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INTEGRATED PATHOLOGY SERVICEGENERAL PATHOLOGY DOCUMENTImmunology Test User Guide [PD-IMM-TestGuide]AUTHOR:Samantha NelsonAPPROVED BY:Sue TantDATE OF ISSUE:16/08/20DATE EFFECTIVE FROM:16/08/20VERSION NO:2REVIEW INTERVAL:BiennialCOPY:1LOCATION OF COPIES:1 Electronic – Q-Pulse2 Electronic - InternetAssayAnti-neutrophil cytoplasmic antibodies SynonymsANCASample type/VolumeOne 7ml SST (Gold top) tube per patientTest instructionsN/AReferral laboratoryN/ATurnaround time10 Working DaysTest indicationsANCA may be perinuclear (P-ANCA) or cytoplasmic (C-ANCA). These are found in small vessel vasculitis but also may be associated with other systemic inflammatory conditions or chronic infections. Antibodies to myeloperoxidase (MPO) and proteinase 3 (PR3) are used to determine the disease-specificities of the ANCA. Reference intervalsReported as Positive p-ANCA; Positive c-ANCA or Negative Interferences It may not be possible to identify ANCA if the patient has a positive ANA. In these samples MPO and PR3 will always be tested. AssayAnti-cardiolipin antibodies SynonymsACL, Cardiolipin, ACASample type/VolumeOne 7ml SST (Gold top) tube per patientTest instructionsN/AReferral laboratoryN/ATurnaround time10 Working DaysTest indicationsAssociated with an increased risk of arteriovenous thrombosis, recurrent foetal loss, and thrombocytopenia. Associated with a prolonged APTT and with the lupus anticoagulant. Reference intervalsIgG ACA: 0-10 GPL-U/mlIgM ACA: 0-10 MPL-U/mlInterferences None known CommentsIt is recommended that positive results are confirmed after 12 weeks AssayAdrenal antibodiesSynonymsN/ASample type/VolumeOne 7ml SST (Gold top) tube per patientTest instructionsN/AReferral laboratoryClinical Laboratory ImmunologyChurchill HospitalHeadingtonOxford OX3 7LEUKSpecimen Reception / Enquiries: 01865 225995Turnaround time14 daysTest indicationsAntibodies to adrenal cortex are present in up to 70% patients with primary Addison's disease. They can also form part of the autoantibody spectrum seen in autoimmune polyendrocrinopathies.Reference intervalsReported as Positive or Negative Interferences All Positive results have a full autoantibody screen carried out to rule out the presence of a mitochondrial antibodyAssayAnti-AMPA1 AntibodiesSynonymsN/ASample type/VolumeOne 7ml SST (Gold top) tube per patientTest instructionsN/A Referral laboratoryClinical Laboratory ImmunologyChurchill HospitalHeadingtonOxford OX3 7LEUKSpecimen Reception / Enquiries:? 01865 225995Turnaround time14 DaysTest indicationsUsed for the diagnosis of treatable autoimmune encephalitis. Reference intervalsQualitativeInterferences N/AAssayAnti- AMPA2 AntibodiesSynonymsN/ASample type/VolumeOne 7ml SST (Gold top) tube per patientTest instructionsN/AReferral laboratoryClinical Laboratory ImmunologyChurchill HospitalHeadingtonOxford OX3 7LEUKSpecimen Reception / Enquiries:?01865 225995Turnaround time14 DaysTest indicationsUsed for the diagnosis of treatable autoimmune encephalitis.Reference intervalsQualitativeInterferences N/AAssayAnti-nuclear antibodiesSynonymsANA, ANF, Hep2Sample type/VolumeOne 7ml SST (Gold top) tube per patientTest instructionsN/AReferral laboratoryN/ATurnaround time10 Working daysTest indicationsHigh titre levels are highly suggestive of a systemic connective tissue disorder, but low levels are frequently found in old age and with any cause of chronic inflammation Reference intervalsReported as Positive (with pattern) or Negative Interferences N/ACommentsCTD screen has replaced ANA as the first line screening test for connective tissue disease AssayAquaporin AntibodiesSynonymsNMO; Aquaporin 4 Sample type/VolumeOne 7ml SST (Gold top) tube per patientTest instructionsN/AReferral laboratoryClinical Laboratory ImmunologyChurchill HospitalHeadingtonOxford OX3 7LEUKSpecimen Reception / Enquiries:?01865 225995Turnaround time14 DaysTest