Order Code LABCDGF Celiac Disease Gluten-Free Cascade, Serum and Whole Blood
Additional Codes
Mayo Test Code: CDGF
Reporting Name
Celiac Disease Gluten-Free CascadeUseful For
Evaluating patients suspected of having celiac disease who are currently (or were recently) on a gluten-free diet
Profile Information
Test ID | Reporting Name | Available Separately | Always Performed |
---|---|---|---|
CELI2 | HLA-DQ Typing | Yes, (Order CELI) | Yes |
CDGF1 | Celiac Disease Interpretation | No | Yes |
Reflex Tests
Test ID | Reporting Name | Available Separately | Always Performed |
---|---|---|---|
TTGA | Tissue Transglutaminase Ab, IgA, S | Yes | No |
DAGL | Gliadin(Deamidated) Ab, IgA, S | Yes | No |
DGGL | Gliadin(Deamidated) Ab, IgG, S | Yes | No |
TTGG | Tissue Transglutaminase Ab, IgG, S | Yes | No |
IGA | Immunoglobulin A (IgA), S | Yes | No |
Testing Algorithm
If HLA-DQ typing is positive or equivocal for DQ2 or DQ8, then IgA, tissue transglutaminase IgA and IgG, and deamidated gliadin IgA and IgG antibody testing will be performed at an additional charge.
The following algorithms are available:
Performing Laboratory
Mayo Clinic Laboratories in RochesterSpecimen Type
SerumWhole Blood ACD-B
Ordering Guidance
This cascade should not be used in patients for whom human leukocyte antigen (HLA) DQ2/DQ8 typing has already been performed. For individuals who are positive for either DQ2 and/or DQ8, CDSP / Celiac Disease Serology Cascade, Serum should be ordered to assess for the presence of autoantibodies associated with celiac disease. For individuals who are negative for DQ2 and DQ8, no further testing is necessary as a diagnosis of celiac disease is unlikely.
Cascade testing is recommended for celiac disease. Cascade testing ensures that testing proceeds in an algorithmic fashion. The following cascades are available; select the appropriate one for your specific patient situation.
-CDCOM / Celiac Disease Comprehensive Cascade, Serum and Whole Blood: Complete testing including HLA DQ
-CDSP / Celiac Disease Serology Cascade, Serum: Complete serology testing excluding HLA DQ
-CDGF / Celiac Disease Gluten-Free Cascade, Serum and Whole Blood: For patients already adhering to a gluten-free diet
To order individual tests, see Celiac Disease Diagnostic Testing Algorithm
Specimen Required
Both whole blood and serum are required.
Specimen Type: Whole Blood
Container/Tube: Yellow top (ACD solution A or B)
Specimen Volume: 6 mL
Collection Instructions: Send whole blood in original tube. Do not aliquot.
Specimen Type: Serum
Collection Container/Tube:
Preferred: Serum gel
Acceptable: Red top
Submission Container/Tube: Plastic vial
Specimen Volume: 2 mL
Collection Instructions: Centrifuge and aliquot serum into plastic vial
Specimen Minimum Volume
Blood: 3 mL
Serum: 1.5 mL
Specimen Stability Information
Specimen Type | Temperature | Time | Special Container |
---|---|---|---|
Serum | Refrigerated (preferred) | 21 days | |
Frozen | 21 days | ||
Whole Blood ACD-B | Refrigerated (preferred) | ||
Ambient |
Special Instructions
Day(s) Performed
Profile tests: Monday through Friday; Reflex tests: Monday through Saturday
CPT Code Information
81376 x 2
82784 (if appropriate)
86258 (if appropriate)
86364 (if appropriate)
86231 (if appropriate)
Method Description
HLA-DQ Typing:
LABType applies Luminex technology to the reverse sequence-specific oligonucleotide probe (SSO) DNA typing method. First, target DNA is polymerase chain reaction (PCR)-amplified using a group-specific primer. The PCR product is biotinylated, which allows it to be detected using R-Phycoerythrin-conjugated streptavidin. The PCR product is denatured and allowed to rehybridize to complementary DNA probes conjugated to fluorescently coded microspheres. A flow analyzer identifies the fluorescent intensity of phycoerythrin on each microsphere. The human leukocyte antigen (HLA) Class II allele or allele groups of the sample is determined by the positive and negative bead IDs using a computer software program. The assignment of the HLA typing is based on the reaction pattern compared to patterns associated with published HLA gene sequences.(Package insert: LABType SSO Typing. TDX-OLI-DMR-PS. One Lambda; Rev. 04, 11/2019)
