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Test Name:
Fatty Acid Profile, Comprehensive (C8-C26), Serum


  • SBMF No:
    42282
  • Performance Lab Name:
    Mayo Medical Laboratories
  • Test Mnemonic:
    FAPCP
  • ABN:
    Required – Not FDA-Approved
  • CPT Code:
    82544
  • LOINC Code:
    19146-0
  • Ref Lab Test No:
    82042
  • Also Known As:
    C8-C26, Fatty Acid Profile
    Comprehensive Fatty Acids
    Comprehensive, Fatty Acid Profile
    Essential Fatty Acids
    Fatty Acids
    LCFA (Long-Chain Fatty Acids)
    Long-Chain Fatty Acids (LCFA)
    MCFA (Medium-Chain Fatty Acids)
    Medium-Chain Fatty Acids (MCFA)
    Omega 3
    Omega 6
    Omega 7
    Omega 9
    Polyunsaturated Fatty Acids
    Very Long Chain Fatty Acids (VLCFA)
    VLCFA (Very Long Chain Fatty Acids)
  • Spec Type:
    Serum
  • Spec Container:
    Gold top (SST) or red top (serum) tube
  • Pref Vol:
    0.5 mL
  • Min Vol:
    0.15 mL
  • Fasting:
    Yes
  • Patient Prep:
    Draw blood following an overnight (12-14 hours) fast
    Patient must not consume any alcohol for 24 hours before the specimen is drawn
    CAUTION: For nutritional assessment, a 12 to 14 hour fast is required; however, patients suspected of having a FAO disorder should not fast before testing owing to the possibility of acute metabolic decompensation. Instead, draw the specimen after the longest fast possible, just before feeding.
  • Spec Collect:
    Routine venipuncture
  • Spec Process:
    Clot 30 minutes
    Promptly centrifuge 15 minutes
    Immediately transfer serum to separate plastic tube and freeze
  • Spec Store Transport:
    Frozen
  • Spec Reject:
    Non-frozen or lipemic sample
  • Spec Remarks:
    Separate serum from cells within 45 minutes of collection
    Patient's age is required on request form for processing
    Include information regarding treatment, family history, and tentative diagnosis
  • Methodology:
    Gas Chromatography-Mass Spectrometry (GC/MS)
    Stable Isotope Dilution Analysis
  • Use:
    This test is a comprehensive profile that provides information regarding mitochondrial and peroxisomal fatty acid metabolism, and the patient's nutritional status, and is useful for:
    -Monitoring patients undergoing diet therapy for mitochondrial or peroxisomal disorders (possibly inducing essential fatty acid deficiency in response to restricted fat intake)
    -Monitoring treatment of essential fatty acid deficiency
    -Monitoring the response to provocative tests (fasting tests, loading tests)
    -Complete evaluation of patients enrolled in clinical studies
  • Clinical Significance:

    This test is a comprehensive profile that provides information regarding mitochondrial and peroxisomal fatty acid metabolism, and the patient's nutritional status.

    Fatty Acid Oxidation Disorders
    Mitochondrial beta-oxidation is the main source of energy to skeletal and heart muscle during periods of fasting. When the body's supply of glucose is depleted, fatty acids are mobilized from adipose tissue and converted to ketone bodies through a series of steps providing an alternate source of energy. Deficient enzymes at any step in this pathway prevent the production of energy during periods of physiologic stress such as fasting or intercurrent illness and can frequently result in life-threatening episodes of metabolic decompensation.

    When properly diagnosed, patients with FAO respond favorably to fasting avoidance, diet therapy, and aggressive treatment of intercurrent illnesses, with significant reduction of morbidity and mortality.

    Quantitative determination of C8-C18 fatty acids is an important element of the work-up and differential diagnosis of candidate patients. Fatty acid profiling can detect quantitatively modest, but nevertheless significant, abnormalities even when patients are asymptomatic and under dietary treatment.

