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MAIN
ANA
C-ANCA P- ANCA ANA
NEGATIVE NEGATIVE NEGATIVE
This serum sample is negative at a dilution of 1:20 for anti-neutrophil cytoplasmic antibodies (ANCA) in both the coarse granular (C-ANCA) and perinuclear (P-ANCA) patterns on both ethanol and formalin fixed human neutrophils. This serum sample is also negative for antinuclear (ANA) and anti-cytoplasmic antibodies at a 1:40 dilution on a human epithelial cell substrate (Hep-2 cells).
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C-ANCA P- ANCA ANA
NEGATIVE NEGATIVE POSITIVE
This serum sample is negative at a dilution of 1:20 for anti-neutrophil cytoplasmic antibodies (ANCA) in both the coarse granular (C-ANCA) and perinuclear (P-ANCA) patterns.
This serum sample is positive for antinuclear antibody (ANA) at a 1:40 dilution in a ____ pattern on a human epithelial cell substrate (Hep-2 cells).
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ANA
PATTERN
C-ANCA
POSITIVE
This serum is positive anti-neutrophil cytoplasmic antibodies (ANCA) in the coarse granular (C-ANCA) pattern at a titer of ___ as measured by immunofluorescence on both ethanol and formalin fixed human neutrophils.
The C-ANCA pattern has been primarily associated with cases of active Wegener's granulomatosis, but may also be seen in systemic necrotizing vasculitis of the polyarteritis group and in the pauci-immune type of idiopathic crescentic glomerulonephritis.
Although a single titer may not reflect severity of disease, serial titers over time are useful for assessment of disease progression and response to therapy.
A confirmatory EIA test for antibodies against proteinase-3 is available.
Antineutrophil cytoplasmic antibodies (ANCA) are a group of autoantibodies which have been associated with some of the necrotizing, systemic vasculitides and the pauci-immune type of idiopathic crescentic glomerulonephritis.
The C-ANCA pattern is caused by antibodies reacting with a 29kd protein found within neutrophil primary granules called proteinase-3 (about 10% of these may be due to antibodies reacting with other neutrophil components such as cathepsin G and cationic protein 57).
This has increased significantly since the previous determination of ___ on ____.
This serum sample is also negative for antinuclear (ANA) and anti-cytoplasmic antibodies at a 1:40 dilution on a human epithelial cell substrate (Hep-2 cells).
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P- ANCA
POSITIVE
The patient's serum is positive for anti-neutrophil cytoplasmic antibodies (ANCA) in the perinuclear (P-ANCA) pattern at a titer of _ as measured by immunofluorescence on both ethanol and formalin fixed human neutrophils. The P-ANCA pattern is caused by antibodies reacting with myeloperoxidase (about 10% of these may be due to antibodies reacting with other neutrophil components such as elastase and lactoferrin).
The P-ANCA pattern has been primarily associated with cases of systemic necrotizing vasculitis of the polyarteritis group and the pauci-immune type of idiopathic crescentic glomerulonephritis, but may also be seen in active Wegener's granulomatosis.
Although a single titer does not necessarily reflect severity of disease, serial titers over time are useful for assessment of disease progression and response to therapy.
A confirmatory EIA test for antibodies against myeloperoxidase is available.
Non MPO P-ANCA antibodies have been identified in autoimmune liver diseases, chronic arthridities and up to 5% of healthy controls (Cees et al Am. J Med 93:675,1992.)
This serum sample is also negative for antinuclear (ANA) and anti-cytoplasmic antibodies at a 1:40 dilution on a human epithelial cell substrate (Hep-2 cells).
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Atypical P-ANCA
THE EXAMINATION SHOWS AN ATYPICAL P-ANCA PATTERN.
The patient's serum is positive for anti-neutrophil cytoplasmic antibodies (ANCA) in an atypical perinuclear (P-ANCA) pattern a titer of _ as measured by immunofluorescence on both ethanol and formalin fixed human neutrophils. The atypical P-ANCA (very perinuclear pattern) has been associated with inflammatory bowel disease and sclerosing cholangitis. It is detected in 60-85% of ulcerative colitis, 10-20% of Crohn disease and also in 65-85% of primary sclerosing cholangitis with and without inflammatory bowel disease (IBD). These IBD-related P-ANCA are not associated with antibody to proteinase-3 or to myeloperoxidase.
This serum sample is also negative for antinuclear (ANA) and anti-cytoplasmic antibodies at a 1:40 dilution on a human epithelial cell substrate (Hep-2 cells).
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ANA Cytoplasmic Pattern
This serum sample is negative at a dilution of 1:20 for anti-neutrophil cytoplasmic antibodies (ANCA) in both the coarse granular (C-ANCA) and perinuclear (P-ANCA) patterns on both ethanol and formalin fixed human neutrophils. This serum sample is also negative for antinuclear antibodies (ANA) at a 1:40 dilution on a human epithelial cell substrate (Hep-2 cells).
This serum sample does however demonstrate a positive reaction with a cytoplasmic antigen on the Hep-2 cell substrate. Tests can be ordered for smooth muscle or mitochondria antibodies if clinically warranted.
