Medical Necessity Documentation:
Client Notes:
Patient Preparation:
Specimen Requirements:
1.0 mL Serum from a SST Gold Top Tube
Collection Instructions:
Mix by inverting tube 5 times.
Separate from cells ASAP or within 2 hours of collection
Transport & Storage: Temperature/Stability:
After separation of cells
72 hours Ambient
2 weeks Refrigerated
1 month Frozen
Rejection Criteria:
repeated freeze/thaw cycles; Amniotic fluid, CSF, pericardial fluid, ocular fluid, peritoneal fluid, synovial fluid, or plasma. Contaminated, hemolyzed, icteric, or lipemic
Reference Range:
Refer to Interpretive Results
Critical Ranges:
Test Comments:
Reflexive Testing:
If AQP4 antibody IgG by ELISA is positive, then AQP4 antibody IgG by IFA will be added. If AQP4 antibody IgG by IFA is positive, then an AQP4 antibody IgG titer will be added. Additional charges apply.
Aquaporin-4 Receptor Antibody, IgG by IFA with Reflex to Titer, Serum
REFLEX: Neuromyelitis Optica/AQP4-IgG Titer, Serum
Methodology:
ELISA / IFA
Clinical Significance:
Approximately 75 percent of patients with neuromyelitis optica (NMO) express antibodies to the aquaporin-4 (AQP4) receptor. Diagnosis of NMO requires the presence of longitudinally extensive acute myelitis (lesions extending over 3 or more vertebral segments) and optic neuritis. While absence of antibodies to the AQP4 receptor does not rule out the diagnosis of NMO, presence of this antibody is diagnostic for NMO.
Documentation:
For evaluation of optic neuritis, acute myelitis, spinal cord lesions, or autoimmune encephalitis
Custom Panel:
No
PRODUCTION SCHEDULE
Turn Around Time:
2 to 7 days
Days Performed:
Tuesday, Thursday
Sites Performed:
ARUP Lab
PHL Test Code:
MSOT
EPIC Test Code:
MISC
Send Out Test Code:
2013327
Alternate Test Names:
AQP4; Devic's Ab; Neuromyelitis Optica (NMO); Neuromyelitis Optica (NMO) Antibody; Optic Neuritix Ab; Optic-Spincal MS Ab; Transverse Myelitis Ab; Vision Loss Ab
Included Tests:
CPT Coding:
86051