Home
HelpTest Code CMMPP Cobalamin, Methionine, and Methylmalonic Acid Pathways, Plasma
Necessary Information
Patient's age and sex are required.
Specimen Required
Supplies: Sarstedt Aliquot Tube, 5 mL (T914)
Collection Container/Tube:
Preferred: Lavender top (EDTA)
Acceptable: Green top (sodium or lithium heparin)
Submission Container/Tube: Plastic vial
Specimen Volume: 1 mL
Collection Instructions:
1. Immediately place specimen on ice.
2. Within 4 hours of collection, centrifuge and aliquot plasma into plastic vial.
3. If blood cannot be placed on wet ice immediately, centrifuge and aliquot plasma into plastic vial within 1 hour of collection.
4. A refrigerated centrifuge is not required if the above time restrictions are met.
Forms
1. Biochemical Genetics Patient Information (T602)
2. If not ordering electronically, complete, print, and send a Biochemical Genetics Test Request (T798) with the specimen.
Useful For
Screening and monitoring patients suspected of or confirmed with an inherited disorder of methionine, cobalamin, or propionate metabolism using plasma specimens
Evaluating individuals with suspected deficiency of vitamin B12
Special Instructions
Method Name
Liquid Chromatography Tandem Mass Spectrometry (LC-MS/MS)
Reporting Name
CMMP, PSpecimen Type
PlasmaSpecimen Minimum Volume
0.3 mL
Specimen Stability Information
| Specimen Type | Temperature | Time |
|---|---|---|
| Plasma | Refrigerated (preferred) | 28 days |
| Frozen | 309 days | |
| Ambient | 28 days |
Reference Values
|
Age |
Total homocysteine |
Methylmalonic acid (nmol/mL) |
2-Methylcitric |
Total cysteine |
Methionine (nmol/mL) |
Cystathionine |
||
|
Female |
Male |
Female |
Male |
|||||
|
0-11 months |
3.1-8.3 |
3.2-9.7 |
0.08-0.32 |
0.02-0.35 |
142.8-258.8 |
14.7-43.1 |
14.5-42.3 |
0.07-0.38 |
|
12-23 months |
3.2-8.3 |
3.3-9.6 |
0.08-0.31 |
0.02-0.35 |
143.7-258.7 |
14.7-43.1 |
14.5-42.2 |
0.07-0.38 |
|
24-35 months |
3.2-8.2 |
3.3-9.6 |
0.08-0.31 |
0.02-0.35 |
144.8-258.6 |
14.7-43.0 |
14.5-42.1 |
0.07-0.38 |
|
3 years |
3.2-8.2 |
3.3-9.6 |
0.08-0.31 |
0.02-0.35 |
146.0-258.5 |
14.7-43.0 |
14.5-42.0 |
0.07-0.38 |
|
4 years |
3.3-8.2 |
3.4-9.5 |
0.08-0.30 |
0.02-0.35 |
148.2-258.4 |
14.7-42.8 |
14.5-41.8 |
0.07-0.38 |
|