Serial monitoring of ANCA
ANCA decreased
The C-ANCA titer has decreased from the previous determination of ___ on mm/dd/yy. This may not be a significant change.
ANCA increased
The C-ANCA titer has increased from the previous determination of ___ on ___. This increased titer suggests progression of disease.
The C-ANCA titer has increased from the previous determination of ___ on ___. This increased titer of one dilution may or may not be significant.
ANCA unchanged
The C-ANCA titer is unchanged from the value of ____ measured on ____.
Specialty Labs Test for MPO, PR-3, etc
SPECIALTY LABS INTERPRETATION: Antineutrophil Cytoplasmic Antibodies (ANCA) Evaluation TEST NAME RESULTS REFERENCE RANGES ANCA IgG (Flow Cytometry) 68 Less than 22 SLI Units ANCA IgM (Flow Cytometry) Less than 30 Less than 30 SLI Units Myeloperoxidase (MPO) Ab 23 21-50 is Weakly Positive Proteinase-3 (PR-3) Ab Less than 10 Less than 10 EIA Units Antinuclear Antibodies Greater than 30 Less than 7.5 IU/mL ANA PATTERN HOMOGENEOUS
The presence of P-ANCA could not be determined because of nuclear fluorescence due to ANA.
Antineutrophil Cytoplasmic Antibodies (ANCA) Evaluation, IFA/FC:
Detection, quantitation and classification of ANCA (including specificity for MPO and PR-3) help distinguish the various forms of renal-limited and multisystem vasculitis. C-ANCA are present in 84-100% of patients with generalized Wegener granulomatosis (WG) and somewhat less frequently in the limited form of WG. C-ANCA-positive sera containing PR-3 Ab are 80% sensitive and 97% specific for WG. Clearly, however, neither the C-ANCA nor P-ANCA patterns per se nor PR-3 or MPO Ab correlate absolutely with any single spectrum of organ involvement in ANCA-related diseases. Positive ANCA results obtained in patients with other types of vasculitis, (sometimes in the form of microscopic polyarteritis, Churg-Strauss syndrome, polyarteritis nodosa and polyangiitis), typically give a P-ANCA pattern and are usually associated with Ab to MPO. Although C-ANCA and P-ANCA (including PR-3 and MPO specificities) are typically of the IgG isotype, ANCA restricted to the IgM isotype and associated with pulmonary hemorrhage are reported, as are ANCA/MPO Ab in about 30% of Ab-mediated glomerular basement membrane disease. About 85% of C-ANCA-positive sera are PR-3 Ab-positive and similarly about 85% of PR-3 Ab-positive sera are C-ANCA-Positive. About 90% of patients with ANCA-related vasculitis/GN who are MPO Ab-positive are P-ANCA positive and vice versa. Ab to PR-3 are highly sensitive and specific for WG, as are Ab to MPO for vasculitis-associated idiopathic crescentic glomerulonephritis, classical polyarteritis, Churg-Strauss syndrome and polyangiitis overlap syndrome with renal manifestations of vasculitis. An atypical P-ANCA pattern is detected in 60-85% of ulcerative colitis, 10-20% of Crohn disease and also in 65-85% of primary sclerosing cholangitis with and without inflammatory bowel disease (IBD). These IBD-related P-ANCA are not associated with Ab to PR-3 or to MPO. In patients with antinuclear Ab, reliable detection of Ab which produce a P-ANCA fluorescence pattern is very difficult; under these circumstances, detection of MPO Ab by EIA is particularly valuable. RECOMMENDATIONS: Serial monitoring of ANCA, including PR-3 or MPO Ab, is valuable in assessing response to therapy and early detection of relapse. Please provide the Specialty Laboratories accession number of this serum when submitting follow-up sera. The sera will be tested simultaneously to optimize the utility of the results. All sera are stored frozen for two months. (301).
Test performed by Specialty Laboratories, Inc.
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8 SPECIALTY LABS INTERPRETATION:
Antineutrophil Cytoplasmic Antibodies (ANCA) Evaluation
TEST NAME ___________________ RESULTS ____REFERENCE RANGES
ANCA IgG (Flow Cytometry) 2.4 Less than 2.5 RFU
ANCA IgM (Flow Cytometry) 4.8 Less than 2.5 RFU
ANCA IgA (Flow Cytometry) 2.3 Less than 2.7 RFU
Myeloperoxidase (MPO) Ab 21 Less than 10 EIA Units
Proteinase-3 (PR-3) Ab * Less than 10 EIA Units
Antinuclear Antibodies * Less than 7.5 IU/mL
* = Less than the limit of detection.
ANCA IgG and IgM
Less than 2.5 RFU Negative
2.5-3.0 RFU Indeterminate
Greater then 3.0 RFU Positive
ANCA IgA
Less than 2.7 RFU Negative
2.7-3.0 RFU Indeterminate
Greater then 3.0 RFU Positive
MPO
Less than 10 Units Negative
10-20 Units Indeterminate
21-50 Units Weakly Positive
51-200 Units Positive
Greater then 3.0 RFU Strongly Positive
The titers of IgG, IgA and IgM ANCA and myoloperoxidase have increased since the previous examination on 3/25/95.