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Test Category: Immunology

Investigation Name:Paraneoplastic Antibodies Immunoblot

Alias or Abbreviation:Paraneoplastic blot, Neuronal

Intro:

Indication: Paraneoplastic neurological antibodies are associated with paraneoplastic neurological syndrome and systemic malignancies Further information: Antibodies tested: Yo (PCA-1), Hu (ANNA1), Ri (ANNA2), GAD65, CV2/CRMP5, Amphiphysin, SOX1, Tr (DNER), Zic4, Recoverin, Ma2/Ta, Titin. Paraneoplastic disorders are characterised by the presence of neuronal autoantibodies in patient serum. Tumours that have been known to initiate paraneoplastic disorders include small cell lung carcinoma (SCLC), thymoma, neuroblastoma, and breast, ovarian, and testicular cancers. The following autoantibodies can be found in paraneoplastic syndromes: Anti-Hu: Type I anti-neuronal nuclear antibody (ANNA-1) is associated with SCLC, resulting in paraneoplastic encephalomyelitis Anti-Ri: Type II anti-neuronal nuclear antibody (ANNA-2) is associated with neuroblastoma (children) and fallopian or breast cancer (adults), resulting in paraneoplastic opsoclonus myoclonus ataxia (POMA) Anti-Yo: Anti-Purkinje cell antibody is associated with gynaecological tumours and breast cancer, resulting in PCD Anti-Tr: Anti-purkinje cell antibody is associated with Hodgkin's disease, resulting in cerebellar degeneration Anti-Ta (Ma2): Anti-neuronal antibody is associated with testicular tumours, and can lead to limbic or brain stem encephalomyelitis Amphiphysin: Associated with tumours of the breast or SCLC leading to opsoclonus, ataxia RMP/CV2: Associated with various tumours, including thymoma, leading to variety of clinical presentations Zic4: Autoantibodies to Zic4 are associated with paraneoplastic cerebellar degeneration and the underlying tumour is often a small cell lung cancer SOX1: In up to 50 percent of patients with Lambert-Eaton myasthenic syndrome (LEMS) - if cancer is detected, almost always a small cell lung cancer (SCLC). In 43 percent of patients with LEMS and SCLC the detectable antibodies are directed to SOX1 Titin: Autoantibodies to Titin can be seen in patients with Myasthenia Gravis and can be associated with the presence of thymoma Recoverin: Autoantibodies to Recoverin have been associated with cancer-associated retinopathy (CAR), a paraneoplastic blinding disease.

Requestable Seperately?No

Minimum Sample Volume:0.25mL

Expected Turnaround Time:Frequency: Daily Target: 10 days

Test Code:PARB

Sample Type:

Serum Gel Tube (Gold top)/ Plasma

Complex Reference Range:Positive/ Negative

Collection Conditions / Other Information:1st class post or Transport

Referred to Another Laboratory?No

Storage Requirements:Ambient temperature

NPEX / PDF Reporting Available:Yes

EQA Scheme:Yes

Further information:Reflexed if paraneoplastic antibody screen is positive

Lead Contact Details:rwh-tr.bcpsimmunologyclinicalqueries@nhs.net

Email Address For Chasing Results:rwh-tr.ImmunologyLab@nhs.net

Methodology:Immunoblot

UKAS Reference Number:9580 (recommended)

Site Sample Tested:Immunology, New Cross Hospital, Wolverhampton