indicationsAquaporin 4 (AQP4) is the major autoantigen in neuromyelitis optica (NMO, or Devic's disease). Antibodies to AQP4 are found in >80% of NMO patients and around 50% of patients with longitudinally extensive transverse myelitis. They are infrequent in patients with optic neuritis without spinal cord involvement.Reference intervalsReported as Positive or NegativeInterferences N/AAssayAutoimmune profileSynonymsAIPSample type/VolumeOne 7ml SST (Gold top) tube per patientTest instructionsN/AReferral laboratoryN/ATurnaround time10 Working daysTest indicationsThis combined test will detect auto antibodies to gastric parietal cells in autoimmune gastritis/pernicious anaemia and mitochondria, smooth muscle, liver-kidney microsomes in autoimmune liver disease.Reference intervalsEach antibody is reported as either positive or negative Interferences The presence of mitochondrial antibodies may obscure any GPC staining present AssayBasal GangliaSynonymsN/ASample type/VolumeOne 7ml SST (Gold top) tube per patientTest instructionsN/AReferral laboratoryNeuroimmunology & CSF Laboratory (NICL)The National Hospital for Neurology & Neurosurgery9th FloorQueens SquareLondonWC1N 3BGTurnaround time10 DaysTest indicationsABGA have been associated with movement disorders (usually tics and chorea) and psychiatric disturbance in children. It is hypothesised that dystonia in adults or adolescents may be part of the clinical spectrum of the post-infectious syndrome associated with ABGA.Reference intervalsReported as Positive or Negative Interferences N/AAssayBeta-2-Glycoprotein-1SynonymsB2GPSample type/VolumeOne 7ml SST (Gold top) tube per patientTest instructionsN/AReferral laboratoryN/ATurnaround time10 Working daysTest indicationsBeta-2-GP-1 is a phospholipid binding protein and antibodies directed against this antigen are seen in patients suffering from the Anti-Phospholipid Syndrome (APS). This test is recommended in patients suspected of having APS in whom the lupus anticoagulant and anti-cardiolipin assays are negative.Reference intervalsNormal range IgG B2GP: 0-10 U/mLNormal range IgM B2GP: 0-10 U/mLInterferences Rheumatoid factor (RF) can interfere with the determination of IgM anti-β2-Glycoprotein I antibodiesAssayC1q AntibodiesSynonymsN/ASample type/VolumeOne 7ml SST (Gold top) tube per patientTest instructionsN/A Referral laboratoryDepartment of Immunology, SheffieldImmunology & protein reference unitPO Box 894SheffieldS5 7YT0114 2715552Turnaround time10 DaysTest indicationsAntibodies against the first component of the classical pathway, C1q, are seen in some forms of systemic lupus erythematosus, and in hypocomplementaemic urticarial vasculitis. It is not generally useful in patients with normal C3, C4 levels.Reference intervalsNormal range <15 U/mLInterferences N/AAssayCaspr2 AntibodiesSynonymsN/ASample type/VolumeOne 7ml SST (Gold top) tube per patientTest instructionsN/AReferral laboratoryClinical Laboratory ImmunologyChurchill HospitalHeadingtonOxford OX3 7LEUKSpecimen Reception / Enquiries:?01865 225995Turnaround time14 DaysTest indicationsSuspicion of autoimmune encephalitis and Morvans Syndrome. CASPR2 (Contactin Associated Protein 2) is a subunit of the potassium channel complex (VGKC) and is included in the group of extracellular antigens. Antibodies against CASPR2 may occur in neuromyotonia, autoimmune encephalitis and Morvan Syndrome.Reference intervalsReported as Negative or PositiveInterferences N/ACommentsCaspr2 antibodies will be automatically tested if the VGKC is positive AssayCyclic Citrullinated Peptide AntibodiesSynonymsCCPSample type/VolumeOne 7ml SST (Gold top) tube per patientTest instructionsN/AReferral laboratoryN/ATurnaround time10 Working daysTest indicationsTo help in the diagnosis of?rheumatoid arthritis (RA)?and differentiate it from other types of arthritis; sometimes to help evaluate the prognosis of a patient with RAReference intervalsNormal