Ordering Recommendation

Useful for initial evaluation of inflammatory CNS demyelinating disease, including neuromyelitis optica spectrum disorder (NMOSD) and NMOSD-like disorders, or autoimmune encephalitis.

Mnemonic
CNS PAN
Methodology

Semi-Quantitative Indirect Fluorescent Antibody

Performed

Mon, Wed, Fri

Reported

1-6 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: 0.3 mL)

Storage/Transport Temperature

Refrigerated.

Unacceptable Conditions

Hemolyzed, contaminated, or severely lipemic specimens.

Remarks
Stability

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

Reference Interval
Test Number Components Reference Interval
2013320 Aquaporin-4 Receptor Antibody, IgG by IFA with Reflex to Titer, Serum Less than 1:10
3001277 Myelin Oligodendrocyte Glycoprotein (MOG) Antibody, IgG by IFA with Reflex to Titer, Serum Less than 1:10

Interpretive Data

Refer to report.

Compliance Category

Laboratory Developed Test (LDT)

Note

If Aquaporin-4 Receptor Antibody, IgG by IFA with Reflex to Titer, Serum is positive, then an Aquaporin-4 Receptor Antibody, IgG by IFA, Serum Titer will be added.  If Myelin Oligodendrocyte Glycoprotein (MOG) Antibody, IgG by IFA with Reflex to Titer, Serum is positive, then a Myelin Oligodendrocyte Glycoprotein (MOG) Antibody Titer, IgG will be added. Additional charges apply.

Hotline History
N/A
CPT Codes

86255 x2; if reflexed, add 86256

Components
Component Test Code* Component Chart Name LOINC
2013322 Neuromyelitis Optica/AQP4-IgG, Serum 63439-4
3001278 MOG Antibody IgG Screen, Serum 91545-4
* 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
Autoimmune CNS Demyelinating Disease Reflexive Panel