Test ID: PNEFS
Neuroimmunology Antibody Follow-up, Serum
Secondary ID 
A test code used for billing and in test definitions created prior to November 2011
NY State Approved Indicates the status of NY State approval and if the test is orderable for NY State clients.
Useful For Suggests clinical disorders or settings where the test may be helpful
Monitoring patients who have previously tested positive for 1 or more antibodies in a Neuroimmunology Laboratory evaluation
Method Name A short description of the method used to perform the test
This follow-up evaluation is used to monitor patients who tested positive for 1 or more antibodies in the Neuroimmunology Laboratory in the past 15 months.
Reporting Name A shorter/abbreviated version of the Published Name for a test; an abbreviated test name
Specimen Type Describes the specimen type needed for testing
Specimen Required Defines the optimal specimen. This field describes the type of specimen required to perform the test and the preferred volume to complete testing. The volume allows automated processing, fastest throughput and, when indicated, repeat or reflex testing.
Container/Tube:
Preferred: Red top
Acceptable: Serum gel
Specimen Volume: 4 mL
Specimen Minimum Volume Defines the amount of specimen required to perform an assay once, including instrument and container dead space. Submitting the minimum specimen volume makes it impossible to repeat the test or perform confirmatory or perform reflex testing. In some situations, a minimum specimen volume may result in a QNS (quantity not sufficient) result, requiring a second specimen to be collected.
Reject Due To Identifies specimen types and conditions that may cause the specimen to be rejected
| Hemolysis | Mild OK; Gross reject |
| Lipemia | Mild OK; Gross reject |
| Icterus | Mild OK; Gross reject |
| Other | NA |
Specimen Stability Information Provides a description of the temperatures required to transport a specimen to the laboratory. Alternate acceptable temperature(s) are also included.
| Specimen Type | Temperature | Time |
|---|---|---|
| Serum | Refrigerated (preferred) | 14 days |
| Ambient | 72 hours | |
| Frozen | ||
Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
Paraneoplastic autoimmune neurological disorders reflect a patient's humoral and cellular immune responses to cancer. The cancer may be new or recurrent, is usually limited in metastatic volume, and is often occult by standard imaging procedures. Autoantibodies specific for onconeural proteins found in the plasma membrane, cytoplasm, and nucleus of neurons or muscle are generated in this immune response and serve as serological markers of paraneoplastic autoimmunity. The most commonly recognized cancers in this context are small-cell lung carcinoma (SCLC), thymoma, ovarian (or related mullerian) carcinoma, breast carcinoma, and Hodgkin's lymphoma. Pertinent childhood neoplasms recognized thus far include neuroblastoma, thymoma, Hodgkin's lymphoma, and chondroblastoma. An individual patient's autoantibody profile can predict a specific neoplasm with 90% certainty, but not the neurological syndrome.
Four classes of autoantibodies are recognized:
-Neuronal nuclear (antineuronal nuclear antibody-type 1 [ANNA-1], ANNA-2, ANNA-3)
-Neuronal and muscle cytoplasmic (Purkinje Cell Cytoplasmic Antibody, Type 1 [PCA-1], PCA-2, PCA-Tr, CRMP-5, amphiphysin, and striational)
-Glial nuclear (anti-glial nuclear antibody)
-Plasma membrane cation channel Antibodies (neuronal P/Q-type and N-type calcium channel and muscle acetylcholine receptor autoantibodies). These autoantibodies are potential effectors of neurological dysfunction.
Seropositive patients usually present with subacute neurological symptoms and signs. The patient may present with encephalopathy, cerebellar ataxia, myelopathy, radiculopathy, plexopathy, sensory, sensorimotor, or autonomic neuropathy, with or without coexisting evidence of a neuromuscular transmission disorder: Lambert-Eaton syndrome (LES), myasthenia gravis, or neuromuscular hyperexcitability. Initial signs may be subtle, but a subacute multifocal and progressive syndrome usually evolves. Sensorimotor neuropathy and cerebellar ataxia are common presentations, but the clinical picture in some patients is dominated by striking gastrointestinal dysmotility, limbic encephalopathy, basal ganglionitis, or cranial neuropathy (especially loss of vision, hearing, smell, or taste). Cancer risk factors include past or family history of cancer, history of smoking or social/environmental exposure to carcinogens. Early diagnosis and treatment of the neoplasm favor less neurological morbidity and offer the best hope for survival.
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.
