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Order Code LABCDGF Celiac Disease Gluten-Free Cascade, Serum and Whole Blood

Additional Codes

Mayo Test Code: CDGF

Reporting Name

Celiac Disease Gluten-Free Cascade

Useful 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:

-Celiac Disease Gluten-Free Cascade Test Algorithm.

-Celiac Disease Routine Treatment Monitoring Algorithm 

Performing Laboratory

Mayo Clinic Laboratories in Rochester

Specimen Type

Serum
Whole 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 

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