Test Catalog

Test Id : UPGC

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Uroporphyrinogen III Synthase (Co-Synthase), Erythrocytes

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Overview

Test Catalog

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

Diagnosis of congenital erythropoietic porphyria

 

This test is not useful for diagnosis of acute intermittent porphyria (AIP).

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

This test is not appropriate for assessment of acute abdominal pain.

Highlights

Congenital erythropoietic porphyria (CEP) is a disease usually seen in pediatric patients.

 

In our testing experience over the last 10 years, fewer than 5 adult patients have been diagnosed with CEP associated with a myelodysplastic syndrome.

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

High-Performance Liquid Chromatography (HPLC)

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

Uroporphyrinogen III Synthase, RBC

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

Congenital Erythropoietic Porphyria (CEP)

Congenital Porphyria

Erythropoietic Uroporphyria

Uroporphyrinogen III Co-synthase

Uroporphyrinogen III Synthase

Gunther Disease

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

WB Heparin

Ordering Guidance

This test is most appropriately used for pediatric patients.

 

This test measures uroporphyrinogen (UPG) III synthase to confirm congenital erythropoietic porphyria, which is typically seen in early infancy. It does not measure UPG I synthase (also known as porphobilinogen deaminase), the enzyme deficient in acute intermittent porphyria (AIP). For AIP (and UPG I synthase), order PBGD_ / Porphobilinogen Deaminase, Whole Blood.

Necessary Information

1. Include a list of medications the patient is currently taking.

2. Date of transfusion, if performed

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

All porphyrin tests on erythrocytes can be performed on one collection tube.

 

Patient Preparation: Patient should abstain from alcohol for 24 hours prior to specimen collection.

Container/Tube: Green top (sodium or lithium heparin)

Specimen Volume: 4 mL

Collection Instructions: Immediately place specimen on wet ice.

Special Instructions
Library of PDFs including pertinent information and forms related to the test

Forms

1. 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)

2. If not ordering electronically, complete, print, and send a Biochemical Genetics Test Request (T798) with the specimen.

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

3 mL

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

Gross hemolysis 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
WB Heparin Refrigerated 7 days

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

Diagnosis of congenital erythropoietic porphyria

 

This test is not useful for diagnosis of acute intermittent porphyria (AIP).

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

This test is not appropriate for assessment of acute abdominal pain.

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

The porphyrias are a group of inherited disorders resulting from enzyme defects in the heme biosynthetic pathway. Congenital erythropoietic porphyria (CEP) is an extremely rare, autosomal recessive porphyria that typically presents in early infancy. Also known as Gunther disease, CEP results from a deficiency of uroporphyrinogen III (co-) synthase (UROIIIS). In most cases, the disorder is suggested during the first few days or weeks of life by pink, violet, or brown urinary staining of diapers. Clinical symptoms include hemolytic anemia, hepatosplenomegaly, skin photosensitivity, scarring and blistering, red or brown dental discoloration (erythrodontia), and hypertrichosis (excess body hair). Growth and cognitive developmental delays are commonly observed in individuals with CEP. A few cases of adult-onset CEP have been reported, typically associated with a myelodysplastic syndrome.

 

The workup of patients with a suspected porphyria is most effective when following a stepwise approach. Molecular confirmatory testing is available on a clinical basis; order CGPH / Custom Gene Panel, Hereditary, Next-Generation Sequencing, Varies; specify UROS Gene List ID: IEMCP-8W4945. See Porphyria (Cutaneous) Testing Algorithm or call 800-533-1710 to discuss testing strategies.

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.

> or =75 Relative Units (normal)

 

See The Heme Biosynthetic Pathway

Interpretation
Provides information to assist in interpretation of the test results

Abnormal results are reported with a detailed interpretation that may include an overview of the results and their significance, a correlation to available clinical information provided with the specimen, differential diagnosis, recommendations for additional testing when indicated and available, and a phone number to reach a laboratory director in case the referring physician has additional questions.

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

This test is not useful for ruling out acute intermittent porphyria (AIP), a disorder caused by decreased uroporphyrinogen I synthase (also known as porphobilinogen deaminase). For AIP, order PBGD_ / Porphobilinogen Deaminase, Whole Blood.

 

This test does not reliably distinguish between individuals who are carriers for congenital erythropoietic porphyria (CEP) and are at risk for having an affected child.

 

If possible, specimens from patients suspected of having CEP should be collected prior to blood transfusions; uroporphyrinogen (UPG) III synthase activity in transfused erythrocytes can cause false-negative results.

 

Abstinence from alcohol for at least 24 hours is essential for accurate results. While the effects of alcohol on this enzyme have not yet been determined, alcohol is known to suppress or induce other enzymes in the heme biosynthetic pathway.

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

1. Tortorelli S, Kloke K, Raymond K: Disorders of porphyrin metabolism. In: Dietzen DJ, Bennett MJ, Wong EDD, eds. Biochemical and Molecular Basis of Pediatric Disease. 4th ed. AACC Press; 2010:307-324

2. Nuttall KL, Klee GG: Analytes of hemoglobin metabolism-porphyrins, iron, and bilirubin. In: Burtis CA, Ashwood ER, eds. Tietz Textbook of Clinical Chemistry. 5th ed. WB Saunders Company; 2001:584-607

3. Anderson KE, Sassa S, Bishop DF, Desnick RJ: Disorders of heme biosynthesis: X-Linked sideroblastic anemia and the porphyrias. 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 May 6, 2022. Available at https://ommbid.mhmedical.com/content.aspx?sectionid=225540906&bookid=2709

4. Erwin AL, Desnick RJ: Congenital erythropoietic porphyria: Recent advances. Mol Genet Metab. 2019 Nov;128(3):288-297. doi: 10.1016/j.ymgme.2018.12.008

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

Washed cells are incubated with aminolevulinic acid as substrate and the series I and III porphyrin isomers formed are measured. The proportion of series III isomers formed in relation to total porphyrins (I + III isomers) represents the uroporphyrinogen III synthase activity. The values are reported as Relative Units.(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.

Varies

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

Residual whole blood, processed specimen: 2 weeks

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 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.

82657

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
UPGC Uroporphyrinogen III Synthase, RBC 11066-8
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.
80288 Uroporphyrinogen III Synthase, RBC 11066-8

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