clinical symptom, it can be identified by this assay as the compound, globotriaosylsphingosine, is detected.

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

Hepatosplenomegaly Panel, B

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

Acid Schingomyelinase Deficiency

ASM Deficiency

Niemann-Pick type A

Niemann-Pick type B

Niemann-Pick type C

Cerebral cholesterinosis

Cerebrotendinous cholesterosis

Van Bogaert-Scherer-Epstein syndrome

Sterol 27-hydrolase deficiency

Ketosterols

Beta glucosidase deficiency

Fabry disease

ASMD

Specimen Type
Describes the specimen type validated for testing

Whole blood

Ordering Guidance

This test should not be used for monitoring patients with confirmed diagnoses. If the testing requested is for monitoring purposes, see:

-CTXWB / Cerebrotendinous Xanthomatosis, Blood

-GPSYW / Glucopsychosine, Blood

-OXYWB / Oxysterols, Blood

 

This test's clinical sensitivity and specificity for the identification of Niemann-Pick type C (NPC) is 75% and 89%, respectively. If NPC is strongly suspected, the recommended test is HSMP / Hepatosplenomegaly Panel, Plasma.

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

Collection Container/Tube:

Preferred: Lavender top (EDTA)

Acceptable: Green top (sodium heparin, lithium heparin), yellow top (ACD B)

Specimen Volume: 1 mL

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

Forms

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

0.25 mL

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

Gross hemolysis OK
Gross lipemia OK
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 Refrigerated (preferred) 72 hours
Ambient 48 hours

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

As a component of the initial evaluation of a patient presenting with hepatosplenomegaly

 

This test is not useful for the identification of carriers.

 

This test should not be used as a monitoring for patients with confirmed diagnoses.

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

Hepatosplenomegaly is a presenting or accompanying feature for many different inborn errors of metabolism. It typically is a consequence of chronic hepatic dysfunction or abnormal storage of lipids, sugars, or other improperly metabolized analytes due to a particular enzymatic deficiency. The diagnosis can occasionally be narrowed down by consideration of clinical symptoms; however, clinical diagnosis can be difficult due to similarity of clinical features across disorders as well as phenotypic variability. Therefore, screening tests can play an important role in the workup of a patient presenting with hepatosplenomegaly who may have a lysosomal or lipid storage disorder.

 

The conditions detected in this assay are cerebrotendinous xanthomatosis, Gaucher disease, and Niemann-Pick (NP) disease types A, B (also known as acid sphingomyelinase deficiency), and, with a lower sensitivity and specificity, NPC.

 

Patients with abnormal results should have follow-up enzymatic or molecular testing for confirmation of diagnosis.

 

Table. Conditions Identifiable by Method

Disorder

Onset

Analyte detected

Gene

Incidence

Cerebrotendinous xanthomatosis (CTX) 

Infancy - adulthood

7-Alpha-hydroxy-4-cholesten-3-one (7aC4)

7-Alpha,12-aplha-dihydroxycholest-4-en-3-one (12aC4)

CYP27A1

1 in 50,000

As high as 1 in 400 in Druze population.

Phenotype: Early onset diarrhea, cataracts, tendon/cerebral xanthomas, osteoporosis, neuropsychological manifestations, liver disease/hepatosplenomegaly.

Gaucher disease

Type I: childhood/adult

Types II/III: neonatal-early childhood

Glucopsychosine (GPSY)

GBA

Type I:

1 in 30,000 to 1 in 100,000

Types II/III:

1 in 100,000

Phenotype: All types exhibit hepatosplenomegaly and hematological abnormalities.

Type I: Organomegaly, thrombocytopenia, and bone pain. Absence of neurologic symptoms.

Types II/III: Primary neurologic disease, developmental delay/regression, hepatosplenomegaly, lung disease. Patients with type II typically die by 2 to 4 years of age. Patients with type III may have a less progressive phenotype and may survive into adulthood.

Niemann-Pick type

A/B (NPA, NPB)

NPA: neonatal

NPB: birth-adulthood

Lyso-sphingomyelin (LSM)

LSM 509

SMPD1

Combined incidence

1 in 250,000

Phenotype:

NPA: Feeding difficulties, jaundice, hepatosplenomegaly, neurologic deterioration, lung disease, hearing and vision impairment, cherry red macula, death usually by 3 years of age.

NPB: Mainly limited to visceral symptoms; hepatosplenomegaly, stable liver dysfunction, pulmonary compromise, osteopenia.

Niemann-Pick type C (NPC)

Variable

(perinatal-adulthood)

Cholestane-3 beta, 5 alpha, 6 beta-triol (COT)

LSM 509

NPC1 or NPC2

1 in 120,000 to 1 in 150,000

Phenotype: Variable clinical presentation; ataxia, vertical supranuclear gaze palsy, dystonia, progressive speech deterioration, seizures, +/- hepatosplenomegaly.

 

Patients with Fabry disease may also be identified by this assay. The glycosphingolipid, globotriaosylsphingosine (LGb3), may be elevated in symptomatic patients and supports a diagnosis of Fabry disease. Normal values of LGb3 do not rule out Fabry disease. Patients with Fabry disease do not have hepatosplenomegaly as an accompanying feature.

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.

