Ashkenazi Jewish Mutation Analysis Panel Without Cystic Fibrosis (CF)
NY State Approved Indicates the status of NY State approval and if the test is orderable for NY State clients.
Carrier screening in individuals of Ashkenazi Jewish ancestry for Bloom syndrome, Canavan disease, FANCC-related Fanconi anemia, familial dysautonomia, Gaucher disease, mucolipidosis IV, Niemann-Pick disease types A and B, and Tay-Sachs disease
Genetics Test Information Provides information that may help with selection of the correct test or proper submission of the test request
Panel includes the following disorders Bloom syndrome, Canavan disease, FANCC related Fanconi anemia, familial dysautonomia, Gaucher disease, mucolipidosis IV, Niemann-Pick disease types A and B, and Tay-Sachs disease. Specific detection rates for the Ashkenazi Jewish population are provided. (ACD/yellow-top tube only)
Additional Tests Lists test(s) that are always performed, at an additional charge, with the initial test(s)
|Test ID||Reporting Name||Available Separately||Always Performed|
|23425||Hexosaminidase A and Tot, WBC/AJ||No, (Bill Only)||Yes|
Testing Algorithm Delineates situation(s) when tests are added to the initial order. This includes reflex and additional tests.
When this test is ordered, hexosaminidase A and total, white blood cells will always be performed at an additional charge.
See Tay-Sachs Disease Carrier Testing Protocol in Special Instructions
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
AJPWO/88887: Polymerase chain reaction (PCR) analysis is used to test for mutations associated with 8 disorders prevalent in the Ashkenazi Jewish population.
(PCR is utilized pursuant to a license agreement with Roche Molecular Systems, Inc.)
23425: Heat Inactivation, Fluorometric, Semiautomated
Reporting Name A shorter/abbreviated version of the Published Name for a test; an abbreviated test name
Ashkenazi Jewish Panel Without CF
Mucolipidosis type IV
Niemann-Pick types A and B
Mucolipidosis type IV
Niemann-Pick types A and B
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.
Specimen must arrive within 72 hours of draw.
Specimen Type: Whole blood
Preferred: Yellow top (ACD)
Acceptable: Any anticoagulant (EDTA is also acceptable for molecular testing, however, an ACD tube is required for testing of hexosaminidase A and total.)
Specimen Volume: 2 full tubes
1. Invert several times to mix blood.
2. Send specimen in original tubes.
Additional Information: A patient education brochure (Supply T561) is available upon request.
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. Molecular Genetics-Biochemical Disorders Patient Information Sheet (Supply T527) in Special Instructions
3. If not ordering electronically, submit a Molecular Genetics Request Form (Supply T245) 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.
Specimen Stability Information Provides a description of the temperatures required to transport a specimen to the laboratory. Alternate acceptable temperature(s) are also included.
Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
Certain genetic diseases are more common in individuals of Ashkenazi Jewish heritage (Jewish individuals of Eastern European ancestry) compared to the non-Jewish population. The majority of these conditions are inherited in an autosomal recessive manner. This group of diseases includes Gaucher, Tay-Sachs, familial dysautonomia, Canavan, mucolipidosis IV, Niemann-Pick Type A and B, FANCC-related Fanconi anemia, and Bloom syndrome. While these conditions are observed outside of the Ashkenazi Jewish population, they occur at a lower frequency. It is estimated that an individual of Ashkenazi Jewish ancestry has a 20% to 25% chance of being a carrier of 1 of these diseases.
Gaucher disease is a relatively rare lysosomal storage disorder resulting from a deficiency of acid beta-glucocerebrosidase. Mutations in the beta-glucocerebrosidase gene, GBA, cause the clinical manifestations of Gaucher disease. There are 3 major types of Gaucher disease: nonneuropathic (type 1), acute neuropathic (type 2), and subacute neuropathic (type 3). Type 1 accounts for over 95% of all cases of Gaucher disease and is the presentation commonly found among Ashkenazi Jewish patients. Type 1 disease does not involve nervous system dysfunction; patients display anemia, low blood platelet levels, massively enlarged livers and spleens, lung infiltration, and extensive skeletal disease. There is a broad spectrum of disease in type 1, with some patients exhibiting severe symptoms and others very mild disease. Types 2 and 3 are associated with neurological disease of variable onset and progression, though type 2 tends to be more severe. Eight common GBA mutations, including the N370S mutation most commonly found in the Ashkenazi Jewish population, are included in this test: delta55bp, V394L, N370S, IVS2+1G->A, 84G->GG, R496H, L444P, and D409H.
