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Test Code PVLE Paraneoplastic Vision Loss Evaluation, Serum

Reporting Name

Paraneoplastic Vision Loss Eval, S

Performing Laboratory

Mayo Clinic Laboratories in Rochester

Useful For

Evaluating patients with rapidly progressive vision loss where a paraneoplastic cause for vision loss (retinopathy or optic neuritis with other findings [eg, retinitis] is suspected)

 

Evaluating patients with small-cell carcinoma who develop vision loss

Method Name

PVLEI: Medical Interpretation

CRMTS, CRMS: Indirect Immunofluorescence Assay (IFA)

CRMWS: Western Blot (WB)

RCVBS: Immunoblot (IB)


Ordering Guidance


Multiple neurological phenotype-specific autoimmune/paraneoplastic evaluations are available. For more information as well as phenotype-specific testing options, refer to Autoimmune Neurology Test Ordering Guide.

 

For a list of antibodies performed with each evaluation, see Autoimmune Neurology Antibody Matrix.



Necessary Information


Provide the following information:

-Relevant clinical information

-Ordering provider name, phone number, mailing address, and e-mail address



Specimen Required


Patient Preparation:

1. For optimal antibody detection, specimen collection is recommended prior to initiation of immunosuppressant medication.

2. This test should not be requested for patients who have recently received radioisotopes, therapeutically or diagnostically, because of potential assay interference. The specific waiting period before specimen collection will depend on the isotope administered, the dose given, and the clearance rate in the individual patient. Specimens will be screened for radioactivity prior to analysis. Radioactive specimens received in the laboratory will be held 1 week and assayed if sufficiently decayed or canceled if radioactivity remains.

Supplies: Sarstedt Aliquot Tube, 5 mL (T914)

Collection Container/Tube:

Preferred: Red top

Acceptable: Serum gel

Submission Container/Tube: Plastic vial

Specimen Volume: 4 mL

Collection Instructions: Centrifuge and aliquot serum into a plastic vial.


Specimen Type

Serum

Specimen Minimum Volume

2 mL

Specimen Stability Information

Specimen Type Temperature Time Special Container
Serum Refrigerated (preferred) 28 days
  Frozen  28 days
  Ambient  72 hours

Reject Due To

Gross hemolysis Reject
Gross lipemia Reject
Gross icterus Reject

Reference Values

COLLAPSIN RESPONSE-MEDIATOR PROTEIN-5-IgGNegative

 

RECOVERIN IMMUNOBLOT

Negative

 

COLLAPSIN RESPONSE-MEDIATOR PROTEIN-5 TITER

<1:240

 

COLLAPSIN RESPONSE-MEDIATOR PROTEIN-5 WESTERN BLOT

Negative

Titers lower than 1:240 are detectable by recombinant CRMP-5 Western blot analysis. CRMP-5 Western blot analysis will be done on request on stored serum (held 4 weeks). This supplemental testing is recommended in cases of chorea, vision loss, cranial neuropathy, and myelopathy. Call 1-800-533-1710 to request CRMP-5 Western blot. Neuron-restricted patterns of IgG staining that do not fulfill criteria for CRMP-5-IgG may be reported as "unclassified antineuronal IgG." Complex patterns that include non-neuronal elements may be reported as "uninterpretable."

Interpretation

Recoverin IgG:

Seropositivity is consistent with a diagnosis of paraneoplastic retinopathy. Considerations include small-cell carcinoma, pulmonary, or extrapulmonary.

 

Collapsin response-mediator protein-5 IgG:

Seropositivity is consistent with a diagnosis of paraneoplastic retinitis or ophthalmitis. Considerations include small-cell carcinoma, pulmonary, or extrapulmonary.

Day(s) Performed

Profile tests: Monday through Sunday; Reflex tests: Varies

Report Available

8 to 10 days

Test Classification

This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. It has not been cleared or approved by the US Food and Drug Administration.

CPT Code Information

86255 x1

84182 x1

84182 CRMWS (if appropriate)

86256 CRMTS (if appropriate)

LOINC Code Information

Test ID Test Order Name Order LOINC Value
PVLE Paraneoplastic Vision Loss Eval, S 104992-3

 

Result ID Test Result Name Result LOINC Value
83077 CRMP-5-IgG, S 72504-4
610009 Recoverin Immunoblot, S 83003-4
607411 Paraneoplas Vision Loss Interp, S 104993-1
618908 IFA Notes 48767-8

Forms

If not ordering electronically, complete, print, and send a Neurology Specialty Testing Client Test Request (T732) with the specimen.

Profile Information

Test ID Reporting Name Available Separately Always Performed
PVLEI Paraneoplas Vision Loss Interp, S No Yes
CRMS CRMP-5-IgG, S No Yes
RCVBS Recoverin Immunoblot, S Yes Yes

Reflex Tests

Test ID Reporting Name Available Separately Always Performed
CRMWS CRMP-5-IgG Western Blot, S Yes No
CRMTS CRMP-5-IgG Titer, S No No

Testing Algorithm

If the indirect immunofluorescence assay (IFA) patterns suggest collapsin response-mediator protein-5 (CRMP-5) antibody, then CRMP-5 IFA titer and CRMP-5 Western blot will be performed at an additional charge.