Medical Necessity Documentation:
Client Notes:
For optimal antibody detection, we recommend blood drawing the specimen before initiation of immunosuppressant medication.
Patient Preparation:
Specimen Requirements:
3.0 mL Serum from a Red Top Tube in a Plastic Vial
Collection Instructions:
Transport & Storage: Temperature/Stability:
72 hours Ambient
28 days Refrigerated
28 days Frozen
Rejection Criteria:
Gross hemolysis • gross lipemia • gross icterus
Reference Range:
MOG FACS, S- negative (reference values apply to all ages); NMO/AQP4 FACS, S- negative (reference values apply to all ages).
Critical Ranges:
Test Comments:
When the results of this assay require further evaluation of myelin oligodendrocyte glycoprotein (MOG-IgG1), the MOG-IgG1 titer will be performed at an additional charge. When the results of this assay require further evaluation of neuromyelitis optica (NMO)/Aquaporin-4-IgG, the neuromyeltis optica (NMO)/aquaporin-4-IgG titer will be performed at an additional charge.
Methodology:
Flow Cytometry
Clinical Significance:
Documentation:
Custom Panel:
No
PRODUCTION SCHEDULE
Turn Around Time:
7 to 10 days
Days Performed:
Monday, Tuesday, Thursday
Sites Performed:
Mayo Laboratory
PHL Test Code:
CDS1
EPIC Test Code:
IMO5737
Send Out Test Code:
CDS1
Alternate Test Names:
Aquaporin; Devic's Antibody; Neruomyelitis Optica (NMO); Optic Neuritis Antibody; Transverse Myelitis Antibody; Vision Loss Antibody
Included Tests:
CNS Demyelinating Disease Interp; Myelin Oligodendrocyte Glycoprotein; Neuromyelitis Optica/Aquaporin-4-IgG
Reflex: Myelin Oligodendrocyte Glycoprotein (MOG-IgG1) Fluorescence-Activated Cell Sorting (FACS) Assay; Neuromyelitis Optica (NMO)/Aquaporin-4-IgG Fluorescence-Activated Cell Sorting (FACS) Assay
CPT Coding:
86053, 86363, 86053-titer (if appropriate), 86363-titer (if appropriate)