range 0-10 U/mLInterferences Grossly haemolysed, lipaemic or microbially contaminated samples may give erroneous results.AssayCoeliac screenSynonymsTTGSample type/VolumeOne 7ml SST (Gold top) tube per patientTest instructionsPatients must be on a gluten containing diet for 6 weeks prior to testing if the assay is being performed for the diagnosis of coeliac diseaseReferral laboratoryN/ATurnaround time10 Working daysTest indicationsFor the investigation and monitoring of coeliac disease. Also seen in patients with dermatitis herpetiformis.Reference intervalsNormal range <10 U/mlInterferences Grossly haemolysed, lipaemic or microbially contaminated samples may give erroneous mentIn the first instance serum will be tested for IgA tissue transglutaminase antibodies. Follow up testing for serum IgA levels and IgA/G endomysial antibodies may be performed. . AssayDNA antibodiesSynonymsDouble-stranded DNA antibodiesSample type/VolumeOne 7ml SST (Gold top) tube per patientTest instructionsN/AReferral laboratoryN/ATurnaround time10 Working daysTest indicationsDiagnosis and monitoring of SLE: Positive anti-DNA antibodies are found in 70-90% of patients with SLE where levels show some correlation with disease activity. A negative test does not exclude the diagnosis. Also found in low levels in other systemic CTD.Reference intervalsNormal range <15 IU/ml Interferences Grossly haemolysed, lipaemic or microbially contaminated samples may give erroneous mentsCTD is used as the first line screening test for all connective tissue diseases. If positive it will be followed up with both DNA and ENA testing. DNA assay should only be requested when monitoring SLE activity.AssayENA ScreenSynonymsExtractable nuclear antigenSample type/VolumeOne 7ml SST (Gold top) tube per patientTest instructionsN/AReferral laboratoryN/ATurnaround time10 Working daysTest indicationsThe ENA screen includes the following antibodies:Anti SSA: Associated with Sjogrens syndrome. SSA is found particularly in subacute cutaneous lupus but also in Sjorgens syndrome and SLE. Anti-SSB: Associated with Sjorgens syndrome. Anti-RNP: Found in 90% of those with MCTDAnti Sm: Indicative of SLE when found alone. Anti-Jo-1: Detected in polymyositis associated with interstitial lung disease. Anti-Scl-70: Detected in scleroderma. CENP: Associated with limited systemic sclerodermaIf the ENA screen is positive the serum will be tested for each of the 7 antibodies individuallyReference intervalsENA screen: Normal range 0-1 ratioSSA: Normal range 1-10 U/mlSSB: Normal range 1-10U/mlSm: Normal range 1-10 U/mlRNP: Normal range 0-10 U/mlScl-70: Normal range 0-10 U/mlJo-1: Normal range 0-10 U/mlCENP: Normal range 0-10 U/mlInterferences Grossly haemolysed, lipaemic or microbially contaminated samples may give erroneous mentsCTD is used as the screening test for all connective tissue diseases. If positive it will be followed up with both the DNA and ENA screen assay. AssayEndomysial antibodiesSynonymsEMASample type/VolumeOne 7ml SST (Gold top) tube per patientTest instructionsPatients must be on a gluten containing diet for 6 weeks prior to testing if the assay is being performed for the diagnosis of coeliac diseaseReferral laboratoryN/ATurnaround time10 Working daysTest indicationsFound in >90% of patients with coeliac disease especially if IgA isotype. Also 35% of patients with Dermatitis Herpetiformis. To assist in the diagnosis of coeliac diseaseReference intervalsReported as Positive or Negative Interferences N/ACommentIn the first instance serum will be tested for IgA tissue transglutaminase antibodies. Follow up testing for serum IgA levels and IgA/G endomysial antibodies may be performed. AssayGABAbSynonymsN/ASample type/volumeOne 7ml SST (Gold top) tube per patientTest instructionsN/AReferral laboratoryClinical Laboratory ImmunologyChurchill HospitalHeadingtonOxford OX3 7LEUKSpecimen Reception / Enquiries:?01865 