5 years |
3.4-8.1 |
3.5-9.4 |
0.08-0.30 |
0.02-0.35 |
150.6-258.3 |
14.8-42.7 |
14.5-41.6 |
0.07-0.38 |
|
6 years |
3.5-8.1 |
3.6-9.4 |
0.08-0.29 |
0.02-0.35 |
153.2-258.3 |
14.8-42.5 |
14.5-41.4 |
0.07-0.38 |
|
7 years |
3.5-8.1 |
3.7-9.4 |
0.08-0.29 |
0.02-0.35 |
155.8-258.4 |
14.8-42.2 |
14.5-41.1 |
0.07-0.38 |
|
8 years |
3.6-8.2 |
3.8-9.3 |
0.08-0.28 |
0.02-0.35 |
158.5-258.7 |
14.9-42.0 |
14.6-40.9 |
0.07-0.37 |
|
9 years |
3.7-8.2 |
3.9-9.4 |
0.09-0.28 |
0.02-0.35 |
161.0-259.1 |
14.9-41.7 |
14.6-40.7 |
0.07-0.37 |
|
10 years |
3.8-8.3 |
4.1-9.4 |
0.09-0.28 |
0.02-0.35 |
163.5-259.7 |
15.0-41.4 |
14.7-40.6 |
0.07-0.37 |
|
11 years |
3.9-8.4 |
4.3-9.4 |
0.09-0.28 |
0.02-0.35 |
165.9-260.5 |
15.1-41.0 |
14.8-40.4 |
0.07-0.37 |
|
12 years |
3.9-8.6 |
4.4-9.5 |
0.09-0.27 |
0.02-0.35 |
168.4-261.4 |
15.1-40.7 |
14.9-40.3 |
0.07-0.37 |
|
13 years |
4.0-8.7 |
4.6-9.6 |
0.09-0.27 |
0.02-0.35 |
170.9-262.4 |
15.2-40.3 |
15.1-40.1 |
0.07-0.36 |
|
14 years |
4.1-8.8 |
4.8-9.7 |
0.09-0.27 |
0.02-0.35 |
173.6-263.6 |
15.3-39.9 |
15.3-40.0 |
0.07-0.36 |
|
15 years |
4.2-8.9 |
5.0-9.8 |
0.09-0.27 |
0.02-0.35 |
176.4-264.7 |
15.4-39.5 |
15.5-39.9 |
0.07-0.36 |
|
16 years |
4.2-9.1 |
5.2-9.9 |
0.09-0.27 |
0.02-0.35 |
179.3-265.9 |
15.5-39.1 |
15.8-39.7 |
0.07-0.35 |
|
17 years |
4.3-9.2 |
5.4-10.0 |
0.09-0.27 |
0.02-0.35 |
182.2-267.1 |
15.6-38.7 |
16.1-39.6 |
0.07-0.35 |
|
18 years |
4.3-9.3 |
5.6-10.1 |
0.08-0.27 |
0.02-0.35 |
184.9-268.3 |
15.7-38.2 |
16.4-39.4 |
0.07-0.35 |
|
19 years |
4.4-9.5 |
5.7-10.3 |
0.08-0.26 |
0.02-0.35 |
187.4-269.4 |
15.7-37.8 |
16.7-39.3 |
0.07-0.34 |
|
20 years |
4.4-9.6 |
5.9-10.5 |
0.08-0.26 |
0.02-0.35 |
189.5-270.5 |
15.8-37.3 |
17.0-39.1 |
0.07-0.34 |
|
21 years |
4.4-9.8 |
6.0-10.6 |
0.08-0.26 |
0.02-0.35 |
191.2-271.7 |
15.9-36.8 |
17.3-38.9 |
0.07-0.33 |
|
22 years |
4.4-9.9 |
6.1-10.8 |
0.08-0.27 |
0.02-0.35 |
192.5-272.8 |
15.9-36.3 |
17.6-38.7 |
0.07-0.33 |
|
23 years |
4.4-10.1 |
6.2-11.0 |
0.08-0.27 |
0.02-0.35 |
193.5-274.1 |
15.9-35.8 |
17.9-38.5 |
0.07-0.33 |
|
24 years |
4.4-10.3 |
6.2-11.1 |
0.08-0.27 |
0.02-0.35 |
194.2-275.4 |
15.9-35.3 |
18.1-38.3 |
0.07-0.32 |
|
25 years |
4.4-10.4 |
6.3-11.3 |
0.08-0.28 |
0.02-0.35 |
194.8-277.0 |
15.9-34.8 |
18.2-38.1 |
