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HelpTest ID: MSP3 Multiple Sclerosis (MS) Profile, Serum and Spinal Fluid
Specimen Required
Both serum and spinal fluid are required. Spinal fluid must be obtained within 1 week of serum collection.
Specimen Type: Spinal fluid
Container/Tube: Sterile vial
Specimen Volume: 1 mL
Collection Instructions: Label specimen as spinal fluid.
Specimen Type: Serum
Container/Tube:
Preferred: Serum gel
Acceptable: Red top
Specimen Volume: 1 mL
Collection Instructions:
1. Centrifuge and aliquot serum within 2 hours of collection.
2. Label specimen as serum.
Useful For
Diagnosing multiple sclerosis, especially helpful in patients with equivocal clinical or radiological findings
Profile Information
| Test ID | Reporting Name | Available Separately | Always Performed |
|---|---|---|---|
| KCSFP | Kappa Free Light Chain, CSF | Yes, (KCSF) | Yes |
| XSRM | Additional sample for reflex OLIGS | No | Yes |
Reflex Tests
| Test ID | Reporting Name | Available Separately | Always Performed |
|---|---|---|---|
| OLIGS | Serum Bands | Yes, (Order OLIG, submit CSF and Serum) | No |
| OLIGC | CSF Bands | Yes, (Order OLIG, submit CSF and Serum) | No |
Testing Algorithm
Kappa free light chain will be performed by nephelometry on all samples. When kappa free light chain results are 0.0600 mg/dL or more, the oligoclonal banding tests will be performed at an additional charge. If the time of testing exceeds the specimen stability for oligoclonal banding tests (ie, 14 days), only kappa free light chain will be performed.
Method Name
KCSFP: Nephelometry
OLIGC, OLIGS: Isoelectric Focusing (IEF) with IgG Immunoblot Detection
Reporting Name
Multiple Sclerosis ProfileSpecimen Type
CSFSerum
Specimen Minimum Volume
Serum, Spinal fluid: 0.5 mL
Specimen Stability Information
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| CSF | Frozen (preferred) | 14 days | |
| Refrigerated | 72 hours | ||
| Ambient | 24 hours | ||
| Serum | Frozen (preferred) | 14 days | |
| Ambient | 14 days | ||
| Refrigerated | 14 days |
Clinical Information
Multiple sclerosis (MS) is a chronic inflammatory demyelinating disease characterized by visual, motor, and sensory disturbances. The diagnosis of MS is dependent on clinical, radiological, and laboratory findings. The detection of increased intrathecal immunoglobulin (Ig) synthesis is the basis for current diagnostic laboratory tests for MS. These tests include the kappa free light chains in cerebrospinal fluid (CSF) and CSF oligoclonal band detection.
Reference Values
KAPPA FREE LIGHT CHAIN
Medical decision point: 0.1000 mg/dL
OLIGOCLONAL BANDS:
<2 bands
Interpretation
When result is 0.1000 mg/dL or more, the kappa free light chain concentration measured in cerebrospinal fluid (CSF) is at or greater than the threshold associated with demyelinating disease. This is a positive result. These findings, however, are not specific for multiple sclerosis (MS) because CSF-specific immunoglobulin synthesis may also be detected in patients with other neurologic diseases (infectious, inflammatory, cerebrovascular, autoimmune, and paraneoplastic). Clinical correlation is recommended. Automatic reflexing to oligoclonal bands will occur.
When result is less than 0.0600 mg/dL, the kappa free light chain concentration measured in CSF is lower than the threshold associated with demyelinating disease. This is a negative result. Testing for oligoclonal banding is not performed. Clinical correlation is recommended.
When result is 0.0600 to 0.0999 mg/dL, the kappa free light chain concentration measured in CSF is slightly elevated but not above the medical decision point of 0.1000 mg/dL associated with demyelinating disease. This is a borderline result. Reflexing to oligoclonal bands will be automatically performed and clinical correlation is recommended.
When the oligoclonal band assay detects 2 or more unique IgG bands in the CSF, the result is positive.
CSF is used in the diagnosis of MS by identifying increased intrathecal IgG synthesis qualitatively (oligoclonal bands). The presence of 2 or more unique CSF oligoclonal bands was reintroduced as one of the diagnostic criteria for MS in the 2017 revised McDonald criteria. These findings, however, are not specific for MS as CSF-specific IgG synthesis may also be found in patients with other neurologic diseases including infectious, inflammatory, cerebrovascular, and paraneoplastic disorders. Clinical correlation is recommended.
Clinical Reference
1. Andersson M, Alvarez-Cermeno J, Bernardi G, et al: Cerebrospinal fluid in the diagnosis of multiple sclerosis: a consensus report. J Neurol Neurosurg Psychiatry. 1994 Aug;57(8):897-902
2. Tourtellotte WW, Walsh MJ, Baumhefner RW, Staugaitis SM, Shapshak P: The current status of multiple sclerosis intra-blood-brain-barrier IgG synthesis. Ann NY Acad Sci. 1984;436:52-67
3. Thompson AJ, Banwell BL, Barkhof F, et al: Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria. Lancet Neurol. 2018 Feb;17(2):162-173
4. Gurtner KM, Shosha E, Bryant SC, et al: CSF free light chain identification of demyelinating disease: comparison with oligoclonal banding and other CSF indexes. Clin Chem Lab Med. 2018;56:1071-1080
5. Saadeh R, Pittock S, Bryant S, et al: CSF Kappa Free Light Chains as a Potential Quantitative Alternative to Oligoclonal Bands in Multiple Sclerosis. In: American Academy of Neurology Annual Meeting. 2019 Philadelphia, PA
Day(s) Performed
Monday through Friday
Report Available
3 to 5 daysTest Classification
This test has been modified from the manufacturer's instructions. Its performance characteristics were determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the US Food and Drug Administration.CPT Code Information
83521
83916 x2 (if appropriate)
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| MSP3 | Multiple Sclerosis Profile | 55121-8 |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| KCSFP | Kappa Free Light Chain, CSF | 48774-4 |
| XSRM | Additional sample for Reflex OLIGS | No LOINC Needed |
Forms
If not ordering electronically, complete, print, and send a Neurology Specialty Testing Client Test Request (T732) with the specimen.
mml-Demyelinating-Diseases