225995Turnaround time14 DaysTest indicationsUsed for the diagnosis of treatable autoimmune encephalitis.Reference intervalsReported as Positive or NegativeInterferences N/AAssayGlutamic Acid Decarboxylase AntibodiesSynonymsGADSample type/VolumeOne 7ml SST (Gold top) tube per patientTest instructionsN/AReferral laboratoryDepartment of Immunology, SheffieldImmunology & protein reference unitPO Box 894SheffieldS5 7YT0114 2715552Turnaround time5 DaysTest indicationsAntibodies to glutamic acid decarboxylase (anti-GAD) are reliable serological markers of Insulin-dependent diabetes mellitus.Anti-GAD antibodies in high titre are associated with the stiff-person syndrome (60% sensitivity), a rare neurological disease characterised by muscle rigidity and spasms.Reference intervalsNormal range <5 U/mlInterferences N/AAssayGanglioside AntibodiesSynonymsGM1 & GQ1bSample type/volumeOne 7ml SST (Gold top) tube per patientTest instructionsN/AReferral laboratoryClinical Laboratory ImmunologyChurchill HospitalHeadingtonOxford OX3 7LEUKSpecimen Reception / Enquiries:?01865 225995Turnaround time21 DaysTest indicationsAnti-ganglioside antibodies are associated with several immunologically mediated peripheral neuropathies e.g. anti-GM1 (IgM) with multifocal motor neuropathy, GQ1b (IgG) with the Miller-Fisher syndrome and GM1 (IgG) with the Guillain-Barre syndrome.Anti-ganglioside antibodies are often found at low titres in normal individuals.Reference intervalsGM1: Normal range <1/200 titreGQ1b:Normal range <1/50 titreInterferences N/AAssayGBM AntibodiesSynonymsN/ASample type/VolumeOne 7ml SST (Gold top) tube per patientTest instructionsN/AReferral laboratoryN/ATurnaround time10 Working daysTest indicationsAntibodies against GBM are seen in Goodpasture’s syndrome, a pulmonary-renal form of vasculitis associated with rapidly progressing renal failure and haemoptysis. About 10% of patients with granulomatosis with polyangiitis may also have GBM antibodies.Reference intervalsNormal range 0-10 U/mLInterferences Grossly haemolysed, lipaemic or microbially contaminated samples may give erroneous results.AssayGlycine Receptor AntibodiesSynonymsN/ASample typeOne 7ml SST (Gold top) tube per patient or 0.5 ml CSFTest instructionsSerum preferredReferral laboratoryClinical Laboratory ImmunologyChurchill HospitalHeadingtonOxford OX3 7LEUKSpecimen Reception / Enquiries:?01865 225995Turnaround time14 daysTest indicationsSuspected Stiff person syndrome and especially PERM (Progressive encephalomyelitis with rigidity and myoclonus).Reference intervalsReported as Positive or Negative Interferences N/AAssayGM1Ab; GQ1bSynonymsGanglioside antibodiesSample type/VolumeOne 7ml SST (Gold top) tube per patientTest instructionsN/AReferral laboratoryClinical Laboratory ImmunologyChurchill HospitalHeadingtonOxford OX3 7LEUKSpecimen Reception / Enquiries:?01865 225995Turnaround time21 DaysTest indicationsAnti-ganglioside antibodies are associated with several immunologically mediated peripheral neuropathies e.g. anti-GM1 (IgM) with multifocal motor neuropathy, GQ1b (IgG) with the Miller-Fisher syndrome and GM1 (IgG) with the Guillain-Barre syndrome.Anti-ganglioside antibodies are often found at low titres in normal individuals.Reference intervalsGM1: Normal range <1/200 titreGQ1b:Normal range <1/50 titreInterferences N/AAssayHistoneSynonymsN/ASample type/VolumeOne 7ml SST (Gold top) tube per patientTest instructionsN/A Referral laboratoryDepartment of Immunology, SheffieldImmunology & protein reference unitPO Box 894SheffieldS5 7YT0114 2715552Turnaround time10 DaysTest indicationsHistone antibodies have been reported in cases of drug-induced SLE. They are temporary and disappear within a few months after withdrawal of the inducing drug.Reference intervalsNormal range <40 U/mlInterferences N/AAssayIA2 AntibodiesSynonymsN/ASample type/VolumeOne 7ml SST (Gold top) tube per patientTest instructionsN/AReferral