Oligoclonal Bands, CSF IgG Oligoclonal Bands and IgG/ALB Ratio

Immunology

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Description

Multiple sclerosis (MS) is a demyelinating disease which usually develops in young adults with a complex predisposing genetic trait and probably requires an inciting environmental insult such as a viral infection to trigger the disease [2]. The detection of IgG oligoclonal bands (OCB) in the CSF is a valuable aid in the diagnosis of demyelinating disease. OCB can be found in over 90% of patients with clinically defined MS [1]. NICE guidelines suggest that CSF analysis for the diagnosis of MS should be made when the diagnosis is clinically uncertain. They recommend that clinical presentation, exclusion of other causes and magnetic resonance imaging should be the initial diagnostic tests performed [3]. Measurement of CSF IgG and Albumin are useful adjuctive tests in the investigation of Multiple Sclerosis as a raised ratio is indicative of intrathecal synthesis of IgG. Intrathecal synthesis is present if more Oligoclonal bands are detected in CSF than in serum. Other conditions are also associated with the presence of plasma cells within the brain which leads to the intrathecal synthesis of oligoclonal immunoglobulin, such as cerebral malignancy, subacute sclerosing pan-encephalitis [1].

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Indications

Investigation of Suspected demyelinating disease. CNS infections, Multiple sclerosis.

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Sample Type

2mL Serum (Gel 5mL Yellow tube) and 1mL CSF. Requests from outside Sheffield: Transport at ambient temperature via Royal Mail or Courier.

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Reference Range

Normal = Negative (Pattern 1).
IgG/ALB RATIO normal range = 0.2 - 0.7.

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Turnaround Time

Within 10 days

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Testing Frequency

Weekly.

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External Notes

Contamination of CSF with blood during lumbar puncture renders the test uninterpretable.

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Patient Preparation

CSF and serum should ideally be taken at the same time. However, it is possible to analyse CSF and serum taken up to 5 days apart.

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References

PRU Handbook of Clinical Immunochemistry. 9th Edition. 2007. [Ref 1]
Sospedra M, Martin R. Immunology of multiple sclerosis.Annu Rev Immunol. 2005. 23:683-747. [Ref 2]
NICE Clinical Guideline 8. Multiple sclerosis - Management of Mulitiple sclerosis in primary and secondary care. 2003. [Ref 3]
Correale J, de los Milagros Bassani Molinas M. Oligoclonal bands and antibody responses in multiple sclerosis. J Neurol. 2002. 249:375-389.

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Please note: the above information is subject to change and we endeavour to keep this website up to date wherever necessary.