Test Catalog

Test Id : B6PRO

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Vitamin B6 Profile (Pyridoxal 5-Phosphate and Pyridoxic Acid), Plasma

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Overview

Test Catalog

Useful For
Suggests clinical disorders or settings where the test may be helpful

Determining vitamin B6 status, including in persons who present with progressive nerve compression disorders, such as carpal tunnel and tarsal tunnel syndromes

 

Determining the overall success of a vitamin B6 supplementation program

 

Diagnosis and evaluation of hypophosphatasia

 

Differentiating between hypophosphatasia or dietary supplementation as the likely cause of elevated pyridoxal-5'-phosphate (PLP) levels

Profile Information
A profile is a group of laboratory tests that are ordered and performed together under a single Mayo Test ID. Profile information lists the test performed, inclusive of the test fee, when a profile is ordered and includes reporting names and individual availability.

Test Id Reporting Name Available Separately Always Performed
PLP Pyridoxal 5-Phosphate (PLP), P Yes Yes
B6PA Pyridoxic Acid (PA), P No Yes

Method Name
A short description of the method used to perform the test

Liquid Chromatography Tandem Mass Spectrometry (LC-MS/MS)

NY State Available
Indicates the status of NY State approval and if the test is orderable for NY State clients.

Yes

Reporting Name
Lists a shorter or abbreviated version of the Published Name for a test

Vitamin B6 Profile (PLP and PA), P

Aliases
Lists additional common names for a test, as an aid in searching

P 5-P

Pyridoxal Phosphate

Soft- B6PRO

Vitamin B6

Pyridoxal 5-Phosphate (PALP)

Specimen Type
Describes the specimen type validated for testing

Plasma Heparin

Shipping Instructions

Specimen Required
Defines the optimal specimen required to perform the test and the preferred volume to complete testing

Patient Preparation:

1. Patient should fast overnight (12-14 hours); infants-should have specimen collected before next feeding. Water may be taken as needed.

2. For 24 hours before specimen collection, patient must not take multivitamins or vitamin supplements.

Supplies: Amber Frosted Tube, 5 mL (T915)

Collection Container/Tube: 

Preferred: Green top (sodium or lithium heparin) or plasma gel separator (PST)

Acceptable: None

Submission Container/Tube: Amber vial

Specimen Volume: 1 mL

Collection Instructions:

1. Within 2 hours of collection, centrifuge at 4 degrees C and aliquot into an amber vial.

2. Freeze immediately.

Specimen Minimum Volume
Defines the amount of sample necessary to provide a clinically relevant result as determined by the testing laboratory. The minimum volume is sufficient for one attempt at testing.

0.75 mL

Reject Due To
Identifies specimen types and conditions that may cause the specimen to be rejected

Gross hemolysis OK
Gross lipemia OK
Gross icterus OK

Specimen Stability Information
Provides a description of the temperatures required to transport a specimen to the performing laboratory, alternate acceptable temperatures are also included

Specimen Type Temperature Time Special Container
Plasma Heparin Frozen 29 days LIGHT PROTECTED

Useful For
Suggests clinical disorders or settings where the test may be helpful

Determining vitamin B6 status, including in persons who present with progressive nerve compression disorders, such as carpal tunnel and tarsal tunnel syndromes

 

Determining the overall success of a vitamin B6 supplementation program

 

Diagnosis and evaluation of hypophosphatasia

 

Differentiating between hypophosphatasia or dietary supplementation as the likely cause of elevated pyridoxal-5'-phosphate (PLP) levels

