Test Code PEWE Porphyrins Evaluation, Washed Erythrocytes
Performing Laboratory
Mayo Clinic Laboratories in Rochester
Reporting Name
Porphyrin Evaluation, RBCSpecimen Type
Washed RBCOrdering Guidance
This is the preferred test for assessment for protoporphyria. The preferred test for assessing lead toxicity in children is blood lead. For more information see PBDV / Lead, Venous, with Demographics, Blood or PBDC / Lead, Capillary, with Demographics, Blood.
For suspected hepatic porphyria, the preferred screening test is urine porphyrins. For more information, see PQNRU / Porphyrins, Quantitative, Random, Urine.
Necessary Information
1. Volume of packed cells and total volume of specimen (red cells + saline) are required and must be sent with specimen.
2. Include a list of medications the patient is currently taking.
Specimen Required
Patient Preparation: For 24 hours before specimen collection, patient must not consume any alcohol.
Collection Container/Tube:
Preferred: Green top (sodium heparin)
Acceptable: Dark blue top (metal free heparin), green top (lithium heparin), or lavender top (EDTA)
Submission Container/Tube: Plastic vial
Specimen Volume: Entire washed erythrocyte suspension
Collection Instructions:
Collect and process whole blood specimen as follows:
1. Transfer entire specimen to a 12-mL graduated centrifuge tube.
2. Centrifuge specimen at 4° C for 10 minutes at 2000 rpm.
3. Record volume of packed cells and the total volume of the specimen.
4. Discard supernatant plasma.
5. Wash packed erythrocytes 2 times by resuspension of at least an equal amount of cold 0.9% saline, mix, and centrifuge for 5 minutes at 2000 rpm, discarding supernatant after each washing.
6. Resuspend packed cells to the original total volume with 0.9% saline. Invert specimen gently to mix.
7. Transfer washed erythrocytes into a plastic vial and freeze.
Reject Due To
| Cell suspension not available | Reject |
Specimen Stability Information
| Specimen Type | Temperature | Time |
|---|---|---|
| Washed RBC | Frozen (preferred) | 14 days |
| Refrigerated | 14 days |
Specimen Minimum Volume
Washed and resuspended erythrocytes: 1 mL
Special Instructions
Day(s) Performed
Monday through Friday
Specimen Retention Time
14 daysReport Available
3 to 5 daysReference Values
<80 mcg/dL
Reflex Tests
| Test ID | Reporting Name | Available Separately | Always Performed |
|---|---|---|---|
| PPFWE | Protoporphyrins, Fractionation, RBC | Yes | No |
Useful For
Preferred test for analysis of erythrocyte porphyrins
Establishing a biochemical diagnosis of erythropoietic protoporphyria and X-linked protoporphyria
Testing Algorithm
This test is recommended for screening patients for possible erythropoietic protoporphyria and X-linked protoporphyria. In addition, it can be used for evaluation of iron-deficiency anemia and chronic lead intoxication. Testing begins with total erythrocyte porphyrins. If the result is below 80 mcg/dL, it is normal, and testing is complete.
If the total erythrocyte porphyrin value is 80 mcg/dL or above, the protoporphyrin fractionation assay will automatically be performed at an additional charge. The fractionation test results include noncomplexed (free) protoporphyrin and zinc-complexed protoporphyrin.
The following algorithms are available:
CPT Code Information
84311-Spectrophotometry, analyte not elsewhere specified
82542-Chromatography (if appropriate)
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| PEWE | Porphyrin Evaluation, RBC | 2814-2 |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| 31942 | Total Porphyrins, RBC | 2814-2 |
| 31943 | Interpretation | 59462-2 |
| BG569 | Total cell suspension | 94496-7 |
| BG570 | Packed cell volume | 94497-5 |
Method Description
This evaluation is performed as a 2-step analysis. First, the total red blood cells (RBC) porphyrin concentration is determined by extracting the porphyrins from washed, resuspended RBCs using a mixture of ethyl acetate and acetic acid. The porphyrins are then back extracted into dilute hydrochloric acid. Total porphyrins are quantified using this extract via spectrofluorometry.(Piomelli S. Free erythrocyte porphyrins in the detection of undue absorption of Pb and Fe deficiency. Clin Chem. 1977;23:264-269; Gou EE, Balwani M, Bissell DM, et al. Pitfalls in erythrocyte protoporphyrin measurement for diagnosis and monitoring of protoporphyrias. Clin Chem. 2015;61[12]:1453-1456. doi:10.1373/clinchem.2015.245456)
If the total porphyrin concentration is elevated, the RBCs are re-extracted to separate and quantify the zinc-complexed and noncomplexed (free) protoporphyrin via high-performance liquid chromatography.(Smith RM, Doran D, Mazur M, Bush B. High-performance liquid chromatographic determination of protoporphyrin and zinc protoporphyrin in blood. J Chromatogr. 1980 Mar;181[3-4]:319-327; Gou EE, Balwani M, Bissell DM, et al. Pitfalls in erythrocyte protoporphyrin measurement for diagnosis and monitoring of protoporphyrias. Clin Chem. 2015;61[12]:1453-1456. doi:10.1373/clinchem.2015.245456)
Forms
If not ordering electronically, complete, print, and send a Biochemical Genetics Test Request (T798) with the specimen.