Antinuclear Antibodies (ANA)

CPT: 86038
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Test Details

Synonyms

  • ANA, IFA
  • ANA-Hep2

Use

Detect antibodies to nuclear antigens

Limitations

Males and females older than 80 years of age have a 50% incidence of low titer ANA. Various medications can induce a "lupoid" condition and elevated ANA titers. Usually, the titer decreases following removal of the drug.

Methodology

Indirect fluorescent antibody (IFA)

Reference Interval

• Negative: <1:80

• Borderline: 1:80

• Positive: >1:80

Additional Information

The indirect immunofluorescent test has three elements to consider in the result:

1. Positive or negative fluorescence. A negative test is strong evidence against a diagnosis of SLE but not conclusive. See Anti-DNA (Single-stranded) Antibodies, Quantitative, IgG [161422].

2. The titer (dilution) to which fluorescence remains positive (provides a reflection of the concentration or avidity of the antibody). Many individuals, particularly the elderly, may have low titer ANA without significant disease substantiated after work-up.

3. The pattern of nuclear fluorescence (reflecting specificity for various diseases). Homogenous and/or nuclear rim (peripheral) pattern correlates with antibody to native DNA and deoxynucleoprotein and bears correlation with SLE, SLE activity, and lupus nephritis. Homogenous (diffuse) pattern suggests SLE or other connective tissue diseases. Speckled pattern correlates with antibody to nuclear antigens extractable by saline; it is found in many disease states, including SLE and scleroderma. When antibodies to DNA and deoxyribonucleoprotein are present (rim and homogenous pattern), there may be interference with the detection of speckled pattern. Nucleolar pattern is seen in sera of patients with progressive systemic sclerosis and Sjögren's syndrome. Centromere pattern is seen in CREST syndrome.

Antinuclear Antibody

ANA Pattern Identification

Found In

Follow-up Tests

Smooth (homogeneous)

SLE

Anti-dsDNA

Anti-ssDNA

Anticardiolipin

Drug-induced lupus (DIL) other collagen diseases: chronic active hepatitis systemic scleroderma

Antihistone

Antichromatin

RF

Scl-70

SS-A/SS-B

Immune complex

Speckled

SLE

Anti-dsDNA

Anti-Sm

Anticardiolipin

Sjögren's syndrome

Anti-SS-A/SS-B

Antihistone

Viral or induced lupus

MCTD

Anti-RNP

RA

RF

Nucleolar

PSS/Scleroderma

Anti-RNP

Scl-70

Anti-SS-A/SS-B

Sjögren's syndrome

Anti-SS-A/SS-B

Subcutaneous SLE

Immune complex

SLE

Anti-dsDNA

Anti-ssDNA

Centromere

Scleroderma

SS-A/SS-B

Scl-70

CREST syndrome

Scl-70

Anti-RNP

Five percent of the apparently "normal population" demonstrate serum ANA. Low titers of ANA reactivity may be seen in patients with rheumatoid arthritis (40% to 60% of patients), scleroderma (60% to 90%), discoid lupus, necrotizing vasculitis, Sjögren's syndrome (80%), chronic active hepatitis, pulmonary interstitial fibrosis, pneumoconiosis, tuberculosis, malignancy, age over 60 (18%), as well as in SLE, especially if the disease is inactive or under treatment. Titers ≥1:160 usually indicate the presence of active SLE, although occasionally other autoimmune disease may induce these high titers. There are now known groups of "ANA-negative" lupus patients. Such patients often have antibodies to SS-A/Ro antigen (usually when a frozen section substrate is used) and subacute cutaneous lupus. Ten percent of patients with SLE manifest biologic false-positive tests for syphilis; this may even be the initial manifestation. Some other tests used in differentiation of autoimmune states include antibody to double-stranded DNA, rheumatoid factor, antibody to extractable nuclear antigens, total hemolytic complement (C3, C4, etc). Although ANA tests are occasionally ordered on cerebrospinal fluid or synovial fluid, the current assays are not standardized for these fluids and such assays do not add to the diagnostic process.

Specimen Requirements

Specimen

Serum

Volume

1 mL

Minimum Volume

0.5 mL

Container

Red-top tube or gel-barrier tube

Storage Instructions

Room temperature

Stability Requirements

Temperature

Period

Room temperature

7 days

Refrigerated

7 days

Frozen

7 days

Freeze/thaw cycles

Stable x2

Causes for Rejection

Hemolysis; lipemia; gross bacterial contamination

LOINC® Map

Order Code Order Code Name Order Loinc Result Code Result Code Name UofM Result LOINC
164947 Antinuclear Antibodies, IFA 5048-4 164947 Antinuclear Antibodies, IFA 5048-4
Reflex Table for Antinuclear Antibodies, IFA
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 012625 FANA Staining Patterns 016279 Homogeneous Pattern 20398-4
Reflex Table for Antinuclear Antibodies, IFA
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 012625 FANA Staining Patterns 016287 Nucleolar Pattern 20399-2
Reflex Table for Antinuclear Antibodies, IFA
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 012625 FANA Staining Patterns 016295 Speckled Pattern 20401-6
Reflex Table for Antinuclear Antibodies, IFA
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 012625 FANA Staining Patterns 016303 Centromere Pattern 5077-3
Reflex Table for Antinuclear Antibodies, IFA
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 012625 FANA Staining Patterns 016264 Spindle Apparatus Pattern 53003-0
Reflex Table for Antinuclear Antibodies, IFA
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 012625 FANA Staining Patterns 016265 Nuclear Membrane Pattern 54006-2
Reflex Table for Antinuclear Antibodies, IFA
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 012625 FANA Staining Patterns 016266 Midbody Pattern 54155-7
Reflex Table for Antinuclear Antibodies, IFA
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 012625 FANA Staining Patterns 016267 Nuclear Dot Pattern 53998-1
Reflex Table for Antinuclear Antibodies, IFA
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 012625 FANA Staining Patterns 016268 PCNA Pattern 53006-3
Reflex Table for Antinuclear Antibodies, IFA
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 012625 FANA Staining Patterns 016269 Centriole Pattern 54151-6
Reflex Table for Antinuclear Antibodies, IFA
Order Code Order Name Result Code Result Name UofM Result LOINC
Reflex 1 012625 FANA Staining Patterns 016271 Note: N/A

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