Effective today, July 23, 2012, the University of Iowa Hospitals and Clinics will offer mailout testing for some individual components of the paraneoplastic autoantibody panel.  The PARANEOPLASTIC AUTOANTIBODY EVALUATION [LAB3800] for serum contains 15 separate tests and generates reflex testing if some initial tests are positive.  This panel has slow turnaround time (up to several weeks) and can generate charges exceeding $2,000.  Analysis of test ordering patterns over the last 3 years revealed that in many cases clinicians only wanted individual tests within this panel to work-up specific syndromes, but until recently the testing was only offered as a complete panel by reference laboratories without ability to be more selective.

The following individual components are now available as mailout tests:

EPIC TEST	EPIC #	ASSOCIATED CLINICAL SYNDROME
NMDA RECEPTOR ANTIBODIES, SERUM	LAB7734	Severe encephalopathy with psychiatric symptoms; autoimmune limbic encephalitis
NMDA RECEPTOR ANTIBODIES, CSF	LAB7731
VOLTAGE-GATED CALCIUM CHANNEL AB	LAB7732	Lambert-Eaton Syndrome
VOLTAGE-GATED POTASSIUM CHANNEL AB	LAB7733	Neuromyotonia (Isaac’s syndrome), Morvan syndrome

Specimen requirements (serum tests): NMDA RECEPTOR ANTIBODIES, SERUM VOLTAGE-GATED CALCIUM CHANNEL AB VOLTAGE-GATED POTASSIUM CHANNEL AB	4.5 mL red top (no additive) 4.5 mL red top (no additive) 4.5 mL red top (no additive)
Specimen requirements (CSF tests): NMDA RECEPTOR ANTIBODIES, CSF	Minimum 1.0 mL CSF

For all four tests, deliver to laboratory as soon as possible after collection.

The availability of these tests should offer more targeted laboratory workup with improved turnaround time over the full paraneoplastic autoantibody panel.  This appears to be particularly important for the anti-NMDA receptor syndromes, which may be more responsive to treatment with immunosuppressant therapy if diagnosed early and for which antibody titers may assist with assessment of therapeutic response.

Questions should be directed to Matthew Krasowski, MD, PhD, medical director of the Clinical Chemistry Laboratory (384-9380, matthew-krasowski@uiowa.edu).