If indirect immunofluorescence assay (IFA) patterns suggest collapsin response-mediator protein (CRMP)-5-IgG, then CRMP-5-IgG Western blot is performed at an additional charge.
If IFA patterns suggest amphiphysin antibody, then amphiphysin antibody and/or amphiphysin immunoblot is performed at an additional charge.
If IFA pattern suggests antineuronal nuclear antibodies (ANNA)-1 antibody, then ANNA-1 and ANNA-2 immunoblot is performed at an additional charge.
If IFA pattern suggests Purkinje cytoplasmic antibody (PCA)-1 antibody, then PCA-1 immunoblot is performed at an additional charge.
If IFA pattern suggests PCA-Tr antibody, then PCA-Tr immunoblot is performed at an additional charge.
If IFA pattern suggests PCA type 1or type trace, then the appropriate antibody specific IFA is performed at an additional charge.
If IFA pattern suggests N-methyl-D-aspartate (NMDA)-receptor, then NMDA-receptor cell-binding assay (CBA) and NMDA-receptor titer are performed at an additional charge.
If IFA pattern suggests alpha-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid (AMPA)-receptor, then AMPA-receptor CBA and AMPA-receptor titer are performed at an additional charge.
If IFA pattern suggests gamma-aminobutyric acid B (GABA-B)-receptor, then GABA-B-receptor CBA and GABA-B-receptor titer are performed at an additional charge.
If IFA pattern suggests dipeptidyl-peptidase-like protein-6 antibody (DPPX) antibody, then DPPX antibody CBA and DPPX titer are performed at an additional charge.
Investigating idiopathic dysautonomic symptoms
Directing a focused search for cancer in patients with idiopathic dysautonomia
Investigating autonomic symptoms that appear in the course or wake of cancer therapy and are not explainable by recurrent cancer or metastasis (detection of autoantibodies in this profile helps differentiate autoimmune dysautonomia from the effects of chemotherapy)
1. For optimal antibody detection, specimen collection is recommended before initiation of immunosuppressant medication or intravenous immunoglobulin treatment.
2. 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 1 week and assayed if sufficiently decayed, or canceled if radioactivity remains.
3. Patient should have no general anesthetic or muscle-relaxant medications in the previous 24 hours.
Provide the following information:
-Relevant clinical information
-Ordering provider name, phone number, mailing address, and e-mail address
Negative results do not exclude autoimmune dysautonomia or cancer.
Intravenous immunoglobulin (IVIg) treatment prior to the serum collection may cause a false-positive result.
*Neuron-restricted patterns of IgG staining that do not fulfill criteria for ANNA-1, CRMP-5-IgG, PCA-1, PCA-2, or PCA-Tr may be reported as "unclassified anti-neuronal IgG." Complex patterns that include nonneuronal elements may be reported as "uninterpretable."
Note: CRMP-5 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, cranial neuropathy, and myelopathy. Call 800-533-1710 to request CRMP-5 Western blot.
Antibodies directed at onconeural proteins shared by neurons, muscle, and glia are valuable serological markers of a patient's immune response to cancer. These autoantibodies are not found in healthy subjects and are usually accompanied by subacute neurological symptoms and signs. It is not uncommon for more than one autoantibody to be detected in patients with autoimmune dysautonomia. These include:
-Plasma membrane cation channel antibodies (neuronal ganglionic [alpha-3]). All of these autoantibodies are potential effectors of autonomic dysfunction.
-Antineuronal nuclear autoantibody-type 1
-Neuronal and muscle cytoplasmic antibodies (CRMP-5 IgG)
A rising autoantibody titer in previously seropositive patients suggests cancer recurrence.