Laboratory Test Guide

Axonal Neuropathy, Autoimmune/Paraneoplastic Evaluation, Serum (Sendout)

General Information

Lab Name

Lab Code

1088

External Test Id

AIAES

Description

Useful For:

Evaluation of patients who present with a subacute neurological disorder of undetermined etiology, especially those with known risk factors for cancer
Directing a focused search for cancer
Investigating neurological symptoms that appear during, or after, cancer therapy, and are not explainable by metastasis
Differentiating autoimmune neuropathies from neurotoxic effects of chemotherapy
Detecting early evidence of cancer recurrence in previously seropositive patients

Refer to Autoimmune Encephalitis Testing Recommendations for additional ordering guidance.

Testing Algorithm: Reflex testing may be performed at additional charge. Refer to Mayo's algorithm below.

Mayo Autoimmune/Paraneoplastic Axonal Neuropathy Evaluation Algorithm

Patient Preparation:

For optimal antibody detection, specimen collection is recommended prior to initiation of immunosuppressant medication or intravenous immunoglobulin (IVIg) treatment.
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.

Ordering Requirements: Laboratory Medicine Resident (LMR) approval is required.

Synonyms

Adaptor Protein 3Beta2 Antibody, AGNA-1, AIAES, Amphiphysin Antibody, ANNA-1, ANNA-3, Anti-Glial Nuclear Ab Type 1, Anti-Neuronal Nuclear Antibody Type 1, Anti-Neuronal Nuclear Antibody Type 3, AP3B2 IFA, Autoimmune Neuropathy, Autoimmune Paraneoplastic Evaluation, Autonomic neuropathy, Axonal Neuropathy, CASPR2 IgG CBA, Collapsin Response-Mediator Protein-5 IgG Western Blot, Contactin-Associated Protein-Like-2 IgG, CRMP-5 IgG Western Blot, GFAP IFA, Glial Fibrillary Acidic Protein Antibody, IgLON Family Member 5 Antibody, IgLON5, Leucine-Rich Glioma Inactivated Protein-1 IgG, LGI1 IgG CBA, Neuronal Intermediate Filament Antibody, Neuropathy, NIF IFA, PCA-1, PCA-2, Peripheral Neuropathy, Polyradiculopathy, Purkinje Cell Cytoplasmic Antibody Type 1, Purkinje Cell Cytoplasmic Antibody Type 2, Sensory Ganglionopathy, Small fiber neuropathy

Interpretation

Method

Panel and reflex tests include the following methods: Immunofluorescence assay (IFA), Cell-binding assay (CBA), Western blot (WB), Immunoblot (IB)

Ref. Range Notes

Reference Values:

Anti-Glial Nuclear Antibody Type 1 (AGNA-1):	Negative
Amphiphysin Antibody:	Negative
Anti-Neuronal Nuclear Antibody Type 1 (ANNA-1):	Negative
Anti-Neuronal Nuclear Antibody Type 3 (ANNA-3):	Negative
Adaptor Protein 3 Beta2 (AP3B2) Antibody IFA:	Negative
Collapsin Response-Mediator Protein-5 (CRMP-5) IgG Western Blot:	Negative
Contactin-Associated Protein-Like-2 (CASPR2) IgG Antibody CBA:	Negative
IgLON Family Member 5 Antibody (IgLON5) CBA:	Negative
Leucine-Rich Glioma Inactivated Protein-1 (LGI1) IgG Antibody CBA:	Negative
Neuronal Intermediate Filament (NIF) Antibody IFA:	Negative
Purkinje Cell Cytoplasmic Antibody Type 2 (PCA-2):	Negative
Purkinje Cell Cytoplasmic Antibody Type 1 (PCA-1):	Negative
Glial Fibrillary Acidic Protein (GFAP) Antibody IFA:	Negative

Note: Includes reference values for panel tests only.

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

Interpretation: Antibodies directed at onconeural proteins shared by neurons, glia, muscle, and certain cancers are valuable serological markers of a patient's immune response to cancer. They are not found in healthy subjects and are usually accompanied by subacute neurological signs and symptoms. Several autoantibodies have a syndromic association, but no autoantibody predicts a specific neurological syndrome. More than one paraneoplastic autoantibody may be detected and associated with specific cancers.

Interferences and Limitations

Cautions:

Negative results do not exclude the possibility of a cancer diagnosis.

Intravenous immunoglobulin treatment prior to the serum collection may cause a false-positive result.

Guidelines

Autoimmune Encephalitis Testing Recommendations

Ordering & Collection

Specimen Type

Blood

Collection

12 mL blood in RED TOP tubes or GOLD SSTs

Approval Required

Laboratory Medicine Resident (LMR) approval is required.

Handling Instructions

Outside Laboratories: Centrifuge sample 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: 3 mL serum

Processing

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

Login: SEND1-;REFRIG

RSNDT1: MAYO
RSTYP1: SRM
RTSRQ1: ;Axonal Neuropathy, Autoimmune Paraneoplastic Evaluation, Serum (Mayo Test AIAES)

Sendouts:

Order Mayo Test: AIAES.