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HelpTest ID: C5OHU C5-OH Acylcarnitine, Quantitative, Random, Urine
Reporting Name
C5-OH Acylcarnitine, QN, UUseful For
Evaluation of patients with an abnormal newborn screen showing elevations of 3-hydroxyisovaleryl-/2-methyl-3-hydroxybutyryl-carnitine
Specimen Type
UrineOrdering Guidance
This second-tier test is used specifically to evaluate a newborn screening elevation of 3-hydroxyisovaleryl-/2-methyl-3-hydroxy acylcarnitine and must not be ordered with either C4U / C4 Acylcarnitine, Quantitative, Random, Urine or C5DCU / C5-DC Acylcarnitine, Quantitative, Random, Urine.
For general screening for metabolic disorders, see OAU / Organic Acids Screen, Random, Urine; ACRN / Acylcarnitines, Quantitative, Plasma; and AAQP / Amino Acids, Quantitative, Plasma.
Necessary Information
Include patient's age, family history, clinical condition (asymptomatic or acute episode), diet, and drug therapy information.
Specimen Required
Patient Preparation: If clinically feasible, discontinue L-carnitine supplementation at least 72 hours before specimen collection.
Supplies: Urine Tubes, 10 mL (T068)
Collection Container/Tube: Clean, plastic urine collection container
Submission Container/Tube: Plastic, 10-mL urine tube
Specimen Volume: 5 mL
Collection Instructions:
1. Collect a random urine specimen.
2. Freeze specimen immediately.
Specimen Minimum Volume
1 mL
Specimen Stability Information
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Urine | Frozen (preferred) | 7 days | |
| Refrigerated | 24 hours |
Reference Values
<2.93 millimoles/mole creatinine
Day(s) Performed
Monday, Wednesday, Friday
Test Classification
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
82017
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| C5OHU | C5-OH Acylcarnitine, QN, U | 50091-8 |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| 88830 | C5-OH Acylcarnitine, QN, U | 50091-8 |
| 28125 | C5-OH Interpretation | 59462-2 |
| 34469 | Reviewed By | 18771-6 |
Genetics Test Information
Elevated 3-hydroxyisovaleryl-/2-methyl-3-hydroxy acylcarnitine (C5-OH) in plasma or newborn screening blood spots is due to one of several biochemical genetic diagnoses: 3-methylcrotonylglycinuria, 3-hydroxy 3-methylglutaryl-CoA lyase deficiency, beta-ketothiolase deficiency, 2-methyl 3-hydroxybutyryl-CoA dehydrogenase deficiency, 3-methylglutaconic aciduria, biotinidase deficiency or holocarboxylase deficiency.
Urine C5OH is useful in differentiating patients with 3-methylcrotonylglycinuria and with 3-methylglutaconic aciduria as they typically excrete larger amounts of C5-OH in urine compared to patients with the other diagnoses.
Clinical Information
The differential diagnosis of an isolated elevation of 3-hydroxyisovaleryl-/2-methyl-3-hydroxy acylcarnitine (C5-OH) in plasma or (newborn screening) blood spots includes the following disorders:
-3-Methylcrotonyl-CoA carboxylase deficiency (common name: 3-methylcrotonylglycinuria), either infantile or maternal
-3-Hydroxy 3-methylglutaryl-CoA lyase deficiency
-Beta-ketothiolase deficiency
-2-Methyl 3-hydroxybutyryl-CoA dehydrogenase deficiency
-3-Methylglutaconic aciduria type I
-Biotinidase deficiency
-Holocarboxylase deficiency
Confirmatory and diagnostic testing are necessary to differentiate these clinical entities. This test can be used to differentiate patients with 3-methylcrotonylglycinuria and with 3-methylglutaconic aciduria as they typically excrete larger amounts of C5-OH in urine compared to patients with the other diagnoses.
The American College of Medical Genetics and Genomics Newborn Screening Work Group published diagnostic algorithms for the follow-up of infants who had positive newborn screening results. For more information, see the Practice Resources: ACT Sheets and Algorithms at www.acmg.net.
Interpretation
Preliminary data showed that an elevated excretion in urine and concentration in plasma of 3-hydroxyisovaleryl-/2-methyl-3-hydroxy acylcarnitine can be the only biochemical abnormalities in patients with 3-methylcrotonylglycinuria.
Clinical Reference
1. Wolfe LA, Finegold DN, Vockley J, et al. Potential misdiagnosis of 3-methylcrotonyl-coenzyme A carboxylase deficiency associated with absent or trace urinary 3-methylcrotonylglycine. Pediatrics. 2007;120(5):e1335-1340
2. Miller MJ, Cusmano-Ozog K, Oglesbee D, Young S; ACMG Laboratory Quality Assurance Committee: Laboratory analysis of acylcarnitines, 2020 update: a technical standard of the American College of Medical Genetics and Genomics (ACMG). Genet Med. 2021;23(2):249-258
Report Available
2 to 5 daysMethod Name
Flow Injection Analysis-Tandem Mass Spectrometry (FIA-MS/MS)
Forms
If not ordering electronically, complete, print, and send a Biochemical Genetics Test Request (T798) with the specimen.
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