HAVING A LP to test for MS REQUIRES A BLOOD DRAW AS WELL

If your doctor does a LP to obtain CSF (spinal fluid) for MS testing, insist that he go ahead and get some of your blood as well.

A forum member asked for additional information about this recently so she would have accurate facts to back her up In case demands became necessary.  I decided to write my answer in a new topic because we are always welcoming new members who are still early in their diagnostic quest.  They need this info BEFORE having an LP done.

So why must a serum sample be drawn at the same time CSF is obtained by LP for MS testing (more specifically for O-band testing)?  The best explanation was written by Quix and is archived in our Health Pages.  You can read the entire article by using this link.

http://www.medhelp.org/health_pages/Multiple-Sclerosis/Can-you-Diagnose-MS-with-an-LP-that-is-Negative-for-O-bands/show/142?cid=36

At the time Quix wrote, it was hard to know how many labs were using the newest testing method.  It seems more standard now (since even large hospitals often use reference labs to run it) but we still hear reports of people who get a negative result despite having NO serum sample drawn.  THAT is impossible.  I’ll quote pieces of the Health Page to show why.

“Oligoclonal bands are large groups of antibodies that can sometimes be found in the blood and in the cerebrospinal fluid, the CSF. They are caused by a state of inflammation in either the body or the Central Nervous System or both.”

“To understand how oligoclonal bands can be important in the diagnosis of MS, you have to understand a little about how they are found and counted. Antibodies are found in the body by drawing blood and testing it, or by obtaining spinal fluid and testing it the same way.”

“The process involves tagging the antibodies with something that will make them visible and then letting them diffuse across an area of gel or across special paper… the body makes millions of different antibodies… and each antibody moves to a different place on the gel…. If there are huge amounts of the same antibody present in the sample of fluid (serum or CSF) then there will be dense lines superimposed on and going across the gel at one or more locations.”

“The blood will show the effect of these colonies out in the body… The CSF may show one of two things. It can ‘echo’ the same O-bands made out in the body… or the CSF can show different O-bands than the serum…. If an O-band appears only in the CSF and not out in the body (the serum of the blood) then we know that those… antibodies [were made] ONLY in the Central Nervous System, as would happen in Multiple Sclerosis.”

“IMPORTANT - The serum and the spinal fluid both must be tested for the O-band result to be valid. It is not enough to look for them in the CSF alone, so there must be a blood draw on the same day as the lumbar puncture. The two results will be compared to see if there are any O-bands that exist ONLY in the CSF, but not out in the body. On the lumbar puncture report the only thing that is usually reported are O-bands that do appear in the CSF but DO NOT appear in the blood/serum.”


Truthfully, a reference lab probably won’t even run the test for CSF O-bands if they don’t receive a serum sample for side-by-side comparison.  Only CSF with zero bands would hold any value and I doubt it is sufficient to justify cost.  Serum drawn on another day is NOT adequately accurate.

SO BE SURE THE LAB (or hospital or doctor) OBTAINS AND SENDS BOTH CSF AND SERUM SAMPLES IF THEY INTEND TO TEST FOR O-BAND PATTERNS FOUND IN SOME PwMS.

Then go home, get a tall (caffeinated) drink, put your head down and your feet up, tell everyone there you are off-duty and RELAX!

Mary

[LisaJF]

Very well written Mary.  Thank you for the information!

I know when my LP was done, the blood was used from the day before or two days before (so I was told by the laboratory).  

My question is though, if no 0-bands exist in the CSF, why care what the serum has them or not or if it was drawn on the same day?

[Lulu54]

Lisa, you would not know if there are UNIQUE o-bands in the CSF until AFTER the LP has been done.  The comparison between CSF and Blood Serum banding is the key component to this test.  

You can have zero bands in the CSF or 20 - that doesn't matter so much.  What does make it significant is if the number in the CSF is different than the number in the serum.   That is the only thing they are really looking at.  

The sample needs to be done within the same time frame because our conditions can change - the head to head comparison of CSF and Blood Serum can only be done accurately if it is done in the same time.

I hope this helps.

Mary, this is a great synopsis.  Thanks for taking the time to do this for everyone.
Lulu

[LisaJF]

Thank you for taking the time to respond to my question.  I don't know why I'm unable to process this information.

If you're CSF is 0 in 0-bands, then what's the difference if your serum has any?

Yes, I'm having a stupid moment, unable to use abstract thinking processes.  Sorry.

