Yale New Haven Hospital

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Paraneoplastic autoAb evaluation, CSF

Lab Section: 

Sendout Reference

 

Lab Location: 

Sendout

Reference Lab: 

Mayo

 

Test ID: 

LAB6683

Synonyms: Anti Hu, PCA-1,Cellebellar AB.

 

Methodology: 

Indirect Immunofluorescence Assay (IFA), Western Blot, Radioimmunoassay, Cell-Binding Assay (CBA)

Schedule: 

Monday Friday

Reported: 

1 week, 5 days

Specimen Requirements: 

Collection: 4.0 mL Cerebrospinal Fluid in a CSF Tube.
Pediatric volume: 2 mL.
Unacceptable conditions: Grossly hemolyzed, lipemic, and/or icteric samples are not acceptable for testing.
Stability: Ambient: 72 hours; Refrigerated (preferred): 28 days; Frozen: 28 days

 

Notes: 

Reflex Criteria: If indirect immunofluorescence assay (IFA) is indeterminate, paraneoplastic autoantibody Western blot is performed at an additional charge. If IFA pattern is suggestive of neuromyelitis optica (NMO), then NMO-IgG is performed at an additional charge. If client requests or if IFA patterns suggest CRMP-5-IgG, CRMP-5-IgG Western blot is performed at an additional charge. If IFA patterns suggest GAD65 antibody, GAD65 antibody radioimmunoprecipitation assay is performed at an additional charge. If IFA patterns suggest amphiphysin antibody, amphiphysin Western blot is performed at an additional charge.

Clinical Indications: An aid in the diagnosis of paraneoplastic neurological autoimmune disorders related to carcinoma of lung, breast, ovary, thymoma, or Hodgkin's lymphoma. Serum is the preferred specimen for paraneoplastic autoantibodies. However, cerebrospinal fluid (CSF) results are sometimes positive when serum results are negative (especially for CRMP-5 and other inflammatory central nervous system autoimmunity). Additionally, CSF is more readily interpretable because it generally lacks the interfering nonorgan-specific antibodies that are common in serum of patients with cancer. Because neurologists typically perform spinal taps in these patients, we recommend that CSF be submitted with serum, either for simultaneous testing or to be held for testing only if serum is negative. CRMP-5-IgG Western blot is also performed by specific request for more sensitive detection of CRMP-5-IgG. Testing should be requested in cases of subacute basal ganglionic disorders (chorea, Parkinsonism), cranial neuropathies (especially loss of vision, taste, or smell), and myelopathies. Several antineuronal and glial autoantibodies are recognized clinically as markers of a patient's immune response to specific cancers (paraneoplastic autoantibodies). Seropositive patients present with neurologic symptoms and signs in >90% of cases. The cancers are most commonly small-cell lung carcinoma (SCLC), ovarian (or related mullerian) carcinoma, breast carcinoma, thymoma, or Hodgkin's lymphoma. The cancers may be new or recurrent, are usually limited in metastatic volume, and are often occult by standard imaging procedures. Detection of the informative marker autoantibodies allows early diagnosis and treatment of the cancer, which may lessen neurological morbidity and improve survival.

Reference Interval: 

See patient report or consult reference laboratory website.

http://www.mayomedicallaboratories.com/test-catalog/Overview/37430

CPT Code(s): 

86256x9, additional charges apply for reflexed tests 84182, 86255, 86341,83519

Last Changed: 

8/28/2017 3:21:25

Last Reviewed: 

8/28/2017 3:21:31