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Test Code C5FX C5 Complement, Functional, Serum

Performing Laboratory

Mayo Medical Laboratories in Rochester

Reporting Name

C5 Complement, Functional, S

Specimen Type

Serum Red


Specimen Required


Patient Preparation: Fasting preferred

Collection Container/Tube: Red top

Submission Container/Tube: Plastic vial

Specimen Volume: 1 mL

Collection Instructions:

1. Immediately after drawing the specimen, place the tube on wet ice.

2. Spin down and separate serum from clot.

3. Immediately freeze specimen.


Reject Due To

Hemolysis

Mild OK; Gross OK

Lipemia

Mild OK; Gross reject

Icterus

Mild OK; Gross OK

Other

Serum gel tube

Specimen Stability Information

Specimen Type Temperature Time
Serum Red Frozen 14 days

Specimen Minimum Volume

0.5 mL

Day(s) and Time(s) Performed

Monday through Saturday; Continuously with a 3 p.m. cutoff

Specimen Retention Time

14 days

Analytic Time

Same day/1 day

Reference Values

29-53 U/mL

Useful For

Diagnosis of C5 deficiency

 

Investigation of a patient with an undetectable total complement (CH50) level

Method Name

Automated Liposome Lysis Assay

Test Classification

This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the U.S. Food and Drug Administration.

CPT Code Information

86161

LOINC Code Information

Test ID Test Order Name Order LOINC Value
C5FX C5 Complement, Functional, S 60472-8

 

Result ID Test Result Name Result LOINC Value
C5FX C5 Complement, Functional, S 60472-8

Clinical Information

Complement proteins are components of the innate immune system. There are 3 pathways to complement activation: 1) the classic pathway, 2) the alternative (or properdin) pathway, and 3) the lectin activation (mannan-binding protein: MBP) pathway. The classic pathway of the complement system is composed of a series of proteins that are activated in response to the presence of immune complexes. The activation process results in the generation of peptides that are chemotactic for neutrophils and that bind to immune complexes and complement receptors. The end result of the complement activation cascade is the formation of the lytic membrane attack complex (MAC).

 

Patients with deficiencies of the late complement proteins (C5, C6, C7, C8, and C9) are unable to form the MAC and may have increased susceptibility to neisserial infections. More than 30 cases of C5 deficiency have been reported. Most of these patients have neisserial infections.

 

Complement levels can be detected by antigen assays that quantitate the amount of the protein (C5AG / C5 Complement, Antigen, Serum). For most of the complement proteins, a small number of cases have been described in which the protein is present but is nonfunctional. These rare cases require a functional assay to detect the deficiency.

Interpretation

Low levels of complement may be due to inherited deficiencies, acquired deficiencies, or due to complement consumption (eg, as a consequence of infectious or autoimmune processes).

 

Absent C5 levels in the presence of normal C3 and C4 values are consistent with a C5 deficiency. Absent C5 levels in the presence of low C3 and C4 values suggest complement consumption.

 

Normal results indicate both normal C5 protein levels and normal functional activity.

Cautions

The total complement (CH50) assay (COM / Complement, Total, Serum) should be used as a screen for suspected complement deficiencies before ordering individual complement component assays. A deficiency of an individual component of the complement cascade will result in an undetectable total complement level.

 

Absent (or low) C5 functional levels in the presence of normal C5 antigen levels should be replicated with a new serum specimen to confirm that C5 inactivation did not occur during shipping.

Clinical Reference

1. Sonntag J, Brandenburg U, Polzehl D, et al: Complement systems in healthy term newborns: reference values in umbilical cord blood. Pediatr Dev Pathol 1998;1:131-135

2. Prellner K, Sjoholm AG, Truedsson L: Concentrations of C1q, factor B, factor D and properdin in healthy children, and the age-related presence of circulating C1r-C1s complexes. Acta Paediatr Scand 1987;76:939-943

3. Davis ML, Austin C, Messmer BL, et al: IFCC-standardization pediatric reference intervals for 10 serum proteins using the Beckman Array 360 system. Clin Biochem 1996;29,5:489-492

4. Gaither TA, Frank MM: Complement. In Clinical Diagnosis and Management by Laboratory Methods. 17th edition. Edited by JB Henry. Philadelphia, WB Saunders Company, 1984, pp 879-892

5. O'Neil KM: Complement deficiency. Clin Rev Allergy Immunol 2000;19:83-108

6. Frank MM: Complement deficiencies. Pediatr Clin North Am 2000;47(6):1339-1354

Method Description

C5 complement activity is measured by mixing patient serum with a C5-deficient serum. The lytic activity of the serum mixture is tested against sensitized, labeled liposomes. If lysis occurs, the patient serum must be the source of the C5. The target liposomes are a commercial reagent (WAKO total complement CH50), and the assay is performed on a Siemens Advia 1200.(Unpublished Mayo information; Yamamoto S, Kubotsu K, Masaaki K, et al: Automated homogeneous liposome-based assay system for total complement activity. Clin Chem 1995;41:586-590)