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Test Code GNF13 Factor XIII Deficiency, F13A1 and F13B Genes, Next-Generation Sequencing, Varies


Ordering Guidance


Special coagulation testing for factor XIII (FXIII) activity should be performed prior to any genetic testing. For assessment of FXIII activity, order ALBLD / Bleeding Diathesis Profile, Limited, Plasma, which includes the factor XIII screening assay.

 

Genetic testing should only be considered if clinical and family history, initial coagulation screens, or initial activity tests indicate a diagnosis of FXIII deficiency (see Testing Algorithm).

 

If genetic testing for hereditary bleeding disorders using a larger panel is desired, both a 6-gene focused bleeding panel and a 25-gene comprehensive bleeding panel are available. For more information see GNBLF / Bleeding Disorders, Focused Gene Panel, Next-Generation Sequencing, Varies or GNBLC / Bleeding Disorders, Comprehensive Gene Panel, Next-Generation Sequencing, Varies.

 

Testing for the F13A1 and F13B genes as part of a customized panel is 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 F13A1 and F13B genes. 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

 

Prenatal Specimens

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.

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.

Secondary ID

619145

Useful For

Evaluating factor XIII deficiency (FXIIID) in patients with a personal or family history suggestive of FXIIID

 

Confirming an FXIIID diagnosis with the identification of known or suspected disease-causing alterations in the F13A1 or F13B genes

 

Determining the disease-causing alterations within the F13A1 or F13B genes to delineate the underlying molecular defect in a patient with a laboratory diagnosis of FXIIID

 

Identifying the causative alterations 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 diagnosis of FXIIID

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

Testing Algorithm

The clinical workup for factor FXIII deficiency (FXIIID) should begin with special coagulation testing for factor XIII activity.

 

A standard testing algorithm for FXIIID has been developed by the Scientific and Standardization Committee of the International Society for Thrombosis and Haemostasis.(1)

 

Genetic testing for FXIIID is indicated if:

-The clot solubility test, a screening test for possible factor XIII deficiency, is abnormal or FXIII antigen or activity is decreased

-Acquired causes of FXIIID have been excluded (eg, leukemia, liver disease, Henoch-Schonlein purpura, inflammatory bowel diseases, disseminated intravascular coagulation, pulmonary embolism, stroke, and sepsis, exposure to valproate)

Note: Factor XIII may occur spontaneously in older adults.

 

For prenatal specimens only:

-If amniotic fluid (nonconfluent cultured cells) is received, amniotic fluid culture/genetic test will be added at an additional charge.

-If chorionic villus specimen (nonconfluent cultured cells) is received, fibroblast culture for genetic test will be added at an additional charge.

 

For any prenatal specimen that is received, maternal cell contamination testing will be performed at an additional charge.

Method Name

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

Reporting Name

F13A1 and B Genes, Full Gene 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

Factor XIII deficiency (FXIIID) is a rare hereditary bleeding disorder associated with germline variants in the F13A1 and F13B genes. It is inherited in an autosomal recessive manner with variable expressivity; both male and female patients may be affected. The estimated prevalence is 1 in 2 million individuals.(2-4)

 

FXIIID caused by homozygous or compound heterozygous variants in F13A1 (FXIII-A deficiency) typically presents as a severe bleeding tendency. Onset of life-threatening symptoms often occurs early with umbilical cord and central nervous system bleeding. Additional symptoms include easy bruising, intramuscular and subcutaneous hematomas, oral mucosal bleeding, epistaxis, perioperative bleeding, and impaired wound healing. Among the rare bleeding disorders, FXIIID appears uniquely associated with pregnancy loss. Affected women have an increased risk of miscarriage, postpartum hemorrhage, menorrhagia, and intraperitoneal bleeding.(2- 7)

 

Individuals with FXIIID caused by homozygous or compound heterozygous variants in F13B (FXIII-B deficiency) tend to have a milder bleeding tendency, although a severe phenotype can occur.(1,2)

 

Accurate correlation between genotype and phenotype in FXIIID has proven challenging due to the unpredictable nature and variability of disease symptoms, its rarity, and the limitation of some laboratory assays. Routine coagulation tests are often normal.(2,3,5)

 

Several causes of acquired (nongenetic) FXIIID should be excluded prior to genetic testing, including leukemia, liver disease, Henoch-Schonlein purpura, inflammatory bowel diseases, disseminated intravascular coagulation, pulmonary embolism, stroke, sepsis, and exposure to valproate. FXIIID also may occur spontaneously in older adults.(1-3)

 

The United Kingdom Haemophilia Centre Doctors' Organization provides guidelines regarding diagnosis and management for individuals with inherited bleeding disorders, including FXIIID.(8)

Reference Values

An interpretive report will be provided.

Interpretation

All detected variants are evaluated according to American College of Medical Genetics and Genomics recommendations.(9) Variants are classified based on known, predicted, or possible pathogenicity and reported with interpretive comments detailing their potential or known significance.

Method Description

Next-generation sequencing (NGS) and/or Sanger sequencing are performed to test for the presence of variants in coding regions and intron/exon boundaries of the F13A1 and F13B genes, as well as some other regions that have known disease-causing variants. The human genome reference GRCh37/hg19 build was used for sequence read alignment. At least 99% of the bases are covered at a read depth over 30X. Sensitivity is estimated at above 99% for single nucleotide variants, above 94% for deletions-insertions (delins) less than 40 base pairs (bp), above 95% for deletions up to 75 bp, and insertions up to 47 bp. NGS and/or a polymerase chain reaction-based quantitative method is performed to test for the presence of deletions and duplications in the F13A1 and F13B genes.

 

There may be regions of genes that cannot be effectively evaluated by sequencing or deletion and duplication analysis as a result of technical limitations of the assay, including regions of homology, high guanine-cytosine (GC) content, and repetitive sequences.(Unpublished Mayo method)

 

The reference transcript for F13A1 is NM_ 000129.4 and F13B is NM_001994.2. Reference transcript numbers may be updated due to transcript re-versioning. Always refer to the final patient report for gene transcript information referenced at the time of testing. Confirmation of select reportable variants may be performed by alternate methodologies based on internal laboratory criteria.

Day(s) Performed

Varies

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

81479

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)

LOINC Code Information

Test ID Test Order Name Order LOINC Value
GNF13 F13A1 and B Genes, Full Gene NGS 92991-9

 

Result ID Test Result Name Result LOINC Value
619146 Test Description 62364-5
619147 Specimen 31208-2
619148 Source 31208-2
619149 Result Summary 50397-9
619150 Result 82939-0
619151 Interpretation 69047-9
619152 Additional Results 82939-0
619153 Resources 99622-3
619154 Additional Information 48767-8
619155 Method 85069-3
619156 Genes Analyzed 82939-0
619157 Disclaimer 62364-5
619158 Released By 18771-6