Skip Ribbon Commands
Skip to main content
Sign In
Navigate Up

22606 IgG Synthesis, CSF

IgG Synthesis, CSF
Test Code: IGG-SYN
Synonyms/Keywords
Immunoglobulin G and albumin in spinal fluid; Immunoglobulin G (IgG) in and albumin in CSF; also IgG and albumin in serum, CSF IgG Synthesis Rate​
Test Components
CSF IgG/Albumin Ratio, IgG Index, IgG Synthesis Rate, Serum IgG and Albumin, CSF IgG and Albumin​
Useful For
Measurement of the CSF proteins, albumin and IgG, are directed mainly towards the demonstration of two common disorders, namely blood-brain barrier damage and selective elevation of IgG due to local synthesis within the CNS.​
Specimen Requirements
Fasting Required Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)		 Pediatric Minimum Volume
(no repeat)
No​
Spinal Fluid (CSF)
and
Serum​
Screw cap, sterile, leakproof tubes for CSF
Red Top Tube (RTT) for serum

Plastic tube for CSF​ 

Serum Separator Tube (SST)
1.0 mL for CSF
 0.5 mL
for serum
​
0.5 mL for CSF
 0.3 mL for serum
​
0.5 mL for CSF
0.3 mL for serum
​
Collection Processing Instructions

CSF must be collected without red cells.  This will elevate both the CSF albumin and IgG because of serum contamination. 

Both CSF and serum are needed for analysis.  Separate labels and accession numbers are generated for blood and CSF samples.​

  • On first accession, one aliquot tube/label is required for the CSF sample and testing.
  • When this test order is placed, a separate accession with the test code "IGGSYN-S" will reflex for the serum testing. 2 aliquot tubes/labels are required for the serum sample and testing​

Serum sample must be drawn within 24 hours of spinal fluid collection.  If serum is not collected within 24 hours of CSF collection, please call Customer Service to discuss the case with a Clinical Chemist.

Separate serum from cells within 2 hours of collection

Specimen Stability Information
Specimen Type Temperature Time
CSF (spinal fluid)​ Refrigerated​ 7 days​
Serum​ Refrigerated​ 7 days​
Frozen​ 3 months​
Rejection Criteria
Hemolysis and/or the presence of intact RBC’s in the CSF specimen
For CSF - frozen samples​
Performing Laboratory Information
Performing Location Day(s) Test Performed Analytical Time Methodology/Instrumentation
Marshfield​ Monday through Friday​ 6-8 hours​ Turbidimetric method/The Binding Site Optilite analyzer
Reference Range Information
Performing Location Reference Range
Marshfield​
IgG (CSF): 0-6.6 mg/dL
Albumin (CSF): 15-32 mg/dL
IgG/Albumin ratio: 0.00-0.27
Serum Albumin (> 1 year): 3300-5000 mg/dL
Serum IgG (Adult): 617-1344 mg/dL
CSF IgG Index: 0.30-0.70
CSF IgG Synthesis Rate: 0.0-8.0 mg/day
Interpretation
An increase in the CSF IgG with a corresponding increase in the CSF IgG/Albumin Ratio suggests that the IgG is produced locally. Increases of IgG and total protein without corresponding increases in the ratio indicate damage to the blood-brain barrier.
 
In rare instances, the CSF albumin can be elevated and the IgG normal. This can mean the blood-brain barrier has become permeable to albumin, but not IgG, which is a larger molecule. Guillian-Barre Syndrome, which has been associated with influenza immunization shots, will give similar results. The total protein will also be elevated in this syndrome. The difference here is that the albumin is derived from breakdown of the CNS tissues.
 
