Recommended standard of cerebrospinal fluid analysis in the. Readily distinguishable igg bands found in the csf are picked up on the qualitative analysis ief as separate bands, socalled ocb. Ocbs oligoclonal bands, qalb csf serum albumin ratio fig. Oligoclonal bands in patients with multiple myeloma. The cerebrospinal fluid in multiple sclerosis immunology frontiers. At presentation, serum protein electrophoresis spe showed a sharp monoclonal spike corresponding to igg and. Prominent serum bands triggered serum protein electrophoresis and immunofixation, which revealed coexisting iggkappa monoclonal protein 2. Oligoclonal bands are a type of protein that is produced by the immune system so the sample they are found in can show where the immune system has been active.
We were also able to detect antigenspecific csf restricted oligoclonal igg. These bands in the csf pattern are produced by a limited number of immunocompetent cell clones, each producing igg with its own specificity. The presence of oligoclonal bands ocbs of immunoglobulin g igg in csf provides evidence for the occurrence of a humoral immune response, but it is not always appreciated that the oligoclonal. Detection of oligoclonal bands in the cerebrospinal fluid and serum. Oligoclonal bands are found in a variety of inflammatory and infectious cns disorders, including paraneoplastic disorders, cns lupus, neurosarcoidosis, and behcet. Intrathecal immunoglobulin g igg and oligoclonal bands ocbs are the most. Early differential diagnosis of multiple sclerosis using a new. To distinguish between oligoclonal bands in the csf due to a peripheral gammopathy and oligoclonal bands due to local production in the cns, serum and csf should be tested simultaneously. Performance characteristics were verified by mayo clinic. The presence of ocbs in the csf has often been used as a diagnostic criterion in ms.
Detection of oligoclonal igg kappa and igg lambda bands in. Previously, only one band was necessary for diagnosis. The diagnostic value of igg index versus oligoclonal bands in. Serum was taken six weeks after the lp and contains extra bands which are not reflected in the csf. A cerebrospinal fluid csf analysis is not mandatory for the diagnosis of multiple sclerosis ms in patients with a clinical syndrome suggestive of ms. Excluding infections, which usually do not present a differential diagnosis. Identical bands in csf and serum do not reflect pathological. Oligoclonal bands can however, be observed in a variety of other diseases, e. We were also able to detect antigenspecific csfrestricted oligoclonal igg. Ms patients positive for oligoclonal bands have greater brain. Five patients displayed on ief a pattern type 2, indicating the presence of specific bands in the csf only, but not in the serum.
Oligoclonal banding, serum and cerebrospinal fluid labcorp. Approximately 79%90% of all patients with multiple sclerosis have permanently observable oligoclonal bands in their csf. Oligoclonal banding, serum and spinal fluid essentia. Note that all the oligoclonal bands present are due to igg. Multiple obands in csf and serum multiple sclerosis medhelp. Oligoclonal bands are present on the electrophoresis of concentrated csf and also on concurrently tested serum of the same patient. Development of oligoclonal band ob in a patient with igg. The significance of serum oligoclonal bands in neurological. Mar 12, 2019 although a single band difference between csf and serum is not diagnostic of multiple sclerosis, more than one half of these patients will progress to a full oligoclonal pattern. Rest of multiple sclerosis profile from csf and serum protein, igg and mbp are normal. Oligoclonal bands are multiple distinct bands in the. Oligoclonal banding, serum and spinal fluid aumc laboratory. The oligoclonal band ocb assay requires paired cerebrospinal fluid csf and serum samples. A demyelinating disorders, typically multiple sclerosis, when the pattern is predominantly one of bands in the csf but absent from the serum approx 5 % of patients will also show bands in the serum.
Our data suggest that in ms patient a b cells and their products in the csf may not be the sole source of intrathecal igg. Bands in csf mean that the immune system has been active in the central nervous system cns and bands in serum mean that the immune system has been active in the rest of the body. Unconcentrated csf and diluted serum are electrophoresed by isoelectric focusing. Multiple cerebrospinal fluid bands with accompanying serum. The role of igg index versus oligoclonal bands in patients. Igg index is obtained by calculating the ratio between csf and serum igg after correcting. Oligoclonal bands are bands of immunoglobulins that are seen when a patients blood serum, gained from blood plasma, or cerebrospinal fluid csf is analyzed. Identical igg concentration in paired csf serum samples the presence of csf oligoclonal bands only, characterizing local igg synthesis, tightly correlates with the diagnosis of multiple sclerosis.
