Test ID: C5OHU
C5-OH Acylcarnitine, Quantitative, Urine
NY State Approved 
Indicates the status of NY State approval and if the test is orderable for NY State clients.
Useful For Suggests clinical disorders or settings where the test may be helpful
Evaluation of patients with an abnormal newborn screen showing elevations of C5-OH
Genetics Test Information Provides information that may help with selection of the correct test or proper submission of the test request
Evaluation of patients with an abnormal newborn screen showing elevations of C5-OH. The results are not informative when patient is receiving L-carnitine supplements.
Special Instructions and Forms Describes specimen collection and preparation information, test algorithms, and other information pertinent to test. Also includes pertinent information and consent forms to be used when requesting a particular test
Method Name A short description of the method used to perform the test
Flow Injection Analysis-Tandem Mass Spectrometry (FIA-MS/MS)
Reporting Name A shorter/abbreviated version of the Published Name for a test; an abbreviated test name
Aliases Lists additional common names for a test, as an aid in searching
3MCC
Biotinidase
BKT
HCS
Hydroxymethylglutaryl-CoA (HMG-CoA) Lyase Deficiency
MCC
MHBD
Multiple Carboxylase Deficiency
3-Hydroxy Isovalerylcarnitine
3-Methylcrotonyl-CoA Carboxylase Deficiency
3-Methylglutaconic Aciduria Type 1
3-Methylglutaconic Aciduria Type I
3-Methylglutaconyl-CoA Hydratase Deficiency
Acylcarnitines, Urine
Beta-Ketothiolase
Beta-Ketothiolase Deficiency
Biotinidase Deficiency
HCS Deficiency
HMG-CoA (Hydroxymethylglutaryl-CoA) Lyase Deficiency
Holocarboxylase Deficiency
Holocarboxylase Synthetase Deficiency
Specimen Type Describes the specimen type needed for testing
Specimen Required Defines the optimal specimen. This field describes the type of specimen required to perform the test and the preferred volume to complete testing. The volume allows automated processing, fastest throughput and, when indicated, repeat or reflex testing.
Collection Container/Tube: Clean, plastic urine collection container
Submission Container/Tube: Plastic, 10-mL urine tube (Supply T068)
Specimen Volume: 5 mL
Collection Instructions:
1. Collect a random urine specimen.
2. Freeze specimen immediately.
Additional Information: Include patient's age, family history, clinical condition (asymptomatic or acute episode), diet, and drug therapy information.
Forms:
1. 1. New York Clients-Informed consent is required. Please document on the request form or electronic order that a copy is on file. An Informed Consent for Genetic Testing (Supply T576) is available in Special Instructions.
2. 2. If not ordering electronically, submit a Biochemical Genetics Request Form (Supply T439) with the specimen.
Specimen Minimum Volume Defines the amount of specimen required to perform an assay once, including instrument and container dead space. Submitting the minimum specimen volume makes it impossible to repeat the test or perform confirmatory or perform reflex testing. In some situations, a minimum specimen volume may result in a QNS (quantity not sufficient) result, requiring a second specimen to be collected.
Reject Due To Identifies specimen types and conditions that may cause the specimen to be rejected
| Hemolysis | NA |
| Lipemia | NA |
| Icterus | NA |
| Other | NA |
Specimen Stability Information Provides a description of the temperatures required to transport a specimen to the laboratory. Alternate acceptable temperature(s) are also included.
| Specimen Type | Temperature | Time |
|---|---|---|
| Urine | Frozen (preferred) | 7 days |
| Refrigerated | 24 hours |
Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
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-(HMG)-CoA lyase deficiency
-Beta-ketothiolase deficiency
-2-Methyl 3-hydroxybutyryl-CoA dehydrogenase deficiency, 3-methylglutaconic aciduria type I, and biotinidase deficiency or holocarboxylase deficiency
Confirmatory and diagnostic testing are necessary to differentiate these clinical entities. This test can be 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.
The American College of Medical Genetics (ACMG) newborn screening work group published diagnostic algorithms for the follow-up of infants who had positive newborn screening results. For further information, see http://www.acmg.net.
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.
<2.93 millimoles/mole creatinine
Interpretation Provides information to assist in interpretation of the test results
Preliminary data showed that an elevated excretion in urine and concentration in plasma of C5-OH can be the only biochemical abnormalities in patients with 3-methylcrotonylglycinuria.
Contact Mayo Medical Laboratories for assistance in test interpretation and additional testing options.
Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
The results of urine acylcarnitines are not informative when the patient is receiving L-carnitine supplements.
Clinical Reference Provides recommendations for further in-depth reading of a clinical nature
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 Nov;120(5):e1335-1340
Method Description Describes how the test is performed and provides a method-specific reference
Acylcarnitines, including 3-hydroxy isovalerylcarnitine, are determined in urine by flow injection analysis tandem mass spectrometry using acetyl-d(3)-carnitine, propionyl-d(3)-carnitine, butyryl-d(3)-carnitine, octanoyl-d(3)-carnitine, dodecanoyl-d(3)-carnitine, and palmitoyl-d(3)-carnitine as internal standards. A total of 20 microL of the diluted urine is extracted with an acidified acetonitrile solution containing the internal standards. The supernatant is evaporated and the residue treated with n-butanolic HCl yielding the acylcarnitines for analysis as their n-butyl esters. (Tortorelli S, Hahn SH, Cowan TM, et al: The urinary excretion of glutarylcarnitine is an informative tool in the biochemical diagnosis of glutaric acidemia type I. Mol Genet Metab 2005;84:137-143)
Day(s) and Time(s) Test Performed Outlines the days and times the test is performed. This field reflects the day and time the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time required before the test is performed. Some tests are listed as continuously performed, which means assays are performed several times during the day.
Monday, Wednesday, Friday
Analytic Time Defines the amount of time it takes the laboratory to setup and perform the test. This is defined in number of days. The shortest interval of time expressed is "same day/1 day," which means the results may be available the same day that the sample is received in the testing laboratory. One day means results are available 1 day after the sample is received in the laboratory.
Maximum Laboratory Time Defines the maximum time from specimen receipt at Mayo Medical Laboratories until the release of the test result
Specimen Retention Time Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded
Performing Laboratory Location The location of the laboratory that performs the test
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's instructions, or as products that do not undergo full FDA review and approval, and are then labeled as an Analyte Specific Reagent (ASR), Investigation Use Only (IUO) product, or a Research Use Only (RUO) product.
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 Medical Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.
82017
LOINC® Code Information Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the result codes returned for this test or profile.
| Result ID | Reporting Name | LOINC Code |
|---|---|---|
| 88830 | C5-OH Acylcarnitine, QN, U | 50091-8 |
| 28125 | C5-OH Interpretation | In Process |
| 34469 | Reviewed By | N/A |
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