0.07-0.32 |
|
26 years |
4.4-10.6 |
6.3-11.4 |
0.08-0.28 |
0.02-0.35 |
195.3-278.6 |
15.9-34.3 |
18.4-37.9 |
0.07-0.32 |
|
27 years |
4.3-10.8 |
6.4-11.6 |
0.08-0.28 |
0.02-0.35 |
196.0-280.5 |
16.0-33.8 |
18.5-37.7 |
0.07-0.31 |
|
28 years |
4.3-11.0 |
6.4-11.7 |
0.08-0.29 |
0.02-0.35 |
196.7-282.4 |
16.0-33.4 |
18.7-37.5 |
0.07-0.31 |
|
29 years |
4.3-11.2 |
6.4-11.8 |
0.08-0.29 |
0.02-0.35 |
197.7-284.3 |
16.0-33.0 |
18.8-37.3 |
0.07-0.31 |
|
30 years |
4.3-11.4 |
6.4-11.9 |
0.08-0.30 |
0.02-0.35 |
198.8-286.3 |
16.1- 32.6 |
18.9-37.1 |
0.07-0.30 |
|
31 years |
4.4-11.6 |
6.4-12.1 |
0.08-0.30 |
0.02-0.35 |
200.2-288.2 |
16.1-32.2 |
19.0-36.9 |
0.07-0.30 |
|
32 years |
4.4-11.8 |
6.4-12.2 |
0.08-0.31 |
0.02-0.35 |
201.7-290.0 |
16.1-31.8 |
19.1-36.7 |
0.07-0.30 |
|
33 years |
4.4-11.9 |
6.4-12.3 |
0.08-0.31 |
0.02-0.35 |
203.4-291.5 |
16.1-31.5 |
19.2-36.5 |
0.07-0.29 |
|
34 years |
4.5-12.1 |
6.4-12.4 |
0.08-0.31 |
0.02-0.35 |
205.2-292.9 |
16.1-31.2 |
19.3-36.3 |
0.07-0.29 |
|
35 years |
4.5-12.2 |
6.4-12.6 |
0.08-0.32 |
0.02-0.35 |
207.2-294.1 |
16.1-30.8 |
19.4-36.1 |
0.07-0.28 |
|
36 years |
4.6-12.4 |
6.4-12.8 |
0.08-0.32 |
0.02-0.35 |
209.3-295.1 |
16.1-30.5 |
19.5-35.9 |
0.07-0.28 |
|
37 years |
4.6-12.5 |
6.4-12.9 |
0.08-0.33 |
0.02-0.35 |
211.5-296.0 |
16.1-30.2 |
19.6-35.6 |
0.07-0.27 |
|
38 years |
4.7-12.7 |
6.4-13.1 |
0.08-0.33 |
0.02-0.35 |
213.8-296.9 |
16.1-29.9 |
19.7-35.4 |
0.07-0.27 |
|
39 years |
4.7-12.8 |
6.4-13.2 |
0.08-0.34 |
0.02-0.35 |
216.3-297.7 |
16.1-29.7 |
19.8-35.2 |
0.07-0.27 |
|
40 years |
4.8-13.0 |
6.5-13.4 |
0.08-0.34 |
0.02-0.35 |
218.9-298.7 |
16.1-29.4 |
19.9-35.0 |
0.07-0.27 |
|
41 years |
4.8-13.2 |
6.5-13.5 |
0.08-0.35 |
0.02-0.35 |
221.6-299.7 |
16.1-29.2 |
20.0-34.8 |
0.07-0.27 |
|
42 years |
4.8-13.4 |
6.5-13.7 |
0.08-0.36 |
0.02-0.35 |
224.3-300.8 |
16.2-29.0 |
20.1-34.6 |
0.07-0.26 |
|
43 years |
4.9-13.5 |
6.6-13.9 |
0.08-0.36 |
0.02-0.35 |
227.0-302.0 |
16.2-28.8 |
20.2-34.4 |
0.07-0.26 |
|
44 years |
4.9-13.7 |
6.6-14.0 |
0.08-0.37 |
0.02-0.35 |
229.8-303.5 |
16.3-28.6 |
20.3-34.2 |
0.07-0.26 |
|
45 years |
4.9-13.9 |
6.6-14.2 |
0.08-0.38 |
0.02-0.35 |
232.6-305.2 |
16.3-28.5 |
20.3-34.0 |
0.07-0.26 |
|
46 years |
4.9-14.0 |
6.7-14.4 |
0.08-0.38 |