    Fatty Acid Deficiency/Excess
    Fats are important sources of energy for tissues and for the function and integrity of cellular membranes. Deficiencies are commonly caused by inadequate dietary intake of lipids due to an unbalanced diet or long-term parenteral nutrition or by intestinal malabsorption.

    The major clinical manifestations associated with essential fatty acid deficiency (EFAD) include dermatitis, increased water permeability of the skin, increased susceptibility to infection, and impaired wound healing. Biochemical abnormalities may be detected before the onset of recognizable clinical manifestations. EFAD can be detected by diminished levels of the essential fatty acids: linoleic acid and alpha-linolenic acid. It can also be detected by increases in the ratio triene/tetraene ratio.

    Excess dietary fatty acids have also been linked to the onset of cardiovascular disease. Elevated levels of linoleic acid can contribute to overproduction of the proinflammatory 2-series local hormones.

    Peroxisomal Disorders
    Peroxisomes are organelles present in all human cells except mature erythrocytes. They carry out essential metabolic functions including beta-oxidation of very long-chain fatty acids (VLCFA), alpha-oxidation of phytanic acid, and biosynthesis of plasmalogen and bile acids. Peroxisomal disorders consist of 2 major groups, disorders of peroxisomal biogenesis (eg, Zellweger syndrome), in which the organelle is not formed, and defects of single peroxisomal enzymes. Peroxisomal beta-oxidation of VLCFA is impaired in all disorders of peroxisomal biogenesis and in selected single enzyme deficiencies, particularly X-linked adrenoleukodystrophy (X-ALD), resulting in elevated concentrations of VLCFA in plasma.

  • Reference Range:

    Octanoic Acid, C8:0
    <1 year:  7-63 nmol/mL
    1-17 years:  9-41 nmol/mL
    > or =18 years:  8-47 nmol/mL

    Decenoic Acid, C10:1
    <1 year:  0.8-4.8 nmol/mL
    1-17 years:  1.6-6.6 nmol/mL
    > or =18 years:  1.8-5.0 nmol/mL

    Decanoic Acid, C10:0
    <1 year:  2-62 nmol/mL
    1-17 years:  3-25 nmol/mL
    > or =18 years:  2-18 nmol/mL

    Lauroleic Acid, C12:1
    <1 year:  0.6-4.8 nmol/mL
    1-17 years:  1.3-5.8 nmol/mL
    > or =18 years:  1.4-6.6 nmol/mL

    Lauric Acid, C12:0
    <1 year:  6-190 nmol/mL
    1-17 years:  5-80 nmol/mL
    > or =18 years:  6-90 nmol/mL

    Tetradecadienoic Acid, C14:2
    <1 year:  0.3-6.5 nmol/mL
    1-17 years:  0.2-5.8 nmol/mL
    > or =18 years:  0.8-5.0 nmol/mL

    Myristoleic Acid, C14:1
    <1 year:  1-46 nmol/mL
    1-17 years:  1-31 nmol/mL
    > or =18 years:  3-64 nmol/mL

    Myristic Acid, C14:0
    <1 year:  30-320 nmol/mL
    1-17 years:  40-290 nmol/mL
    > or =18 years:  30-450 nmol/mL

    Hexadecadienoic Acid, C16:2
    <1 year:  4-27 nmol/mL
    1-17 years:  3-29 nmol/mL
    > or =18 years:  10-48 nmol/mL

    Hexadecenoic Acid, C16:1w9
    <1 year:  21-69 nmol/mL
    1-17 years:  24-82 nmol/mL
    > or =18 years:  25-105 nmol/mL

    Palmitoleic Acid, C16:1w7
    <1 year:  20-1,020 nmol/mL
    1-17 years:  100-670 nmol/mL
    > or =18 years:  110-1,130 nmol/mL

    Palmitic Acid, C16:0
    <1 year:  720-3,120 nmol/mL
    1-17 years:  960-3,460 nmol/mL
    > or =18 years:  1,480-3,730 nmol/mL

