Specimen:

Serum

Collection Medium:

Minimum:

Adult - 5 mL; red top tube
Pediatric - 2 mL; red top tube

Testing Schedule:

Daily - Batch analysis performed daily excluding 
weekends and university holidays.

Analytic Time:

3 days

Reference Range:

ANCA screen and titer: <1:40 Titer, includes interpretative report.

Comments:

Please include relevant clinical information on test order form.

Test includes both C-ANCA and P-ANCA screening and titering.  AMPO and 
APR3 confirmatory tests are performed if screen is positive or 
inconclusive.  Anti-neutrophil cytoplasmic antibodies are associated 
primarily with two groups of diseases: systemic necrotizing 
vasculitis/glomerulonephritis and inflammatory bowel and liver disease.  
Because the laboratory testing  strategies are different for these two 
groups of disease, different tests must be ordered for each of these 
workups.  "ANCA" is the test to be ordered when 
vasculitis/glomerulonephritis is in the differential diagnosis.
"UC-ANCA" is the test to order to evaluate patients with suspected 
inflammatory bowel or liver disease (see UC-ANCA listing for more 
testing information).

The "ANCA" test starts with immunofluorescence screening for both
C-ANCA (primarily associated with Wegner's granulomatosis) and p-ANCA 
(primarily associated with microscopic polyarteritis and pauci-immune 
GN). If the ANCA screen is positive, titration to end-point is 
performed. It is strongly recommended that confirmatory testing for 
anti-proteinase 3 (APR3) and anti-myeloperoxidase (AMPO) be performed 
at the time of initial identification of ANCA. P-ANCA can be confused 
with "UC-ANCA" or ANA on IFA screening.  Approximately 5% of patients 
with either "C-ANCA" or "P-ANCA" will have a specificity different from 
that usually associated with the ANCA IFA pattern (eg: P-ANCA may have 
PR3 specificity and the C-ANCA may have AMPO specificity).

Methodology:

ANCA screen and titer:  Indirect Immunofluorescence
AMPO and APR3:  Enzyme-Linked Immunosorbent Assay Test (ELISA)

CPT Code:

86255 ANCA screen, 86255-26 ANCA screen interpretation, 86256 ANCA 
titer, 86256-26 ANCA titer interpretation, 83520 APR3, 83520 AMPO

See also:
Myeloperoxidase Antibody, Serum
Proteinase 3 Antibody, Serum
UC-ANCA Screen and Interpretation, Serum