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Beta HCG, Quant (BHCG)

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EPIC Test Name

BETA HCG, QUANT

EPIC Code

LAB2551

Specimen Requirements

plasma
Minimum Volume:0.5 mL
Collection:Collect using standard laboratory procedures
Transport:Room Temperature ASAP
Stability:Refrigerated: 14 days at 4-8 degrees C
Frozen: 12 months at -20 degrees C
Container:LIT-GRN
Processing/Storage:Centrifuge, aliquot and freeze.
Rejection Causes:Hemolysis,
Insufficient Sample Volume, lipemic samples

Methods

Chemiluminescent

Turnaround Time

SpecimenTurnaround TimeFrequency
plasmaStat: 90 minutes Routine: 4 hours24/7

Reference Ranges

Chemiluminescent
AgeAll RangeMale RangeUnit
55 years up to 999 years<5<2mIU/mL
0 years up to 55 years<14<2mIU/mL

Clinical Indications

Human chorionic gonadotropin is a glycoprotein hormone that consists of a alpha- and a beta-subunit. The alpha subunit is similar to that for luteinizing hormone (LH), follicle-stimulating hormone (FSH), and thyrotropin (TSH). It is the beta-subunit of hCG that differs HCG from other pituitary hormones.
During pregnancy, hCG is produced in the placenta and peaked around week 10 gestation to maintain the corpus luteum, hence, progesterone production in the first trimester. Thereafter, the placenta produces steroid hormones, taking place of the role of hCG; hCG concentrations fall sharply until reaching around week 20, then leveling off, though still significantly higher than its pre-pregnancy levels. After delivery, miscarriage, or pregnancy termination, hCG concentration falls exponentially with a half-life of 24 to 36 hours, until pre-pregnancy levels are reached.
In non-pregnant woman, hCG can be produced by tumors of the trophoblast, germ cell tumors with trophoblastic components, and some non-trophoblastic tumors. At least 6 different forms of hCG have been identified in serum: nonnicked and nicked intact hCG (hCG and hCGn), nonnicked and nicked free beta-subunit (hCG-beta and hCGn-beta), and regular and hyperglycosylated (or large) free hCG.
In pregnancy, intact hCG predominates, whereas free hCG-beta accounts for 1% of total beta-hCG (hCG + hCG-beta) in serum. However, in patients with trophoblastic diseases or testicular tumors, the free hCG-beta concentration is disproportionately increased, and the ratio of free hCG-beta to intact hCG or to hCG + hCG-beta is markedly increased. Therefore, measurements of beta-hCG are important in diagnosis and management of trophoblastic diseases and testicular tumors. beta-hCG have also been suggested to be better biomarkers than intact hCG in prenatal screening for Down syndrome.

Additional Information

• If a serial monitoring of hCG concentration is required, the same assay or method should be used for all measurements, due to lack of standardization of various assays.
• If serum hCG concentrations > 15 to 20 IU/L, urine hCG should also be in detectable level if it is truly elevated. Undetectable urinary hCG suggesting a false-positive serum hCG test. Contact laboratory for investigation.
• Notify laboratory supervisor or director if beta-hCG or hCG test result does not correlate with the clinical presentation.

Common Synonyms

Quantitative beta HCG, blood pregnancy HCG + B-subunit For tumor marker and pregnancy, HCGS

