Autoimmune Dysautonomia Evaluation, Serum




Test Mnemonic

AIDYSA

CPT Codes

  • 83519 - QTY (1)
  • 86255 - QTY (7)

Includes

  • AP3B2 IFA, S
  • DPPX Ab CBA, S
  • AChR Ganglionic Neuronal Ab
  • ANNA-1
  • Dysautonomia, Interpretation
  • CASPR2-IgG CBA,
  • CRMP-5-IgG
  • LGI1-IgG CBA
  • Purkinje Cell Cytoplasmic Ab Type 2

Performing Laboratory

Mayo Clinic Dpt of Lab Med & Pathology


Specimen Requirements

Volume Type Container Collect Temperature Transport Temperature Special Instructions
4 mLSerumNo additive (Red) RefrigeratedDraw 2 tubes to ensure adequate serum volume. Patient should have no general anesthetic or muscle-relaxant medications in the previous 24 hours. Specimen collection is recommended before initiation of immunosuppressant medication. This test should not be requested in patients who have recently received radioisotopes (refer to Special Information).

Alternate Specimen Requirements

Volume Type Container Collect Temperature Transport Temperature Special Instructions
4 mLSerumSST (Gold) RefrigeratedDraw 2 tubes to ensure adequate serum volume. Patient should have no general anesthetic or muscle-relaxant medications in the previous 24 hours. Specimen collection is recommended before initiation of immunosuppressant medication. This test should not be requested in patients who have recently received radioisotopes (refer to Special Information).

Minimum Specimen Requirements

Volume Type Container Collect Temperature Transport Temperature Special Instructions
2.5 mL    Serum

Stability

Environmental Condition Description
Refrigerated28 days (preferred)
Frozen28 days
Ambient72 hours

Days Performed

Mon - Sun

Turnaround Time

8 - 11 days

Methodology

Name Description
Cell Binding Assay (CBA) 
Radioimmunoassay (RIA) 
Immunofluorescence 

Reference Range

AChR Ganglionic Neuronal Ab
Sex Age From Age To Type Range Range Unit
       < or = 0.02 nmol/L 
CASPR2-IgG CBA Serum
Sex Age From Age To Type Range Range Unit
       Negative 
LGI1-IgG CBA Serum
Sex Age From Age To Type Range Range Unit
       Negative 

Special Info

Reflex Algorithm: Each reflex test performed incurs additional charge. If the indirect immunofluorescence assay (IFA) patterns suggest collapsin response-mediator protein (CRMP)-5-IgG, then CRMP-5-IgG IFA titer and CRMP-5-IgG Western blot will be performed. If the IFA pattern suggests antineuronal nuclear antibody type 1 (ANNA-1), then ANNA-1 immunoblot, ANNA-1 IFA titer, and ANNA-2 immunoblot will be performed. If the IFA pattern suggests adaptor protein 3 beta 2 (AP3B2) antibody, then AP3B2 cell-binding assay (CBA) and AP3B2 IFA titer will be performed at an additional charge. If DPPX antibody CBA is positive, then DPPX IFA titer will be performed. If the IFA pattern suggests Purkinje cytoplasmic antibody type 2 (PCA-2), then PCA-2 titer is performed. Neuron-restricted patterns of IgG staining that do not fulfill criteria for ANNA-1, CRMP-5-IgG, or PCA-2 may be reported as "unclassified anti-neuronal IgG." Complex patterns that include nonneuronal elements may be reported as "uninterpretable." Include ordering provider name, number, address, and email. Include relevant clinical information. Patient Prep: For optimal antibody detection, collection of specimen before initiation of immunosuppressant medication is recommended. This test should not be requested in patients who have recently received radioisotopes, therapeutically or diagnostically, because of potential assay interference. The specific waiting period before specimen collection will depend on the isotope administered, the dose given, and the clearance rate in the individual patient. Specimens will be screened for radioactivity prior to analysis. Radioactive specimens received in the laboratory will be held 1 week and assayed if sufficiently decayed, or canceled if radioactivity remains. Patient should have no general anesthetic or muscle-relaxant medications in the previous 24 hours. Grossly hemolyzed, grossly lipemic, or grossly icteric specimens will be rejected.

Clinical Info

Investigation of idiopathic dysautonomic symptoms. In patients with idiopathic dysautonomia, directing a focused search for cancer. Investigation of autonomic symptoms that appear in the course or wake of cancer therapy and are not explainable by recurrent cancer or metastasis; detection of autoantibodies in this profile helps differentiate autoimmune dysautonomia from the effects of chemotherapy. Caution: Negative results do not exclude autoimmune dysautonomia or cancer. Note: CRMP-5 titers < 1:240 are detectable by recombinant CRMP-5 Western blot analysis, which can be done upon request on stored serum (held 4 weeks). This supplemental testing is recommended in cases of chorea, vision loss, cranial neuropathy, and myelopathy.