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Test Id : GAAW

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Acid Alpha-Glucosidase, Leukocytes

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Overview

Test Catalog

Useful For
Suggests clinical disorders or settings where the test may be helpful

Diagnosis of Pompe disease

Genetics Test Information
Provides information that may help with selection of the correct genetic test or proper submission of the test request

This test provides diagnostic testing for individuals with decreased alpha-glucosidase activity on newborn screen or clinical signs and symptoms suspicious for Pompe disease.

Testing Algorithm
Delineates situations when tests are added to the initial order. This includes reflex and additional tests.

For testing algorithm information see Newborn Screen Follow-up for Pompe Disease.

For Newborn Screening ACT Sheet for Pompe Disease (Glycogen Storage Disease Type II) information, visit www.acmg.net/PDFLibrary/Pompe.pdf.

Method Name
A short description of the method used to perform the test

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

NY State Available
Indicates the status of NY State approval and if the test is orderable for NY State clients.

Yes

Reporting Name
Lists a shorter or abbreviated version of the Published Name for a test

Acid Alpha-Glucosidase, Leukocytes

Aliases
Lists additional common names for a test, as an aid in searching

Acid Alpha-Glucosidase

Acid Maltase Deficiency

Alpha-Glucosidase Deficiency

Glycogen Storage Disease Type II (GSD II)

Pompe Disease

Testing Algorithm
Delineates situations when tests are added to the initial order. This includes reflex and additional tests.

For testing algorithm information see Newborn Screen Follow-up for Pompe Disease.

For Newborn Screening ACT Sheet for Pompe Disease (Glycogen Storage Disease Type II) information, visit www.acmg.net/PDFLibrary/Pompe.pdf.

Specimen Type
Describes the specimen type validated for testing

Whole Blood ACD

Shipping Instructions

For optimal isolation of leukocytes, it is recommended the specimen arrive refrigerate within 6 days of collection to be stabilized. Collect specimen Monday through Thursday only and not the day before a holiday. Specimen should be collected and packaged as close to shipping time as possible.

Specimen Required
Defines the optimal specimen required to perform the test and the preferred volume to complete testing

Container/Tube:

Preferred: Yellow top (ACD solution B)

Acceptable: Yellow top (ACD solution A) or lavender top (EDTA)

Specimen Volume: 6 mL

Collection Instructions: Send whole blood specimen in original tube. Do not aliquot.

Special Instructions
Library of PDFs including pertinent information and forms related to the test

Forms

1. 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)

2. Biochemical Genetics Patient Information (T602)

3. If not ordering electronically, complete, print, and send a Biochemical Genetics Test Request (T798) with the specimen.

Specimen Minimum Volume
Defines the amount of sample necessary to provide a clinically relevant result as determined by the testing laboratory. The minimum volume is sufficient for one attempt at testing.

2 mL

Reject Due To
Identifies specimen types and conditions that may cause the specimen to be rejected

Gross hemolysis Reject

Specimen Stability Information
Provides a description of the temperatures required to transport a specimen to the performing laboratory, alternate acceptable temperatures are also included

Specimen Type Temperature Time Special Container
Whole Blood ACD Refrigerated (preferred) 6 days
Ambient 6 days

Useful For
Suggests clinical disorders or settings where the test may be helpful

Diagnosis of Pompe disease

Genetics Test Information
Provides information that may help with selection of the correct genetic test or proper submission of the test request

This test provides diagnostic testing for individuals with decreased alpha-glucosidase activity on newborn screen or clinical signs and symptoms suspicious for Pompe disease.

Testing Algorithm
Delineates situations when tests are added to the initial order. This includes reflex and additional tests.

For testing algorithm information see Newborn Screen Follow-up for Pompe Disease.

For Newborn Screening ACT Sheet for Pompe Disease (Glycogen Storage Disease Type II) information, visit www.acmg.net/PDFLibrary/Pompe.pdf.

