
What labs are needed for diagnosis and treatment?
It is a complex question, because there is no diagnostic test for PANS/PANDAS -- it is a clinical diagnosis. We use the labs to exclude other causes, and sometimes to help point us toward possible triggers that can be addressed.
There is a long list of possible labs in PANS/PANDAS, many listed below. The challenges to ordering them all are as follows:
Significance of positive results. If it is positive, does that mean it is involved in the disease process? Maybe it is because of the disease and not causing it? Maybe it is a random finding that isn't connected?
Trustworthy results. Maybe it is a false positive by labs whose businesses are driven by "finding" these sorts of problems. Maybe it is false negative by a lab whose processes do not give us the whole picture.
Cost of testing. Many of these are not covered by insurance and testing can run easily into the thousands of dollars. And may not give us any information which helps us.
Impact. Even with positive or negative results, we treat the PATIENT and how they are feeling, not the test result. So these may not inform our treatment. Further, they can cause harm by leading us down a goosechase of testing and treatment that does not actually improve the person's health (or worsens it!).
Ultimately, the tests need to be decided upon through joint discussion between the patient and the doctor. Knowing that we can use them thoughtfully, but that there are limits to what they can tell us, can help us decide the right approach for each person.
General Blood |
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| CBC with diff/plt |
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| Comprehensive metabolic panel (CMP) |
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| Iron/TIBC |
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| Ferritin |
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| TSH |
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| Free T4 |
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| Free T3 |
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| Reverse T3 |
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| Ceruloplasmin |
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| Lipid panel |
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General Inflammation |
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| Hs-CRP |
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| D-Dimer |
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| Prostaglandin D2 |
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Infection |
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| Rapid Strep antigen test |
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| Strep culture (throat) |
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| Anti-Dnase B Strep ab |
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| ASO Strep ab |
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| Mycoplasma pneumoniae IgG/IgM |
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| Chlamydia pneumonia IgG/IgM/IgA |
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| Toxoplasma gondii IgG and IgM |
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| EBV antibody profile |
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| EBV early antigen |
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| Pneumococcal ab titers |
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| Tetanus / diph ab titers |
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| DNA PCR molds |
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Autoimmunity |
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| Celiac antibody panel |
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| Celiac disease HLA (DQ2/DQ8) |
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| ANA with reflex panel |
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| Anti-Thyroglobulin AB |
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| TPO antibodies |
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| RF |
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| Anti-ccp ab (igA/IgG) |
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| Complement C4a |
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| Human TGFb-1 |
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| Autoimmune encehalitis antibodies |
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Immune and Allergic |
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| Area 5 environmental allergies IgE |
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| Mold allergies IgE |
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| IgA, IgG, IgM quant |
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| IgG subclasses 1-4 |
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| IgA subclasses |
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| Tryptase |
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Specialty Tick-bourne testing |
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Babesia – B duconi | Immunoblot IgG and IgM |
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| IFA |
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| FiSH |
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| PCR screen |
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Borrelia burdorferi | Immunoblot PCR |
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| WB IgM, IgG ab, IFA |
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| ELISA IgG and IgM |
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| Borellia speciation |
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| IgX Spot |
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Bartonella | Immunoblot igG and IgM, IFA |
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| igX spot |
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| PCR |
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| FiSH |
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Other tick-bourne | Broad coverage antibody test |
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| PCR |
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| Immunoblots (igM and igG) |
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| Lyme WB IgG and igM |
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| Anaplasma IgG abd IgM IFA |
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| Ehrlichia PCR |
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| Rickettsia PCR |
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| Anti-lysoganglioside GM-1 |
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| Anti-tubulin |
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| CaMKII stimulation assay |
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Stool testing | Culture |
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| O&P |
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| Yeast |
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| Calprotectin |
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| Blood |
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| Fatty acid (short-chain, fat stain) |
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| Other |
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Nasal swab |
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| Nasal bacterial culture |
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| Nasal fungal culture |
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| Biofilm analysis |
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Cunningham Panel |
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| Anti-dopamine D1 R |
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| Anti-dopamine D2L R |
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| Anti-lysogangliaside |
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| Anti-tubulin |
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| Ca/Calmodulin protein kinase II |
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Micronutrients & Vitamins |
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| Copper |
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| Homocysteine |
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| Folate |
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| Glutathione |
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| Vitamin D, 25-OH |
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| Methylmalonic acid |
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| RBC magnesium |
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| RBC zinc |
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| B6 |
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| B12 |
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| Serum heavy metals |
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| “Metabolomix” |
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Genetics |
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| MTHFR |
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| COMT |
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| Whole Exome? |
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