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Test Code BPGMM 2,3-Bisphosphoglycerate Mutase, Full Gene Sequencing Analysis

Useful For

Diagnosis of 2,3-bisphosphoglycerate mutase deficiency in individuals with lifelong, unexplained erythrocytosis


Identifying mutation carriers in family members of an affected individual for the purposes of preconception genetic counseling

Testing Algorithm

This evaluation is recommended for patients presenting with lifelong erythrocytosis, usually with a positive family history of similar symptoms. Due to the rarity of this disorder, other more common causes of erythrocytosis should be excluded prior to ordering (see Erythrocytosis Evaluation Testing Algorithm in Special Instructions). Polycythemia vera and chronic myeloproliferative neoplasm should be excluded prior to testing. A JAK2 V617F, JAK2 exon 12, or a von Hippel Lindau (VHL) mutation should not be present. Patient serum erythropoietin levels should be normal or elevated and oxygen dissociation p50 values decreased in test candidates. For a reflexive evaluation including p50 testing, hemoglobin electrophoresis, and mutation analysis of genes associated with hereditary erythrocytosis, order REVE / Erythrocytosis Evaluation.

Method Name

Polymerase Chain Reaction (PCR) Amplification/Sanger Sequence Analysis 

Reporting Name

BPGM Full Gene Sequencing

Specimen Type


Advisory Information

This test detects mutations in the BPGM gene only. For a complete evaluation in an algorithmic fashion, order REVE/ Erythrocytosis Evaluation.

Shipping Instructions

Specimens must arrive within 7 days (168 hours) of collection.

Specimen Required

Submit only 1 of the following specimens:


Specimen Type: Peripheral blood

Collection Container/Tube:

Preferred: EDTA (lavender top)

Acceptable: ACD (yellow top), Heparin (green top)

Specimen Volume: 4 mL

Collection Instructions:

1. Invert several times to mix blood.

2. Send specimen in the original tube.


Specimen Type: Extracted DNA from whole blood

Container/Tube: 1.5- to 2-mL tube

Specimen Volume: Entire specimen

Collection Instructions: Label specimen as extracted DNA from blood and provide indication of volume and concentration of the DNA

Specimen Minimum Volume

1 mL

Specimen Stability Information

Specimen Type Temperature Time
Varies Varies 7 days

Reject Due To


Mild OK; Gross reject






Bone marrow, paraffin-embedded tissue, frozen tissue, paraffin-embedded bone marrow aspirate clot, methanol-acetic acid (MAA)-fixed pellets, moderately to severely clotted

Clinical Information

Erythrocytosis (ie, increased RBC mass, elevated RBC count, and elevated hemoglobin and hematocrit) may be primary, due to an intrinsic defect of bone marrow stem cells, as in polycythemia vera (PV); or secondary, in response to increased serum erythropoietin (Epo) levels. Secondary erythrocytosis is associated with a number of disorders including chronic lung disease, chronic increase in carbon monoxide (due to smoking), cyanotic heart disease, high-altitude living, renal cysts and tumors, hepatoma, and other Epo-secreting tumors. When these common causes of secondary erythrocytosis are excluded, a heritable cause involving hemoglobin or erythrocyte regulatory mechanism may be suspected.


Unlike PV, hereditary erythrocytosis is not associated with the risk of clonal evolution and should present with isolated erythrocytosis that has been present since birth. A rare subset of cases is associated with pheochromocytoma and paraganglioma formation later in life. Hereditary erythrocytosis may be caused by mutations in one of several genes and inherited in either an autosomal dominant or autosomal recessive manner. A family history of erythrocytosis would be expected in these cases, although de novo mutations have also been reported.


Genetic mutations causing hereditary erythrocytosis have been found in genes coding for alpha and beta hemoglobins, hemoglobin stabilization proteins (eg, 2,3-bisphosphoglycerate mutase: BPGM), the erythropoietin receptor (EPOR), and oxygen-sensing pathway enzymes (hypoxia-inducible factor: HIF, prolyl hydroxylase domain: PHD, and von Hippel Lindau: VHL), see table. High-oxygen-affinity hemoglobin variants and BPGM abnormalities result in a decreased p50 result, whereas those affecting EPOR, HIF, PHD, and VHL have normal p50 results. The true prevalence of mutations causing hereditary erythrocytosis is unknown.


Erythrocytosis Testing



Serum Epo


JAK2 V617F




JAK2 exon 12






Decreased to normal level




Normal level




Normal level


Beta Globin


Normal level to increased


Alpha Globin


Normal level to increased




Normal level to increased




Markedly Increased


Reference Values

An interpretive report will be provided.


An interpretive report will be provided and will include specimen information, assay information, and whether the specimen was positive for any mutations in the gene. If positive, the mutation will be correlated with clinical significance, if known.

Clinical Reference

1. Petousi N, Copley RR, Lappin TR, et al: Erythrocytosis associated with a novel missense mutation in the BPGM gene. Haematologica 2014 Oct;99:e201-e204

2. Hoyer JD, Allen SL, Beutler E, et al: Erythrocytosis due to bisphosphoglycerate mutase deficiency with concurrent glucose-6-phosphate dehydrogenase (G-6-PD) deficiency. Am J Hematol 2004;75(4):205-208

3. Rosa R, Prehu MO, Beuzard Y, Rosa J: The first case of a complete deficiency of diphosphoglycerate mutase in human erythrocytes. J Clin Invest 1978;62(5):907-915

Day(s) and Time(s) Performed

Monday through Friday

Analytic Time

10 days

Performing Laboratory

Mayo Medical Laboratories in Rochester

Test Classification

This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the U.S. Food and Drug Administration.

CPT Code Information

81479-Unlisted Molecular Pathology procedure

LOINC Code Information

Test ID Test Order Name Order LOINC Value
BPGMM BPGM Full Gene Sequencing In Process


Result ID Test Result Name Result LOINC Value
37111 BPGM Gene Sequencing Result In Process
37112 BPGM Interpretation In Process


1. New York Clients-Informed consent is required. Please document on the request form or electronic order that a copy is on file. An Informed Consent for Genetic Testing ( (T576) is available in Special Instructions.

2. Erythrocytosis Patient Information ( (T694) in Special Instructions

3. If not ordering electronically, complete, print, and send a Benign Hematology Test Request Form (T755) with the specimen (