Clinical Information
Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test

Vitamin B6 is a generic term that refers to the pyridine-based compounds pyridoxine, 4-pyridoxic acid, pyridoxamine, pyridoxal, and their phosphorylated derivatives. Pyridoxal-5'-phosphate (PLP) is the biologically active form and serves as a cofactor for more than 140 different enzyme reactions, representing 4% of all known catalytic activity. Deficiencies can occur in people with mutations of pyridoxal kinase or pyridoxine 5'-phosphate oxidase, as well as in individuals who are pregnant, have kidney disease, are severely malnourished, or have malabsorption. Additionally, deficiencies have been observed with the usage of certain drugs such as isoniazid, penicillamine, benserazide, and carbidopa. Vitamin B6 deficiency is a potential cause of burning mouth syndrome and a possible potentiating factor for carpal tunnel and tarsal tunnel syndromes. Persons who present chronic, progressive nerve compression disorders may be deficient in vitamin B6 and should be evaluated. Vitamin B6 deficiency is associated with symptoms of scaling of the skin, severe gingivitis, irritability, weakness, depression, dizziness, peripheral neuropathy, and seizures. In the pediatric population, deficiencies have been characterized by diarrhea, anemia, and seizures. Conversely, exceptionally high levels of vitamin B6 can also have toxic effects resulting in sensory and motor neuropathies. Markedly elevated PLP in conjunction with low or normal levels of pyridoxic acid are observed in cases of hypophosphatasia, a disorder caused by loss-of-function mutation(s) of the gene ALPL that encodes the tissue-nonspecific isoenzyme of alkaline phosphatase

Reference Values
Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.

PYRIDOXAL 5-PHOSPHATE

5-50 mcg/L

 

PYRIDOXIC ACID

3-30 mcg/L

Interpretation
Provides information to assist in interpretation of the test results

Levels for fasting individuals falling in the range of 3 to 30 mcg/L for pyridoxic acid (PA) and 5 to 50 mcg/L for pyridoxal 5-phosphate (PLP) are indicative of adequate nutrition.

 

The following are interpretative guidelines based on PLP and PA results:

If PLP is >100 mcg/L and PA is < or =30 mcg/L:

-The increased PLP is suggestive of hypophosphatasia. Consider analysis of serum alkaline phosphatase isoenzymes (ALKP / Alkaline Phosphatase, Total and Isoenzymes, Serum) and urinary phosphoethanolamine (AAPD / Amino Acids, Quantitative, Random, Urine)

 

If PLP is >100 mcg/L and PA is 31 to 100 mcg/L or PLP is 81 to 100 mcg/L and PA is < or =30 mcg/L:

-The increased PLP is likely related to dietary supplementation; however, a mild expression of hypophosphatasia cannot be excluded. Consider analysis of serum alkaline phosphatase isoenzymes (ALKP / Alkaline Phosphatase, Total and Isoenzymes, Serum) and urinary phosphoethanolamine (AAPD / Amino Acids, Quantitative, Random, Urine).

 

If PLP is 51 to 80 mcg/L or PLP is 81 to 100 mcg/L and PA is >30 mcg/L or PLP is >100 mcg/L and PA is >100 mcg/L:

-The elevated PLP is likely due to dietary supplementation.

Cautions
Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances

Reference ranges were established using healthy fasting volunteers who abstained from vitamin supplementation for 24 hours prior to specimen collection. Vitamin supplementation and nonfasting may result in elevated plasma vitamin concentrations.

Clinical Reference
Recommendations for in-depth reading of a clinical nature

1. Whyte MP, Zhang F, Wenkert D, et al. Hypophosphatasia: Vitamin B6 status of affected children and adults. Bone. 2022;154:116204. doi:10.1016/j.bone.2021.116204

2. Vitamin B6-Fact Sheet for Health Professionals. US Department of Health and Human Services, National Institutes of Health. Office of Dietary Supplements. Updated June 16, 2023. Accessed February 5, 2025. Available at: https://ods.od.nih.gov/factsheets/VitaminB6-HealthProfessional/

3. Sodi R, Taylor A. Vitamins and trace elements In: Rifai N, Horvath AR, Wittwer CT, eds. Tietz Fundamentals of Clinical Chemistry and Molecular Diagnostics. 8th ed. Elsevier; 2020:466-487

