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22847 Pyruvate in Blood

Pyruvate in Blood
Test Code: PYRUV
Synonyms/Keywords
Pyruvid Acid, Pyruvate in whole blood​
Useful For
This test is useful for investigating possible disorders of mitochondrial metabolism when used in conjunction with blood lactate collected at the same time to determine the lactate-to-pyruvate ratio.
Specimen Requirements
Fasting Required Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)		 Pediatric Minimum Volume
(no repeat)
No​ Whole Blood​ Gray Top Tube  (GYTT)​ ​ 3 mL​ 2.5 mL​ 1.2 mL​
Collection Processing Instructions
The specimen should be wrapped with a cold pack and sent immediately over to Clinical Manual via the pneumatic tube system. If specimen obtained during non-routine working hours, take specimen to the Clinical Automated section. A protein-free filtrate of the whole blood specimen should be prepared by lab personnel within 15 minutes of collection.
  
For Outreach:
If not possible to transport blood to Marshfield Labs within 15 minutes, immediately pipette 2 ml of well-mixed whole blood into 4 mL cold 7% perchloric acid. Shake to mix well. Place on ice and refrigerate.  For specimens where only 1 mL is available: use 1 mL of blood to 2 mL of perchloric acid.  Tubes of 4 mL of 7% perchloric acid are available from Marshfield Labs. ​
Specimen Stability Information
Specimen Type Temperature Time
Precipitated Whole Blood ​ ​ Ambient 5 days​
Refrigerate (recommended)​ 30 days​
Rejection Criteria
​Whole blood that is not precipitated with 7% perchloric acid within 15 minutes
Performing Laboratory Information
Performing Location Day(s) Test Performed Analytical Time Methodology/Instrumentation
Marshfield​ Monday through Friday​ 6-8 hours​ Sigma Enzymatic Spectrophotometry/Shimadzu UV-1601​
Test Information
This test was developed and its performance characteristics determined by Marshfield Labs. This laboratory is certified under the Clinical Laboratory Improvement Amendments (CLIA) to perform high complexity testing.
Reference Range Information
Performing Location Reference Range
Marshfield​

Whole blood adults and children: 0.03-0.10 mmol/L

Interpretation

An elevated lactate-to-pyruvate (L:P) ratio may indicate inherited disorders of the respiratory chain complex, tricarboxylic acid cycle disorders and pyruvate carboxylase deficiency. Respiratory chain defects usually result in L: P ratios >20.

A low L:P ratio (disproportionately elevated pyruvic acid) may indicate an inherited disorder of pyruvate metabolism. Defects of the pyruvate dehydrogenase complex result in L: P ratios <10.

The L:P ratio is characteristically normal in other patients. An artifactually high ratio can be found if the patient is acutely ill.

Cerebrospinal fluid (CSF) L:P ratio may assist in evaluation of patients with neurologic dysfunction and normal blood L: P ratios. Blood and CSF specimens should be collected at the same time.

Limitations:

  • Pyruvic acid levels alone have little clinical utility. Abnormal concentrations of pyruvic acid, and lactate-to-pyruvate (L:P) ratios, are not diagnostic for a particular disorder but must be interpreted in the context of the patient's clinical presentation and other laboratory studies. The determination of pyruvic acid is of diagnostic value when lactic acid is measured and the L:P ratio is established in the same specimen.
  • The L:P ratio is elevated in several, but not all mitochondrial respiratory chain disorders. Determination of lactate, pyruvate, and L: P ratio in cerebrospinal fluid is helpful in directing attention toward a possible mitochondrial disorder in cases with predominantly neurologic dysfunction and normal blood lactate levels.
  • When comparing blood and cerebrospinal fluid (CSF) L:P ratios, blood and CSF specimens should be collected at the same time.
  • Correct specimen collection and handling is crucial to achieve reliable results.
Outreach CPTs
CPT Modifier
(if needed)		 Quantity Description Comments
84210​ ​ ​ ​ ​
Classification
This test was developed and its performance characteristics determined by Marshfield Labs. This laboratory is certified under the Clinical Laboratory Improvement Amendments (CLIA) to perform high complexity testing.
​
Synonyms/Keywords
Pyruvid Acid, Pyruvate in whole blood​
Ordering Applications
Ordering Application Description
​Centricity ​Pyruvate
​Cerner Pyruvic Acid​
If the ordering application you are looking for is not listed, contact your local laboratory for assistance.
Specimen Requirements
Fasting Required Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)		 Pediatric Minimum Volume
(no repeat)
No​ Whole Blood​ Gray Top Tube  (GYTT)​ ​ 3 mL​ 2.5 mL​ 1.2 mL​
Collection Processing
The specimen should be wrapped with a cold pack and sent immediately over to Clinical Manual via the pneumatic tube system. If specimen obtained during non-routine working hours, take specimen to the Clinical Automated section. A protein-free filtrate of the whole blood specimen should be prepared by lab personnel within 15 minutes of collection.
  