Tay-Sachs disease is caused by an absence of hexosaminidase (HexA) enzyme activity, which results in the accumulation of the sphingolipid GM2 ganglioside. Mutations in the HEXA gene cause the clinical manifestations of Tay-Sachs disease (TSD). The most common form of TSD becomes apparent in infancy when mild motor weakness is noted along with impaired visual acuity and the presence of a "startle response." Other manifestations of this condition include progressive neurodegeneration, seizures, and blindness, leading to total incapacitation and death. This panel tests for the 3 common mutations in the Ashkenazi Jewish population: 1278insTATC, G269S, and IVS12+1G->C. Also included in this assay are the mutations IVS9+1G->A and delta7.6kb mutations along with the R247W and R249W polymorphisms associated with pseudodeficiency.
Familial dysautonomia affects sensory, parasympathetic, and sympathetic neurons. Patients experience gastrointestinal dysfunction, pneumonia, vomiting episodes, altered sensitivity to pain and temperature, and cardiovascular problems. Progressive neuronal degeneration continues throughout the lifespan. Mutations in the IKBKAP gene cause the clinical manifestations of familial dysautonomia. Two mutations in the IKBKAP gene are common in the Ashkenazi Jewish population: IVS20(+6)T->C and R696P.
Canavan disease is a severe leukodystrophy resulting from a deficiency of the enzyme aspartoacylase. Mutations in the ASPA gene cause the clinical manifestations of Canavan disease. The deficiency of aspartoacylase leads to spongy degeneration of the brain, and the disease is characterized by delayed development beginning at age 3 to 6 months, head lag, macrocephaly, and hypotonia. Death usually occurs in the first decade of life. Four ASPA mutations are included in this test: 433(-2)A->G, A305E, E285A, and Y231X.
Mucolipidosis IV is a lysosomal storage disease characterized by mental retardation, hypotonia, corneal clouding, and retinal degeneration. Mutations in the MCOLN1 gene are responsible for the clinical manifestations of mucolipidosis IV. Two mutations in the MCOLN1 gene account for the majority of mutations in the Ashkenazi Jewish population: IVS3(-2)A->G and delta6.4kb.
Niemann-Pick Disease Types A and B:
Niemann-Pick disease (types A and B) is a lysosomal storage disease caused by a deficiency of the enzyme acid sphingomyelinase. The clinical presentation of type A disease is characterized by jaundice, progressive loss of motor skills, feeding difficulties, learning disabilities, and hepatosplenomegaly. Death usually occurs by age 3. Type B disease is milder, though variable in its clinical presentation. Most individuals with type B do not have neurologic involvement and survive to adulthood. Mutations in the SMPD1 gene are known to cause Niemann-Pick disease types A and B. There are 3 common mutations causing Niemann-Pick type A in the Ashkenazi Jewish population: L302P, R496L, and fsP330. The deltaR608 mutation accounts for approximately 90% of the type B mutant alleles in individuals from the Maghreb region of North Africa and 100% of the mutation alleles in Gran Canaria Island.
Fanconi anemia is an aplastic anemia that leads to bone marrow failure and myelodysplasia or acute myelogenous leukemia. Physical findings include short stature; upper limb, lower limb, and skeletal malformations; and abnormalities of the eyes and genitourinary tract. Mutations in several genes have been associated with Fanconi anemia, although 1 mutation, IVS4(+4)A->T, in the FANCC gene is common in the Ashkenazi Jewish population. A second mutation, 322delG, is over represented in FANCC patients of Northern European ancestry.
Bloom syndrome is characterized by short stature, sun sensitivity, susceptibility to infections, and a predisposition to cancer. Mutations in the BLM gene lead to genetic instability (increased chromosomal breakage and sister chromatid exchange) and cause the clinical manifestations of Bloom syndrome. The protein encoded by the BLM gene is a helicase involved in maintaining DNA integrity. There is a common mutation in the Ashkenazi Jewish population: 2281delATCTGAinsTAGATTC (2281del6/ins7).
Because of the high sensitivity of carrier testing in the Ashkenazi Jewish population, the American College of Medical Genetics and Genomics (ACMG) recommends that carrier screening for cystic fibrosis, Canavan, Tay-Sachs, familial dysautonomia, Niemann-Pick type A, Fanconi anemia (FANCC), Bloom syndrome, mucolipidosis IV, and Gaucher disease be offered to individuals of Ashkenazi Jewish ancestry. The mutation detection rates and carrier frequencies for the diseases included in this panel are listed below. Of note, testing for cystic fibrosis is not included in this panel. If testing for this disorder is desired, please see details and ordering information under CFPB Cystic Fibrosis Mutation Analysis, 106-Mutation Panel.
Carrier Rate in the AJ Population
Mutation Detection Rate
Niemann-Pick type A/B
FANCC-related Fanconi anemia
*with biochemical testing
The Ashkenazi Jewish panel is useful for identifying carriers of these 8 conditions in an at-risk population. Because the diseases included in the panel are inherited in an autosomal recessive manner, the presence of a family history is not a prerequisite for testing consideration. The identification of disease-causing mutations allows for carrier testing of at-risk family members and prenatal diagnosis for pregnancies in which both parents are known carriers. Refer to Carrier Testing for Tay-Sachs Disease and Other GM2 Gangliosidosis Variants: Supplementing Traditional Biochemical Testing with Molecular Methods, Mayo Medical Laboratories Communique 2004 Jul;29(7) for more information regarding diagnostic strategy.
