Congenital Factor XIII Deficiency via the F13B Gene
Summary and Pricing 
Test Method
Exome Sequencing with CNV Detection
| Test Code | Test Copy Genes | Test CPT Code | Gene CPT Codes Copy CPT Code | Base Price | |
|---|---|---|---|---|---|
| 4147 | F13B | 81479 | 81479,81479 | $990 | Order Options and Pricing |
Pricing Comments
Our favored testing approach is exome based NextGen sequencing with CNV analysis. This will allow cost effective reflexing to PGxome or other exome based tests. However, if full gene Sanger sequencing is desired for STAT turnaround time, insurance, or other reasons, please see link below for Test Code, pricing, and turnaround time information. If the Sanger option is selected, CNV detection may be ordered through Test #600.
An additional 25% charge will be applied to STAT orders. STAT orders are prioritized throughout the testing process.
Click here for costs to reflex to whole PGxome (if original test is on PGxome Sequencing platform).
Click here for costs to reflex to whole PGnome (if original test is on PGnome Sequencing platform).
The Sanger Sequencing method for this test is NY State approved.
For Sanger Sequencing click here.Turnaround Time
3 weeks on average for standard orders or 2 weeks on average for STAT orders.
Please note: Once the testing process begins, an Estimated Report Date (ERD) range will be displayed in the portal. This is the most accurate prediction of when your report will be complete and may differ from the average TAT published on our website. About 85% of our tests will be reported within or before the ERD range. We will notify you of significant delays or holds which will impact the ERD. Learn more about turnaround times here.
Targeted Testing
For ordering sequencing of targeted known variants, go to our Targeted Variants page.
Clinical Features and Genetics
Clinical Features
Factor XIII deficiency is a rare bleeding disorder that is typically severe. The first and most characteristic symptom seen in about 80% of patients is umbilical cord bleeding following birth. Other frequent symptoms include superficial bruising, subcutaneous hematomas, spontaneous abortions in early pregnancy and joint bleeds leading to hemarthrosis (Schroeder and Kohler 2013). Intracranial hemorrhage appears in one in four patients and is a leading cause of death. Unlike other rare bleeding disorders, mucosal tract bleeding is a common symptom and seen in over a third of affected individuals. This is due to the dual role of Factor XIII in crosslinking fibrin chains to promote clotting and crosslinking fibronectin and collagen to enhance gut wound healing. Factor XIII deficiency is also acquired through development of autoantibodies against FXIII protein (Hayashi et al. 2012; Sugiyama et al. 2013). Genetic testing may aid in differential diagnosis of acquired and congenital forms of the deficiency. Affected patients with congenital factor XIII deficiency may be treated with fresh frozen plasma, recombinant FXIII or plasma derived FXIII concentrates to mitigate symptoms (Nugent 2006; Inbal et al. 2012). These therapies fail to alleviate disease in acquired Factor XIII deficiency and require immunosuppressive drugs for treatment. Diagnosis of Factor XIII deficiency is often difficult because deficiency cannot be detected by routine global coagulation assays (Bolton-Maggs et al. 2012) and because FXIII laboratory assays must be carefully timed with blood sampling (Perez et al. 2011; Karimi et al. 2009).
Genetics
Factor XIII deficiency is inherited in an autosomal recessive manner through mutations in the F13A1 and F13B genes. Mutations in the F13B gene are causative in ~20% cases of Factor XIII deficiencies with missense, small insertions/deletions, and splice site alterations being documented (Schroeder and Kohler 2013; www.f13-database.de). To date, large deletions and duplications have not been reported. Mutations are found throughout the F13B gene and presumably alter protein folding and stability (Ivaskevicius et al. 2010; Biswas et al. 2011). The FXIII protein is a heterotetramer consisting of two A and two B subunits (FXIII A2B2). This tetramer functions as a transglutaminase with the A subunit containing the catalytic domain and the B subunit being the carrier protein. In plasma, FXIII activation is essential for fibrin polymerization and stabilizing clots during the hemostatic process (Muszbek et al. 2011).
Clinical Sensitivity - Sequencing with CNV PGxome
Rare bleeding disorders (RBD) comprise of inherited deficiencies of coagulation factors fibrinogen, FII, FV, FV + FVIII, FVII, FX, FXI, and FXIII. Factor XIII deficiencies are found ~5% of all RBD cases. In patients with Factor XIII deficiency, F13B mutations are found in >20% of cases (Peyvandi et al. 2013). Analytical sensitivity should be high because all mutations reported are detectable by sequencing.
Testing Strategy
This test provides full coverage of all coding exons of the F13B gene plus 10 bases of flanking noncoding DNA in all available transcripts along with other non-coding regions in which pathogenic variants have been identified at PreventionGenetics or reported elsewhere. We define full coverage as >20X NGS reads or Sanger sequencing. PGnome panels typically provide slightly increased coverage over the PGxome equivalent. PGnome sequencing panels have the added benefit of additional analysis and reporting of deep intronic regions (where applicable).
Dependent on the sequencing backbone selected for this testing, discounted reflex testing to any other similar backbone-based test is available (i.e., PGxome panel to whole PGxome; PGnome panel to whole PGnome).
