Tissue Transglutaminase IgG

Label Mnemonic:	TTGG
Epic code:	LAB8014
Downtime form:	Doctor/Provider Orders - Pathology Core and Specialty Care Nursery

Chemistry
6240 RCP
356-3527

Specimen(s):

Plasma

Collection Medium:

Plasma Separator Tube 4.5 mL

Minimum:

Adult - 3 mL plasma separator tube
Pediatric - two Microtainer^® devices

Testing Schedule:

24 hrs/day, 7 days a week, including holidays.

Turn Around Time:

3 hours (upon receipt in laboratory)

Reference Range:

Negative: <15 U/mL
Positive: 15 U/mL or greater

This testing is only available as reflex to tissue transglutaminase (TTG) IgA if total IgA is too low for TTG IgA measurement or in selected protocols and order sets for pediatric orders in children less than 2 years old.

Comments:

Celiac disease or gluten-sensitive enteropathy is an immune-
mediated disorder that primarily affects the gastrointestinal tract 
and is characterized by chronic inflammation of the small intestine 
mucosa, which may result in atrophy of intestinal villi, malabsorption 
and a variety of clinical manifestations. It is caused by a 
pathological intolerance to gliadin, the alcohol-soluble fraction of 
gluten in wheat, rye and barley. Celiac disease manifests at any age 
with a peak onset in early childhood. Recent studies now suggest that 
its prevalence is in the range of 0.5 to 1.0% of the U.S. population 
with certain populations having an increased prevalence of celiac 
disease. Celiac disease is also associated with selective IgA 
deficiency and autoimmune disorders.  The US incidence rate is 1:130, 
which is similar to European countries.

Diagnosis of celiac disease is based on a combination of clinical 
symptoms and the following factors:
   IgA and/or IgG antibodies to tissue transglutaminase (TTG)
   IgA and/or IgG antibodies to deamidated gliadin
   Endomysial IgA and/or IgG antibodies
   Human leukocyte antigen (HLA)-DQ2 or DQ8 genotypes
   Biopsy of the small intestine (demonstrating flat mucosa)
   Or a patient's satisfactory response to a gluten-free diet (GFD).

IgA deficiency is more common in the celiac disease (2-3%) versus the 
average population (0.1-0.2%). Therefore, it is recommended that IgG 
antibodies to TTG be determined if there is total IgA deficiency.  
Current guidelines also indicate that TTG IgG ordering may be useful in 
children less than 2 years old.  Except for children less than 2 years 
old, TTG IgG generally has lower sensitivity and specificity than TTG 
IgA in patients without total IgA deficiency.

References:
1. The National Institutes of Health (NIH) Consensus Development
   Conference on Celiac Disease, NIH Consensus Development Conference
   Statement, June 28-30, 2004. 
2. van der Windt, et al. Diagnostic Testing for Celiac Disease Among
   Patients with Abdominal Symptoms: a Systematic Review. JAMA May
   2010, 303(17);1738-46. 
3. G. Holmes, C. Catassi, A. Fasano. Fast Facts: Celiac Disease. 2nd
   Edition; August 2009, 57-63. 
4. Rashtak S., Ettore M., Homberger H., Murray J. Comparative
   Usefulness of Deamidated Gliadin Antibodies in the Diagnosis of
   Celiac Disease. Clin Gastroenterol Hepatol April 2008, 6(4); 426-
   32. 
5. Green, P.H., Jones. R. Celiac Disease: A Hidden Epidemic. 2006,
   45-48. 
6. Van Meensel B, Hiele M, Hoffman I, et al. 2004. Diagnostic accuracy
   of ten second-generation (human) tissue transglutaminase antibody
   assays in celiac disease. Clin Chem. 50: 2125-35.

Methodology:

Multiplex flow immunoassay

CPT Code:

83520