Lisa

[shoshin]

To try to answer what I think is your question, from the point of view of MS if you have no o-bands in your CSF then it doesn't matter about the serum. However, as Lulu pointed out, you can't know that ahead of time so you should be sure they draw the blood. But if you had 0 CSF o-bands and they didn't take or lost your blood, there would be no point in a do-over for MS.

If you look at the chart in the health page, it tells you a little bit about the possible combinations of serum and CSF o-bands.

If the o-bands are only in the CSF or if there are unique ones in the CSF that aren't in the blood, this suggests that the inflammation is in the CNS and this is where the antibodies are being created.

If the same o-bands are in both the blood and the CSF, this suggests a systemic infection or antibody production that started in the body and crossed the blood-brain barrier into the CNS. This old article talks about people with neuro disorders and the same o-bands both in the CSF and the blood and found that "neoplasia and peripheral neuropathies accounted for over 50% of the diagnoses, infections and systemic inflammatory disorders for 32%, and multiple sclerosis was diagnosed in only one case."

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1014760/

If the o-bands are only in the blood, that means that the antibodies are being generated in the body and not crossing the blood-brain barrier. There is a brief mention of possible dx's for oligoclonal bands in the blood starting on p 45 of this document:

http://www.bcsls.net/pages/documents/Moss-SerumProteinElectrophoresis.pdf

I hope somewhere in there is an answer to your question.

sho

[jibjen]

Hi,

This is great, unfortunately when I went for LP I assumed the hospital KNEW what to do..I had an inconclusive LP because they never took blood when they did the LP....It was a wated LP, AND a lot of pain as I ended up in hospital with spinal headache.

rrrr

Jibs

[MrsAristotle]

when i had my LP they found inflammation in my blood as well, so the neuro told me even though there were lots of o bands in my csf there was inflammation in my blood but he didnt explain it. When I said to him could the inflammation in the blood just be a coincidence he said yes. So from what I have just read he was talking through the hole in his bottom lol.

The thing is Mr Neuro if I had O BANDS in my CFS (he said lots), and inflammation in my blood test and I dont have MS, then what do I have lol. They just leave us high and dry dont they.

Also i have to say. The LP was a walk in the park it did not hurt at all, HOWEVER, when he took the blood it was agony I nearly hit him. He made such a mess of it, the pain was horrendous and I nearly fainted. I have had loads of blood tests this was the worse even when I had one done by an old nurse who had retired and came at me with shaking hands she did a better job lol.

I thought the way you explained it was excellent. Thank you, but non the wiser lol.

Still in hell....ooops sorry no mans land. xx

[heartfelt77]

So, what my understanding is if you have no 0 bands in your blood or serum it is very possible you don't have Ms.  

Is this correct?  

Misty

[SarahL2491]

I don't think that means no MS, misty, but I too have trouble wrapping my brain around it...I will have to draw out a flow chart to understand it!  LOL

[shoshin]

@Misty I think that, despite our desire for a black-and-white answer, the LP doesn't give one. It's just a piece of evidence that adds weight to one side of the scale or other. It isn't conclusive in-and-of-itself and it's meaning also depends on other factors. All other things being equal, no CSF o-bands point away from MS. However, some people dx'd with definite MS, (perhaps as many as 1 in 20), even with optimal testing, do not show o-bands. So no o-bands does not equal no MS.

"more than 95% of patients with multiple sclerosis (MS) have CSF OB of IgG class not detectable in serum" --> up to 5% don't

http://www.ncbi.nlm.nih.gov/pubmed/16945427

sho

[MrsAristotle]

I was told by my uncle who is a radiologist and physician in Italy that they only use the LP to rule out other diseases.

Even a negative LP for MS does not mean someone does not have MS, it is a bit hit and miss and many neuros do not like using this method as a diagnostic tool for MS only for other diseases which would definitely show positive on one.

I have met a few people over my time on forums who have had negative LPs but positive MRIS and been diagnosed with MS.

[kwarendorf]

Lisa - the short answer to your question is that if you have no o-bands in your CSF it does not matter when, or if, they draw blood.

The downside to a non-existent/non-simultaneous blood draw is that if they do find o-bands in your CSF the information is of limited value. For full value they need to compare the results with blood drawn at the same time.

O-bands in CSF + O-bands in Blood = Non-MS indicator

O-bands in CSF + No O-bands in Blood = MS indicator

Hope this helps,
Kyle

[sllowe]

Mrs. A -

The banding in each should have been compared.

Where your case is concerned (it was in blood serum and CSF) it would be moreso important to the neuro in the context of MS if "unique" banding were identified in the CSF. So, they would know the origin (blood, or CNS).

-shell