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Labs for PANS/PANDAS

Writer's picture: Rachel RothRachel Roth

Many tests can be used in PANS/PANDAS, but we are still learning which ones should guide treatment
Many tests can be used in PANS/PANDAS, but we are still learning which ones should guide treatment

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:

  1. 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?

  2. 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.

  3. 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.

  4. 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

 

 

 

CBC with diff/plt

 

 

Comprehensive metabolic panel (CMP)

 

 

Iron/TIBC

 

 

Ferritin

 

 

TSH

 

 

Free T4

 

 

Free T3

 

 

Reverse T3

 

 

Ceruloplasmin

 

 

Lipid panel

 

General Inflammation

 

 

 

Hs-CRP

 

 

D-Dimer

 

 

Prostaglandin D2

 

Infection

 

 

 

Rapid Strep antigen test

 

 

Strep culture (throat)

 

 

Anti-Dnase B Strep ab

 

 

ASO Strep ab

 

 

Mycoplasma pneumoniae IgG/IgM

 

 

Chlamydia pneumonia IgG/IgM/IgA

 

 

Toxoplasma gondii IgG and IgM

 

 

EBV antibody profile

 

 

EBV early antigen

 

 

Pneumococcal ab titers

 

 

Tetanus / diph ab titers

 

 

DNA PCR molds

 

Autoimmunity

 

 

 

Celiac antibody panel

 

 

Celiac disease HLA (DQ2/DQ8)

 

 

ANA with reflex panel

 

 

Anti-Thyroglobulin AB

 

 

TPO antibodies

 

 

RF

 

 

Anti-ccp ab (igA/IgG)

 

 

Complement C4a

 

 

Human TGFb-1

 

 

Autoimmune encehalitis antibodies

 

 

 

 

Immune and Allergic

 

 

 

Area 5 environmental allergies IgE

 

 

Mold allergies IgE

 

 

IgA, IgG, IgM quant

 

 

IgG subclasses 1-4

 

 

IgA subclasses

 

 

Tryptase

 

Specialty Tick-bourne testing

 

 

Babesia – B duconi

Immunoblot IgG and IgM

 

 

IFA

 

 

FiSH

 

 

PCR screen

 

Borrelia burdorferi

Immunoblot PCR

 

 

WB IgM, IgG ab, IFA

 

 

ELISA IgG and IgM

 

 

Borellia speciation

 

 

IgX Spot

 

Bartonella

Immunoblot igG and IgM, IFA

 

 

igX spot

 

 

PCR

 

 

FiSH

 

Other tick-bourne

Broad coverage antibody test

 

 

PCR

 

 

Immunoblots (igM and igG)

 

 

Lyme WB IgG and igM

 

 

Anaplasma IgG abd IgM IFA

 

 

Ehrlichia PCR

 

 

Rickettsia PCR

 

 

Anti-lysoganglioside GM-1

 

 

Anti-tubulin

 

 

CaMKII stimulation assay

 

Stool testing

Culture

 

 

O&P

 

 

Yeast

 

 

Calprotectin

 

 

Blood

 

 

Fatty acid (short-chain, fat stain)

 

 

Other

 

 

 

 

 

Nasal swab

 

 

 

Nasal bacterial culture

 

 

Nasal fungal culture

 

 

Biofilm analysis

 

Cunningham Panel

 

 

 

Anti-dopamine D1 R

 

 

Anti-dopamine D2L R

 

 

Anti-lysogangliaside

 

 

Anti-tubulin

 

 

Ca/Calmodulin protein kinase II

 

Micronutrients & Vitamins

 

 

 

Copper

 

 

Homocysteine

 

 

Folate

 

 

Glutathione

 

 

Vitamin D, 25-OH

 

 

Methylmalonic acid

 

 

RBC magnesium

 

 

RBC zinc

 

 

B6

 

 

B12

 

 

Serum heavy metals

 

 

“Metabolomix”

 

Genetics

 

 

 

MTHFR

 

 

COMT

 

 

Whole Exome?

 


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