    Gamma-Linolenic Acid, C18:3w6
    <1 year:  6-110 nmol/mL
    1-17 years:  9-130 nmol/mL
    > or =18 years:  16-150 nmol/mL

    Alpha-Linolenic Acid, C18:3w3
    <1 year:  10-190 nmol/mL
    1-17 years:  20-120 nmol/mL
    > or =18 years:  50-130 nmol/mL

    Linoleic Acid, C18:2w6
    1-31 days:  350-2,660 nmol/mL
    32 days-11 months:  1,000-3,300 nmol/mL
    1-17 years:  1,600-3,500 nmol/mL
    > or =18 years:  2,270-3,850 nmol/mL

    Oleic Acid, C18:1w9
    <1 year:  250-3,500 nmol/mL
    1-17 years:  350-3,500 nmol/mL
    > or =18 years:  650-3,500 nmol/mL

    Vaccenic Acid, C18:1w7
    <1 year:  140-720 nmol/mL
    1-17 years:  320-900 nmol/mL
    > or =18 years:  280-740 nmol/mL

    Stearic Acid, C18:0
    <1 year:  270-1,140 nmol/mL
    1-17 years:  280-1,170 nmol/mL
    > or =18 years:  590-1,170 nmol/mL

    EPA, C20:5w3
    <1 year:  2-60 nmol/mL
    1-17 years:  8-90 nmol/mL
    > or =18 years:  14-100 nmol/mL

    Arachidonic Acid, C20:4w6
    <1 year:  110-1,110 nmol/mL
    1-17 years:  350-1,030 nmol/mL
    > or =18 years:  520-1,490 nmol/mL

    Mead Acid, C20:3w9
    1-31 days:  8-60 nmol/mL
    32 days-11 months:  3-24 nmol/mL
    > or =1 year:  7-30 nmol/mL

    Homo-Gama-Linolenic Acid, C20:3w6
    <1 year:  30-170 nmol/mL
    1-17 years:  60-220 nmol/mL
    > or =18 years:  50-250 nmol/mL

    Arachidic Acid, C20:0
    <1 year:  30-120 nmol/mL
    1-17 years:  30-90 nmol/mL
    > or =18 years:  50-90 nmol/mL

    DHA, C22:6w3
    <1 year:  10-220 nmol/mL
    1-17 years:  30-160 nmol/mL
    > or =18 years:  30-250 nmol/mL

    DPA, C22:5w6
    <1 year:  3-70 nmol/mL
    1-17 years:  10-50 nmol/mL
    > or =18 years:  10-70 nmol/mL

    DPA, C22:5w3
    <1 year:  6-110 nmol/mL
    1-17 years:  30-270 nmol/mL
    > or =18 years:  20-210 nmol/mL

    DTA, C22:4w6
    <1 year:  2-50 nmol/mL
    1-17 years:  10-40 nmol/mL
    > or =18 years:  10-80 nmol/mL

    Docosenoic Acid, C22:1
    <1 year:  2-20 nmol/mL
    > or =1 year:  4-13 nmol/mL

    Docosanoic Acid, C22:0
    0.0-96.3 nmol/mL

    Nervonic Acid, C24:1
    <1 year:  30-150 nmol/mL
    1-17 years:  50-130 nmol/mL
    > or =18 years:  60-100 nmol/mL

    Tetracosanoic Acid, C24:0
    0.0-91.4 nmol/mL

    Hexacosenoic Acid, C26:1
    <1 year:  0.2-2.1 nmol/mL
    > or =1 year:  0.3-0.7 nmol/mL

    Hexacosanoic Acid, C26:0
    0.00-1.30 nmol/mL

    Pristanic Acid, C15:0(CH[3])(4)
    1 day-4 months:  0.00-0.60 nmol/mL
    5-8 months:  0.00-0.84 nmol/mL
    9-12 months:  0.00-0.77 nmol/mL
    13-23 months:  0.00-1.47 nmol/mL
    > or =2 years:  0.00-2.98 nmol/mL

