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HelpTest ID: HSMWB Hepatosplenomegaly Panel, Blood
Advisory Information
This test should not be used for monitoring patients with confirmed diagnoses. If a physician is requesting testing for monitoring purposes, see:
CTXWB / Cerebrotendinous Xanthomatosis, Blood
GPSYW / Glucopsychosine, Blood
OXYWB / Oxysterols, Blood
Specimen Required
Container/Tube:
Preferred: Lavender top (EDTA)
Acceptable: Sodium heparin, lithium heparin, ACD B
Specimen Volume: 1 mL
Forms
If not ordering electronically, complete, print, and send an Inborn Errors of Metabolism Test Request (T798) with the specimen.
Useful For
As a component of the initial evaluation of a patient presenting with hepatosplenomegaly
Method Name
Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS)
Reporting Name
Hepatosplenomegaly Panel, BSpecimen Type
Whole bloodSpecimen Minimum Volume
0.25 mL
Specimen Stability Information
| Specimen Type | Temperature | Time |
|---|---|---|
| Whole blood | Refrigerated (preferred) | 72 hours |
| Ambient | 48 hours |
Clinical Information
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 with hepatosplenomegaly and a suspected lysosomal or lipid storage disorder.
The conditions detected in this assay are cerebrotendinous xanthomatosis, Gaucher disease, and Niemann-Pick disease types A, B, and C.
|
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 age 2-4. Patients with type 3 may have a less progressive phenotype and may survive into adulthood. |
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|
Niemann-Pick type A/B (NPA, NPB) |
NPA: neonatal NPB: birth-adulthood |
lyso-sphingomyelin (LSM) lyso-sphingomyelin 509 (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 age 3. NPB: mainly limited to visceral symptoms; hepatosplenomegaly, stable liver dysfunction, pulmonary compromise, osteopenia. |
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|
Niemann-Pick type C |
Variable (Perinatal-Adulthood) |
Cholestane-3 beta, 5 alpha, 6 beta-triol (COT) lyso-sphingomyelin 509 (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. |
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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.
Patients with testing indicative of 1 of the above disorders should have follow-up enzymatic of molecular testing for confirmation of diagnosis.
Reference Values
CHOLESTANE-3-BETA,5-ALPHA,6-BETA-TRIOL
Cutoff: ≤0.800 nmol/mL
LYSO-SPHINGOMYELIN
Cutoff: ≤0.100 nmol/mL
GLUCOPSYCHOSINE
Cutoff: ≤0.040 nmol/mL
7-ALPHA-HYDROXY-4-CHOLESTEN-3-ONE (7aC4)
Cutoff: ≤0.750 nmol/mL
7-ALPHA,12-ALPAH-DIHYDROXYCHOLEST-4-en-3-ONE (12aC4)
Cutoff: ≤0.250 nmol/mL
GLOBOTRIAOSYLSPHINGOSINE
Cutoff: ≤0.034 nmol/mL
Interpretation
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 (CTX).
An elevation of lyso-sphingomyelin (LSM) and lyso-sphingomyelin 509 (LSM 509) is highly suggestive of Niemann-Pick type A or B (NPA or NPB) disease.
An elevation of cholestane-3 beta, 5 alpha, 6 beta-triol (COT) lyso-sphingomyelin 509 (LSM 509) is highly suggestive of Niemann-Pick disease type C (NPC).
An elevation of glucopsychosine is indicative of Gaucher disease.
Clinical Reference
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 GeneReviews Edited by RA Pagon, MP Adam, HH Ardinger, et al. University of Washington, Seattle. 1993-2017. 2003 Jul 16. Available at www.ncbi.nlm.nih.gov/books/NBK1409/
3. Grabowski GA, Petsko GA, Kolodny EH: Grabowski G.A., Petsko G.A., Kolodny E.H. Grabowski, Gregory A., et al.Gaucher Disease. In The Online Metabolic and Molecular Bases of Inherited Disease. Edited by D Valle, AL Beaudet, B Vogelstein, et al. New York, McGraw-Hill, 2014. Accessed August 11, 2017. Available at http://ommbid.mhmedical.com/content.aspx?bookid=971§ionid=626438844. 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. Patterson M: Niemann-Pick disease type C. In GeneReviews. Edited by RA Pagon, MP Adam, HH Ardinger, et al. Retrieved April 7, 2017. Available at www.ncbi.nlm.nih.gov/books/NBK1296/
Day(s) and Time(s) Performed
Tuesday and Thursday 8 a.m.
Analytic Time
2 days (not reported Saturday or Sunday)Test Classification
This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the U.S. Food and Drug Administration.CPT Code Information
82542
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| HSMWB | Hepatosplenomegaly Panel, B | 92744-2 |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| 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 |
mml-biochemical