Test Catalog

Test Id : BAPS

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Bile Acid Profile, Serum

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Overview

Test Catalog

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

Evaluating the enterohepatic cycle consisting of the biliary system, intestine, portal circulation, and hepatocytes

 

Supporting researchers in need of free and conjugated values of all 20 bile acid species as well as total bile acid

Highlights

This is a serum test that measures all free and conjugated bile acids, including 20 individual species and total bile acids.

 

No interpretation is provided for this test that quantitates all free and conjugated bile acid species.

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

Bile Acid Profile, S

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

Peroxisomal Disorder

Peroxisomal Biogenesis Disorder

Zellweger syndrome

D-bifunctional protein deficiency

Alpha methyl-CoA racemase deficiency

Cholic acid

Chenodeoxycholic acid

Deoxycholic acid

Ursodeoxycholic acid

Hyodeoxycholic acid

Lithocholic acid

Glycocholic acid

Glcyochenodeoxycholic acid

Glcyodeoxycholic acid

Glycoursodeoxycholic acid

Glycohyodeoxycholic acid

Glycolithocholic acid

Taurocholic acid

Taurochenodeoxycholic acid

Taurodeoxycholic acid

Tauroursodeoxycholic acid

Taurohyodeoxycholic acid

Taurolithodeoxycholic acid

Dihydroxycholestanoic acid

Trihydroxycholestanoic acid

Total bile acids

Specimen Type
Describes the specimen type validated for testing

Serum

Ordering Guidance

This test is intended for use by research scientists. Approval must be obtained before ordering.

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

Patient Preparation: Patient must be fasting for 12 to 14 hours.

Collection Container/Tube:

Preferred: Serum gel

Acceptable: Red top

Submission Container/Tube: Plastic vial

Specimen Volume: 0.5 mL

Collection Instructions: Centrifuge and aliquot serum into a plastic vial.

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.

0.3 mL

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

Gross hemolysis OK
Gross lipemia OK

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
Serum Refrigerated (preferred) 90 days
Ambient 90 days
Frozen 90 days

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

Evaluating the enterohepatic cycle consisting of the biliary system, intestine, portal circulation, and hepatocytes

 

Supporting researchers in need of free and conjugated values of all 20 bile acid species as well as total bile acid

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

Bile acids are formed in the liver from cholesterol, conjugated primarily to glycine and taurine, stored and concentrated in the gallbladder, and secreted into the intestine after the ingestion of a meal. In the intestinal lumen, the bile acids serve to emulsify ingested fats and thereby promote digestion. During the absorptive phase of digestion, approximately 90% of the bile acids are reabsorbed.

 

The efficiency of the hepatic clearance of bile acids from portal blood maintains serum concentrations at low levels in normal persons. An elevated fasting level, due to impaired hepatic clearance, is a sensitive indicator of liver disease. Following meals, serum bile acid levels have been shown to increase only slightly in normal persons, but markedly in patients with various liver diseases, including cirrhosis, hepatitis, cholestasis, portal-vein thrombosis, Budd-Chiari syndrome, cholangitis, Wilson disease, and hemochromatosis. No increase in bile acids will be noted in patients with intestinal malabsorption. Metabolic hepatic disorders involving organic anions (eg, Gilbert disease, Crigler-Najjar syndrome, and Dubin-Johnson syndrome) do not cause abnormal serum bile acid concentrations.

 

The concentration of bile acids in serum is influenced by many different liver diseases due to the inability of the liver to efficiently extract circulating bile acids from portal blood.

 

In addition, bile acid levels are altered in several biochemical genetic conditions, such as peroxisomal biogenesis disorders (eg, Zellweger spectrum disorder) and disorders of bile acid synthesis (eg, D-bifunctional protein deficiency and alpha methyl-CoA racemase deficiency), due to the loss of specific enzymes important for bile acid metabolism.

 

This analysis includes a quantitative characterization of primary and secondary bile acids as well as 2 bile acid precursor species for the assessment of bile acid metabolism.

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.

