Test Code MPS3B Mucopolysaccharidosis III, Three-Enzyme Panel, Blood Spot
Necessary Information
1. Patient's age is required.
2. Reason for testing is required
Specimen Required
Submit only 1 of the following specimen types:
Preferred:
Specimen Type: Blood spot
Supplies: Card-Blood Spot Collection (Filter Paper) (T493)
Container/Tube:
Preferred: Blood Spot Collection Card
Acceptable: Whatman Protein Saver 903 Paper, PerkinElmer 226 filter paper, Munktell filter paper, or blood collected in tubes containing ACD or EDTA and dried on filter paper.
Specimen Volume: 2 Blood spots
Collection Instructions:
1. An alternative blood collection option for a patient older than 1 year is a fingerstick. For detailed instructions, see How to Collect Dried Blood Spot Samples.
2. At least 2 spots should be complete (ie, unpunched).
3. Let blood dry on filter paper at room temperature in a horizontal position for a minimum of 3 hours.
4. Do not expose specimen to heat or direct sunlight.
5. Do not stack wet specimens.
6. Keep specimen dry.
Specimen Stability Information: Refrigerated (preferred) 60 days/Ambient 7 days/Frozen 60 days
Additional Information:
1. For collection instructions, see Blood Spot Collection Instructions
2. For collection instructions in Spanish, see Blood Spot Collection Card-Spanish Instructions (T777)
3. For collection instructions in Chinese, see Blood Spot Collection Card-Chinese Instructions (T800)
Acceptable:
Specimen Type: Whole Blood
Container/Tube:
Preferred: Lavender top (EDTA)
Acceptable: Yellow top (ACD)
Specimen Volume: 2 mL
Collection Instructions: Send whole blood specimen in original tube. Do not aliquot.
Specimen Stability Information: Refrigerate (preferred) 7 days/Ambient 48 hours
Useful For
Supporting the biochemical diagnosis of mucopolysaccharidoses types IIIA, IIIB, IIIC
This test is not useful for carrier detection.
Reflex Tests
Test ID | Reporting Name | Available Separately | Always Performed |
---|---|---|---|
MPSBS | Mucopolysaccharidosis, BS | Yes | No |
Testing Algorithm
If results are normal, testing is complete.
If results indicate mucopolysaccharidoses IIIA, IIIB, or IIIC, quantitation of heparan sulfate, dermatan sulfate and keratan sulfate may be performed at an additional charge.
Special Instructions
Method Name
Liquid Chromatography Tandem Mass Spectrometry (LC-MS/MS)
Reporting Name
MPS III (Three) Panel, BSSpecimen Type
Whole bloodSpecimen Minimum Volume
Blood spots: 1
Whole blood: 0.5 mL
Specimen Stability Information
Specimen Type | Temperature | Time | Special Container |
---|---|---|---|
Whole blood | Varies |
Reject Due To
Blood spot specimen that shows serum rings or has multiple layers | Reject |
Insufficient specimen | Reject |
Unapproved filter papers | Reject |
Clinical Information
Mucopolysaccharidosis III (MPS III; Sanfilippo syndrome) is caused by reduced or absent activity of 1 of 4 enzymes involved in heparan sulfate degradation. Patients with MPS III uniformly excrete heparan sulfate resulting in similar clinical phenotypes and are further classified as type A, B, C, or D based upon the specific enzyme deficiency. MPS III is characterized by severe central nervous system (CNS) degeneration but only mild physical disease. Such disproportionate involvement of the CNS is unique among the MPS. Onset of clinical features, most commonly behavioral problems and delayed development, usually occurs between 2 and 6 years of age in a child who previously appeared normal. Severe neurologic degeneration occurs in most patients by 6 to 10 years of age accompanied by a rapid deterioration of social and adaptive skills with death generally occurring by their 20s. The occurrence of MPS III varies by subtype with types A and B being the most common and types C and D being very rare. The collective incidence is approximately 1 in 58,000 live births. This assay detects 3 of the 4 MPSIII types (MPS IIIA, IIIB, and IIIC).
A diagnostic workup for MPS typically also includes GAG determination in urine (MPSQU / Mucopolysaccharides Quantitative, Random, Urine) or blood (MPSBS / Mucopolysaccharidosis, Blood Spot or MPSER / Mucopolysaccharides Quantitative, Serum) and molecular genetic analysis of the relevant gene(s). For MPS III, a molecular panel is available that includes SGSH, NAGLU, GNS, HGSNAT (CGPH / Custom Gene Panel, Hereditary, Next-Generation Sequencing, Varies; specify Gene List ID: IEMCP-7YM613).
Reference Values
HEPARAN-N-SULFATASE:
>0.06 nmol/mL/hour
N-ACETYL-ALPHA-D-GLUCOSAMINIDASE:
>0.70 nmol/mL/hour
HEPARAN-ALPHA-GLUCOSAMINIDE N-ACETYLTRANSFERASE:
>0.50 nmol/mL/hour
An interpretive report will be provided.
Interpretation
Abnormal results are not sufficient to establish a diagnosis of a particular disease. To verify a preliminary diagnosis based on this assay, additional biochemical or molecular genetic analyses are required.
When abnormal results are detected, a detailed interpretation is given, including an overview of the results and of their significance, a correlation to available clinical information, elements of differential diagnosis, recommendations for additional biochemical testing and in vitro confirmatory studies (enzyme assay, molecular genetic analysis), and a phone number to reach one of the laboratory directors in case the referring physician has additional questions.
Cautions
The enzyme for mucopolysaccharidosis (MPS) IIID (N-acetylglucosamine 6-sulfatase) is not evaluated on this panel.
Individuals with pseudodeficiency alleles can show reduced enzyme activity.
Carrier status (heterozygosity) for these conditions cannot be reliably detected.
Enzyme levels may be normal in individuals receiving enzyme replacement therapy or who have undergone hematopoietic stem cell transplant.
Method Description
One dried blood spot sample (DBS) is incubated with a mix of substrate and internal standard (IS) for iduronate 2-sulfatase, heparan N-sulfatase, alpha-N-acetylglucosaminidase, N-acetylgalactosamine-sulfate, beta-galactosidase, arylsulfatase B, beta-glucuronidase, and tripeptidyl peptidase 1. A second DBS sample is incubated with a mix of substrate and IS for acetyl-CoA:alpha-glucosaminide N-acetyltransferase; and a third DBS sample with a mix of substrate and IS for palmitoyl-protein thioesterase 1. Following overnight incubation, the samples are combined, extracted by liquid-liquid extraction, and analyzed by tandem mass spectrometry.(Unpublished Mayo method)
Day(s) Performed
Thursday
Report Available
8 to 15 daysPerforming Laboratory
Mayo Clinic Laboratories in RochesterTest 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
82657
83864 (if appropriate)
LOINC Code Information
Test ID | Test Order Name | Order LOINC Value |
---|---|---|
MPS3B | MPS III (Three) Panel, BS | 104112-8 |
Result ID | Test Result Name | Result LOINC Value |
---|---|---|
BG751 | Reason for Referral | 42349-1 |
618419 | Heparan-N-sulfatase | 104113-6 |
618420 | N-acetyl-alpha-D-glucosaminidase | 104114-4 |
618421 | Heparan-alpha-glucosaminide N-acetyltransferase | 104115-1 |
618422 | Interpretation | 59462-2 |
618418 | Reviewed By | 18771-6 |