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Test Code GNBLF Bleeding Disorders, Focused Gene Panel, Next-Generation Sequencing, Varies


Ordering Guidance


Special coagulation testing for evaluating patients with bleeding or hypocoagulability states should be performed prior to genetic testing. For more information see ALBLD / Bleeding Diathesis Profile, Limited, Plasma.

This test is designed to evaluate factor (F) VII, FVIII, FIX, FXI, GP1BA, and von Willebrand disease bleeding disorders.

 

If testing for hereditary bleeding disorders using a larger panel is desired, a 25-gene bleeding panel is available; order GNBLC / Bleeding Disorders, Focused Gene Panel, Next-Generation Sequencing, Varies

 

This test is not designed to evaluate for a single common hereditary bleeding disorder, such as when an individual has a known family history of hemophilia A or B or von Willebrand disease, specifically. If testing for a particular common hereditary bleeding disorder is desired, single gene tests are available for the F8, F9, and VWF genes. See GNHMA / Hemophilia A, F8 Gene, Next-Generation Sequencing, Varies; GNHMB / Hemophilia B, F9 Gene, Next-Generation Sequencing, Varies; or GNVWD von Willebrand Disease, VWF and GP1BA Genes, Next-Generation Sequencing, Varies

 

This test does not evaluate for the presence of inversions in the F8 gene that can cause hemophilia A. If testing for possible inversions in the F8 gene is desired, order F8INV / Hemophilia A F8 Gene, Intron 1 and 22 Inversion Mutation Analysis, Whole Blood

 

This test is not designed to evaluate for hereditary thrombosis disorders. If thrombosis is the indication for testing and testing for hereditary thrombosis disorders is desired, order GNTHR / Thrombosis Disorders, Comprehensive Gene Panel, Next-Generation Sequencing, Varies

 

This test is not designed to evaluate for inherited platelet disorders. If a platelet disorder is suspected and comprehensive testing for platelet disorders is desired, order GNPLT / Platelet Disorders, Comprehensive Gene Panel, Next-Generation Sequencing, Varies

 

Customization of this panel and single gene analysis for any gene present on this panel are available. For more information, see CGPH / Custom Gene Panel, Hereditary, Next-Generation Sequencing, Varies.

 

Targeted testing for familial variants (also called site-specific or known mutations testing) is available for the genes on this panel. See FMTT / Familial Variant, Targeted Testing, Varies. To obtain more information about this testing option, call 800-533-1710.



Additional Testing Requirements


All prenatal specimens must be accompanied by a maternal blood specimen; order MATCC / Maternal Cell Contamination, Molecular Analysis, Varies on the maternal specimen as this must be a different order number than the prenatal specimen.



Shipping Instructions


Specimen preferred to arrive within 96 hours of collection.



Necessary Information


Rare Coagulation Disorder Patient Information is required. Testing may proceed without the patient information; however, the information aids in providing a more thorough interpretation. Ordering providers are strongly encouraged to fill out the form and send with the specimen.



Specimen Required


Patient Preparation: A previous bone marrow transplant from an allogenic donor will interfere with testing. For instructions for testing patients who have received a bone marrow transplant, call 800-533-1710.

 

Submit only 1 of the following specimens:

 

Specimen Type: Whole blood

Container/Tube:

Preferred: Lavender top (EDTA)

Acceptable: Yellow top (ACD)

Specimen Volume: 3 mL

Collection Instructions:

1. Invert several times to mix blood.

2. Send whole blood specimen in original tube. Do not aliquot.

Specimen Stability Information: Ambient (preferred) 4 days/Refrigerated

 

Due to its complexity, consultation with the laboratory is required for all prenatal testing; call 800-533-1710 to speak to a genetic counselor.

 

Specimen Type: Amniotic fluid

Container/Tube: Amniotic fluid container

Specimen Volume: 20 mL

Specimen Stability Information: Refrigerated (preferred)/Ambient

Additional information:

1. A separate culture charge will be assessed under CULAF / Culture for Genetic Testing, Amniotic Fluid.

2. All prenatal specimens must be accompanied by a maternal blood specimen; order MATCC / Maternal Cell Contamination, Molecular Analysis, Varies on the maternal specimen.

 

Specimen Type: Chorionic villi

Container/Tube: 15-mL tube containing 15 mL of transport media

Specimen Volume: 20 mg

Specimen Stability Information: Refrigerated

Additional Information:

1. A separate culture charge will be assessed under CULFB / Fibroblast Culture for Biochemical or Molecular Testing. An additional 3 to 4 weeks is required to culture fibroblasts before genetic testing can occur.

2. All prenatal specimens must be accompanied by a maternal blood specimen; order MATCC / Maternal Cell Contamination, Molecular Analysis, Varies on the maternal specimen.

