Fragile X Syndrome, PCR With Reflex to Southern Blot

CPT 81243
Synonyms
  • FRAXA

Test Details

Use

Carrier screening for individuals who are pregnant or considering pregnancy and who have no family or personal history of fragile X syndrome, fragile X-related disorders (primary ovarian insufficiency, or late-onset ataxia) or unexplained intellectual disabilities, developmental delay, or autism.

Methodology

Polymerase chain reaction (PCR) followed by capillary electrophoresis with reflex to Southern blot analysis for all positive samples.

Fragile X syndrome: DNA is amplified by the polymerase chain reaction (PCR) to determine the size of the CGG repeat region within the FMR1 gene. PCR products are generated using a fluorescence labeled primer and sized by capillary gel electrophoresis. If indicated, Southern blot analysis is performed by hybridizing the probe StB12.3 to EcoRI- and EagI- digested DNA. The analytical sensitivity of both Southern blot and PCR analyses is 99% for expansion mutations in the FMR1 gene. Reported CGG repeat sizes may vary as follows: +/- one for repeats less than 60, and +/- two to four for repeats in the 60 - 120 range. For repeats greater than 120, the accuracy is +/- 10%. If 55-90 trinucleotide repeats are detected in carrier screening females, a PCR assay targeting AGG sequences within the CGG repeats is performed to assess the number and position of AGG interruptions.

References

American College of Obstetricians and Gynecologists Committee on Genetics. Committee Opinion No. 469: Carrier screening for fragile X syndrome. Obstet Gynecol. 2010;116(4):1008-10.20859177
Hagerman PJ, Hagerman RJ. The fragile X premutation: A maturing perspective. Am J Hum Genet. 2004 May;74(5):805-816.15052536
Jacquemont S, Hagerman RJ, Leehey MA, et al. Penetrance of the fragile X-associated tremor/ataxia syndrome in a premutation carrier population. JAMA. 2004 Jan 28; 291(4):460-469.14747503

Additional Information

Fragile X syndrome is the leading cause of inherited intellectual disability, affecting approximately 1 in 4,000 males and 1 in 8,000 females. It is found in all ethnic groups, and can occur in families with no history of intellectual disability. Women may decide to have testing to find out if they are carriers, and therefore are at risk of having a child with fragile X syndrome. The carrier frequency in women is approximately 1 in 260. Fragile X test is commonly used for individuals at higher risk, including those that may be symptomatic or have a family history suggestive of fragile X syndrome.

Specimen Requirements

Information on collection, storage, and volume

Specimen

Whole blood

Volume

10 mL

Minimum Volume

10 mL

Container

Lavender-top (EDTA) tube or yellow-top (ACD) tube

Storage Instructions

Room temperature

Causes for Rejection

Frozen specimen; hemolysis; quantity not sufficient for analysis; improper container; unlabeled or mislabeled specimen