Of note, approximately 1 in 25 individuals of Ashkenazi Jewish ancestry are also carriers of CF. Therefore, the American College of Medical Genetics also recommends that carrier screening for CF be offered to individuals of Ashkenazi Jewish ancestry who are pregnant or considering pregnancy. Carrier screening for CF is available by ordering CFPB/9497 Cystic Fibrosis Mutation Analysis, 106-Mutation Panel.
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.
An interpretive report will be provided.
An interpretive report will be provided.
Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
This assay will not detect all of the mutations that cause these 8 diseases. Therefore, the absence of a detectable mutation(s) does not rule out the possibility that an individual is a carrier of or affected with 1 or more of the listed diseases.
Test results should be interpreted in the context of clinical findings, family history, and other laboratory data. Errors in our interpretation of results may occur if information given is inaccurate or incomplete.
Rare polymorphisms exist that could lead to false-negative or false-positive results. If results obtained do not match the clinical findings, additional testing should be considered.
In rare cases, DNA alterations of undetermined significance may be identified.
A previous bone marrow transplant from an allogenic donor will interfere with testing. Call Mayo Medical Laboratories for instructions for testing patients who have received a bone marrow transplant.
Clinical Reference Provides recommendations for further in-depth reading of a clinical nature
Gross SJ, Pletcher BA, Monaghan KG: Carrier screening individuals of Ashkenazi Jewish descent. Genet Med 2008:10(1):54-56
Method Description Describes how the test is performed and provides a method-specific reference
A laboratory-developed multiplex PCR-based assay is used to detect the following mutations: 84G->GG, IVS2(+1)G->A, N370S, delta55bp, V394L, D409H, L444P, and R496H mutations in the GBA gene (Gaucher disease); delta7.6kb, R247W, R249W, G269S IVS9(+1)G->A, 1278insTATC, and IVS12(+1)G->C mutations in the HEXA gene (Tay-Sachs disease); 433(-2)A->G, E285A, Y231X (C->A & C->T), and A305E mutations in the ASPA gene (Canavan disease); R696P and IVS20(+6)T->C mutations in the IKBKAP gene (familial dysautonomia); 2281del6/ins7 mutation in the BLM gene (Bloom syndrome); 322delG and IVS4(+4)A->T mutations in the FANCC gene (Fanconi anemia); L302P, fsP330, R496L, and deltaR608 mutations in the SMPD1 gene (Niemann-Pick disease types A and B); and delta6.4kb and IVS3(-2)A->G mutations in the MCOLN1 gene (mucolipidosis type IV). (Fulton R, McDade R, Smith P, et al: Advanced multiplexed analysis with the FlowMetrix system. Clin Chem 1997;43:1749-1756; Ye F, Li MS, Taylor JD, et al: Fluorescent microsphere-based readout technology for multiplexed human single nucleotide polymorphism analysis and bacterial identification. Hum Mutat 2001 Apr;17:305-316)
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.
Tuesday; 10 a.m.
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
Whole Blood: 2 weeks (if available) Extracted DNA: 3 months
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.
This test was developed using an analyte specific reagent. Its performance characteristics were 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 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.
81200-ASPA aspartoacylase (eg, Cnavan disease) gene analysis, common variants (eg, E285A, Y231X)
81290-MCOLN1 (mucolipin 1) (eg, mucolipidosis, type IV) gene analysis, common variants (eg, IVS3-2A->G, del6.4kb)
81260-IKBKAP (inhibitor of kappa light polypeptide gene enhance in B-cells, kinase complex-associated protein) (eg, Familial dysautonomia) gene analysis common variants (eg, 2507_6T->C, R696P)
81255-HEXA (hexosaminidase A (alpha polypeptide) (eg, Tay-Sachs disease) gene analysis, common variants (eg, 1278insTATC, 1421+1G->C, G269S)
81251-GBA (glucosidase, beta acid) (eg, Gaucher disease) gene analysis, common variants (eg, N370S, 84GG, L444P, IVS2+1G->A)
81242-FANCC (Fanconi anemia, complementation group C) (eg, Fanconi anemia, type C) gene analysis, common variant (eg, IVS4+4A->T)
81209-BLM (Bloom syndrome, Rec! helicase-like) (eg, Bloom syndrome) gene analysis, 2281 del6ins7 variant
81330-SMPD1 (sphingomyelin phosphodiesterase 1, acid sysosomal) (eg, Niemann-Pick disease, Type A) gene analysis, common variants (eg, R496L, L302P, fsP330)
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|
|27177||Reason For Referral||42349-1|