Specimen

Serum

Collection Medium:

Minimum:

Adult minimum: 12 mls whole blood in two 6 ml red top tubes to yield
  (min: 4.0 mL serum)

Pediatric minimum: 6 mls whole blood in one red top tube to yield
  (min: 2.0 mL serum)

Analytic Time:

2 weeks

Reference Range:

NEURONAL NUCLEAR ANTIBODIES
Antineuronal Nuclear Antibody-Type 1 (ANNA-1)
   Negative at <1:240
Antineuronal Nuclear Antibody-Type 2 (ANNA-2)
   Negative at <1:240
Antineuronal Nuclear Antibody-Type 3 (ANNA-3)
   Negative at <1:240

NEURONAL AND MUSCLE CYTOPLASMIC ANTIBODIES
Purkinje Cell Cytoplasmic Antibody, Type 1 (PCA-1)
   Negative at <1:240
Purkinje Cell Cytoplasmic Antibody, Type 2 (PCA-2)
   Negative at <1:240
Purkinje Cell Cytoplasmic Antibody, Type Tr  (PCA-Tr)
   Negartive at <1:240
Amphiphysin Antibody
   Negative at <1:240
CRMP-5-IgG
  Negative at <1:240

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, cranial neuropathy, and 
myelopathy. Call the Clinical Pathology Core Laboratory at 356-3527 to 
request CRMP-5 Western blot.

Striational (Striated Muscle) Antibodies
   Negative at <1:60

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

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."

VGKC-Antibody:  Neuronal voltage-gated potassium channel
   Less than or equal to 0.02 nmol/L

Comments:

If IFA are indeterminate, paraneoplastic autoantibody Western blot
is performed.  If requested or if IFA suggests CRMP-5-IgG, CRMP-5-IgG 
Western blot is performed.  If calcium channel P/Q-Type or N-Type is 
>20, paraneoplastic auto-antibody Western blot and CRMP-5-IgG Western 
blot are performed.  If IFA suggests GAD65 antibody, GAD65 antibody 
radioimmuno-preciptation assay is performed.  If ACh receptor binding 
antibody is >0.02 or if striational antibodies is >= 1:60, ACh receptor 
modulating antibodies, paraneoplastic autoantibody Western blot, and 
CRMP-5-IgG Western blot are performed.  If ACh receptor modulating 
antibodies antibody is >= 40% loss, ACh receptor blocking antibodies 
radioimmunoassay is performed.

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.

Methodology:

Indirect Immunofluorescence (IFA)
Enzyme Immunoassay (EIA)
Radioimmunoassay (RIA)
Western Blot

CPT Code:

83519  modifier 59  ACh Receptor (muscle) binding antibody
83519  modifier 59  AChR Ganglionic neuronal antibody
83519  modifier 59  N-type Calcium channel antibody
83519  modifier 59  P/Q-type Calcium channel antibody
83520  Striational (striated muscle) antibodies
86256  AGNA
86256  Amphiphysin
86256  ANNA-1
86256  ANNA-2
86256  ANNA-3
86256  CRMP-5-IgG
86256  PCA-1
86256  PCA-2
86256  PCA-Tr
83519  modifier 59  ACh receptor (muscle) blocking antibodies (if
       appropriate)
83519  modifier 59  ACh receptor (muscle) modulating antibodies (if
       appropriate)
84182  CRMP-5-IgG Western blot (if appropriate)
84182  Paraneoplastic autoantibody Western blot confirmation (if
       appropriate)
86341  GAD65 antibody assay (if appropriate)
83519  VGKC-Antibody

See also:
Paraneoplastic Autoantibody Evaluation, CSF