0.02-0.35 |
235.3-307.3 |
16.4-28.4 |
20.4-33.8 |
0.07-0.26 |
|
47 years |
4.9-14.2 |
6.7-14.5 |
0.08-0.39 |
0.02-0.35 |
238.0-309.7 |
16.4-28.2 |
20.4-33.6 |
0.07-0.26 |
|
48 years |
5.0-14.3 |
6.8-14.7 |
0.08-0.39 |
0.02-0.35 |
240.8-312.6 |
16.5-28.1 |
20.5-33.3 |
0.07-0.26 |
|
49 years |
5.0-14.4 |
6.8-14.9 |
0.08-0.40 |
0.02-0.35 |
243.5-315.9 |
16.5-28.0 |
20.5-33.1 |
0.07-0.26 |
|
50 years |
5.0-14.5 |
6.8-15.0 |
0.08-0.40 |
0.02-0.35 |
246.2-319.7 |
16.5-27.9 |
20.6-32.8 |
0.07-0.26 |
|
51 years |
5.1-14.6 |
6.8-15.2 |
0.08-0.41 |
0.02-0.35 |
248.9-323.8 |
16.5-27.8 |
20.6-32.5 |
0.07-0.26 |
|
52 years |
5.1-14.7 |
6.9-15.4 |
0.08-0.41 |
0.02-0.35 |
251.5-328.1 |
16.5-27.6 |
20.7-32.3 |
0.07-0.26 |
|
53 years |
5.1-14.8 |
6.9-15.5 |
0.08-0.42 |
0.02-0.35 |
254.0-332.4 |
16.5-27.5 |
20.8-32.1 |
0.07-0.26 |
|
54 years |
5.2-14.9 |
6.9-15.6 |
0.08-0.42 |
0.02-0.35 |
256.4-336.5 |
16.5-27.4 |
21.0-31.9 |
0.07-0.25 |
|
55 years |
5.2-15.0 |
6.9-15.7 |
0.08-0.43 |
0.02-0.35 |
258.6-340.2 |
16.5-27.3 |
21.1-31.7 |
0.07-0.25 |
|
56 years |
5.3-15.0 |
6.9-15.8 |
0.08-0.43 |
0.02-0.35 |
260.6-343.6 |
16.6-27.2 |
21.2-31.5 |
0.07-0.25 |
|
57 years |
5.3-15.1 |
6.9-15.9 |
0.08-0.44 |
0.02-0.35 |
262.5-346.5 |
16.6-27.1 |
21.2-31.3 |
0.07-0.25 |
|
58 years |
5.3-15.2 |
6.9-16.0 |
0.08-0.44 |
0.02-0.35 |
264.3-349.0 |
16.6-27.1 |
21.3-31.0 |
0.07-0.25 |
|
59 years |
5.4-15.2 |
6.9-16.0 |
0.08-0.44 |
0.02-0.35 |
266.2-351.1 |
16.7-27.1 |
21.3-30.8 |
0.07-0.25 |
|
60 years |
5.4-15.3 |
6.9-16.1 |
0.08-0.45 |
0.02-0.35 |
268.3-353.1 |
16.8-27.1 |
21.3-30.6 |
0.07-0.25 |
|
61 years |
5.4-15.4 |
7.0-16.2 |
0.09-0.45 |
0.02-0.35 |
270.8-355.1 |
16.9-27.2 |
21.3-30.3 |
0.07-0.25 |
|
62 years |
5.5-15.4 |
7.0-16.2 |
0.09-0.46 |
0.02-0.35 |
273.8-357.3 |
17.0-27.2 |
21.2-30.0 |
0.08-0.25 |
|
63 years |
5.5-15.5 |
7.0-16.3 |
0.09-0.46 |
0.02-0.35 |
277.5-359.7 |
17.1-27.3 |
21.2-29.8 |
0.08-0.25 |
|
64 years |
5.6-15.5 |
7.1-16.3 |
0.09-0.46 |
0.02-0.35 |
281.9-362.3 |
17.2-27.4 |
21.1-29.5 |
0.08-0.25 |
|
65 years |
5.6-15.6 |
7.1-16.3 |
0.09-0.47 |
0.02-0.35 |
286.9-365.2 |
17.3-27.6 |
21.1-29.2 |
0.08-0.25 |
|
66 years |
5.7-15.6 |
7.1-16.3 |
0.09-0.47 |
0.02-0.35 |
292.4-368.3 |
17.4-27.7 |
21.1-29.0 |
0.08-0.25 |