laboratoryDepartment of Immunology, SheffieldImmunology & protein reference unitPO Box 894SheffieldS5 7YT0114 2715552Turnaround time10 DaysTest indicationsAutoimmune Diabetes Mellitus.Reference intervalsNormal range 0-10 IU/mlInterferences N/AAssayInsulin AntibodiesSynonymsN/ASample type/VolumeOne 7ml SST (Gold top) tube per patientTest instructionsN/AReferral laboratoryDepartment of Immunology, SheffieldImmunology & protein reference unitPO Box 894SheffieldS5 7YT0114 2715552Turnaround time5 DaysTest indicationsPredictor for type 1 diabetes. Insulin resistance.Reference intervals< 5 mg/L Negative.5-10 mg/L Equivocal.> 10 mg/L PositiveInterferences N/AAssayIntrinsic factor antibodies SynonymsN/ASample type/VolumeOne 7ml SST (Gold top) tube per patientTest instructionsN/AReferral laboratoryN/ATurnaround time10 Working daysTest indicationsFound in Pernicious anaemia; Request with AIP for parietal cell abs in patients with low B12 levels Reference intervalsNormal range 0-10 U/mLInterferences Grossly haemolysed, lipaemic or microbially contaminated samples may give erroneous results.AssayIslet cell antibodiesSynonymsN/ASample type/VolumeN/ATest instructionsRequest GAD antibodies. This test is no longer offered.Referral laboratoryN/ATurnaround timeN/ATest indicationsSee GAD antibodies. Reference intervalsN/AInterferences N/AAssayLiver blotSynonymsExtended liver panelSample type/VolumeOne 7ml SST (Gold top) tube per patientTest instructionsN/AReferral laboratoryDiagnostic Immunology and Allergy King's College HospitalBessemer Wing - 1st FloorDenmark HillLondon SE5 9RS 020 3299 1555Turnaround time6 DaysTest indicationsThe extended liver blot includes the following:AMA-M2: Has a prevalence of approximately 85-95% in PBC. It is also seen in 30-96% of overlap-syndrome cases.M2-3E: Occur with a prevalence of 90-95% in PBC cases. Also found in AIH patients with a prevalence of 4%.Sp100: Detected in PBC patients with a prevalence of 15-31%.PML: Associated with PBC (prevalence 13%) and AIH (prevalence 4%).Gp210: Detected with a prevalence of 26% in PBC and 4% in AIH.LKM-: Has a prevalence of around 70% in AIH Type 2.LC-1: Detected in approximately 10% of AIH Type 1 and 35% of AIH Type 2 patients.SLA/LP: Found in AIH patients with a prevalence of 15-30% (Europe, North America) and 7% (Japan).Ro-52: Has a prevalence of 5-19% in AIH. Not specific for autoimmune liver disease and can be found in sera from patients with myositis, SSc and other collagenoses.Reference intervalsEach antibody is reported as either Positive or NegativeInterferences N/AAssayLgi1SynonymsN/ASample typeOne 7ml SST (Gold top) tube per patient, CSF accepted but serum preferredTest instructionsN/AReferral laboratoryClinical Laboratory ImmunologyChurchill HospitalHeadingtonOxford OX3 7LEUKSpecimen Reception / Enquiries:?01865 225995Turnaround time14 DaysTest indicationsLGI1 and CASPR2 are VGKC-complex antibodies. Antibodies to LGI1 are frequent in limbic encephalitis with low plasma sodium and often associated with a particular seizure type called faciobrachia dystonic seizures. Antibodies to CASPR2 are found mostly in patients who have Morvans syndrome. They have also been found recently in some patients with cerebellar ataxia not necessarily with VKGC-complex precipitating antibodies.Reference intervalsReported as Positive or Negative Interferences N/AAssayM2SynonymsMitochondrial antibodiesSample type/VolumeOne 7ml SST (Gold top) tube per patientTest instructionsN/AReferral laboratoryN/ATurnaround time10 Working daysTest indicationsM2 antibodies are a highly sensitive and specific marker of Primary Biliary Cirrhosis, present in 95% of cases. Also found in a small percentage of patients with autoimmune chronic active hepatitis. M2 antibodies are directed against Pyruvate Dehydrogenase.Reference intervalsNormal range 0-6 IU/mlInterferences Grossly haemolysed, lipaemic or microbially contaminated samples may give