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--- investigations:csf_immunoglobulins [2022/04/30 19:21] – administrator@icnapedia.org
+++ content:csf_immunoglobulins [2024/03/08 19:50] (current) – [Interpretation] administrator@icnapedia.org
@@ Line 1: / Line 1: @@
-====== Immunoglobulin - qualitative: oligoclonal bands ======
+====== Oligoclonal bands ======
+Oligoclonal bands (OCBs) are bands of immunoglobulins that are seen when a patient's blood serum, or cerebrospinal fluid (CSF) is analyzed. The presence of two or more bands of immunoglobulin on isoelectric focusing (IEF ) of
-The presence of two or more bands of immunoglobulin on isoelectric focusing (IEF ) of
 CSF is referred to as 'oligoclonal bands' (OCBs). This CSF oligoclonal banding is only
 indicative of local CNS IgG production when the banding pattern in the CSF is distinct
-from the pattern seen in the serum. For this reason a serum sample must be sent with a
+from the pattern seen in the serum.
-CSF sample, as is done of course for the CSF:serum IgG index.
 While OCBs are well known to assist in the diagnosis of multiple sclerosis it is
-important to recognize that they are found in many other situations with infections
+important to recognize that they are found in many other situations like
-(subacute sclerosing panencephalitis, rubella panencephalitis, neurosyphilis,
-neuroborreliosis) or autoimmunity (anti-NMDA receptor encephalitis).
+infections
+  * subacute sclerosing panencephalitis
+  * rubella panencephalitis
+  * neurosyphilis
+  * neuroborreliosis
+or autoimmune conditions
+  * anti-NMDA receptor encephalitis)
+  * Guillain–Barré syndrome
+  * Neuromyelitic optica
 Although it has been suggested that in adults, where multiple sclerosis is a
 predominant condition that it is only necessary' to request IEF for OCB, in children it is
 wise to request both quantitative (CSF:serum IgG index) and qualitative (isoelectric
-focusing for OCB) measures to determine whether there is local CSF IgC synthesis.
+focusing for OCB) measures to determine whether there is local CSF IgG synthesis [(:harvard:invchildneurology)].
+===== Interpretation =====
+**Five patterns are typically recognised:**
+  * Normal CSF pattern - polyclonal IgG
+  * Oligoclonal CSF with a normal serum pattern – consistent with MS
+  * Oligoclonal bands in CSF not seen in serum but some common oliogoclonal bands found in both – consistent with MS but can have other causes.
+  * Identical oligoclonal bands in serum and CSF - this indicates that there is no local synthesis. This pattern is seen in Guillain Barre, HIV infection and other chronic inflammatory states.
+  * Monoclonal band in CSF and serum – myeloma or Monoclonal gammopathy of undetermined significance (MGUS).
 ----
-**Source:**King, M. D., & Stephenson, J. B. (Eds.). (2009). A handbook of neurological investigations in children. Mac Keith Press Practical Guides.
+~~REFNOTES~~
-{{tags:>oligoclonal bands}}
+{{tag>oligoclonal_bands labtests}}
+~~DISCUSSION~~