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Test ID PKUBS Phenylalanine and Tyrosine, Blood Spot


Necessary Information


Patient’s age 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, Ahlstrom 226 filter paper, Munktell filter paper, or blood collected in tubes containing heparin, ACD or EDTA and dried on filter paper.

Specimen Volume: 2 Blood spots

Collection Instructions:

1. Let blood dry on filter paper at room temperature in a horizontal position for 3 or more hours.

2. At least 2 spots should be complete, ie, unpunched.

3. Do not expose specimen to heat or direct sunlight.

4. Do not stack wet specimens.

5. Keep specimen dry.

Specimen Stability Information: Ambient (preferred) 90 days/Refrigerated 90 days/Frozen 90 days

Additional Information:

1. For collection instructions, see Blood Spot Collection Instructions in Special Instructions.

2. For collection instructions in Spanish, see Blood Spot Collection Card-Spanish Instructions (T777) in Special Instructions.

3. For collection instructions in Chinese, see Blood Spot Collection Card-Chinese Instructions (T800) in Special Instructions.

 

Acceptable

Specimen Type: Whole Blood

Container/Tube:

Preferred: Lavender top (EDTA)

Acceptable: Green top (sodium or lithium heparin) and yellow top (ACD)

Specimen Volume: 2 mL

Collection Instructions: Send specimen in original tube.

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


Useful For

Monitoring effectiveness of dietary therapy in patients with hyperphenylalaninemia

 

This test is not sufficient for follow-up for abnormal newborn screening results or for establishing a diagnosis of a specific cause of hyperphenylalaninemia

Method Name

Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS)

Reporting Name

Phenylalanine and Tyrosine, BS

Specimen Type

Whole blood

Specimen Minimum Volume

Blood Spots: 1
Whole Blood: 0.5 mL

Specimen Stability Information

Specimen Type Temperature Time Special Container
Whole blood Varies

Clinical Information

Phenylketonuria (PKU) is the most frequent inherited disorder of amino acid metabolism (about 1:10,000-1:15,000) and was the first successfully treated inborn error of metabolism. It is inherited in an autosomal recessive manner and is caused by a defect in the enzyme phenylalanine hydroxylase (PAH), which converts the essential amino acid phenylalanine to tyrosine. Deficiency of PAH results in decreased levels of tyrosine and an accumulation of phenylalanine in blood and tissues. Untreated, PKU leads to severe brain damage with intellectual impairment, behavior abnormalities, seizures, and spasticity. The level of enzyme activity differentiates classic PKU (PAH activity <1%) from other milder forms; however, all are characterized by increased levels of phenylalanine (hyperphenylalaninemia). Treatment includes the early introduction of a diet low in phenylalanine.

 

Tetrahydrobiopterin (BH4) is a cofactor of not only PAH, but also of the tyrosine and tryptophan hydroxylases. Approximately 2% of patients with hyperphenylalaninemia have a deficiency of BH4, which causes a secondary deficit of the neurotransmitters dopamine and serotonin. There are 4 autosomal-recessive disorders associated with BH4 deficiency plus hyperphenylalaninemia; guanosine triphosphate cyclohydrolase deficiency, 6-pyruvoyl tetrahydropterine synthase deficiency, dihydropteridine reductase deficiency, and pterin-4 alpha carbinolamine dehydratase (PCD) deficiency. This group of disorders, with the exception of PCD, is characterized by progressive dystonia, truncal hypotonia, extremity hypertonia, seizures, and mental retardation though milder presentations exist. PCD has no symptoms other than transient alterations in tone. Treatment may include administration of BH4, L-dopa (and carbidopa) 5-hydroxytryptophan supplements, and a low phenylalanine diet.

 

Tyrosine is a nonessential amino acid that is derived from dietary sources, the hydroxylation of phenylalanine, or protein breakdown. Primary (PKU) and secondary (defects of BH4 metabolism) hyperphenylalaninemia can cause abnormally low levels of tyrosine. Measurement of the phenylalanine:tyrosine ratio is helpful in monitoring appropriate dietary intake.

Reference Values

PHENYLALANINE

27.0-107.0 nmol/mL

 

TYROSINE

<4 weeks 40.0-280.0 nmol/mL

≥4 weeks 25.0-150.0 nmol/mL

Interpretation

The quantitative results of phenylalanine and tyrosine with age-dependent reference values are reported without added interpretation. When applicable, reports of abnormal results may contain an interpretation based on available clinical information.

 

A phenylalanine:tyrosine ratio higher than 3 is considered abnormal.

Clinical Reference

1. Mitchell GA, Grompe M, Lambert M, Tanguay RM: Hypertyrosinemia. In The Online Metabolic and Molecular Bases of Inherited Diseases. Edited by D Valle, AL Beaudet, B Vogelstein, et al. New York, McGraw-Hill Medical, 2014. Accessed July 31, 2019. Available at http://ommbid.mhmedical.com/content.aspx?bookid=971&Sectionid=62673883

2. Donlon J, Sarkissian C, Levy H, Scriver CR: Hyperphenylalaninemia: Phenylalanine hydroxylase deficiency. In The Online Metabolic and Molecular Bases of Inherited Diseases. Edited by D Valle, AL Beaudet, B Vogelstein, et al. New York, McGraw-Hill Medical, 2014. Accessed July 31, 2019. Available at http://ommbid.mhmedical.com/content.aspx?bookid=971&Sectionid=62673211

Day(s) and Time(s) Performed

Monday through Friday; 9 a.m.

Analytic Time

3 days

Test Classification

This test was developed and its performance characteristics 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

84030

84510

82542 (if appropriate for government payers)

LOINC Code Information

Test ID Test Order Name Order LOINC Value
PKUBS Phenylalanine and Tyrosine, BS 79621-9

 

Result ID Test Result Name Result LOINC Value
92405 Phenylalanine, BS 29573-3
92406 Tyrosine, BS 35571-9
92407 Reviewed By 18771-6

Forms

If not ordering electronically, complete, print, and send an Inborn Errors of Metabolism Test Request (T798) with the specimen.

Mayo Clinic Laboratories | Pediatric Catalog Additional Information:

mcl-newborn