erroneous results.AssayMyelin Oligodendeocyte Glycoprotein AntibodiesSynonymsMOGSample type/VolumeOne 7ml SST (Gold top) tube per patientTest instructionsN/AReferral laboratoryClinical Laboratory ImmunologyChurchill HospitalHeadingtonOxford OX3 7LEUKSpecimen Reception / Enquiries:?01865 225995Turnaround time14 DaysTest indicationsNeuromyelitis optica patients negative for NMO (Aquaporin 4) antibodies.Reported in some children with Acute disseminated encephalomyelitis (ADEM) or Multiple sclerosis (MS).Reference intervalsReported as Positive or Negative Interferences N/AAssayMuscle Specific Kinase AntibodiesSynonymsMUSKSample type/VolumeOne 7ml SST (Gold top) tube per patientTest instructionsN/A Referral laboratoryClinical Laboratory ImmunologyChurchill HospitalHeadingtonOxford OX3 7LEUKSpecimen Reception / Enquiries:?01865 225995Turnaround time21 DaysTest indicationsMuscle specific tyrosine kinase (MUSK) is a surface membrane enzyme that is essential in aggregating Acetylcholine receptor during the development of the neuromuscular junction. Recent studies have shown that antibodies to Musk are present in 40% to 50% of patients with generalized Acetylcholine Receptor seronegative MG. Anti-Musk antibodies have not been found in patients with purely ocular myasthenia or in those with anti-acetylcholine receptor antibodies.Reference intervalsReported as Positive or Negative Interferences N/AAssayMyositis panelSynonymsN/ASample type/VolumeOne 7ml SST (Gold top) tube per patientTest instructionsN/AReferral laboratoryClinical Laboratory ImmunologyChurchill HospitalHeadingtonOxford OX3 7LEUKSpecimen Reception / Enquiries:?01865 225995Turnaround time14 DaysTest indicationsThe myositis panel includes:Mi-2 antibodies are typically found in patients with steroid responsive dermatomyositis. They are rare in polymyositis. Mi-2 antibodies are invariably of high titre and show no variation during the course of the disease or treatment.Antibodies to PM-Scl75 and PM-Scl100 antigen are found in 50-70% of patients with the polymyositis/ scleroderma overlap syndrome. PM-Scl75 is seen in 8% of patients with myositis and 3% of patients with systemic sclerosis but 25% of patients with scleroderma/myositis overlap syndrome. PM-Scl100 is not as closely associated with systemic sclerosis as PM-Scl75. Ku antibodies are seen in a variety of diseases including systemic lupus erythematosus, mixed connective tissue disease, scleroderma and the polymysitis/scleroderma overlap syndrome. They are also seen in patients with pulmonary hypertension. Jo-1 antibodies are found in 20-40% of patients with aggressive polymyositis, usually in association with interstitial lung disease and arthralgia. PL-7 and PL-12 are associated with polymyositis and dermatomyositis, they are also seen in anti-synthetase syndrome (ASS) recognized as a spectrum of myositis, interstitial pneumonia, non-erosive arthritis, fever and Raynaud’s phenomena. PL-12 may also be associated with lung disease in the absence of clinically apparent myositis.Anti-Ro52 can be seen in Sj?gren's syndrome, SLE, cutaneous lupus erythematosus, neonatal lupus and primary biliary cirrhosis.Signal recognition peptide (SRP) antibodies can be found in approximately 5% of polymyositis and dermatomyositis cases. They are also markers for necrotising myopathy which shows similar skin changes to dermatomyositis but has more acute symptoms including muscle pain/weakness and interstitial lung disease.EJ (glycyl) and OJ (Isoleucyl) are markers for polymyositis and may be found in interstitial lung fibrosis, in overlap syndrome, arthritis and Raynaud’s syndrome . EJ may also be observed in SLE.Reference intervalsEach test reported as Positive or Negative Interferences N/AAssayNeuronal Antibodies SynonymsParaneoplastic antibodies; Purkinje antibodies; Hu, Yo, RiSample type/VolumeOne 7ml SST (Gold top) tube per patientTest instructionsN/AReferral