Paraneoplastic Autoantibody Evaluation Cascade, Serum


Abbrev Code:PNPLTP   
Order Code:LAB3686Order Name:Paraneoplastic Autoantibody Evaluation Cascade, Serum
Synonyms:Neuronal Antibody; Calcium Channel Binding Antibody
Methodology:Indirect immunofluorescence, enzyme immunoassay, radioimmunoassay, Western blot, cell binding assay, Live-cell assay.
See PAVAL Additional Information
CPT Codes: 83519 x1, 86596 x1, 86255 x9, 84182 x7, 86255 x2, 86256 x9
Test Includes:See PAVAL Additional Information
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.
Compliance:

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

Specimen:Blood
Optimal Volume:8 mL
Minimum\Peds Volume:4.2 mL
Container:Red (gel)
Alternate Containers: Red (no gel)
Patient Preparation:
  1. Specimen collection is recommended prior to initiation of immunosuppressant medication.
  2. For optimal antibody detection, specimen collection is recommended prior to initiation of immunosuppressant medication or intravenous immunoglobulin (IVIg) treatment.
  3. 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.  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.
  4. 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


Interpretive

Reference Range:See PAVAL Additional Information
Limitations:
  • Negative results do not exclude cancer.
  • Intravenous immunoglobulin (IVIg) treatment prior to the serum collection may cause a false positive result.
  • This evaluation does not include Ma2 autoantibody (alias MaTa). Ma2 autoantibody has been described in patients with brainstem and limbic encephalitis in the context of testicular germ cell neoplasms. Scrotal ultrasound is advisable in men who present with unexplained subacute encephalitis. N-methyl-D-asparate receptor antibodies have been reported in women with paraneoplastic encephalitis related to ovarian teratoma.
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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