Oligoclonal Banding

CPT: 83916
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Test Details

Synonyms

  • CSF Protein

Use

Diagnose diseases of the central nervous system including meningitis, tumor, syphilis, and multiple sclerosis

Methodology

Isoelectric focusing (IEF) and immunoblotting on agarose gel

Reference Interval

None found; four or more CSF-specific bands have been shown to be most consistent with MS.

Additional Information

Most of the clinical interest in CSF electrophoresis is focused on the γ region. Oligoclonal bands are multiple distinct bands in the γ zone of the CSF pattern that are not present in serum. These bands in the CSF pattern are produced by a limited number of immunocompetent cell clones, each producing IgG with its own specificity. More than 90% of patients with multiple sclerosis show oligoclonal banding at some time during the course of their disease.

The presence of oligoclonal bands in CSF from patients with multiple sclerosis does not correlate with the activity of the demyelinating process. Oligoclonal bands can be present even when the CSF IgG level is normal.

Approximately 2% to 3% of clinically confirmed MS patients show little or no evidence of oligoclonal bands in the CSF; however oligoclonal bands may develop as the disease progresses.

Increased IgG production by the central nervous system is not specific for multiple sclerosis, but is an indication of chronic neural inflammation. Oligoclonal bands in CSF have been reported in cases of neurosyphilis, acute bacterial or viral meningitis, progressive multifocal leukoencephalopathy, subacute sclerosing panencephalitis, progressive rubella panencephalitis, polyneuritis, optic neuritis, trypanosomiasis, and other infectious or autoimmune diseases.

The oligoclonal band pattern is blurred when a concomitant inflammatory response causes increased protein leakage of plasma proteins into the CSF. If the CSF protein concentration is >200 mg/dL, even high immunoglobulin production in the central nervous system can be obscured by the presence of plasma proteins.

Since 80% of normal CSF protein is derived from serum, patients with serum monoclonal proteins may also have corresponding CSF bands. In addition, serum oligoclonal bands are present in some patients with Hodgkin's disease and in up to 5% of normal individuals. Therefore, CSF electrophoretic patterns cannot be interpreted without corresponding serum patterns.

Specimen Requirements

Specimen

Cerebrospinal fluid (CSF) and serum, collected at the same time

Volume

0.5 mL cerebrospinal fluid (CSF) and 0.5 mL serum

Minimum Volume

0.1 mL CSF and 0.1 mL serum

Container

Red-top tube or gel-barrier tube and plastic (CSF) tube

Patient Preparation

Spinal tap

Collection

Spinal tap and venipuncture.

Storage Instructions

Room temperature

Stability Requirements

Temperature

Period

Room temperature

14 days

Refrigerated

14 days

Frozen

14 days

Freeze/thaw cycles

Stable x3

Causes for Rejection

Plasma instead of serum specimen (since fibrinogen band may obscure the β−γ electrophoretic zone); serum and CSF not collected within eight hours of each other

Clinical Information

References

Fortini AS, Sanders EL, Weinshenker BG, Katzmann JA. Cerebrospinal fluid oligoclonal bands in the diagnosis of multiple sclerosis. Isoelectric focusing with IgG immunoblotting compared with high-resolution agarose gel electrophoresis and cerebrospinal fluid IgG index. Am J Clin Pathol. 2003 Nov; 120(5):672-675. 14608891

LOINC® Map

Order Code Order Code Name Order Loinc Result Code Result Code Name UofM Result LOINC
019216 Oligoclonal Banding 111237 Oligoclonal Bands N/A
019216 Oligoclonal Banding 111666 Oligoclonal Bands 48668-8

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