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 Statement D: For laboratory tests using a manufactured RUO kit. 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 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