Chenodeoxycholic acid: < or =2.26 nmol/mL

Cholic acid: < or =2.74 nmol/mL

Deoxycholic acid: < or =2.84 nmol/mL

Dihydroxycholestanoic acid: < or =0.07 nmol/mL

Glycochenodeoxycholic acid: < or =5.14 nmol/mL

Glycocholic acid: < or =2.17 nmol/mL

Glycodeoxycholic acid: < or =3.88 nmol/mL

Glycohyodeoxycholic acid: < or =0.01 nmol/mL

Glycolithocholic acid: < or =0.11 nmol/mL

Glycoursodeoxycholic acid: < or =1.00 nmol/mL

Hyodeoxycholic acid: < or =0.12 nmol/mL

Lithocholic acid: < or =0.09 nmol/mL

Taurochenodeoxycholic acid: < or =0.80 nmol/mL

Taurocholic acid: < or =0.31 nmol/mL

Taurodeoxycholic acid: < or =0.78 nmol/mL

Taurohyodeoxycholic acid: < or =0.02 nmol/mL

Taurolithocholic acid: < or =0.04 nmol/mL

Tauroursodeoxycholic acid: < or =0.05 nmol/mL

Trihydroxycholestanoic acid: < or =1.73 nmol/mL

Ursodeoxycholic acid: < or =0.64 nmol/mL

Total bile acids: < or =19.00 nmol/mL

Interpretation
Provides information to assist in interpretation of the test results

Total bile acids are metabolized in the liver and can serve as a marker for normal liver function. Increases in serum C27 bile acids are seen in patients with peroxisomal biogenesis disorders (eg, as Zellweger spectrum disorder) or single enzyme defects of bile acid synthesis (eg, D-bifunctional protein deficiency and alpha methyl CoA racemases).

 

Totals of the free and conjugated bile acid species for all 20 bile acids in addition to total bile acids will be reported. No 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

Bile acid concentrations in serum may be elevated post meal or due to bile acid therapy, such as cholic acid, deoxycholic acid, or ursodeoxycholic acid.

 

Do not use for assessment of general liver dysfunction in adults or diagnosis or monitoring of intrahepatic cholestasis of pregnancy.

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

1. Sundaram SS, Bove KE, Lovell MA, Sokol RJ. Mechanisms of disease: inborn errors of bile acid synthesis. Nat Clin Pract Gastroenterol Hepatol. 2008;5(8):456-468

2. Wanders RJA, Rizzo WB. Inborn errors of peroxisome biogenesis and function. In: Sarafoglou K, Hoffmann GF, Roth KS, eds. Pediatric Endocrinology and Inborn Errors of Metabolism. McGraw-Hill Medical Division. 2nd ed. 2017:427-446

3. Ducroq DH, Morton MS, Shadi N, et al. Analysis of serum bile acids by isotope dilution-mass spectrometry to assess the performance of routine total bile acid methods. Ann Clin Biochem. 2010;47(Pt 6):535-540

4. Fischler B, Eggersten G, Bjorkhem I. Genetic defects in synthesis and transport of bile acids. In: Sarafoglou K, Hoffmann GF, Roth KS, eds. Pediatric Endocrinology and Inborn Errors of Metabolism. McGraw-Hill Medical Division; 2017:447-460

5. Society for Maternal-Fetal Medicine (SMFM). Lee RH, Mara Greenberg, Metz TD, Pettker CM. Society for Maternal-Fetal Medicine Consult Series #53: Intrahepatic cholestasis of pregnancy: replaces consult #13, April 2011. Am J Obstet Gynecol. 2021;224(2):B2-B9. doi:10.1016/j.ajog.2020.11.002

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

Bile acid concentrations in serum are measured by liquid chromatography tandem mass spectrometry stable isotope dilution analysis. Serum is mixed with isotopically labeled internal standards of selected bile acids and then subjected to protein precipitation. Sample preparation is semiautomated using a liquid handler. Reverse-phase liquid chromatography is performed to separate free bile acids, their respective tauro- and glyco-conjugates, and 2 bile acid precursors.(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.

Monday through Friday

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.

3 to 5 days

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

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.

82542

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
BAPS Bile Acid Profile, S 43130-4
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.
35802 Chenodeoxycholic acid 30519-3
35801 Cholic acid 30518-5
35803 Deoxycholic acid 30520-1
35819 Dihydroxycholestanoic acid 53479-2
35808 Glycochenodeoxycholic acid 93335-8
35807 Glycocholic acid 93334-1
35809 Glycodeoxycholic acid 93333-3
35811 Glycohyodeoxycholic acid 93332-5
35812 Glycolithocholic acid 93331-7
35810 Glycoursodeoxycholic acid 93330-9
35805 Hyodeoxycholic acid 93329-1
35806 Lithocholic acid 74897-0
35814 Taurochenodeoxycholic acid 93328-3
35813 Taurocholic acid 93327-5
35815 Taurodeoxycholic acid 93326-7
35817 Taurohyodeoxycholic acid 93325-9
35818 Taurolithocholic acid 93324-2
35816 Tauroursodeoxycholic acid 93323-4
35820 Trihydroxycholestanoic acid 38188-9
35804 Ursodeoxycholic acid 55159-8
35821 Total bile acids 14628-2

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