laboratoryClinical Laboratory ImmunologyChurchill HospitalHeadingtonOxford OX3 7LEUKSpecimen Reception / Enquiries:?01865 225995Turnaround time14 DaysTest indicationsAnti-Hu: Type I anti-neuronal nuclear antibody (ANNA-1) is associated with SCLC, resulting in paraneoplastic encephalomyelitis. Anti-Ri: Type II anti-neuronal nuclear antibody (ANNA-2) is associated with neuroblastoma (children) and fallopian or breast cancer (adults), resulting in paraneoplastic opsoclonus myoclonus ataxia (POMA). Anti-Yo: Anti-Purkinje cell antibody is associated with gynaecological tumours and breast cancer, resulting in PCD Anti-Tr: Anti-purkinje cell antibody is associated with Hodgkin's disease, resulting in cerebellar degeneration. Anti-Ma (Ma1): Anti-neuronal antibody is not associated with any specific tumour, and can lead to limbic or brain stem encephalomyelitis.Anti-Ta (Ma2): Anti-neuronal antibody is associated with testicular tumours, and can lead to limbic or brain stem encephalomyelitis.Amphiphysin: Associated with tumours of the breast or SCLC leading to opsoclonus, ataxia RMP/CV2: Associated with various tumours, including thymoma, leading to variety of clinical presentations. Zic4: Autoantibodies to Zic4 are associated with paraneoplastic cerebellar degeneration and the underlying tumor is often a small cell lung cancer. SOX1: In up to 50 % of patients with Lambert-Eaton myasthenic syndrome (LEMS) - if cancer is detected, almost always a small cell lung cancer (SCLC). In 43 % of patients with LEMS and SCLC the detectable antibodies are directed to SOX1.Reference intervalsEach test is reported as Positive or Negative Interferences N/ACommentThe basic assay only includes Hu, Ri and Yo. If other tests are required they must be specified.AssayNMDASynonymsFixed NMDASample type/volumeOne SST (Gold top) tube per patient or 0.5ml CSF. Test instructionsN/AReferral laboratoryClinical Laboratory ImmunologyChurchill HospitalHeadingtonOxford OX3 7LEUKSpecimen Reception / Enquiries:?01865 225995Turnaround timeFixed cell assay: 7 Days Live cell assay: 14 DaysTest indicationsN-methyl-D-aspartate (NMDA) receptor antibodies are associated with the different sub units of the NMDA receptor. Antibodies to the delta or NR2 subunits of NMDA receptor are associated with limbic encephalitis, systemic lupus erythematosus (SLE), ataxia and epilepsia partialis continua. Antibodies against the NR1, NR2A and NR2B subunits of the NMDA are found in patients presenting with psychiatric symptoms, amnesia, seizures, dyskinesias, autonomic dysfunction and loss of consciousness.Reference intervalsReported as Positive or Negative Interferences N/AAssayOvarian antibodiesSynonymsN/ASample type/VolumeOne 7ml SST (Gold top) tube per patientTest instructionsN/AReferral laboratoryClinical Laboratory ImmunologyChurchill HospitalHeadingtonOxford OX3 7LEUKSpecimen Reception / Enquiries:?01865 225995Turnaround time20 DaysTest indicationsPresent in patients with either isolated primary ovarian failure or associated with other autoimmune endocrinopathies eg Hypoadrenalism, Insulin dependent diabetes, Pernicious anaemia.Reference intervalsReported as Positive or Negative Interferences N/AAssayPhospholipase- 2 Receptor AntibodiesSynonymsPLA2Sample type/VolumeOne 7ml SST (Gold top) tube per patientTest instructionsN/AReferral laboratoryDepartment of ImmunologyPO Box 894SHEFFIELDS5 7YT0114 2715552Turnaround time14 DaysTest indicationsThe Phospholipase A2 receptor (PLA2R) antibody is seen in patients with idiopathic membranous nephropathy (IMN).Reference intervalsNormal range <14 RU/mLInterferences N/AAssaySpecific IgESynonymsRAST, Allergy testSample type/VolumeOne 7ml SST (Gold top) tube per patientTest instructionsN/AReferral laboratoryA range of allergens are tested in house. Where this is not possible samples are referred to:Diagnostic Immunology and Allergy King's College HospitalBessemer Wing - 1st FloorDenmark