Paraneoplastic Antibody Expanded Evaluation with Reflex to Titer and LB, CSF

Initial panel consists of: Neurology Ab Screen Tissue IFA, AMPAR1, AMPAR2, Aquaporin4, DPPX, GABABR, NMDAR1, CASPR2, LGI1, and VGKC.

If Paraneoplastic Expanded Ab Screen, Tissue IFA suggests one or more positive analytes, a line blot consisting of 10 analytes will be performed: ANNAI (Hu), ANNA2 (Ri), PCAI (Yo), Ma2/Ta, CRMP5(CV2), Amphiphysin, AGNAI (SOXI), GAD65, PCA Tr (DNER), and Zic4.

If the Paraneoplastic Expanded Ab Screen, Tissue IFA suggests ANNA3, then titer will be performed (CPT code 86256).
If the Paraneoplastic Expanded Ab Screen, Tissue IFA suggests PCA-2, then titer will be performed (CPT code 86256).

If the Paraneoplastic Expanded Ab Screen, Tissue IFA suggests PCA-Tr (DNER) and Neurology Antibody Line Blot shows PCA Tr (DNER) negative and PCAI (Yo) negative, then Purkinje Cell Cytoplasmic Antibody Type Tr (DNER), CBA, IFA will be performed at an additional charge (CPT code(s): 86255).
If Purkinje Cell Cytoplasmic Antibody Type Tr (DNER), CBA is positive, then titer will be performed.

If the Paraneoplastic Expanded Ab Screen, Tissue IFA for Myelin suggests myelin antibody, then Myelin antibody IFA titer will be performed at an additional charge (CPT code(s): 86256).

If the Neurology Antibody, CBA is positive for NMDARI, AMPAR2, LGI-I, or CASPR2, then those analytes will be titered at an additional charge (CPT code(s): 86256 for each titer performed, 86052 for AQP4 Titer).

If the Aquaporin 4(AQP4)Ab, CBA is positive, then titer will be performed at an additional charge (CPT code(s): 86052).

If the Neurology Antibody, CBA is positive for AMPARI or GABA-B Receptor, then titers will be performed.

If the DPPX Receptor Antibody, CBA is positive, then titer will be performed.

Detection of antineuronal autoantibodies aids the diagnosis of autoimmune paraneoplastic syndromes, encephalopathies, and other autoimmune neurological conditions. Identification of specific antineuronal autoantibodies may also help in the diagnostic workup for occult malignancies. Finally, knowledge of the specific identity of antineuronal autoantibodies aids greatly in making therapeutic decisions for patients. Antineuronal antibodies are detected and identified by Indirect Immunofluorescence, using multiple neuronal tissues, non-neuronal tissues, and transfected substrate cells, as well as Radioimmunoassays. Line Blot assays are used for confirmatory reflex testing.