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HelpTest Code GNHMA Hemophilia A, F8 Gene, Next-Generation Sequencing, Varies
Ordering Guidance
For male patients, this test should only be considered if clinical and family history, initial coagulation screens, and/or initial activity tests indicate a diagnosis of hemophilia A. For female patients, this test should only be considered if there is a confirmed diagnosis of hemophilia A in a family member or the patient has abnormally low factor VIII (FVIII) activity.
This test does not measure FVIII activity levels. For assessment of FVIII activity, order F8A / Coagulation Factor VIII Activity Assay, Plasma.
For individuals with bleeding symptoms and no known personal or family history of hemophilia A, consider ALBLD / Bleeding Diathesis Profile, Limited, Plasma or the specific factor assays.
This test does not evaluate for the presence of inversions in the F8 gene that can cause hemophilia A. If testing for possible inversions in the F8 gene is desired, order F8INV / Hemophilia A F8 Gene, Intron 1 and 22 Inversion Mutation Analysis, Whole Blood.
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 F8 gene 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 variants testing) is available for the F8 gene. 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
Hemophilia A 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. Hemophilia A Patient Information (T712) 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.
Useful For
Confirming a clinical diagnosis of hemophilia A in affected male patients with the identification of a disease-causing variant in the F8 gene
Determining the disease-causing alteration within the F8 gene to delineate the underlying molecular defect in a male patient with a laboratory diagnosis of hemophilia A
Identifying the causative alteration for prognostic and genetic counseling purposes
Assessing hemophilia A carrier status for female patients with a family history of hemophilia A
Prenatal testing for hemophilia A when a familial F8 variant has been previously identified in a family member
Genetics Test Information
This test utilizes next-generation sequencing to detect single nucleotide and copy number variants in the F8 gene associated with hemophilia A (also known as factor VIII deficiency). See Method Description for additional details.
Identification of a disease-causing variant may assist with diagnosis, prognosis, clinical management, recurrence risk assessment, familial screening, and genetic counseling for hemophilia A.
Disease States
- Hemophilia A
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 hemophilia A in symptomatic male patients should begin with special coagulation testing for factor VIII (FVIII) activity. Genetic testing is indicated if FVIII activity is less than 40% of normal (Note: reference range may vary depending on the locally established reference range) and von Willebrand factor antigen testing is normal. For more information see Hemophilia Testing Algorithm.
FVIII clotting activity does not correlate as well with bleeding severity in female patients and therefore, is unreliable in the detection of female carriers of hemophilia A. Carrier status is determined by identification of a heterozygous disease-causing variant in F8 by molecular genetic testing. For female patients with a suspected or confirmed diagnosis of hemophilia A in a family member, carrier testing is recommended as specified by the Hemophilia Carrier Testing Algorithm.(1-3)
Acquired (nongenetic) causes of hemophilia A that should be excluded before genetic testing include heparin use, disorders associated with antibodies to clotting factors such as systemic lupus erythematosus or antiphospholipid syndrome, pregnancy/postpartum period, rheumatic disease, solid or hematologic malignancies, and use of certain drugs such as penicillin, sulfamides, phenytoin, interferon, fludarabine.
For prenatal specimens only:
Prenatal genetic testing for hemophilia A is not routinely performed without the prior identification of a familial F8 variant in an affected male relative or a carrier female relative. Requests for prenatal testing for hemophilia A without a known familial F8 variant are performed at the discretion of a Molecular Hematopathology Laboratory Director.
-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.
Special Instructions
Method Name
Sequence Capture and Targeted Next-Generation Sequencing (NGS) followed by Polymerase Chain Reaction (PCR) and Sanger Sequencing
Reporting Name
F8 Gene, Full Gene NGSSpecimen Type
VariesSpecimen 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
Hemophilia A is a hereditary bleeding disorder associated with germline variants in the F8 gene. It is inherited in an X-linked recessive manner with variable expressivity and is estimated to affect 1 in 4000-5000 live male births.(2)
Hemophilia A is characterized by a deficiency in clotting factor VIII (FVIII), an essential blood coagulation protein. Symptomatic male patients may experience mild to severe bleeding problems, including excessive bruising, prolonged epistaxis, post-operative bleeding, hemarthrosis, deep-muscle hematomas, and/or intracranial or gastrointestinal tract bleeding.(2,3) Female carriers are not typically affected but some may experience increased bleeding tendencies especially after medical procedures and surgery. Note that FVIII activity may not correlate with the severity of symptoms in females.(4-6)
Several causes of acquired (nongenetic) hemophilia A should be excluded prior to genetic testing, including heparin use, disorders associated with antibodies to clotting factors such as systemic lupus erythematosus or antiphospholipid syndrome, pregnancy and the postpartum period, rheumatic disease, solid and hematologic malignancies, and use of certain drugs (eg, penicillin, sulfamides, phenytoin, interferon, fludarabine).(7)
The World Federation of Hemophilia provides guidelines regarding diagnosis, management, and laboratory testing for individuals with hemophilia A.(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.
Day(s) Performed
Varies
Report Available
28 to 42 daysSpecimen Retention Time
Whole blood: 2 weeks (if available); Extracted DNA: 3 months; Amniotic fluid, cultured amniocytes, chorionic villi, cultured chorionic villi: 1 monthPerforming 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
81407
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 |
|---|---|---|
| GNHMA | F8 Gene, Full Gene NGS | 94234-2 |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| 619104 | Test Description | 62364-5 |
| 619105 | Specimen | 31208-2 |
| 619106 | Source | 31208-2 |
| 619107 | Result Summary | 50397-9 |
| 619108 | Result | 82939-0 |
| 619109 | Interpretation | 69047-9 |
| 619110 | Additional Results | 82939-0 |
| 619111 | Resources | 99622-3 |
| 619112 | Additional Information | 48767-8 |
| 619113 | Method | 85069-3 |
| 619114 | Genes Analyzed | 82939-0 |
| 619115 | Disclaimer | 62364-5 |
| 619116 | Released By | 18771-6 |