Ordering Recommendation

Preferred reflexive panel for diagnosing myasthenia gravis. Includes acetylocholine receptor (AChR) binding and blocking antibodies with reflex to AChR modulating antibodies. 

Mnemonic
ACHR R PAN
Methodology

Quantitative Radioimmunoassay/Semi-Quantitative Flow Cytometry

Performed

Sun-Sat

Reported

3-7 days

New York DOH Approval Status
This test is New York DOH approved.
Specimen Required
Patient Preparation
Collect

Serum Separator Tube (SST).

Specimen Preparation

Separate from cells ASAP or within 2 hours of collection. Transfer 1 mL serum to an ARUP Standard Transport Tube. (Min: 0.5 mL)

Storage/Transport Temperature

Refrigerated.

Unacceptable Conditions

Contaminated, hemolyzed, or severely lipemic specimens.

Remarks
Stability

After separation from cells: Ambient: 48 hours; Refrigerated: 2 weeks; Frozen: 1 year (avoid repeated freeze/thaw cycles)

Reference Interval
Test Number
Components
Reference Interval
0080009 Acetylcholine Receptor Binding Antibody
Negative 0.0-0.4 nmol/L
Positive 0.5 nmol/L or greater

0099580 Acetylcholine Receptor Blocking Antibody Effective November 18, 2013
Negative: 0-26% blocking
Indeterminate: 27-41% blocking
Positive: 42% or greater blocking

0099521 Acetylcholine Receptor Modulating Antibody Effective August 20, 2012
Negative 0-45% modulating
Positive 46% or greater modulating

Interpretive Data

Approximately 85-90 percent of patients with myasthenia gravis (MG) express antibodies to the acetylcholine receptor (AChR), which can be divided into binding, blocking, and modulating antibodies. Binding antibody can activate complement and lead to loss of AChR. Blocking antibody may impair binding of acetylcholine to the receptor, leading to poor muscle contraction. Modulating antibody causes receptor endocytosis resulting in loss of AChR expression, which correlates most closely with clinical severity of disease. Approximately 10-15 percent of individuals with confirmed myasthenia gravis have no measurable binding, blocking, or modulating antibodies.

Compliance Statement B: For laboratory developed tests not using a RUO kit, and for FDA approved, cleared or 510(k) exempt assays with alterations. This test was developed and its performance characteristics determined by ARUP Laboratories. The U. S. Food and Drug Administration has not approved or cleared this test; however, FDA clearance or approval is not currently required for clinical use. The results are not intended to be used as the sole means for clinical diagnosis or patient management decisions.

Note

If Acetylcholine Receptor Binding Antibody result is greater than 0.4 nmol/L or Acetylcholine Receptor Blocking Antibody result is greater than 26 percent, then Acetylcholine Receptor Modulating Antibody (ARUP test code 0099521) will be added. Additional charges apply.

Hotline History
N/A
CPT Codes

83519; 83516; if reflexed, add 83516

Components
Component Test Code* Component Chart Name LOINC
0080009 Acetylcholine Binding Antibody 11034-6
0099580 Acetylcholine Blocking Antibody 42937-3
* Component test codes cannot be used to order tests. The information provided here is not sufficient for interface builds; for a complete test mix, please click the sidebar link to access the Interface Map.
Aliases
  • AChR Antibody
  • AChR reflex panel
  • Muscle nicotinic Acetylcholine Receptor (AChR) Binding Antibody
  • Myasthenia Gravis Antibodies
  • Myasthenia Gravis Antibodies Reflex
Acetylcholine Receptor Antibody Reflexive Panel