Test Code DYS2 Dysautonomia, Autoimmune/Paraneoplastic Evaluation, Serum
Ordering Guidance
Multiple neurological phenotype-specific autoimmune/paraneoplastic evaluations are available. For more information as well as phenotype-specific testing options, refer to Autoimmune Neurology Test Ordering Guide.
When more than one evaluation is ordered on the same order number, the duplicate test will be canceled.
For a list of antibodies performed with each evaluation, see Autoimmune Neurology Antibody Matrix.
This test should not be requested for 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.
Necessary Information
Provide the following information:
-Relevant clinical information
-Ordering provider name, phone number, mailing address, and e-mail address
Specimen Required
Patient Preparation: For optimal antibody detection, specimen collection is recommended before initiation of immunosuppressant medication or intravenous immunoglobulin treatment.
Supplies: Sarstedt Aliquot Tube, 5 mL (T914)
Collection Container/Tube:
Preferred: Red top
Acceptable: Serum gel
Submission Container/Tube: Plastic vial
Specimen Volume: 4 mL
Collection Instructions: Centrifuge and aliquot serum into a plastic vial.
Forms
If not ordering electronically, complete, print, and send a Neurology Specialty Testing Client Test Request (T732) with the specimen.
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)
Profile Information
Test ID | Reporting Name | Available Separately | Always Performed |
---|---|---|---|
ADEI | Dysautonomia, Interpretation, S | No | Yes |
GANG | AChR Ganglionic Neuronal Ab, S | No | Yes |
ANN1S | Anti-Neuronal Nuclear Ab, Type 1 | No | Yes |
APBIS | AP3B2 IFA, S | No | Yes |
CRMS | CRMP-5-IgG, S | No | Yes |
CS2CS | CASPR2-IgG CBA, S | No | Yes |
DPPCS | DPPX Ab CBA, S | No | Yes |
LG1CS | LGI1-IgG CBA, S | No | Yes |
PCAB2 | Purkinje Cell Cytoplasmic Ab Type 2 | No | Yes |
Testing Algorithm
If the indirect immunofluorescence assay (IFA) patterns suggest collapsin response-mediator protein (CRMP)-5-IgG, then the CRMP-5-IgG IFA titer and CRMP-5-IgG Western blot will be performed at an additional charge.
If the IFA pattern suggests antineuronal nuclear antibody type 1 (ANNA-1), then the ANNA-1 immunoblot, ANNA-1 IFA titer, and ANNA-2 immunoblot will be performed at an additional charge.
If the IFA pattern suggests adaptor protein 3 beta 2 (AP3B2) antibody, then the AP3B2 cell-binding assay (CBA) and AP3B2 IFA titer will be performed at an additional charge.
If the dipeptidyl-peptidase-like protein-6 antibody (DPPX) antibody CBA result is positive, then DPPX IFA titer will be performed at an additional charge.
If the IFA pattern suggests Purkinje cytoplasmic antibody type 2 (PCA-2), then the PCA-2 titer is performed at an additional charge.
For more information see Autoimmune/Paraneoplastic Dysautonomia Evaluation Algorithm.
Method Name
ANN1S, AN1TS, APBIS, APBTS, DPPTS, PCAB2, PC2TS, CRMS, CRMTS: Indirect Immunofluorescence Assay (IFA)
APBCS, CS2CS, DPPCS, LG1CS: Cell Binding Assay (CBA)
CRMWS: Western Blot (WB)
AN1BS, AN2BS: Immunoblot (IB)
GANG: Radioimmunoassay (RIA)
ADEI: Medical Interpretation
Reporting Name
Dysautonomia, Autoimm/Paraneo, SSpecimen Type
SerumSpecimen Minimum Volume
2.5 mL
Specimen Stability Information
Specimen Type | Temperature | Time | Special Container |
---|---|---|---|
Serum | Refrigerated (preferred) | 28 days | |
Frozen | 28 days | ||
Ambient | 72 hours |
Reference Values
Test ID |
Reporting name |
Methodology* |
Reference value |
ADEI |
Dysautonomia, Interpretation, S |
Medical interpretation |
Interpretive report |
GANG |
AChR Ganglionic Neuronal Ab, S |
RIA |
≤0.02 nmol/L |
ANN1S |
Anti-Neuronal Nuclear Ab, Type 1 |
IFA |
Negative |
APBIS |
AP3B2 IFA, S |
IFA |
Negative |
CS2CS |
CASPR2-IgG CBA, S |
CBA |
Negative |
CRMS |
CRMP-5-IgG, S |
IFA |
Negative |
DPPCS |
DPPX Ab CBA, S |
CBA |
Negative |
LG1CS |
LGI1-IgG CBA, S |
CBA |
Negative |
PCAB2 |
Purkinje Cell Cytoplasmic Ab Type 2 |
IFA |
Negative |
Reflex Information:
Test ID |
Reporting name |
Methodology* |
Reference value |
AN1BS |
ANNA-1 Immunoblot, S |
IB |
Negative |
AN1TS |
ANNA-1 Titer, S |
IFA |
<1:240 |
AN2BS |
ANNA-2 Immunoblot, S |
IB |
Negative |
APBCS |
AP3B2 CBA, S |
CBA |
Negative |
APBTS |
AP3B2 IFA Titer, S |
IFA |
<1:240 |
CRMTS |
CRMP-5-IgG Titer, S |
IFA |
<1:240 |
CRMWS |
CRMP-5-IgG Western Blot, S |
WB |
Negative |
DPPTS |
DPPX Ab IFA Titer, S |
IFA |
<1:240 |
PC2TS |
PCA-2 Titer, S |
IFA |
<1:240 |
*Methodology abbreviations:
Immunofluorescence assay (IFA)
Cell-binding assay (CBA)
Western blot (WB)
Radioimmunoassay (RIA)
Immunoblot (IB)
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."
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.
Day(s) Performed
Report Available
8 to 12 daysPerforming Laboratory
Mayo Clinic Laboratories in RochesterTest Classification
This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. It has not been cleared or approved by the US Food and Drug Administration.CPT Code Information
83519
86255 x 7
84182 AN1BS (if appropriate)
86256 AN1TS (if appropriate)
84182 AN2BS (if appropriate)
86255 APBCS (if appropriate)
86256 APBTS (if appropriate)
86256 CRMTS (if appropriate)
84182 CRMWS (if appropriate)
86256 DPPTS (if appropriate)
86256 PC2TS (if appropriate)
LOINC Code Information
Test ID | Test Order Name | Order LOINC Value |
---|---|---|
DYS2 | Dysautonomia, Autoimm/Paraneo, S | 99000-2 |
Result ID | Test Result Name | Result LOINC Value |
---|---|---|
80150 | ANNA-1, S | 33615-6 |
83077 | CRMP-5-IgG, S | 72504-4 |
84321 | AChR Ganglionic Neuronal Ab, S | 94694-7 |
83138 | PCA-2, S | 84925-7 |
34270 | Dysautonomia, Interpretation, S | 69048-7 |
64279 | LGI1-IgG CBA, S | 94287-0 |
64281 | CASPR2-IgG CBA, S | 94285-4 |
64933 | DPPX Ab CBA, S | 94676-4 |
615863 | AP3B2 IFA, S | 101907-4 |
618892 | IFA Notes | 48767-8 |