|
67 years |
5.7-15.7 |
7.2-16.3 |
0.09-0.47 |
0.02-0.35 |
298.1-371.6 |
17.5-27.8 |
21.0-28.7 |
0.09-0.25 |
|
68 years |
5.8-15.7 |
7.2-16.3 |
0.09-0.47 |
0.02-0.35 |
303.6-374.8 |
17.7-27.9 |
21.0-28.5 |
0.09-0.25 |
|
69 years |
5.9-15.7 |
7.2-16.3 |
0.09-0.47 |
0.02-0.35 |
308.7-377.8 |
17.8-28.0 |
21.0-28.4 |
0.09-0.25 |
|
70 years |
6.0-15.8 |
7.3-16.3 |
0.09-0.48 |
0.02-0.35 |
313.1-380.7 |
18.0-28.1 |
21.0-28.3 |
0.09-0.25 |
|
71 years |
6.1-15.8 |
7.3-16.3 |
0.09-0.48 |
0.02-0.35 |
316.5-383.2 |
18.1-28.2 |
20.9-28.2 |
0.09-0.25 |
|
72 years |
6.2-15.8 |
7.3-16.3 |
0.09-0.48 |
0.02-0.35 |
318.9-385.3 |
18.3-28.3 |
20.9-28.0 |
0.09-0.25 |
|
73 years |
6.3-15.9 |
7.3-16.3 |
0.09-0.48 |
0.02-0.35 |
320.1-387.0 |
18.5-28.4 |
20.8-27.9 |
0.10-0.26 |
|
74 years |
6.4-15.9 |
7.3-16.3 |
0.09-0.48 |
0.02-0.35 |
320.6-388.3 |
18.8-28.5 |
20.8-27.8 |
0.10-0.26 |
|
75 years |
6.5-15.9 |
7.3-16.3 |
0.09-0.48 |
0.02-0.35 |
320.3-389.3 |
19.1-28.5 |
20.8-27.7 |
0.10-0.26 |
|
76 years |
6.6-15.9 |
7.3-16.3 |
0.09-0.48 |
0.02-0.35 |
319.6-389.9 |
19.3-28.6 |
20.8-27.5 |
0.10-0.26 |
|
77 years |
6.7-16.0 |
7.4-16.3 |
0.10-0.48 |
0.02-0.35 |
319.1-390.2 |
19.6-28.6 |
20.9-27.4 |
0.10-0.26 |
|
78 years |
6.8-16.0 |
7.4-16.3 |
0.10-0.48 |
0.02-0.35 |
318.5-390.5 |
20.0-28.7 |
20.9-27.2 |
0.11-0.26 |
|
79 years |
6.9-16.0 |
7.5-16.3 |
0.10-0.48 |
0.02-0.35 |
317.9-390.6 |
20.3-28.7 |
21.0-27.1 |
0.11-0.26 |
|
80 years |
7.0-16.0 |
7.5-16.3 |
0.10-0.48 |
0.02-0.35 |
317.9-390.6 |
20.3-28.7 |
21.0-27.1 |
0.11-0.26 |
|
81 years |
7.1-16.0 |
7.7-16.2 |
0.10-0.48 |
0.02-0.35 |
317.9-390.6 |
20.3-28.7 |
21.0-27.1 |
0.11-0.26 |
|
82 years |
7.2-16.0 |
7.8-16.2 |
0.10-0.48 |
0.02-0.35 |
317.9-390.6 |
20.3-28.7 |
21.0-27.1 |
0.11-0.26 |
|
83 years |
7.2-16.0 |
7.9-16.2 |
0.10-0.48 |
0.02-0.35 |
317.9-390.6 |
20.3-28.7 |
21.0-27.1 |
0.11-0.26 |
|
84 years |
7.3-16.0 |
8.0-16.2 |
0.10-0.48 |
0.02-0.35 |
317.9-390.6 |
20.3-28.7 |
21.0-27.1 |
0.11-0.26 |
|
85 years |
7.3-16.0 |
8.2-16.2 |
0.10-0.48 |
0.02-0.35 |
317.9-390.6 |
20.3-28.7 |
21.0-27.1 |
0.11-0.26 |
|
>85 years |
7.4-16.0 |
8.3-16.2 |
0.10-0.48 |
0.02-0.35 |
317.9-390.6 |
20.3-28.7 |
21.0-27.1 |
0.11-0.26 |
Interpretation
An interpretive report will be provided.
