Myelopathy, Autoimmune/Paraneoplastic Evaluation, Serum
Test Mnemonic
MLPTHY
CPT Codes
- 86341 - QTY (1)
- 84182 - QTY (1)
- 86255 - QTY (16)
- 86053 - QTY (1)
- 86363 - QTY (1)
Includes
- Amphiphysin Ab, S
- AGNA-1, S
- ANNA-1, S
- ANNA-2, S
- ANNA-3, S
- AP3B2 IFA, S
- CRMP-5-IgG Western Blot, S
- DPPX Ab CBA, S
- GABA-B-R Ab CBA, S
- GAD65 Ab Assay, S
- GFAP IFA, S
- mGluR1 Ab IFA, S
- MOG FACS, S
- Neurochondrin IFA, S
- NIF IFA, S
- NMO/AQP4 FACS, S
- PCA-1, S
- PCA-2, S
- Septin-7 IFA, S
- TRIM46 Ab IFA, S
Performing Laboratory
Mayo Clinic Dpt of Lab Med & Pathology
Specimen Requirements
| Volume | Type | Container | Collect Temperature | Transport Temperature | Special Instructions |
|---|---|---|---|---|---|
| 4 mL | Serum | No additive (Red) | Refrigerated | Draw 2 tubes to ensure adequate serum volume. 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). Centrifuge and transfer serum to standard aliquot tube. |
Alternate Specimen Requirements
| Volume | Type | Container | Collect Temperature | Transport Temperature | Special Instructions |
|---|---|---|---|---|---|
| 4 mL | Serum | SST (Gold) | Refrigerated | Draw 2 tubes to ensure adequate serum volume. 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). Centrifuge and transfer serum to standard aliquot tube. |
Minimum Specimen Requirements
| Volume | Type | Container | Collect Temperature | Transport Temperature | Special Instructions |
|---|---|---|---|---|---|
| 2 mL |
Stability
| Environmental Condition | Description |
|---|---|
| Refrigerated | 28 days |
| Frozen | 28 days |
| Ambient | 72 hours |
Days Performed
Sun - Sat
Turnaround Time
9 - 13 days
Methodology
| Name | Description |
|---|---|
| Cell Binding Assay (CBA) | |
| Flow Cytometry (FC) | |
| Immunoblot (IB) | |
| Indirect Immunofluorescence Assay (IFA) | |
| Radioimmunoassay (RIA) | |
| Western Blot (WB) |
Reference Range
| CRMP-5 Western Blot | |||||
|---|---|---|---|---|---|
| Sex | Age From | Age To | Type | Range | Range Unit |
| Negative | |||||
| GAD65 Antibody | |||||
| Sex | Age From | Age To | Type | Range | Range Unit |
| < or = 0.02 nmol/L | |||||
| GFAP IFA S | |||||
| Sex | Age From | Age To | Type | Range | Range Unit |
| Negative | |||||
| mGluR1 Ab IFA, S | |||||
| Sex | Age From | Age To | Type | Range | Range Unit |
| Negative | |||||
| NMO Aquaporin 4 IgG | |||||
| 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 antiglial nuclear antibody (AGNA)-1, then the AGNA-1 immunoblot and AGNA-1 IFA titer will be performed. If the IFA patterns suggest amphiphysin antibody, then the amphiphysin immunoblot and amphiphysin IFA titer will be performed. If the IFA pattern suggests antineuronal nuclear antibody type 1 (ANNA-1), then the ANNA-1 IFA titer, ANNA-1 immunoblot, and ANNA-2 immunoblot will be performed. If the IFA pattern suggests ANNA-2 antibodies, then the ANNA-2 IFA titer, ANNA-2 immunoblot, and ANNA-1 immunoblot will be performed. If the client requests or the IFA pattern suggests ANNA-3 antibodies, then the ANNA-3 IFA titer will be performed. If the IFA pattern suggests adaptor protein 3 beta 2 (AP3B2) antibodies, then the AP3B2 cell-binding assay (CBA) and AP3B2 IFA titer will be performed. If the CRMP-5-IgG Western blot is positive, then the CRMP-5-IgG IFA titer will be performed. If the IFA pattern suggests Purkinje cytoplasmic antibody type 1 (PCA-1), then the PCA-1 immunoblot and PCA-1 IFA titer will be performed. If the IFA pattern suggests PCA-2 antibody, then the PCA-2 IFA titer will be performed. If gamma-aminobutyric acid B (GABA-B) receptor antibody CBA result is positive, then the GABA-B-receptor antibody IFA titer will be performed. If the dipeptidyl-peptidase-like protein-6 (DPPX) antibody CBA result is positive, then the DPPX antibody IFA titer will be performed. If the IFA pattern suggests metabotropic glutamate receptor 1 (mGluR1) antibody, then the mGluR1antibody CBA and mGluR1 antibody IFA titer will be performed. If the IFA pattern suggests glial fibrillary acidic protein (GFAP) antibody, then the GFAP antibody CBA and GFAP antibody IFA titer will be performed. If the neuromyelitis optica/aquaporin-4-IgG (NMO/AQP4-IgG) fluorescence-activated cell sorting (FACS) screen assay requires further investigation, then the NMO/AQP4-IgG FACS titration assay will be performed. If the myelin oligodendrocyte glycoprotein (MOG) FACS screen assay requires further investigation, then the MOG FACS titration assay will be performed. If the IFA pattern suggests neuronal intermediate filament (NIF) antibody, then the alpha internexin CBA, NIF heavy chain CBA, NIF light chain CBA, and NIF antibody IFA titer will be performed. If the IFA pattern suggests neurochondrin antibody, then the neurochondrin antibody CBA and neurochondrin IFA titer will be performed. If the IFA pattern suggests septin-7 antibody, then the septin-7 CBA and septin-7 IFA titer will be performed. If the IFA pattern suggests tripartite motif-containing protein 46 (TRIM46) antibody, then the TRIM46 antibody CBA and TRIM46 IFA titer will be performed. This test should not be requested for 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. Grossly hemolyzed, lipemic or icteric specimens will be rejected. This test is New York state approved.
Clinical Info
This test is useful for evaluating patients with suspected autoimmune myelopathy, myelitis, and paraneoplastic myelopathy. Patients with autoimmune myelopathy present with subacute onset and rapid progression of spinal cord symptoms with one or more of the following: weakness, gait difficulties, loss of sensation, neuropathic pain, and bowel and bladder dysfunction. Clinical history and examination, spinal cord magnetic resonance imaging, and cerebrospinal fluid (CSF) testing may provide clues to an autoimmune diagnosis. Autoimmune myelopathy evaluation of both serum and CSF can assist in the diagnosis (paraneoplastic or idiopathic autoimmune) and aid distinction from other causes of myelopathy (multiple sclerosis, sarcoidosis, vascular disease). Early testing may assist in early diagnosis of occult cancer, prompt initiation of immune therapies, or both.