For Outreach:
If not possible to transport blood to Marshfield Labs within 15 minutes, immediately pipette 2 ml of well-mixed whole blood into 4 mL cold 7% perchloric acid. Shake to mix well. Place on ice and refrigerate.  For specimens where only 1 mL is available: use 1 mL of blood to 2 mL of perchloric acid.  Tubes of 4 mL of 7% perchloric acid are available from Marshfield Labs. ​
Specimen Stability Information
Specimen Type Temperature Time
Precipitated Whole Blood ​ ​ Ambient 5 days​
Refrigerate (recommended)​ 30 days​
Rejection Criteria
​Whole blood that is not precipitated with 7% perchloric acid within 15 minutes
Useful For
This test is useful for investigating possible disorders of mitochondrial metabolism when used in conjunction with blood lactate collected at the same time to determine the lactate-to-pyruvate ratio.
Reference Range Information
Performing Location Reference Range
Marshfield​

Whole blood adults and children: 0.03-0.10 mmol/L

Interpretation

An elevated lactate-to-pyruvate (L:P) ratio may indicate inherited disorders of the respiratory chain complex, tricarboxylic acid cycle disorders and pyruvate carboxylase deficiency. Respiratory chain defects usually result in L: P ratios >20.

A low L:P ratio (disproportionately elevated pyruvic acid) may indicate an inherited disorder of pyruvate metabolism. Defects of the pyruvate dehydrogenase complex result in L: P ratios <10.

The L:P ratio is characteristically normal in other patients. An artifactually high ratio can be found if the patient is acutely ill.

Cerebrospinal fluid (CSF) L:P ratio may assist in evaluation of patients with neurologic dysfunction and normal blood L: P ratios. Blood and CSF specimens should be collected at the same time.

Limitations:

  • Pyruvic acid levels alone have little clinical utility. Abnormal concentrations of pyruvic acid, and lactate-to-pyruvate (L:P) ratios, are not diagnostic for a particular disorder but must be interpreted in the context of the patient's clinical presentation and other laboratory studies. The determination of pyruvic acid is of diagnostic value when lactic acid is measured and the L:P ratio is established in the same specimen.
  • The L:P ratio is elevated in several, but not all mitochondrial respiratory chain disorders. Determination of lactate, pyruvate, and L: P ratio in cerebrospinal fluid is helpful in directing attention toward a possible mitochondrial disorder in cases with predominantly neurologic dysfunction and normal blood lactate levels.
  • When comparing blood and cerebrospinal fluid (CSF) L:P ratios, blood and CSF specimens should be collected at the same time.
  • Correct specimen collection and handling is crucial to achieve reliable results.
For more information visit:
Performing Laboratory Information
Performing Location Day(s) Test Performed Analytical Time Methodology/Instrumentation
Marshfield​ Monday through Friday​ 6-8 hours​ Sigma Enzymatic Spectrophotometry/Shimadzu UV-1601​
For billing questions, see Contacts
Outreach CPTs
CPT Modifier
(if needed)		 Quantity Description Comments
84210​ ​ ​ ​ ​
Classification
This test was developed and its performance characteristics determined by Marshfield Labs. This laboratory is certified under the Clinical Laboratory Improvement Amendments (CLIA) to perform high complexity testing.
​
For most current information refer to the Marshfield Laboratory online reference manual.