Alberta Precision Laboratories

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Organization:

Alberta Precision Laboratories

Message Alert:

PLEASE NOTE: This Test Directory is in an interim state and due to changes pertaining to the DynaLIFE transition, performing site for routing has not been updated. Please refer to Laboratory Information System for appropriate routing.

Test Name/Synonym:

S-Adenosylmethionine and S-Adenosylhomocysteine, Plasma (Synonyms: ADOHCY, ADOMET, SAH, SAM, SAMe, Hypermethioninemia, Homosystinuria)

Clinical Indications:

This test is for the further investigation in a patient with hypermethioninemia and/or homocystinuria to distinguish between several disorders affecting methionine metabolism and the methylation cycle.

Test Includes:

Metabolites reported: S-Adenosylmethionine and S-Adenosylhomocysteine

Ordering Alert:

This test is considered specialty testing; this test will be cancelled if sufficient clinical justification is not provided.

Minimum 4 hour fast recommended or as specified by physician.

Shipping and Handling Alert:

Specimen must be processed within 1 hour of collection. Refer to Processing section for details.

LABID (Connect Care):

LAB4037

Test Code:

CALGARY ZONE	BGLBL; IN BGL TEST NAME FIELD ENTER ADENOSYLMETH
OTHER ZONES	NOT SPECIFIED

Specimen Type:

Blood

Primary Container:

Green top – Sodium heparin (no gel)

Alternate Containers:

Green top - Lithium heparin (no gel)
Pink top - K2 EDTA
Royal blue top - K2 EDTA

Minimum Collection Volume:

0.5 mL whole blood

Specimen Collection Requirements:

Collect one Sodium heparin (or alternate) tube.

Indicate length of fast on the requisition.

Test Resources:

Submit request using the applicable requisition or Connect Care online order entry:

Biochemical Genetics Laboratory Requisition

Please ensure all required information, including patient's clinical history/indication, is provided on the requisition.

Stability and Storage:

Refrigerated: whole blood specimen up to 1 hour
Frozen: plasma aliquot

Processing:

For ALL collection locations except for Alberta Children’s Hospital (ACH), within 1 hour of time of collection:
1. Centrifuge.
2. Transfer plasma to aliquot tube.
3. Write "NaHep", "LiHep" or "K2 EDTA" on the aliquot tube label.
4. Freeze aliquot tube.

If collected at ACH outpatient Lab:

Immediately call BCG Lab for specimen pickup.
The primary tube can be put on ice (ensure not to freeze sample) or refrigerated until specimen pickup.
If specimen is collected after 14:30, process sample as described above.

Transportation:

Transport frozen specimens on dry ice.
Samples must not thaw during transport.

Method:

Liquid chromatography tandem mass spectrometry (LC-MS/MS).

Method and Interpretation of Results:

S-adenosylmethionine and S-adenosylhomocysteine are detected using liquid chromatography, electrospray-ionization tandem mass spectrometry (LS-MS/MS) with a deuterium-labelled internal standard.

S-adenosylmethionine and S-adenosylhomocysteine can be abnormal in the following enzyme deficiencies / disorders:

Disorders with elevated S-adenosylmethionine and S-adenosylhomocysteine

cystathionine beta-synthase deficiency (classical homocystinuria)
S-adenosylhomocysteine hydrolase (SAHH) deficiency
adenosine kinase (ADK) deficiency

Disorders with elevated S-adenosylmethionine Only

glycine N-methyltransferase (GNMT) deficiency
mtDNA depletion syndrome

Disorders with low-normal S-adenosylmethionine

methionine adenosyltransferase (MAT) I/III deficiency
methylenetetrahydrofolate reductase deficiency (MTHFR)
methionine synthase deficiency
Cobalamin (Cbl) C, D, E, F, G, J and X deficiencies
transcobalamin II deficiency
severe folate or B12 deficiencies

Other causes of Elevated S-adenosylmethionine and S-adenosylhomocysteine

chronic kidney disease

Routine Turn Around Time:

45 days

Testing Schedule:

Monthly

Reference Interval:

Metabolite	Normal Range	Units
S-Adenosylmethionine (SAM)	86 - 132	nmol/L
S-Adenosylhomocysteine (SAH)	9 - 29	nmol/L
Total (SAM + SAH)	102 - 161

Testing Area:

Biochemical Genetics

Performing Site:

Alberta Children’s Hospital

Additional Test Information:

For priority turn-around contact Biochemical Genetics South Laboratory.

Contact Comments:

Biochemical Genetics South 403-955-7379

Last Updated On:

Monday, April 17, 2023

Date of Last Review:

Aug 1 2022 12:00AM