Anti-nuclear antibody by IFA
Anti-nuclear antibody by IFA-12467
FANA
Positive screening results reflex to a titer at an additional charge.
If positive, a pattern including the following will be reported out along with a titer up to ≥2560. If cytoplasmic staining is present, it will be noted:
- Homogenous
- Speckled
- Dense fine speckled
- Centromere
- Spindle
- Nucleolar
- Nuclear dots
Circulating autoantibodies directed against nuclear antigens (ANA) can be titered and identified by pattern by using indirect fluorescent antibody (IFA) procedures. The ANA titer is a diagnostic aid only. Low titer positives may occur in healthy people, therefore, a positive titer must be interpreted in the context of the patient’s clinical picture. Multiple antibodies may be present, making individual antibody identification difficult. Serial dilutions may aid in pattern determination.
Excessive hemolysis or lipemia may produce non-specific background staining which may interfere with the interpretation of the reaction
Immediatley following collection, mix sample by gently inverting 5 times
- Allow sample to clot for a minimum of 30 minutes
- Spin within two (2) hours of sample collection
Gold serum separator (SST) tube
- Allow sample to clot
- Spin
- Transfer serum to a False bottom plasma/serum transport vial/tube (AHL), labelled as serum, within two (2) hours of sample collection
Refrigerated (preferred) - 7 days
Frozen (OK)
- Improper labels (unlabeled or mislabeled)
- Hemolysis (some procedures)
- Improper anticoagulant or ratio
- Delay in transport
- Improper storage temperature affecting results
- Improper container
- Leaking container resulting in compromised specimen
- Quantity not sufficient (QNS)
Immunofluorescence Antibody (IFA) on Hep-2 Substrate, IgG
Negative
The most common autoantibodies and their associated ANA pattern are listed below. Some patterns are more specific to the disease process involved than others. For example, the homogeneous, nucleolar, and centromere patterns are fairly specific for SLE, scleroderma, and CREST variant of scleroderma respectively. On the other hand, the speckled pattern is the most nonspecific. Also note that patients undergoing successful treatment may be negative for ANA.
|
Autoantibody/Antigens recognized |
ANA pattern |
Disease association |
|
Double & Single Stranded DNA |
Homogeneous/Rim |
SLE & low levels may occur in other rheumatic disease |
|
Histones |
Homogeneous/Rim |
Drug-induced lupus, SLE |
|
Deoxynucleoprotein |
Homogeneous/Rim |
Drug-induced lupus, SLE |
|
Smith(Sm) |
Speckled |
Diagnostic of SLE |
|
Nuclear RNP |
Speckled |
High titer-Mixed connective tissue disorder/SLE |
|
SS-A (Ro) |
Speckled Negative (low titer) |
Sjogren’s’ syndrome, SLE |
|
SS-B (La) |
Speckled |
Sjogren’s syndrome |
|
Centromere |
Centromere |
CREST variant of Scleroderma |
|
RNA Polymerase I |
Nucleolar |
Scleroderma- high prevalence |
|
Fibrillarin |
Nucleolar |
Scleroderma |
|
DNA Topoisomerase I (Scl-70) |
Nucleolar |
Scleroderma |
|
PM-ScL |
Nucleolar |
Polymyositis |
|
Mitotic Spindle Apparatus, NuMA |
Spindle (MSA) |
Carpal tunnel syndrome, SLE, Sjogren’s |
|
Jo-1 |
Cytoplasmic Nucleolus |
Polymyositis |
Drugs that have been reported to induce SLE include: Salicylic acid, mephenytoin, carbamazepine, ethosuximide, phenytoin, primidone, trimethadione, chlorpromazine, chlorthalidone, D-penicillin, griseofulvin, hadrallazine, isoniazid, levodopa, methyldopa, oral contraceptive, phenylbutazone, practolol, procainamide, quinidine, streptomycin, sulphonamides, tetracycline, and many more
Additional CPT codes (if appropriate):
86039 - Titer