Immunoglobulin A:
Total IgA levels are measured by immunonephelometry. In this Siemens Nephelometer II method, the light scattered onto the antigen-antibody complexes is measured. The intensity of the measured scattered light is proportional to the amount of antigen-antibody complexes in the sample under certain conditions. If the antibody volume is kept constant, the signal behaves proportionally to the antigen volume. A reference curve is generated by a standard with a known antigen content on which the scattered light signals of the samples can be evaluated and calculated as an antigen concentration. Antigen-antibody complexes are formed when a sample containing antigen and the corresponding antiserum are put into a cuvette. A light beam is generated with a light-emitting diode, which is transmitted through the cuvette. The light is scattered onto the immuno-complexes that are present. Antigen and antibody are mixed in the initial measurement, but no complex is formed yet. An antigen-antibody complex is formed in the final measurement. The result is calculated by subtracting the value of the final measurement from the value of the initial measurement. The distribution of intensity of the scattered light depends on the ratio of the particle size of the antigen-antibody complexes to the radiated wavelength. (Instruction manual: Siemens Nephelometer II, Siemens, Inc.; Version 2.3, 2008; Addendum to the Instruction Manual 2.3, 08/2017)
Tissue Transglutaminase IgA/IgG Antibodies:
IgA and IgG antibodies to tissue transglutaminase (tTG) are detected by enzyme-linked immunosorbent assay (ELISA). Recombinant human tTG antigen expressed in Escherichia coli is adsorbed to wells of a microtiter plate under conditions that preserve the native state of the antigen. Diluted patient sera are added to the microtiter plate wells under conditions that allow binding of the antibodies to the tTG antigen. Unbound sample constituents are washed away, and horseradish peroxidase (HRP)-labeled antihuman IgA or IgG antibody conjugate is added to each well. After a second incubation, unbound HRP-label is removed, and bound conjugate is detected by adding tetramethylbenzidine (TMB) chromogenic substrate. After a final incubation, colored product is measured spectrophotometrically; the absorbance of the patient sample is compared to the positive calibrator. The absorbance is directly proportional to the level of IgA or IgG antibodies to tTG, which is expressed in arbitrary units.(Package inserts: QUANTA Lite R h-tTG IgA and IgG. Inova Diagnostics, Inc.; Rev. 8, 01/2020)
Deamidated Gliadin IgA/IgG Antibodies:
IgA and IgG antibodies to deamidated gliadin peptides are detected by ELISA. Purified peptides are adsorbed to wells of a microtiter plate under conditions that preserve the native state of the antigen. Diluted patient sera are added to the microtiter plate wells under conditions that allow binding of the antibodies to the deamidated gliadin peptides. Unbound sample constituents are washed away, and HRP-labeled antihuman IgA or IgG antibody conjugate is added to each well. After a second incubation, unbound HRP-label is removed, and bound conjugate is detected by adding TMB chromogenic substrate. After a final incubation, colored product is measured spectrophotometrically; the absorbance of the patient sample is compared to the positive calibrator. The absorbance is directly proportional to the level of IgA or IgG antibodies to deamidated gliadin peptides, which is expressed in arbitrary units.(Package inserts: QUANTA Lite Gliadin IgA II. INOVA Diagnostics, Inc.; Rev. 2, 10/2019; QUANTA Lite Gliadin IgG II. INOVA Diagnostics, Inc.; Rev.4, 05/2020)
Reject Due To
Gross hemolysis | Reject |
Gross lipemia | Reject |
Gross icterus | OK |
Method Name
Polymerase Chain Reaction (PCR)/Sequence-Specific Oligonucleotide Probe (SSO)
Forms
If not ordering electronically, complete, print, and send Gastroenterology and Hepatology Test Request (T728) with the specimen
Reference Values
HLA-DQ TYPING
Presence of HLA-DQ2 or HLA-DQ8 alleles associated with celiac disease