 

Acceptable:

Specimen Type: Confluent cultured cells

Container/Tube: T-25 flask

Specimen Volume: 2 Flasks

Collection Instructions: Submit confluent cultured cells from another laboratory.

Specimen Stability Information: Ambient (preferred)/Refrigerated

Additional Information:

All prenatal specimens must be accompanied by a maternal blood specimen; order MATCC / Maternal Cell Contamination, Molecular Analysis, Varies on the maternal specimen.


Forms

1. Rare Coagulation Disorder Patient Information (T824) is required.

2. New York Clients-Informed consent is required. Document on the request form or electronic order that a copy is on file. The following documents are available:

-Informed Consent for Genetic Testing (T576)

-Informed Consent for Genetic Testing (Spanish) (T826)

3. If not ordering electronically, complete, print, and send an Coagulation Test Request (T753) with the specimen.

Useful For

Evaluating hereditary bleeding in patients with a personal or family history suggestive of a hereditary bleeding disorder and initial laboratory testing results are suggestive for factors VII, VIII, IX, or XI deficiency, or a von Willebrand disease

 

Confirming a hereditary bleeding disorder diagnosis with the identification of a known or suspected disease-causing alteration in one or more of 6 genes associated with a variety of hereditary bleeding disorders

 

Determining the disease-causing alterations within one or more of these 6 genes to delineate the underlying molecular defect in a patient with a laboratory diagnosis of a bleeding disorder

 

Identifying the causative alteration for genetic counseling purposes

 

Prognosis and risk assessment based on the genotype-phenotype correlations

 

Carrier testing for close family members of an individual with a hereditary bleeding disorder diagnosis

Disease States

  • Hemophilia A
  • Hemophilia B

Reflex Tests

Test ID Reporting Name Available Separately Always Performed
CULFB Fibroblast Culture for Genetic Test Yes No
CULAF Amniotic Fluid Culture/Genetic Test Yes No
MATCC Maternal Cell Contamination, B Yes No

Method Name

Sequence Capture and Targeted Next-Generation Sequencing (NGS) followed by Polymerase Chain Reaction (PCR) and Sanger Sequencing

Reporting Name

Bleeding Focused Gene Panel, NGS

Specimen Type

Varies

Specimen Minimum Volume

Blood: 1 mL; Amniotic fluid: 10 mL; Other specimen types: See Specimen Required

Specimen Stability Information

Specimen Type Temperature Time Special Container
Varies Varies

Reject Due To

All specimens will be evaluated at Mayo Clinic Laboratories for test suitability.

Clinical Information

Congenital or acquired bleeding diatheses are caused by a wide variety of coagulation abnormalities. The clinical presentation of an underlying bleeding disorder may include epistaxis, easy bruising, ecchymoses, muscle hematomas, menorrhagia, post-operative bleeding, bleeding into joint spaces, mucosal tract bleeds, intracranial bleeding, or gastrointestinal bleeding.

 

Determination of a hereditary bleeding disorder contributing to bleeding events in an individual or family can be useful for prognosis and risk assessment. Identification of an alteration that is known or suspected to cause disease can also be useful for determining the risk of bleeding for family members.

 

This panel evaluates 6 genes associated with a variety of hereditary bleeding disorders, including factor VII deficiency, hemophilia A, hemophilia B, factor XI deficiency, platelet-type von Willebrand disease, and von Willebrand disease.

 

The risk for developing bleeding associated with these syndromes varies. For example, in symptomatic individuals with factor VII deficiency, the most common symptoms have been reported as mucocutaneous, soft tissue, and joint and gastrointestinal bleeding; while those in individuals with factor X deficiency were bleeding after surgery and trauma; additionally, heavy menstrual bleeding was reported as common in both disorders.(1) Several of the genes on this panel have established bleeding risk or expert group guidelines.(1-7)

 

Indications for testing include, but are not limited to:

-Individuals with a suspected bleeding disorder for which there is no specific coagulation assay readily available

-Individuals who are at risk for being a carrier of a bleeding disorder, especially those bleeding disorders where carrier status cannot be easily determined by available coagulation assays

-Individuals whose personal or family histories indicate coinheritance of multiple hereditary bleeding disorders

Reference Values

An interpretive report will be provided.

Day(s) Performed

Varies

Report Available

28 to 42 days

Performing Laboratory

Mayo Clinic Laboratories in Rochester

Test 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

81238

81407

81408

81479

81479 (if appropriate for government payers)

88233-Tissue culture, skin, solid tissue biopsy (if appropriate)

88240-Cryopreservation (if appropriate)

88235-Amniotic fluid culture (if appropriate)

81265-Maternal cell contamination (if appropriate)