NEURONAL NUCLEAR ANTIBODIES
Antineuronal Nuclear Antibody-Type 1 (ANNA-1)
<1:240
Antineuronal Nuclear Antibody-Type 2 (ANNA-2)
<1:240
Antineuronal Nuclear Antibody-Type 3 (ANNA-3)
<1:240
NEURONAL AND MUSCLE CYTOPLASMIC ANTIBODIES
Purkinje Cell Cytoplasmic Antibody, Type 1 (PCA-1)
<1:240
Purkinje Cell Cytoplasmic Antibody, Type 2 (PCA-2)
<1:240
Purkinje Cell Cytoplasmic Antibody, Type Tr (PCA-Tr)
<1:240
Amphiphysin Antibody
<1:240
CRMP-5-IgG
<1:240
Striational (Striated Muscle) Antibodies
<1:60
Paraneoplastic Autoantibody Western Blot Confirmation
Negative
CRMP-5-IgG Western Blot
Negative
CATION CHANNEL ANTIBODIES
N-Type Calcium Channel Antibody
< or =0.03 nmol/L
P/Q-Type Calcium Channel Antibody
< or =0.02 nmol/L
ACh Receptor (Muscle) Binding Antibody
< or =0.02 nmol/L
AChR Ganglionic Neuronal Antibody
< or =0.02 nmol/L
ACh Receptor (Muscle) Modulating Antibodies
0-20% (reported as __% loss of AChR)
GAD65 ANTIBODY ASSAY
< or =0.02 nmol/L
Neuron-restricted patterns of IgG staining that do not fulfill criteria for amphiphysin, ANNA-1, ANNA-2, ANNA-3, PCA-1, PCA-2, PCA-Tr, or CRMP-5-IgG may be reported as "unclassified antineuronal IgG." Complex patterns that include non-neuronal elements may be reported as "uninterpretable."
Note: Titers lower than 1:240 are detectable by recombinant CRMP-5 Western blot analysis. CRMP-5 Western blot analysis will be done on request on stored serum (held 4 weeks). This supplemental testing is recommended in cases of chorea, vision loss, and cranial neuropathy and myelopathy. Call the Neuroimmunology Laboratory at 800-533-1710 or 507-266-5700 to request CRMP-5 Western blot.
Interpretation Provides information to assist in interpretation of the test results
Antibodies directed at onconeural proteins shared by neurons, muscle, and certain cancers are valuable serological markers of a patient's immune response to cancer. They are not found in healthy subjects and are usually accompanied by subacute neurological symptoms and signs. Several autoantibodies have a syndromic association, but no known autoantibody predicts a specific neurological syndrome. Conversely, a positive autoantibody profile has 80% to 90% predictive value for a specific cancer. It is not uncommon for more than 1 paraneoplastic autoantibody to be detected, each predictive of the same cancer.
Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
This test should only be utilized when the presence of paraneoplastic autoantibodies has been previously documented.
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 one week and assayed if sufficiently decayed, or canceled if radioactivity remains.
Method Description Describes how the test is performed and provides a method-specific reference
Varies based on target autoantibody.
Day(s) and Time(s) Test Performed Outlines the days and times the test is performed. This field reflects the day and time the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time required before the test is performed. Some tests are listed as continuously performed, which means assays are performed several times during the day.
ANNA-1: Monday through Friday; 11:30 a.m.
ANNA-2: Monday through Friday; 11:30 a.m.
ANNA-3: Monday through Friday; 11:30 a.m.
PCA-1: Monday through Friday; 11:30 a.m.
PCA-2: Monday through Friday; 11:30 a.m.
PCA-Tr: Monday through Friday; 11:30 a.m.
Amphiphysin: Monday through Friday; 11:30 a.m.
CRMP-5-IgG: Monday through Friday; 11:30 a.m.
Striational (striated muscle) antibodies: Monday through Friday
P/Q-type calcium channel antibody; Monday through Thursday, Sunday; 2 p.m.
N-type calcium channel antibody; Monday through Thursday, Sunday; 2 p.m.
ACh receptor (muscle) binding antibody: Monday through Friday, Sunday; 2 p.m.
AChR ganglionic neuronal antibody: Monday through Thursday, Sunday; 2 p.m.
Paraneoplastic autoantibody Western blot confirmation: Monday through Friday; 8 a.m
CRMP-5-IgG Western blot: Monday through Friday; 8 a.m.
ACh receptor (muscle) modulating antibodies: Monday through Thursday; 11 a.m.
GAD65: Monday through Friday; 6 a.m.
Analytic Time Defines the amount of time it takes the laboratory to setup and perform the test. This is defined in number of days. The shortest interval of time expressed is "same day/1 day," which means the results may be available the same day that the sample is received in the testing laboratory. One day means results are available 1 day after the sample is received in the laboratory.
Maximum Laboratory Time Defines the maximum time from specimen receipt at Mayo Medical Laboratories until the release of the test result
Specimen Retention Time Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded
Performing Laboratory Location The location of the laboratory that performs the test
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 Medical Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.
83519-59-ACh receptor (muscle) binding antibody (if appropriate)
83519-59-ACh receptor (muscle) modulating antibodies (if appropriate)
83519-59-AChR ganglionic neuronal antibody (if appropriate)
83519-59-N-type calcium channel antibody (if appropriate)
83519-59-P/Q-type calcium channel antibody (if appropriate)
83520-Striational (striated muscle) antibodies (if appropriate)
84182-CRMP-5-IgG Western blot (if appropriate)
84182-Paraneoplastic autoantibody Western blot confirmation (if appropriate)
86256-Amphiphysin (if appropriate)
86256-ANNA-1 (if appropriate)
86256-ANNA-2 (if appropriate)
86256-ANNA-3 (if appropriate)
86256-CRMP-5-IgG (if appropriate)
86256-PCA-1 (if appropriate)
86256-PCA-2 (if appropriate)
86256-PCA-Tr (if appropriate)
86341-GAD65 antibody assay (if appropriate)
LOINC® Code Information Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the result codes returned for this test or profile.
| Result ID | Reporting Name | LOINC Code |
|---|---|---|
| 84300 | Neuroimmunology Ab Follow-up, S | In Process |
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