Clinical Information
Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test

Pompe disease, also known as glycogen storage disease type II, is an autosomal recessive disorder caused by a deficiency of the lysosomal enzyme acid alpha-glucosidase (GAA; acid maltase) due to variants in the GAA gene. The estimated incidence is 1 in 40,000 live births. In Pompe disease, glycogen that is taken up by lysosomes during physiologic cell turnover accumulates, causing lysosomal swelling, cell damage, and organ dysfunction. This leads to progressive muscle weakness, cardiomyopathy, and, eventually, death. Individuals with Pompe disease, especially those with infantile, childhood, and juvenile onset, can have elevations of serum enzymes (eg, creatine kinase) secondary to cellular dysfunction.

 

The clinical phenotype of Pompe disease lies on a spectrum dependent on age of onset and residual enzyme activity. Complete loss of enzyme activity causes onset in infancy leading to death, typically within the first year of life when left untreated. Juvenile and adult-onset forms, as the names suggest, are characterized by later onset and longer survival. All disease variants are eventually associated with progressive muscle weakness and respiratory insufficiency. Cardiomyopathy is associated almost exclusively with the infantile form. Treatment with enzyme replacement therapy is available, making early diagnosis of Pompe disease desirable, as early initiation of treatment may improve prognosis. Newborn screening can identify individuals with all forms of Pompe disease, even before onset of symptoms. Unaffected individuals with GAA pseudodeficiency alleles and carriers may also be identified by newborn screening.

 

Determination of GAA enzyme activity in leukocytes can help distinguish between infantile and later onset Pompe disease, but it may also be deficient in individuals with pseudodeficiency alleles and in some carriers. Urine glucotetrasaccharides (HEX4 / Glucotetrasaccharides, Random, Urine) have been shown to be elevated in some individuals, particularly those with infantile onset, and may aid in the initial diagnosis and treatment monitoring.

 

Molecular genetic analysis of the GAA gene (GAAZ / Pompe Disease, Full Gene Analysis, Varies) is necessary for differentiating alterations from disease-causing variants in affected individuals and for carrier detection in family members.

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.

> or =1.50 nmol/hour/mg protein

An interpretive report is provided.

Interpretation
Provides information to assist in interpretation of the test results

When abnormal results are detected, a detailed interpretation is given, including an overview of the results and of their significance, a correlation to available clinical information, elements of differential diagnosis, recommendations for additional biochemical testing and in vitro, confirmatory studies (enzyme assay, molecular analysis), and a phone number to reach one of the laboratory directors in case the referring physician has additional questions.

Cautions
Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances

Pseudodeficiency results in low measured acid alpha-glucosidase activity, but it is not consistent with Pompe disease. Molecular analysis (GAAZ / Pompe Disease, Full Gene Analysis, Varies) should be performed to resolve the clinical question.

 

Additional biochemical or molecular testing is recommended to confirm a diagnosis if an enzyme deficiency is detected by this screening test.

 

Enzyme levels may be normal in individuals receiving enzyme replacement therapy.

Clinical Reference
Recommendations for in-depth reading of a clinical nature

1. Elliott S, Buroker N, Cournoyer JJ, et al: Pilot study of newborn screening for six lysosomal storage diseases using tandem mass spectrometry. Mol Genet Metab. 2016 Aug;118(4):304-309. doi: 10.1016/j.ymgme.2016.05.015

2. Matern D, Gavrilov D, Oglesbee D, Raymond K, Rinaldo P, Tortorelli S: Newborn screening for lysosomal storage disorders. Semin Perinatol. 2015 Apr;39(3):206-216. doi: 10.1053/j.semperi.2015.03.005