Csf oligoclonal bands are important in the diagnosis of. Increased intrathecal ig synthesis may occur in other inflammatory csf diseases and, therefore, this assay is not specific for ms specificity 95%. Oligoclonal bands in csf not seen in serum but some common oliogoclonal bands found in both consitent with ms but can have other causes. Oligoclonal bands increase the specificity of mri criteria. Cerebrospinal fluid csf analysis is an important tool in the evaluation. Oligoclonal bands are an important indicator in the diagnosis of multiple sclerosis. Rheumatologist ruled out lupus, arthritis, sjogren. Test code lab740 oligoclonal banding, serum and spinal fluid important note. Immunofixation and protein electrophoresis csf health.
According to the criteria defined by the international myeloma working group imwg in 2008, the definition of complete response cr in mm requires the absence of the original monoclonal protein in both serum and urine immunofixation electrophoresis ife. Geisinger medical laboratoriesgeisinger proven diagnostics. Although a single band difference between csf and serum is not diagnostic of multiple sclerosis, more than one half of these patients will progress to a full oligoclonal pattern. For the detection of oligoclonal bands, paired serum and csf samples are required. Multiple obands in csf and serum multiple sclerosis. However, in the 2017 mcdonald diagnostic criteria presence of 2 oligoclonal igg bands ocb in the csf, but absence in the corresponding serum, can be used to fulfill the distribution in time dit criteria, possibly leading to an earlier diagnosis. The separated immunoglobulin ig are visualized by an igg immunoblot, and ocbs that are present in the csf and not in the serum are reported. The presence of oligoclonal band is unrelated to disease activity. Their presence suggests inflammation of the central nervous system due.
The presence of oligoclonal bands ocbs of immunoglobulin g igg in csf provides evidence for the occurrence of a humoral immune response, but it is not. We analyzed serum and csf clinical lab parameters in 115 patients. Oligoclonal banding, serum and spinal fluid ohiohealth. Blood must be taken at the same time as the lumbar puncture lp, if not then within two to three weeks of the lp. If results are abnormal there are 2 or more bandings found in the csf and not in the blood serum. You may need this test if your healthcare provider thinks you have ms or another nervous system. Csf oligoclonal banding is a test to look for inflammationrelated proteins in the cerebrospinal fluid csf, the clear fluid that flows in the space surrounding the spinal cord and brain. Oligoclonal bands igg regional medical lab test directory. Pdf the significance of serum oligoclonal bands in. The samples were stored at 40c until oligoclonal band testing was performed. The existence of these bands within the csf, but not within the serum, is a strong.
The clinical significance of single or double bands in. Oligoclonal bands, in the csf but not in the serum, in these particular cases help to make one more confident about a diagnosis of multiple sclerosis. Early differential diagnosis of multiple sclerosis using a. Igg antibody repertoire in multiple sclerosis as a new diagnostic tool. An increase in the amount of these proteins could be a sign of an inflammatory or. The other pattern, with ocgbs in serum and additional bands in cerebrospinal fluid, was mostly found in central nervous system infections. Due to their sensitivity, a positive test requires more bands than in the past, and varies depending on different labs.
A glimpse at the cerebrospinal fluid immunoglobulins in. Measuring these bands in a paired serum and csf sample by isoelectric. The csf oligoclonal band screen looks for these bands in your csf. Recommended standard of cerebrospinal fluid analysis in. Other diseases that cause oligoclonal bands multiple. Clinical aspects of ms diagnosis and differential diagnosis background and objectives. Most automated blood gas analyzers directly measure. Oligoclonal bands ocbs are bands of immunoglobulins that are seen when a patients blood serum, or cerebrospinal fluid csf is analyzed. Oligoclonal bands definition of oligoclonal bands by.
The occurrence of single monoclonal bands in csf is uncommon. Oligoclonal bands ocb of the cerebrospinal fluid csf have been important in. Identical oligoclonal bands in serum and csf no local synthesis, pattern seen in guillain barre, hiv infection and other chronic inflammatory states. Isoelectric focusing ief with igg immunoblot detection. The remaining four presented ocbs in the csf and additional identical bands both in the csf and in the serum pattern type 3, also indicative of intrathecal igg synthesis. Serum and csf igg concentrations were analyzed in a nephelometer bnii. Interpretation a finding of 4 or more cerebrospinal fluid csf specific bands ie, bands that are present in csf but are absent in serum is consistent with multiple sclerosis. Oligoclonal bands ocbs are bands of immunoglobulins that are seen when a patients blood. They are used in the diagnosis of various neurological and blood diseases, especially in multiple sclerosis. Multiple igg bands present in csf but not in serum are diagnostic of oligoclonal bands, consistent with multiple sclerosis. These patients frequently displayed a mirror pattern, with identical bands in serum and cerebrospinal fluid. Immunoglobulins found in the cerebrospinal fluid of patients with multiple sclerosis ms and, occasionally, in other neurological conditions.