HillLondon SE5 9RS 020 3299 1555Turnaround time10 Working daysTest indicationsFor the investigation of allergy: only request clinically indicated allergens.Reference intervalsNormal range <0.35 kUA/lInterferences N/AAssaySKINSynonymsIMF; Indirect skin immunofluorescence Sample type/VolumeOne 7ml SST (Gold top) tube per patientTest instructionsNone Referral laboratoryN/ATurnaround time10 Working daysTest indicationsImmunofluorescence testing plays an important role in the diagnosis of several autoimmune skin diseases. The blistering skin diseases where IIF is used are:Pemphigus Vulgaris (PV)Serum antibodies directed against the cell surface of epidermal keratinocytes are found in 90% of patients with Pemphigus and correlate with disease activity.Bullous PemphigoidSerum antibodies directed against the basement membrane are present in 70% of patients. Antibody levels do not reflect disease activity and antibody tends to persist even following successful therapy. Antibodies are uncommon in normal individuals or in other skin diseases.Reference intervalsQualitativeInterferences N/AAssaySLASynonymsSample type/VolumeOne 7ml SST (Gold top) tube per patientTest instructionsReferral laboratoryDiagnostic Immunology and Allergy Department at King's College HospitalGeneral Enquiry : 020 3299 8752 / 020 3299 1171King's College HospitalBessemer Wing - 1st FloorDenmark HillLondon SE5 9RSTurnaround time6 Days Test indicationsPart of Liver immunoblot panel, includes M2, LKM, LC-1 and SLA antibodies.Anti-soluble liver antigen (anti-SLA) is one of a number of autoantibodies associated with autoimmune hepatitis (AIH). However, it is not unique to AIH and has been described in 10% of patients with chronic hepatitis C virus infection. It is detected by immunoassay but not by IIF. The antigenic target is a 50 kD cytosolic protein.Reference intervalsQualitativeInterferences N/AAssayThyroid receptor antibodies SynonymsTSHR, TRAbSample type/VolumeOne 7ml SST (Gold top) tube per patientTest instructionsN/AReferral laboratoryN/ATurnaround time10 Working days Test indicationsFound in Graves’ disease, check especially in pregnant women with Graves’ diseaseReference intervals<1.75 IU/L = NegativeInterferences N/AAssayVoltage Gated Calcium Channel AntibodiesSynonymsVGCCSample typeOne SST (Gold top) tube per patient, CSF accepted but serum preferred. Test instructions1 ml sample volume preferredReferral laboratoryClinical Laboratory ImmunologyChurchill HospitalChurchill DriveOld RoadHeadingtonOxford OX3 7LEUKSpecimen Reception / Enquiries:?0044 (0) 1865 225995Turnaround time21 DaysTest indicationsThe assay is positive in approximately 85% of patients with the Lambert Eaton myasthenic syndrome (with or without small cell lung carcinoma SCLC) and in about 30% of Cerebellar ataxia with SCLC. Calcium channel antibodies are rarely found in patients without myasthenic symptoms, except at low titre in a few cases with small cell lung cancer. This is because small cell lung cancers express this voltage gated calcium channel.Reference intervalsNegative = <45pMLow Positive = 45-100pMInterferences N/AAssayVoltage Gated Potassium Channel AntibodiesSynonymsVGKCSample typeOne SST (Gold top) tube per patient, CSF accepted but serum preferredTest instructions1 ml sample volume preferredReferral laboratoryClinical Laboratory ImmunologyChurchill HospitalChurchill DriveOld RoadHeadingtonOxford OX3 7LEUKSpecimen Reception / Enquiries:?0044 (0) 1865 225995Turnaround time14 DaysTest indicationsThis test is indicated in the investigation of acquired neuromyotonia (Isaacs syndrome).??This is a rare and heterogenous syndrome of continuous motor unit activity of peripheral nerve origin that manifests as various combinations of muscle stiffness, cramps, twitching, weakness, and delayed muscle relaxation.Reference intervals<69 pmol/LInterferences N/A ................
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