    Phytanic Acid, C16:0(CH[3])(4)
    1 day-4 months:  0.00-5.28 nmol/mL
    5-8 months:  0.00-5.70 nmol/mL
    9-12 months:  0.00-4.40 nmol/mL
    13-23 months:  0.00-8.62 nmol/mL
    > or =2 years:  0.00-9.88 nmol/mL

    Triene/Tetraene Ratio
    1-31 days:  0.017-0.083
    32 days-17 years:  0.013-0.050
    > or = 18 years:  0.010-0.038

    Total Saturated Acid
    <1 year:  1.2-4.6 mmol/L
    1-17 years:  1.4-4.9 mmol/L
    > or =18 years:  2.5-5.5 mmol/L

    Total Monounsaturated Acid
    <1 year:  0.3-4.6 mmol/L
    1-17 years:  0.5-4.4 mmol/L
    > or =18 years:  1.3-5.8 mmol/L

    Total Polyunsaturated Acid
    <1 year:  1.1-4.9 mmol/L
    1-17 years:  1.7-5.3 mmol/L
    > or =18 years:  3.2-5.8 mmol/L

    Total w3
    <1 year:  0.0-0.4 mmol/L
    1-17 years:  0.1-0.5 mmol/L
    > or =18 years:  0.2-0.5 mmol/L

    Total w6
    <1 year:  0.9-4.4 mmol/L
    1-17 years:  1.6-4.7 mmol/L
    > or =18 years:  3.0-5.4 mmol/L

    Total Fatty Acids
    <1 year:  3.3-14.0 mmol/L
    1-17 years:  4.4-14.3 mmol/L
    > or =18 years:  7.3-16.8 mmol/L

    Interpretation
    An increased triene/tetraene ratio is consistent with essential fatty acid deficiency.

    Fatty acid oxidation (FAO) disorders are recognized on the basis of disease-specific patterns that are correlated to the results of other investigations in plasma (carnitine, acylcarnitines) and urine (organic acids, acylglycines).

    Increased concentrations of serum VLCFA C24:0 and C26:0 are seen in peroxisomal disorders, X-linked adrenoleukodystrophy, adrenomyeloneuropathy, and Zellweger syndrome (cerebrohepatorenal syndrome).

    Increased concentrations of serum phytanic acid (along with normal pristanic acid concentrations) are seen in the Refsum disease (phytanase deficiency). Serum phytanic acid concentration also may be increased in other peroxisomal disorders and, when combined with the VLCFA, pristanoic acid and pipecolic acid allow differential diagnosis of peroxisomal disorders.

  • Additional Test Info:

    This test was developed and its performance characteristics determined by Laboratory Medicine and Pathology, Mayo Clinic. This test has not been cleared or approved by the U.S. Food and Drug Administration.

    Clinical Reference

    1. Stellaard F, ten Brink HJ, Kok RM et al: Stable isotope dilution analysis of very long chain fatty acids in plasma, urine, and amniotic fluid by electron capture negative ion mass fragmentography. Clin Chim Acta 1990;192:133-144
    2. ten Brink HJ, Stellaard F, van den Heuvel et al: Pristanic acid and phytanic acid in plasma from patients with peroxisomal disorders: stable isotope dilution analysis with electron capture negative ion mass fragmentography. J Lipid Res 1992;33:41-47
    3. Rinaldo P, Matern D, Bennett MJ: Fatty acid oxidation disorders. Ann Rev Physiol 2002;64:477-502
    4. Jeppesen PB, Chistensen MS, Hoy CE, Mortensen PB: Essential fatty acid deficiency in patients with severe fat malabsorption. Am J Clin Nutr 1997;65:837-843
    5. Lagerstedt SA Hinrichs DR, Batt SM, et al: Quantitative determination of plasma c8-c26 total fatty acids for the biochemical diagnosis of nutritional and metabolic disorders. Mol Gen Metab. 2001;73(1):38-45

  • Day Run:
    Mon-Fri
  • Time Run:
    7:00 am
  • Time Reported:
    Within 8 days
  • Test Type:
    CHEMISTRY

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