Dysautonomia, Autoimmune/Paraneoplastic Evaluation, Serum (Sendout)

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General Information

Lab Name
Lab Code
996
External Test Id
DYS2
Description

Useful For:

  • 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)

Refer to Autoimmune Encephalitis Testing Recommendations for additional ordering guidance.

Test Algorithm: Refer to Mayo's algorithm (linked below) for additional detail on tests and potential reflex tests included in this panel. Reflex testing may be performed at additional charge.

Patient Preparation:

  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.
Synonyms
AChR Ganglionic Neuronal Antibody, ANNA-1, Anti-CV2, Anti-Enteric Neuronal Antibody, Anti-Hu, Anti-Neuronal Nuclear Antibody Type 1, Antineuronal, AP3B2 IFA, Cantoxin (Receptor Antibodies), CASPR2 IgG CBA, Cerebellar Antibodies, Chorea, Collapsin Response-Mediator Protein-5 Antibody (CRMP-5), Cramp-fasciculation, CRMP-5 IgG, Dipeptidyl aminopeptidase-like protein 6, Dorsal Root Ganglion Antibody, DPPX Ab CBA, DYS2, Dysautonomia Autoimmune Paraneoplastic Evaluation, Hu Antibody, Isaacs disease, LGI1 IgG CBA, Motor End-Plate Antibody, Motor Nerve Terminal Antibodies, Myoid Antibody, Neuromuscular hyperexcitability, Neuromyotonia, Neuronal ganglionic acetylcholine receptor antibody, Neuronal Nuclear Antibody Panel, Neuronal Potassium Channel Ab, Neuronal-Anti, Paraneoplastic Neurological Autoimmunity, PCA-2, Purkinje Cell Cytoplasmic Antibody Type 2, Stiff-man Syndrome

Interpretation

Method

Panel tests and reflex tests use the following methods: Indirect Immunofluorescence Assay (IFA), Cell Binding Assay (CBA), Western blot (WB), Radioimmunoassay (RIA), Immunoblot (IB)

Ref. Range Notes

Reference Values:

AChR Ganglionic Neuronal Antibody: < or =0.02 nmol/L
Anti-Neuronal Nuclear Antibody, Type 1 (ANNA-1): Negative
Adaptor Protein 3 Beta2 (AP3B2) Antibody IFA: Negative
Contactin-Associated Protein-Like-2 (CASPR2) IgG Antibody CBA: Negative
Collapsin Response-Mediator Protein-5 (CRMP-5) IgG: Negative
Dipeptidyl Aminopeptidase-Like Protein 6 (DPPX) Antibody CBA: Negative
Leucine-Rich Glioma Inactivated Protein-1 IgG (LGI1) Antibody CBA: Negative
Purkinje Cell Cytoplasmic Antibody Type 2 (PCA-2): Negative

Note: Includes reference values for panel tests only.

Neuron-restricted patterns of IgG staining that do not fulfill criteria for ANNA-1, CRMP-5-IgG, or PCA-2 may be reported as "unclassified anti-neuronal IgG." Complex patterns that include nonneuronal elements may be reported as "uninterpretable."

CRMP-5 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.

Guidelines

Ordering & Collection

Specimen Type
Blood
Collection

Collect 12 mL blood in RED TOP tubes or GOLD TOP SST

Handling Instructions

Outside Laboratories: Centrifuge samples and transfer serum to a separate plastic vial. Refrigerate serum.

Stability: Refrigerated (preferred): 28 days; Frozen: 28 days; Ambient: 72 hours.

Reject Due To: Gross hemolysis, lipemia, or icterus.

Quantity
requested: 4 mL serum
minimum: 2.5 mL serum

Processing

Processing

Centrifuge samples and transfer serum to a separate plastic vial. Refrigerate serum.

Login: SEND1-;REFRIG

  • RSNDT1: MAYO
  • RSTYP1: SRM
  • RTSRQ1: ;Dysautonomia, Autoimmune/Paraneoplastic Evaluation, Serum (Mayo Test DYS2)

Sendouts:

  • Order Mayo Test: DYS2.

Stability: Refrigerated (preferred): 28 days; Frozen: 28 days; Ambient: 72 hours.

Reject Due To: Gross hemolysis, lipemia, or icterus.

Performance

LIS Dept Code
Performing Location(s)
Sendout Mayo Clinic Laboratories
800-533-1710

200 First Street Southwest
Rochester, MN 55901
Frequency
Performed: Varies. Report Available: 7-10 days from sample receipt at the performing laboratory.
Available STAT?
No

Billing & Coding

CPT codes
Billing Comments

CPTs: 83519, 86255x7

  • Note: Includes panel tests only. Reflex testing may be added at additional charge.
LOINC