Performed

Lab
Chemistry - Community
Chemistry - Downtown

Interpretative Information

• In patients with pregnancy termination, (normal delivery, miscarriage), beta hCG falls with a half-life of 24 to 36 hours till reaching pre-pregnancy levels. An absent or significantly slower reduction of beta-hCG can be seen in patients with retained products of conception or placental and/or fetal tissue.
• Significant elevations of beat-hCG can be associated with gestational trophoblastic disease (GTD), usually above the value of 2 x the medians for gestational age. The beta-hCG may persistently increase or even rises beyond the first trimester, when it normally starts to decrease.
• Serum hCG concentration elevation were seen in about 40% - 50% of patients with nonseminomatous testicular cancer and 20% to 40% of patients with seminoma. Markedly elevated levels of hCG (>5000 IU/L) are uncommon in patients with pure seminoma suggesting the presence of a mixed testicular cancer.
• Ovarian germ cell tumors (about 10% ovarian tumors) showed increased hCG levels in 20% - 50% of cases. Children with Teratomas may shown elevated hCG, even benign, resulting in precocious pseudopuberty and hCG concentrations can be increased to levels similar to testicular cancer.
• Some non-reproductive tumors, e.g., hepatobiliary tumors (hepatoblastomas, hepatocellular carcinomas, and cholangiocarcinomas) and neuroendocrine tumors (eg, islet cell tumors and carcinoids), are also commonly associated with hCG elevation.
• Since many hCG-producing tumors also produce alpha fetoprotein (AFP), AFP is recommended for test in the diagnostic workup.
• in management for hCG-secreting tumors patients, a complete therapeutic response is characterized by a decline in hCG concentrations with an apparent half-life of 24 to 36 hours to concentrations of within the reference range.
• For GTD and some tumors that may produce hyperglycoslated hCG with a longer half-life; but an apparent half-life of > 3 days suggests the existence of residual hCG-producing tumor tissue.
• An increased hCG concentration > upper limit of the reference range in patients who were diagnosed with hCG-producing tumors and had previously been treated successfully, indicates possible occurrence of local or distant metastasis.
• Transient increase of serum beta hCG, in response to chemotherapy in patients with susceptible tumors due to massive tumor cell lysis, may occur and should not be confused with tumor progression.
• Serum beta-hCG within reference range may not always rule out tumor persistence, it may occur to tumors undergoing transition to differentiated teratomas, which may not produce beta-hCG.
• In perimenopausal and postmenopausal women, Low levels or significantly higher than the upper limit of reference range of hCG is a normal physiologic phenomenon (https://www.ajog.org/article/S0002-9378(07)01178-7/abstract). In postmenopausal women, hCG levels ranging from 11.6 +/- 7.0 IU/L even greater have been reported.
• In patients with end-stage renal failure, up to a 10-fold elevation in serum beta-hCG levels may occur.

CPT

84702

LOINC

2111-3

References

1. Cao ZT and Rej R. Are laboratories reporting serum quantitative hCG results correctly? Clin Chem 2008;54:761-4.
2. Cole LA. Immunoassay of human chorionic gonadotropin, its free subunits, and metabolites. Clin Chem 1997;43:2233–43.
3. Stenman UH, Tiitinen A, Alfthan H, Valmu L. The classification, functions and clinical use of different isoforms of HCG. Hum Reprod Update 2006; 12:769 –84.
4. Thomas CMG, Reijnders FJL, Segers MFG, Doesburg WH, Rolland R. Human choriogonadotropin (hCG): comparisons between determinations of intact hCG, free hCG beta-subunit, and “total” hCG + beta in serum during the first half of high-risk pregnancy. Clin Chem 1990;36:651–5.
5. Fan C, Goto S, Furuhashi Y, Tomoda Y. Radioimmunoassay of the serum free beta-subunit of human chorionic gonadotropin in trophoblastic disease. J Clin Endocrinol Metab 1987;64:313–8.
6. Rinker AD, Tietz NW. beta-hCG vs intact hCG assays in the detection of trophoblastic disease. Clin Chem 1989;35:1799 –800.
7. Cole LA, Shahabi S, Butler SA, Mitchell H, Newlands ES, Behrman HR, Verrill HL. Utility of commonly used commercial human chorionic gonadotropin immunoassays in the diagnosis and management of trophoblastic diseases. Clin Chem 2001;47:308 –15.
8. Cole LA, Khanlian SA, Muller CY, Giddings A, Kohorn E, Berkowitz R. Gestational trophoblastic diseases: 3. Human chorionic gonadotropin-free beta-subunit, a reliable marker of placental site trophoblastic tumors. Gynecol Oncol 2006;102: 160 –4.
9. Sailer B, Clara R, Spottl G, Siddle K, Mann K. Testicular cancer secretes intact human choriogonadotropin (hCG) and its free -subunit: evidence that hCG (+hCG-beta) assays are the most reliable in diagnosis and follow-up. Clin Chem 1990;36: 234 –9.
10. Cole LA, Sutton JM. Selecting an appropriate hCG test for managing gestational trophoblastic disease and cancer. J Reprod Med 2004;49:545–53.
11. Palomaki GE, Lambert-Messerlian GM, Canick JA. A summary analysis of Down syndrome markers in the late first trimester. Adv Clin Chem 2007; 43:177–210.
12. Schneider DT, Calaminus G, Gobel U: Diagnostic value of alpha 1-fetoprotein and beta-human chorionic gonadotropin in infancy and childhood. Pediatr Hematol Oncol. 2001;18(1):11-26
13. Cole LA, Butler S: Detection of hCG in trophoblastic disease. The USA hCG reference service experience. J Reprod Med. 2002;40(6):433-444
14. von Eyben FE: Laboratory markers and germ cell tumors. Crit Rev Clin Lab Sci .2003;40(4):377-427
15. Sturgeon CM, Duffy MJ, Stenman UH: National Academy of Clinical Biochemistry laboratory medicine practice guidelines for use of tumor markers in testicular, prostate, colorectal, breast, and ovarian cancers. Clin Chem. 2008; 54(12):e11-79

Contact Information

Chemistry - Downtown: (315)464-4460
Chemistry - Community: (315)492-5531
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