A finding of 4 or more cerebrospinal fluid csf specific bands ie, bands that are present in csf but are absent in serum is consistent with multiple sclerosis. Csf is the fluid that surrounds your brain and spinal cord. The presence of oligoclonal bands is unrelated to disease activity. Oligoclonal bands and igg elevation in the cerebrospinal fluid csf provide further. Isoelectric focusing on agarose gels with immunoblotting. Csf oligoclonal banding is a test to look for inflammationrelated proteins in the cerebrospinal fluid csf. Results cannot be relied upon beyond this time limit half life of serum igg is about 23 days. Jul 24, 2014 oligoclonal bands are immunoglobulins that collect in a patients blood plasma or cerebrospinal fluid csf. Is it possible to have ms when lp shows multiple oligoclonal bands in csf and serum. Though not every person with ms has ocbs, their presence is generally associated with a younger age of onset and a poorer disease outcome.
The complex relationship between oligoclonal bands, lymphocytes. Csf oligoclonal bands blood sciences test exeter clinical. In people with ms who have this test, csf shows a pattern called oligoclonal bands. Oligoclonal bands are proteins called immunoglobulins. Oligoclonal bands are defined as at least two bands seen in the csf with no. Specimen collection and processing instructions for. In a very high proportion of patients with multiple sclerosis 90% the csf contains oligoclonal bands that are not present in the serum. Pdf oligoclonal bands in the cerebrospinal fluid of.
Oligoclonal banding, serum and spinal fluid mayo clinic. There was good agreement concerning the presence or absence of intrathecal synthesis. Other application for ocbs is as a tool to classify patients. The clinical diagnosis of multiple sclerosis can be supported by analysis of cerebrospinal fluid csf. The principal purpose of the oligoclonal band test is to detect intrathecal synthesis of igg. Oligoclonal bands are proteins called immunoglobulins, which suggest inflammation of the central nervous system. Examination of cerebrospinal fluid csf samples obtained from 7 patients showed no cells. The detection in tears remains controversial but some reports suggested a replacement of csf analysis by ocb detection in tears.
The diagnostic value of igg index versus oligoclonal bands. Csf oligoclonal banding medical tests ucsf benioff. Catalog id olig oligoclonal banding, serum and spinal fluid. The presence of oligoclonal bands ocbs of immunoglobulin g igg in csf provides evidence for the occurrence of a humoral immune response, but it is not always appreciated that the oligoclonal igg may have originated in the serum. However, in the 2017 mcdonald diagnostic criteria presence of 2 oligoclonal igg bands ocb in. Albumin, in contrast, is produced in the liver and the presence of albumin in the csf is due to.
Oligoclonal bands of intrathecal origin occur in three groups of central nervous system cns disease. Confused about oligoclonal bands multiple sclerosis society. Oligoclonal bands in multiple sclerosis university of. The presence of these proteins indicates inflammation of the central nervous system. Food and drug administration and is used per manufacturers instructions. Csf is the clear fluid that flows in the space around the spinal cord and brain. This example demonstrates the effect of unpaired samples on oligoclonal bands. They are used as a marker of ms when magnetic resonance imaging studies of the brain are not diagnostic. In process result id test result name result loinc value.
Oligoclonal band analysis south tees hospitals nhs. Apr 21, 2019 if results are normal one or less bandings will be found in the csf. The complex relationship between oligoclonal bands. Oligoclonal band definition of oligoclonal band by. The hydragel csf isofocusing kit used on the hydrasys focusing instrument provides qualitative detection and immunological characterization of igg oligoclonal banding in human csf and serum.
This test uses an electrical current on a csf sample to separate out types of protein called immunoglobulins. Their presence provides useful information when in agreement with the other clinical investigations. Isoelectric focusing isoelectric focusing ief is regarded as the gold standard for the detection of cns inflammation. Oligoclonal bands are present in the csf of more than 85% of patients with clinically definite multiple sclerosis ms. Approximately 50% of cases of monoclonal csf bands occur without a corresponding serum band. Csf oligoclonal bands are found in 83% to 94% of patients with definite ms. Test classification this test has been cleared or approved by the u. Csf oligoclonal bands are present in 95100% of patients with ms 8,12. The absence of bands in the serum corresponding to those present in the csf might lead to incorrect interpretation of intrathecal igg synthesis pattern 2 andor 3.
Although csf iggocb are not included as a mandatory tool in 2010. No patients with other inflammatory neurologic diseases showed itgs. There are unique differences between ms and patients with other inflammatory neurological disorders. Oligoclonal band definition of oligoclonal band by medical. An oligoclonal band is a protein called an immunoglobulin. The oligoclonal bands are thus local to the central nervous system.