Test ID: AGA
Alpha-Galactosidase, Leukocytes
Useful For 
Suggests clinical disorders or settings where the test may be helpful
Diagnosis of Fabry disease in males
Verifying abnormal serum alpha-galactosidase results in males with a clinical presentation suggestive of Fabry disease
Genetics Test Information Provides information that may help with selection of the correct test or proper submission of the test request
Diagnosis of Fabry disease in males
Useful to verify abnormal serum alpha-galactosidase results in males with a clinical presentation suggestive of Fabry disease.
Enzyme testing is useful in identifying affected males. Enzyme levels for carriers are usually within the normal range. Order FABMS/88264 Fabry Disease, Full Gene Analysis for carrier testing
Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
Fabry disease is an X-linked lysosomal storage disorder resulting from deficient activity of the enzyme alpha-galactosidase A (alpha-Gal A) and the subsequent deposition of glycosylsphingolipids in tissues throughout the body, in particular, the kidney, heart, and brain. More than 150 mutations in the GLA gene have been identified in individuals diagnosed with Fabry disease. Severity and onset of symptoms are dependent on the amount of residual enzyme activity. The classic form of Fabry disease occurs in males with less than 1% alpha-Gal A activity. Symptoms usually appear in childhood or adolescence and can include acroparesthesias (pain crises in the extremities), multiple angiokeratomas, reduced or absent sweating, and corneal opacity. In addition, progressive renal involvement leading to end-stage renal disease typically occurs in adulthood followed by cardiovascular and cerebrovascular disease. The estimated incidence is 1 in 40,000 males.
Males with residual alpha-Gal A activity may present with either a renal or cardiac form of Fabry disease with onset of symptoms later in life. Individuals with the renal variant typically present in the third decade with the development of renal insufficiency and, ultimately, end-stage renal disease. These individuals may or may not share other symptoms with the classic form of Fabry disease. Individuals with the cardiac variant are often asymptomatic until they present with cardiac findings such as cardiomyopathy, mitral insufficiency, or conduction abnormalities in the fourth decade. The cardiac variant is not associated with renal failure. Variant forms of Fabry disease may be underdiagnosed.
Females who are carriers of Fabry disease can have clinical presentations ranging from asymptomatic to severely affected and may have alpha-Gal A activity in the normal range; therefore, additional studies including molecular genetic analysis of the GLA gene (FABMS/88264 Fabry Disease, Full Gene Analysis) are recommended to detect carriers.
Reduced or absent alpha-Gal A in blood spots, leukocytes (AGA/8785 Alpha-Galactosidase, Leukocytes), or serum (AGAS/8784 Alpha-Galactosidase, Serum) can indicate a diagnosis of classic or variant Fabry disease. Molecular sequence analysis of the GLA gene (FABMS/88264 Fabry Disease, Full Gene Analysis) allows for detection of the disease-causing mutation in affected patients and carrier detection in females.
See Fabry Disease: Newborn Screen-Positive Follow-up algorithm and Fabry Disease Testing Algorithm in Special Instructions.
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 =23.1 nmol/hour/mg protein
An interpretative report will be provided.
Note: Results from this assay do not reflect carrier status because of individual variation of alpha-galactosidase enzyme levels.
Interpretation Provides information to assist in interpretation of the test results
Deficiency of alpha-galactosidase A (alpha-Gal A) is diagnostic for Fabry disease in males.
Urine sediment analysis (CTSA/81979 Ceramide Trihexoside/Sulfatide Accumulation in Urine Sediment, Urine) for the accumulating trihexoside substrate is also recommended.
Carriers usually have alpha-galactosidase levels in the normal range.
See Fabry Disease: Newborn Screen-Positive Follow-up algorithm and Fabry Disease Testing Algorithm in Special Instructions.
Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
Carrier detection using enzyme levels is unreliable; mutation analysis (FABMS/88264 Fabry Disease, Full Gene Analysis) is the recommended test.
Clinical Reference Provides recommendations for further in-depth reading of a clinical nature
1. Desnick RJ, Ioannou YA, Eng CM: a-Galactosidase A deficiency: Fabry disease. In The Metabolic Basis of Inherited Disease. Vol. 2. Seventh edition. Edited by CR Scriver, AL Beaudet, WS Sly, D Valle. New York, McGraw-Hill Book Company, 1995, pp 2741-2784
2. De Schoenmakere G, Poppe B, Wuyts B, et al: Two-tier approach for the detection of alpha-galactosidase A deficiency in kidney transplant recipients. Nephrol Dial Transplant 2008;23:4044-4048
3. Spada M, Pagliardini S, Yasuda M, et al: High incidence of later-onset Fabry disease revealed by newborn screening. Am J Hum Genet 2006;79:31-40
4. Mehta A, Hughes DA: Fabry Disease. GeneReviews. Edited by RA Pagon, TD Bird, CR Dolan, et al: University of Washington, Seattle. Last updated March 2011
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