This test may be used to aid in the diagnosis of Multiple sclerosis, Systemic lupus Erythematosus, Neurosarcoidosis, Syphilis, and CNS Lymphoma.
Outreach CPTs
CPT Modifier
(if needed)		 Quantity Description Comments
82784​ ​ ​ CSF IgG​ ​
82784​ ​ ​ Serum IgG​ ​
82042 ​ ​ CSF Albumin​ ​
82040 ​ ​ ​ Serum Albumin​ ​
Synonyms/Keywords
Immunoglobulin G and albumin in spinal fluid; Immunoglobulin G (IgG) in and albumin in CSF; also IgG and albumin in serum, CSF IgG Synthesis Rate​
Test Components
CSF IgG/Albumin Ratio, IgG Index, IgG Synthesis Rate, Serum IgG and Albumin, CSF IgG and Albumin​
Ordering Applications
Ordering Application Description
​Cerner ​IgG Synthesis, CSF
​COM ​IgG - Synthesis Rate
If the ordering application you are looking for is not listed, contact your local laboratory for assistance.
Specimen Requirements
Fasting Required Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)		 Pediatric Minimum Volume
(no repeat)
No​
Spinal Fluid (CSF)
and
Serum​
Screw cap, sterile, leakproof tubes for CSF
Red Top Tube (RTT) for serum

Plastic tube for CSF​ 

Serum Separator Tube (SST)
1.0 mL for CSF
 0.5 mL
for serum
​
0.5 mL for CSF
 0.3 mL for serum
​
0.5 mL for CSF
0.3 mL for serum
​
Collection Processing

CSF must be collected without red cells.  This will elevate both the CSF albumin and IgG because of serum contamination. 

Both CSF and serum are needed for analysis.  Separate labels and accession numbers are generated for blood and CSF samples.​

  • On first accession, one aliquot tube/label is required for the CSF sample and testing.
  • When this test order is placed, a separate accession with the test code "IGGSYN-S" will reflex for the serum testing. 2 aliquot tubes/labels are required for the serum sample and testing​

Serum sample must be drawn within 24 hours of spinal fluid collection.  If serum is not collected within 24 hours of CSF collection, please call Customer Service to discuss the case with a Clinical Chemist.

Separate serum from cells within 2 hours of collection

Specimen Stability Information
Specimen Type Temperature Time
CSF (spinal fluid)​ Refrigerated​ 7 days​
Serum​ Refrigerated​ 7 days​
Frozen​ 3 months​
Rejection Criteria
Hemolysis and/or the presence of intact RBC’s in the CSF specimen
For CSF - frozen samples​
Useful For
Measurement of the CSF proteins, albumin and IgG, are directed mainly towards the demonstration of two common disorders, namely blood-brain barrier damage and selective elevation of IgG due to local synthesis within the CNS.​
Test Components
CSF IgG/Albumin Ratio, IgG Index, IgG Synthesis Rate, Serum IgG and Albumin, CSF IgG and Albumin​
Reference Range Information
Performing Location Reference Range
Marshfield​
IgG (CSF): 0-6.6 mg/dL
Albumin (CSF): 15-32 mg/dL
IgG/Albumin ratio: 0.00-0.27
Serum Albumin (> 1 year): 3300-5000 mg/dL
Serum IgG (Adult): 617-1344 mg/dL
CSF IgG Index: 0.30-0.70
CSF IgG Synthesis Rate: 0.0-8.0 mg/day
Interpretation
An increase in the CSF IgG with a corresponding increase in the CSF IgG/Albumin Ratio suggests that the IgG is produced locally. Increases of IgG and total protein without corresponding increases in the ratio indicate damage to the blood-brain barrier.
 
In rare instances, the CSF albumin can be elevated and the IgG normal. This can mean the blood-brain barrier has become permeable to albumin, but not IgG, which is a larger molecule. Guillian-Barre Syndrome, which has been associated with influenza immunization shots, will give similar results. The total protein will also be elevated in this syndrome. The difference here is that the albumin is derived from breakdown of the CNS tissues.
 
This test may be used to aid in the diagnosis of Multiple sclerosis, Systemic lupus Erythematosus, Neurosarcoidosis, Syphilis, and CNS Lymphoma.
For more information visit:
Performing Laboratory Information
Performing Location Day(s) Test Performed Analytical Time Methodology/Instrumentation
Marshfield​ Monday through Friday​ 6-8 hours​ Turbidimetric method/The Binding Site Optilite analyzer
For billing questions, see Contacts
Outreach CPTs
CPT Modifier
(if needed)		 Quantity Description Comments
82784​ ​ ​ CSF IgG​ ​
82784​ ​ ​ Serum IgG​ ​
82042 ​ ​ CSF Albumin​ ​
82040 ​ ​ ​ Serum Albumin​ ​
For most current information refer to the Marshfield Laboratory online reference manual.