Test Code KCSF Immunoglobulin Kappa Free Light Chain, Spinal Fluid
Ordering Guidance
For evaluation of multiple sclerosis, Multiple Sclerosis (MS) Profile, Serum and Spinal Fluid, SFIG/ Cerebrospinal Fluid IgG Index Profile, Serum and Spinal Fluid in conjunction with OLIG / Oligoclonal Banding, Serum and Spinal Fluid are still available as individually orderable tests.
In addition, a multiple sclerosis profile (MSP3 / Multiple Sclerosis (MS) Profile, Serum and Spinal Fluid) is available. This profile starts with immunoglobulin kappa free light chain testing. When that is borderline or elevated, additional testing for oligoclonal banding will be performed and results interpreted accordingly.
Specimen Required
Specimen Type: Spinal fluid
Container/Tube: Sterile vial
Specimen Volume: 1 mL
Collection Instructions: Label specimen as spinal fluid.
Useful For
Diagnosing multiple sclerosis and other demyelinating conditions
Evaluating patients who present with a clinically isolated syndrome in which the patient reports symptoms (headaches, optic neuritis, fatigue, and many others, depending on the disease location) characteristic of inflammation and demyelination of the central nervous system
Recommended in cases where the imaging findings are atypical and in populations in which multiple sclerosis is less common (eg, children, older individuals, or non-White populations)
The test is not useful when a clear diagnosis is already known because a positive result does not correlate with severity of the disease or disease outcomes.
Method Name
Nephelometry
Reporting Name
Kappa Free Light Chain, CSFSpecimen Type
CSFSpecimen Minimum Volume
0.5 mL
Specimen Stability Information
Specimen Type | Temperature | Time | Special Container |
---|---|---|---|
CSF | Frozen (preferred) | 28 days | |
Refrigerated | 72 hours | ||
Ambient | 24 hours |
Reject Due To
Gross hemolysis | Reject |
Gross icterus | OK |
Clinical Information
Multiple sclerosis (MS) is a chronic demyelinating disease of the central nervous system (CNS). The clinical diagnosis of MS is centered on each patient while applying diagnostic guidelines. Immunoglobulin free light chain (FLC) presence in cerebrospinal fluid (CSF) is an alternative for diagnosing MS using nephelometry. Light chains are produced in excess during antibody formation and secreted from plasma cells or plasma blasts. Quantitative FLC assays use antisera directed against epitopes that are exposed only when the light chains are free (unbound to heavy chain) in solution. FLC immunoassays can be used to specifically quantitate FLC even in the presence of large concentrations of polyclonal immunoglobulins.
Routine use of isoelectric focusing electrophoresis coupled with IgG-specific immunoblotting (IgG-IEF) identifies immunoglobulins specific to the CNS. This method is part of the diagnostic criteria used in cases of MS, ie, oligoclonal banding (OLIG / Oligoclonal Banding, Serum and Spinal Fluid). However, oligoclonal banding is a labor-intensive technique that includes subjective interpretation of IgG bands from paired CSF and serum.
This test, when considered positive at a concentration greater than or equal to 0.1000 mg/dL as a medical decision point, has a sensitivity of 70.4% with a specificity of 86.8%. The differences between this test and the oligoclonal banding analysis are not statistically significant (p=0.20), and the 2 tests show comparable performance. However, this test does not require a paired serum specimen, offers a shorter turnaround-time for results, and an objective quantitative result.
This testing is most useful in patients presenting with a clinically isolated syndrome, which is a clinical episode where patient reports symptoms (headaches, optic neuritis, fatigue, and many others, depending on the disease location) characteristic of inflammation and demyelination of the CNS, and needs to be checked by a neurologist. This is when the likelihood of a diagnosis of MS is greater or most likely but not yet known or confirmed. CSF laboratory testing is also strongly recommended in cases where the imaging findings are atypical and in populations in which MS is less common (eg, children, older individuals, or non-White populations).
Reference Values
Medical Decision Point: 0.1000 mg/dL
Positive: ≥0.1000 mg/dL
Borderline: 0.0600 mg/dL-0.0999 mg/dL
Negative <0.0600 mg/dL
Day(s) Performed
Monday through Friday
Report Available
1 to 3 daysPerforming Laboratory
Mayo Clinic Laboratories in RochesterTest 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
Forms
If not ordering electronically, complete, print, and send a Neurology Specialty Testing Client Test Request (T732) with the specimen.