CHOLESTANE-3-BETA,5-ALPHA,6-BETA-TRIOL

Cutoff: < or =0.800 nmol/mL

 

LYSO-SPHINGOMYELIN

Cutoff: < or =0.100 nmol/mL

 

GLUCOPSYCHOSINE

Cutoff: < or =0.040 nmol/mL

 

7-ALPHA-HYDROXY-4-CHOLESTEN-3-ONE (7aC4)

Cutoff: < or =0.750 nmol/mL

 

7-ALPHA,12-ALPAH-DIHYDROXYCHOLEST-4-en-3-ONE (12aC4)

Cutoff: < or =0.250 nmol/mL

 

GLOBOTRIAOSYLSPHINGOSINE

Cutoff: < or =0.034 nmol/mL

Interpretation
Provides information to assist in interpretation of the test results

An elevation of 7-alpha-hydroxy-4-cholesten-3-one (7aC4) and 7-alpha,12-alpha-dihydroxycholest-4-en-3-one (12aC4) is strongly suggestive of cerebrotendinous xanthomatosis.

 

An elevation of lyso-sphingomyelin (LSM) and LSM 509 is highly suggestive of Niemann-Pick type A or B disease.

 

An elevation of cholestane-3 beta, 5 alpha, 6 beta-triol and LSM 509 is highly suggestive of Niemann-Pick disease type C.

 

An elevation of glucopsychosine is indicative of Gaucher disease.

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

Patients with Wolman disease or cholestatic biliary atresia may have a profile similar to Niemann-Pick disease type C.

 

Patients with bile acid malabsorption or ileal resection may have elevations of 7-alpha-hydroxy-4-cholesten-3-one (7aC4).

 

This test does not identify all causes of hepatosplenomegaly.

 

A positive test result is strongly suggestive of a diagnosis but needs follow-up by stand-alone biochemical or molecular assay.

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

1. DeBarber AE, Luo J, Star-Weinstock M, et al: A blood test for cerebrotendinous xanthomatosis with potential for disease detection in newborns. J Lipid Res. 2014;55:146-154

2. Federico A, Dotti MT, Gallus GN: Cerebrotendinous xanthomatosis. In: Adam MP, Everman DB, Mirzaa GM, et al, eds. GeneReviews [Internet]. University of Washington, Seattle; 2003. Updated April 14, 2016. Accessed December 14, 2022. Available at www.ncbi.nlm.nih.gov/books/NBK1409/

3. Grabowski GA, Petsko GA, Kolodny EH: Gaucher disease. In: Valle DL, Antonarakis S, Ballabio A, Beaudet AL, Mitchell GA. eds. The Online Metabolic and Molecular Bases of Inherited Disease. McGraw-Hill; 2019. Accessed December 14, 2022. Available at https://ommbid.mhmedical.com/content.aspx?sectionid=225546056&bookid=2709

4. Murugeasan V, Chuan WL, Liu J, et al: Glucosylsphingosine is a key biomarker of Gaucher disease. Am J Hematol. 2016;91(11):1082-1089

5. Wasserstein MP, Schuchman EH. Acid sphingomyelinase deficiency. In: Adam MP, Everman DB, Mirzaa GM, et al., eds. GeneReviews [Internet]. University of Washington, Seattle; 2006. Updated February 25, 2021. Accessed December 14, 2022. Available at www.ncbi.nlm.nih.gov/books/NBK1370/.

6. Wasserstein M, Dionisi-Vici C, Giugliani R, Hwu WL, Lidove O, Lukacs Z, Mengel E, Mistry PK, Schuchman EH, McGovern M. Recommendations for clinical monitoring of patients with acid sphingomyelinase deficiency (ASMD). Mol Genet Metab. 2019 Feb;126(2):98-105

7. Patterson M: Niemann-Pick disease type C. In: Adam MP, Everman DB, Mirzaa GM, et al, eds. GeneReviews [Internet]. University of Washington, Seattle; 2000. Updated December 10, 2020. Accessed December 14, 2022. Available at www.ncbi.nlm.nih.gov/books/NBK1296/

8. Geberhiwot T, Moro A, Dardis A, et al; International Niemann-Pick Disease Registry (INPDR): Consensus clinical management guidelines for Niemann-Pick disease type C. Orphanet J Rare Dis. 2018 Apr 6;13(1):50. doi: 10.1186/s13023-018-0785-7

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

Whole blood is spotted on filter paper and dried overnight. A 3-mm dried blood spot is extracted with internal standard. The extract is subjected to liquid chromatography tandem mass spectrometry (LC-MS/MS) analysis. The MS/MS is operated in the multiple reaction monitoring positive mode to follow the precursor to product species transitions for each analyte and internal standard. The ratio of the extracted peak areas to internal standard determined by the LC-MS/MS is used to calculate the concentration of in the sample.(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.

Tuesday

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 9 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: 7 days; Dried blood spot: Normal results: 2 months; Abnormal result: Indefinitely

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

Rochester

Fees
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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.

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
HSMWB Hepatosplenomegaly Panel, B 92744-2
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.
601534 Interpretation (HSMWB) 59462-2
601528 Cholestane-3beta,5alpha,6beta-triol 92756-6
601529 Lyso-sphingomyelin 92748-3
601530 Glucopsychosine 92751-7
601531 7a-hydroxy-4-cholesten-3-one 92762-4
601532 7a,12a-dihydroxycholest-4-en-3-one 92759-0
601533 Globotriaosylsphingosine 92753-3
601535 Reviewed By 18771-6

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Sample Reports
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Normal Reports | Abnormal Reports

SI Sample Reports
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