When abnormal results are detected, a detailed interpretation is given, including an overview of the results and of their significance, a correlation to available clinical information, elements of differential diagnosis, recommendations for additional biochemical testing, and in vitro confirmatory studies (complementation studies, molecular analysis), and a phone number to reach one of the laboratory directors in case the referring physician has additional questions.
Abnormal results are not sufficient to conclusively establish a diagnosis of a particular disease. To verify a preliminary diagnosis based on the analysis, independent biochemical (eg, complementation studies) or molecular genetic analyses are required.
Clinical Reference
1. Turgeon CT, Magera MJ, Cuthbert CD, et al. Determination of total homocysteine, methylmalonic acid, and 2-methylcitric acid in dried blood spots by tandem mass spectrometry. Clin Chem. 2010;56(11):1686-1695
2. Tortorelli S, Turgeon CT, Lim JS, et al. Two-tier approach to the newborn screening of methylenetetrahydrofolate reductase deficiency and other remethylation disorders with tandem mass spectrometry. J Pediatr. 2010;157(2):271-275
3. Huemer M, Diodato D, Schwahn B, et al. Guidelines for diagnosis and management of the cobalamin-related remethylation disorders cblC, cblD, cblE, cblF, cblG, cblJ and MTHFR deficiency. J Inherit Metab Dis. 2017;40(1):21-48
4. Baric I, Staufner C, Augoustides-Savvopoulou P, Chien YH, Dobbelaere D, Grunert SC. Consensus recommendations for the diagnosis, treatment and follow-up of inherited methylation disorders. J Inherit Metab Dis. 2017;40(1):5-20
5. Morris AA, Kozich V, Santra S, et al. Guidelines for the diagnosis and management of cystathionine beta-synthase deficiency. J Inherit Metab Dis. 2017;40(1):49-74
6. Sloan JS, Carrillo N, Adams D, Venditti CP. Disorders of intracellular cobalamin metabolism. In: Adam MP, Feldman J, Mirzaa GM, et al, eds. GeneReviews [Internet]. University of Washington, Seattle; 2008. Updated December 16, 2021. Accessed November 29, 2024. Available at www.ncbi.nlm.nih.gov/books/NBK1328/
7. Langan RC, Goodbred AJ. Vitamin B12 deficiency: Recognition and management. Am Fam Physician. 2017;96(6):384-389
Day(s) Performed
Monday, Wednesday, Friday
Report Available
3 to 6 daysPerforming Laboratory
Mayo Clinic Laboratories in Rochester
Test Classification
This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. It has not been cleared or approved by the US Food and Drug Administration.CPT Code Information
83090
83918
82136
82542 (if appropriate for government payers)
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| CMMPP | CMMP, P | 104535-0 |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| 606110 | Interpretation | 59462-2 |
| 606104 | Total Homocysteine | 13965-9 |
| 606105 | Methylmalonic acid | 13964-2 |
| 606119 | 2-Methylcitric acid | 26904-3 |
| 606106 | Methionine | 20651-6 |
| 606107 | Total Cysteine | 20641-7 |
| 606108 | Cystathionine | 26607-2 |
| 606109 | Reviewed By | 18771-6 |