Indications for Test
Candidates typically have moderate to severe bleeding episodes with umbilical cord bleeding often being the first symptom of disease. Ideal candidates have decreased FXIII functional activity assay. This test may also be considered for the reproductive partners of individuals who carry pathogenic variants in F13B.
Candidates typically have moderate to severe bleeding episodes with umbilical cord bleeding often being the first symptom of disease. Ideal candidates have decreased FXIII functional activity assay. This test may also be considered for the reproductive partners of individuals who carry pathogenic variants in F13B.
Gene
| Official Gene Symbol | OMIM ID |
|---|---|
| F13B | 134580 |
| Inheritance | Abbreviation |
|---|---|
| Autosomal Dominant | AD |
| Autosomal Recessive | AR |
| X-Linked | XL |
| Mitochondrial | MT |
Disease
| Name | Inheritance | OMIM ID |
|---|---|---|
| Factor XIII, B Subunit, Deficiency Of | AR | 613235 |
Citations
- Biswas A, Ivaskevicius V, Seitz R, Thomas A, Oldenburg J. 2011. An update of the mutation profile of Factor 13 A and B genes. Blood Rev. 25: 193–204. PubMed ID: 21640452
- Bolton-Maggs PHB, Favaloro EJ, Hillarp A, Jennings I, Kohler HP. 2012. Difficulties and pitfalls in the laboratory diagnosis of bleeding disorders. Haemophilia 18 Suppl 4: 66–72. PubMed ID: 22726086
- Factor XIII Registry Database
- Hayashi T, Kadohira Y, Morishita E, Asakura H, Souri M, Ichinose A. 2012. A case of acquired FXIII deficiency with severe bleeding symptoms. Haemophilia 18: 618–620. PubMed ID: 22356719
- Inbal A, Oldenburg J, Carcao M, Rosholm A, Tehranchi R, Nugent D. 2012. Recombinant factor XIII: a safe and novel treatment for congenital factor XIII deficiency. Blood 119: 5111–5117. PubMed ID: 22451421
- Ivaskevicius V, Biswas A, Loreth R, Schroeder V, Ohlenforst S, Rott H, Krause M, Kohler H-P, Scharrer I, Oldenburg J. 2010. Mutations affecting disulphide bonds contribute to a fairly common prevalence of F13B gene defects: results of a genetic study in 14 families with factor XIII B deficiency. Haemophilia 16: 675–682. PubMed ID: 20331752
- Karimi M, Bereczky Z, Cohan N, Muszbek L. 2009. Factor XIII Deficiency. Semin. Thromb. Hemost. 35: 426–438. PubMed ID: 19598071
- Muszbek L, Bereczky Z, Bagoly Z, Komáromi I, Katona É. 2011. Factor XIII: a coagulation factor with multiple plasmatic and cellular functions. Physiol. Rev. 91: 931–972. PubMed ID: 21742792
- Nugent DJ. 2006. Prophylaxis in rare coagulation disorders -- factor XIII deficiency. Thromb. Res. 118 Suppl 1: S23–28. PubMed ID: 16616323
- Perez DL, Diamond EL, Castro CM, Diaz A, Buonanno F, Nogueira RG, Sheth K. 2011. Factor XIII deficiency related recurrent spontaneous intracerebral hemorrhage: a case and literature review. Clin Neurol Neurosurg 113: 142–145. PubMed ID: 20950938
- Peyvandi F. et al. 2013. Blood. 122: 3423-31. PubMed ID: 24124085
- Schroeder V, Kohler HP. 2013. Factor XIII deficiency: an update. Semin. Thromb. Hemost. 39: 632–641. PubMed ID: 23929307
- Sugiyama H, Uesugi H, Suzuki S, Tanaka K, Souri M, Ichinose A. 2013. Aggressive fatal case of autoimmune hemorrhaphilia resulting from anti-Factor XIII antibodies. Blood Coagul. Fibrinolysis 24: 85–89. PubMed ID: 23183237
Ordering/Specimens
Ordering Options
We offer several options when ordering sequencing tests. For more information on these options, see our Ordering Instructions page. To view available options, click on the Order Options button within the test description.
myPrevent - Online Ordering
- The test can be added to your online orders in the Summary and Pricing section.
- Once the test has been added log in to myPrevent to fill out an online requisition form.
- PGnome sequencing panels can be ordered via the myPrevent portal only at this time.
Requisition Form
- A completed requisition form must accompany all specimens.
- Billing information along with specimen and shipping instructions are within the requisition form.
- All testing must be ordered by a qualified healthcare provider.
For Requisition Forms, visit our Forms page
If ordering a Duo or Trio test, the proband and all comparator samples are required to initiate testing. If we do not receive all required samples for the test ordered within 21 days, we will convert the order to the most effective testing strategy with the samples available. Prior authorization and/or billing in place may be impacted by a change in test code.
Specimen Types
Specimen Requirements and Shipping Details
PGxome (Exome) Sequencing Panel
PGnome (Genome) Sequencing Panel
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ORDER OPTIONS
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2) Select Additional Test Options
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