3. Reuser AJJ, Hirschhorn R, Kroos MA: Pompe disease: Glycogen storage disease type II, acid a-glucosidase (acid maltase) deficiency. In: Valle DL, Antonarakis S, Ballabio A, Beaudet AL, Mitchell GA. eds. Online Metabolic and Molecular Bases of Inherited Disease. McGraw-Hill; 2019. Accessed June 30, 2020. Available at https://ommbid.mhmedical.com/content.aspx?bookid=2709&sectionid=225890450

4. Lin N, Huang J, Violante S, et al: Liquid chromatography-tandem mass spectrometry assay of leukocyte acid alpha-glucosidase for post-newborn screening evaluation of Pompe disease. Clin Chem. 2017 Apr;63(4):842-851. doi: 10.1373/clinchem.2016.259036

5. Leslie N, Bailey L: Pompe disease. In: Adam MP, Ardinger HH, Pagon RA, et al. GeneReviews [Internet]. University of Washington, Seattle; 2007. Updated May 11, 2017. Accessed March 23, 2022. Available at www.ncbi.nlm.nih.gov/books/NBK1261/

Method Description
Describes how the test is performed and provides a method-specific reference

The specimens are incubated with a mix of substrate and internal standard for acid alpha-glucosidase and alpha-galactosidase (GLA). The reaction is then stopped using acetonitrile, centrifuged, and a portion of the supernatant is prepared for analysis by liquid chromatography-tandem mass spectrometry. GLA is included to verify sample integrity.(Unpublished Mayo method)

PDF Report
Indicates whether the report includes an additional document with charts, images or other enriched information

No

Day(s) Performed
Outlines the days the test is performed. This field reflects the day that the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time before the test is performed. Some tests are listed as continuously performed, which means that assays are performed multiple times during the day.

Preanalytical processing: Monday through Saturday.

Assay performed: Monday, Wednesday

Report Available
The interval of time (receipt of sample at Mayo Clinic Laboratories to results available) taking into account standard setup days and weekends. The first day is the time that it typically takes for a result to be available. The last day is the time it might take, accounting for any necessary repeated testing.

5 to 9 days

Specimen Retention Time
Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded

WBC homogenate: 1 month

Performing Laboratory Location
Indicates the location of the laboratory that performs the test

Rochester

Fees
Several factors determine the fee charged to perform a test. Contact your U.S. or International Regional Manager for information about establishing a fee schedule or to learn more about resources to optimize test selection.

  • Authorized users can sign in to Test Prices for detailed fee information.
  • Clients without access to Test Prices can contact Customer Service 24 hours a day, seven days a week.
  • Prospective clients should contact their account representative. For assistance, contact Customer Service.

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 instructions, or as products that do not undergo full FDA review and approval, and are then labeled as an Analyte Specific Reagent (ASR) product.

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
Provides guidance in determining the appropriate Current Procedural Terminology (CPT) code(s) information for each test or profile. The listed CPT codes reflect Mayo Clinic Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.

CPT codes are provided by the performing laboratory.

82657

LOINC® Information
Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the order and results codes of this test. LOINC values are provided by the performing laboratory.

Test Id Test Order Name Order LOINC Value
GAAW Acid Alpha-Glucosidase, Leukocytes 24051-5
Result Id Test Result Name Result LOINC Value
Applies only to results expressed in units of measure originally reported by the performing laboratory. These values do not apply to results that are converted to other units of measure.
606267 Acid Alpha-Glucosidase, Leukocytes 24051-5
606268 Interpretation 59462-2
606269 Reviewed By 18771-6

Test Setup Resources

Setup Files
Test setup information contains test file definition details to support order and result interfacing between Mayo Clinic Laboratories and your Laboratory Information System.

Excel | Pdf

Sample Reports
Normal and Abnormal sample reports are provided as references for report appearance.

Normal Reports | Abnormal Reports

SI Sample Reports
International System (SI) of Unit reports are provided for a limited number of tests. These reports are intended for international account use and are only available through MayoLINK accounts that have been defined to receive them.

SI Normal Reports | SI Abnormal Reports