4. Morris MS, Picciano MF, Jacques PF, Selhub J. Plasma pyridoxal 5'-phosphate in the US population: the National Health and Nutrition Examination Survey, 2003-2004. Am J Clin Nutr. 2008;87(5):1446-1454. doi:10.1093/ajcn/87.5.1446

Method Description
Describes how the test is performed and provides a method-specific reference

The stable isotope pyridoxal 5-phosphate-d2 and/or pyridoxic acid-d2 is added to plasma as an internal standard. Meta-phosphoric acid solution is then added to precipitate the proteins. Following sedimentation of the proteins, an aliquot of the clarified supernatant fluid is subjected to separation of pyridoxal 5-phosphate, pyridoxic acid, and internal standards from other plasma components by reverse-phase high-performance liquid chromatography with quantitation by tandem mass spectrometry.(Maus A, Girtman A, Kiesling J, Faber J, Grebe SKG. Overcoming the chromatographic challenges when performing LC-MS/MS measurements of pyridoxal-5'-phosphate. J Chromatogr B Analyt Technol Biomed Life Sci. 2023;1217:123605. doi:10.1016/j.jchromb.2023.123605)

PDF Report
Indicates whether the report includes an additional document with charts, images or other enriched information

No

Day(s) Performed
Outlines the days the test is performed. This field reflects the day that the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time before the test is performed. Some tests are listed as continuously performed, which means that assays are performed multiple times during the day.

Monday through Thursday, Saturday, Sunday

Report Available
The interval of time (receipt of sample at Mayo Clinic Laboratories to results available) taking into account standard setup days and weekends. The first day is the time that it typically takes for a result to be available. The last day is the time it might take, accounting for any necessary repeated testing.

2 to 5 days

Specimen Retention Time
Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded

2 weeks

Performing Laboratory Location
Indicates the location of the laboratory that performs the test

Rochester

Fees
Several factors determine the fee charged to perform a test. Contact your U.S. or International Regional Manager for information about establishing a fee schedule or to learn more about resources to optimize test selection.

  • Authorized users can sign in to Test Prices for detailed fee information.
  • Clients without access to Test Prices can contact Customer Service 24 hours a day, seven days a week.
  • Prospective clients should contact their account representative. For assistance, contact Customer Service.

Test Classification
Provides information regarding the medical device classification for laboratory test kits and reagents. Tests may be classified as cleared or approved by the US Food and Drug Administration (FDA) and used per manufacturer instructions, or as products that do not undergo full FDA review and approval, and are then labeled as an Analyte Specific Reagent (ASR) product.

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
Provides guidance in determining the appropriate Current Procedural Terminology (CPT) code(s) information for each test or profile. The listed CPT codes reflect Mayo Clinic Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.

CPT codes are provided by the performing laboratory.

82542

84207

LOINC® Information
Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the order and results codes of this test. LOINC values are provided by the performing laboratory.

Test Id Test Order Name Order LOINC Value
B6PRO Vitamin B6 Profile (PLP and PA), P 95266-3
Result Id Test Result Name Result LOINC Value
Applies only to results expressed in units of measure originally reported by the performing laboratory. These values do not apply to results that are converted to other units of measure.
61065 Pyridoxic Acid (PA), P 1688-1
4047 Pyridoxal 5-Phosphate (PLP), P 30552-4

Test Setup Resources

Setup Files
Test setup information contains test file definition details to support order and result interfacing between Mayo Clinic Laboratories and your Laboratory Information System.

Excel | Pdf

Sample Reports
Normal and Abnormal sample reports are provided as references for report appearance.

Normal Reports | Abnormal Reports

SI Sample Reports
International System (SI) of Unit reports are provided for a limited number of tests. These reports are intended for international account use and are only available through MayoLINK accounts that have been defined to receive them.

SI Normal Reports | SI Abnormal Reports