Combined Factor V and Factor VIII Deficiency via the MCFD2 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 | |
|---|---|---|---|---|---|
| 4185 | MCFD2 | 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
Combined Factor V and Factor VIII deficiency (F5F8D) is a disorder highlighted by excessive bleeding. Mild to moderate spontaneous bleeding symptoms including easy bruising, epistaxis, and menorrhagia typically begin in childhood (Zhang 2009). Symptom severity is linked to the amount of Factor V and VIII protein loss with affected individuals having 5-30% of normal levels. In milder cases, bleeding episodes are seen after trauma, child birth, surgery, or dental extractions (Spreafico and Peyvandi 2009). F5F8D is likely underdiagnosed as many patients are asymptomatic until experiencing traumatic events or misdiagnosed as single factor deficiencies. Generally, bleeding episodes are comparable to patients with single deficiencies in Factor V or VIII also making correct diagnosis of F5F8D challenging. Disease occurrence is highest in Middle Eastern Jews and non-Jewish Iranians with an estimated 1 in 100,000 being affected (Neerman-Arbez et al. 1999). Fresh frozen plasma and recombinant Factor VIII have been effective in treated individuals. These treatments are particularly effective as pre-operative therapies to curtail anticipated bleeding episodes (Zhang 2009).
Genetics
F5F8D is inherited in an autosomal recessive manner. Mutations in the LMAN1 or MCFD2 genes are causative for 70% and 30% of cases respectively (Zhang 2006, Zhang 2008). While clinically indistinguishable, individuals with mutations in MCFD2 often have more pronounced decreases in Factor V and VIII protein levels compared to patients with LMAN1 mutations. MCFD2 mutations are found throughout the gene with small insertions or deletions and splicing mutations being most prevalent (Zhang et al. 2003). Missense mutations have also been found at lower frequencies and disrupt MCFD2-LMAN1 interactions. The MCFD2 protein interacts directly with LMAN1 to facilitate intracellular transport of Factor V and Factor VIII proteins between the endoplasmic reticulum and Golgi (Nishio et al 2010).
Clinical Sensitivity - Sequencing with CNV PGxome
MCFD2 mutations have been found in 30% of individuals with F5F8D (Zhang et al. 2006). Analytical sensitivity should be high because all mutations in MCFD2 reported are detectable by this method.
Testing Strategy
This test provides full coverage of all coding exons of the MFCD2 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
Patients with excess bleeding, prolonged PT and PPT are candidates for testing. Ideal candidates also show decreased FV and FVIII activity indicative of a combined factor deficiency. This test may also be considered for the reproductive partners of individuals who carry pathogenic variants in MFCD2.
Patients with excess bleeding, prolonged PT and PPT are candidates for testing. Ideal candidates also show decreased FV and FVIII activity indicative of a combined factor deficiency. This test may also be considered for the reproductive partners of individuals who carry pathogenic variants in MFCD2.
Gene
| Official Gene Symbol | OMIM ID |
|---|---|
| MCFD2 | 607788 |
| Inheritance | Abbreviation |
|---|---|
| Autosomal Dominant | AD |
| Autosomal Recessive | AR |
| X-Linked | XL |
| Mitochondrial | MT |
Disease
| Name | Inheritance | OMIM ID |
|---|---|---|
| Factor V And Factor VIII, Combined Deficiency Of, 2 | 613625 |
Citations
- Neerman-Arbez M, Johnson KM, Morris MA, McVey JH, Peyvandi F, Nichols WC, Ginsburg D, Rossier C, Antonarakis SE, Tuddenham EG. 1999. Molecular analysis of the ERGIC-53 gene in 35 families with combined factor V-factor VIII deficiency. Blood 93: 2253-2260. PubMed ID: 10090934
- Nishio M, Kamiya Y, Mizushima T, Wakatsuki S, Sasakawa H, Yamamoto K, Uchiyama S, Noda M, McKay AR, Fukui K, Hauri H-P, Kato K. 2010. Structural basis for the cooperative interplay between the two causative gene products of combined factor V and factor VIII deficiency. Proc. Natl. Acad. Sci. U.S.A. 107: 4034-4039. PubMed ID: 20142513
- Spreafico M, Peyvandi F. 2009. Combined Factor V and Factor VIII Deficiency. Semin. Thromb. Hemost. 35: 390-399. PubMed ID: 19598067
- Zhang B, Cunningham MA, Nichols WC, Bernat JA, Seligsohn U, Pipe SW, McVey JH, Schulte-Overberg U, Bosch NB de, Ruiz-Saez A, White GC, Tuddenham EGD, et al. 2003. Bleeding due to disruption of a cargo-specific ER-to-Golgi transport complex. Nat. Genet. 34: 220-225. PubMed ID: 12717434
- Zhang B, McGee B, Yamaoka JS, Guglielmone H, Downes KA, Minoldo S, Jarchum G, Peyvandi F, Bosch NB de, Ruiz-Saez A, Chatelain B, Olpinski M, et al. 2006. Combined deficiency of factor V and factor VIII is due to mutations in either LMAN1 or MCFD2. Blood 107: 1903-1907. PubMed ID: 16304051
- Zhang B. 2009. Recent developments in the understanding of the combined deficiency of FV and FVIII. Br. J. Haematol. 145: 15-23. PubMed ID: 19183188
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
No Additional Test Options are available for this test.