Bloom Syndrome DNA Mutation Analysis

Test Code

90872

CPT Codes
81209

Physician Attestation of Informed Consent

This germline genetic test requires physician attestation that patient consent has been received if ordering medical facility is located in AK, DE, FL, GA, IA, MA, MN, NV, NJ, NY, OR, SD or VT or test is performed in MA.

Preferred Specimen

4 mL whole blood collected in an EDTA (lavender-top) tube, EDTA (royal blue-top) tube, ACD (yellow-top) tube, or sodium or lithium heparin (green-top) tube

Minimum Volume

3 mL whole blood • 10 mL amniotic fluid • 10 mg CVS

Other Acceptable Specimens

Bone marrow collected in EDTA (lavender-top) tube • 10 amniotic fluid collected in a sterile leak-proof container • Cultured cells collected in each (x2) sterile T-25 flasks, 75% confluent • 10 mg chorionic villi collected in a sterile tube filled with sterile culture media

Instructions

Do not hold specimen; forward to laboratory when specimen arrives.

Whole blood: Specimen stability is crucial. Store and ship room temperature immediately. Do not freeze.

For fetal testing:
1) Please call 1-866-GENE-INFO (1-866-436-3463) prior to submission;
2) Documentation of parental carrier status must be provided;
3) It is required that Maternal Cell Contamination Study, STR Analysis be ordered in conjunction with fetal testing. A separate tube of maternal blood (EDTA) is required for this test.

Amniotic fluid (acceptable): Normal collection procedure. Specimen stability is crucial. Store and ship at room temperature immediately. Do not refrigerate or freeze; forward to laboratory when sample arrives.
Amniocyte or Chorionic Villus (CVS) culture (acceptable): Two sterile T25 flasks, 75% confluent, filled with culture medium. Specimen stability is crucial. Store and ship at room temperature immediately. Do not refrigerate or freeze; forward to laboratory when cells arrive.
Dissected Chorionic Villus (CVS) biopsy (acceptable): 10-20 mg dissected chorionic villi collected in sterile tube, filled with sterile culture medium. Specimen stability is crucial. Store and ship at room temperature immediately. Do not refrigerate or freeze; forward to laboratory when sample arrives.

Transport Temperature

Room temperature

Specimen Stability

Whole blood and bone marrow
Room temperature: 8 days
Refrigerated: 8 days
Frozen: Unacceptable
⁠⁠⁠⁠⁠⁠⁠
Fetal specimens
Room temperature: 48 hours
Refrigerated: Unacceptable
Frozen: Unacceptable

Reject Criteria (Eg, hemolysis? Lipemia? Thaw/Other?)

Do not reject

Methodology
Polymerase Chain Reaction (PCR) • Next Generation Sequencing

FDA Status
This test was developed and its analytical performance characteristics have been determined by Quest Diagnostics. It has not been cleared or approved by the U.S. Food and Drug Administration. This assay has been validated pursuant to the CLIA regulations and is used for clinical purposes.

Setup Schedule

Set up: Mon, Sat; Report available: 10-16 days

Limitations

This test only detects the 2281del6ins7 mutation that is responsible for approximately 97% of the Bloom syndrome mutations common in the Ashkenazi Jewish population.

Reference Range

See Laboratory Report

Clinical Significance

Bloom Syndrome is an autosomal recessive disease associated with a high frequency of chromosome breakages. Patients are predisposed to malignancy, pigmentation abnormalities of the skin, short stature, and other medical conditions. 97% of patients have a single mutation that is found in approximately 1 in 100 individuals of Ashkenazi Jewish heritage.

The CPT Codes provided in this document are based on AMA guidelines and are for informational purposes only. CPT coding is the sole responsibility of the billing party. Please direct any questions regarding coding to the payor being billed. Any Profile/panel component may be ordered separately. Reflex tests are performed at an additional charge.