Paraneoplastic Autoantibody Evaluation, Serum

Sunquest Code:PNPLTP  
Epic Code:LAB3686Epic Name:Paraneoplastic Antibody
Synonyms:Neuronal Antibody; Calcium Channel Binding Antibody
Methodology:Indirect immunofluorescence, enzyme immunoassay, radioimmunoassay, Western blot; cell-binding assay, Live-cell assay
Test Includes:Antineuronal nuclear aby, Type 1,2 and 3; ; Purkinje cell cytoplasmic aby Type 1,2 and Tr; Amphiphysin Aby, S; CRMP-5-IgG; Striational (Striated Muscle) Aby, S; Calcium channel binding aby, P/Q. Anti-Glial Nuclear Ab, Type 1; AChR Ganglionic Neuronal Ab, S; Neuronal (V-G) K+ Channel Ab, S.
The following tests are reflexed and charged separately as indicated: Paraneoplas Autoantibody Western Blot; CRMP-5-IgG Western Blot; GAD65 Ab Assay S; Ach Receptor (muscle) modulating aby; Amphiphysin Western Blot, S;  CBA, S; NMDA-R Ab CBA, S; R Ab CBA, S; GABA-B-R Ab CBA, S; NMDA-R Ab IF Titer Assay, S; AMPA-R Ab IF Titer Assay, S; GABA-B-R Ab IF Titer Assay, S; ; Ach Receptor (muscle) binding aby; CASPR2-IgG CBA, S; mGluR1 Ab CBA, S; mGluR1 Ab IFA, S; mGluR1 Ab IFA Titer, S. See Associated Link for testing algorithm.

Due to reagent shortage component STR: Striational (Striated Muscle) Antibodies, Serum, is unable to be performed upon arrival at Mayo Clinic Laboratories. All evaluations will be finalized without the STR component and there is no recommended alternative.
Turnaround Time:Specimens are sent to reference laboratory Mon-Fri; results are reported in 10-17 days.
Special Instructions:Include relevant clinical information, name, phone number, mailing address of ordering physician. 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.

This test was developed and its performance characteristics determined by Laboratory Medicine and Pathology, Mayo Clinic. This test has not been cleared by the U.S. Food and Drug Administration.

Associated Links:

Paraneoplastic Evaluation Algorithm

Collection Instructions

Optimal Volume:8 mL
Minimum\Peds Volume:4.2 mL
Container:Red (no gel)
Patient Preparation:
  1. Specimen collection is recommended prior to initiation of immunosuppressant medication.
  2. This test should not be requested in patients who have recently received radioisotopes 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.
  3. Patient should have no general anesthetic or muscle-relaxant drugs in the previous 24 hours.
Causes for Rejection:Grossly hemolyzed, lipemic or icteric specimen.

Processing and Shipping

Specimen Processing:Centrifuge and aliquot 4 mL, 2 mL minimum. Store in refrigerator.
Shipping Instructions:Ship at refrigerated temperature.
Stability:72 hours at room temperature; 28 days refrigerated (preferred) or frozen.
Test Performed at or Referral Lab Lab Sendouts  (Mayo)
Referral Lab number:PAVAL


Reference Range:
Antineuronal Nuclear Antibody Type 1 (ANNA-1) Negative at less than 1:240
Antineuronal Nuclear Antibody Type 2 (ANNA-2) Negative at less than 1:240
Antineuronal Nuclear Antibody Type 3 (ANNA-3) Negative at less than 1:240
Amti-Glial/Neuronal Nuclear Antibody A Type 1 (AGNA-1) Negative at less than 1:240
Purkinje Cell Cytoplasmic Antibody, Type 1 (PCA-1) Negative at less than 1:240
Purkinje Cell Cytoplasmic Antibody, Type 1 (PCA-2) Negative at less than 1:240
Purkinje Cell Cytoplasmic Antibody  Type Tr (PCA-Tr) Negative at less than 1:240
Amphiphysin Antibody Negative at less than 1:240
CRMP-5-IgG Negative at less than 1:240
Neuronal (V-G) + Channel Ab, S 0.02 nmol/L or less
Calcium Channel Antibody, N-Type 0.03 nmol/L or less
Calcium Channel Antibody, P/Q-Type 0.02 nmol/L or less
AChR Ganglionic Neural Antibody 0.02 nmol/L or less
Striational (Striated  Muscle) Ab, S 1:120 or less
Neuronal-restricted patterns of IgG staining that do not fulfill criteria for amphiphysin, ANNA-1, ANNA-2, 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".
Use:Serological evaluation of patients who present with a subacute neurological disorder of undetermined etiology, especially those with known risk factors for cancer. Directing a focused search for cancer. Investigating neurological symptoms that appear in the course of, or after, cancer therapy, and are not explainable by metastasis. Differentiating autoimmune neuropathies from neurotoxic effects or chemotherapy. Monitoring the immune response of seropositive patients in the course of cancer therapy. Detecting early evidence of cancer recurrence in previously seropositive patients.

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