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Test Name:
Neutrophil Cytoplasmic IgG Antibodies
- SBMF No:
28291 - Performance Lab Name:
Immunology - Test Mnemonic:
ANCA G - ABN:
Not required - CPT Code:
86255 - LOINC Code:
17357-5; 63311-5; 29641-8 - Test Includes:
c-ANCA
p-ANCA
a-ANCA - Also Known As:
ANCA IgG Antibodies
Anti-Neutrophil Cytoplasmic IgG Antibodies - Also See:
28292 – Neutrophil Cytoplasmic IgG Antibodies, with MPO & PR-3 Antibodies if Indicated
28293 – Myeloperoxidase and Proteinase-3 IgG Antibodies - Spec Type:
Serum - Spec Container:
Gold top (SST) or red top (serum) tube - Pref Vol:
1.0 mL - Min Vol:
0.5 mL - Fasting:
No - Spec Collect:
Routine venipuncture - Spec Process:
Clot 30 minutes
Promptly centrifuge 15 minutes
Immediately transfer serum to separate plastic tube
Properly centrifuged gel barrier tube sample does not require transfer of serum to separate tube - Spec Store Transport:
Refrigerated - Spec Stability:
1 week refrigerated (2-8°C)
2 weeks frozen (-20°C) – Do not use frost-free units that undergo repeated freeze/thaw cycles - Spec Reject:
Severely hemolyzed, lipemic, or heat-inactivated sample - Methodology:
Indirect Immunofluorescence - Use:
Diagnosis and follow-up of Wegener’s Granulomatosis (WG)
Evaluation of patients suspected of having systemic vasculitis, especially patients with renal disease or unexplained multi-organ disease possibly due to vasculitis - Clinical Significance:
Three types of Anti-Neutrophil Cytoplasmic Antibody (ANCA) patterns are detectable using standard immunofluorescent methodology. The classic ANCA pattern appears as a diffuse granular cytoplasmic fluorescence and is specific for antibodies vs. serine protease 3 (PR-3). This pattern, characteristic of Wegener’s granulomatosis and to a lesser extent microscopic polyarteritis, has been designated c-ANCA. A second ANCA pattern has been described that appears as perinuclear neutrophilic stain and has been designated pANCA. The p-ANCA pattern is specific for other neutrophilic enzymes, including myeloperoxidase (MPO), elastase, and lactoferrin. The most common target antigen associated with pANCA is myeloperoxidase. pANCA is seen in association with a more organ-limited vasculitis, in particular pauci-immune necrotizing glomerulonephritis. pANCA is typically not seen in systemic vasculitis. A third type of ANCA pattern, called Atypical ANCA (a-ANCA), occurs when the initially positive p-ANCA cannot be confirmed on formalin-fixed slides and the ANA is negative. This has been described in ulcerative colitis and ascending cholangitis.In patients with active generalized Wegener’s granulomatosis (WG), the frequency of positive cANCA results (sensitivity) is approximately 85-90%. A negative test of c-ANCA does not completely rule out WG. In addition, positive c-ANCA results and antibodies to PR-3 can also be seen in polyarteritis nodosa. In patients with documented WG, rising titers of c-ANCA suggest relapse and falling titers suggest response to therapy. In patients with active renal disease, a positive p-ANCA result suggests the presence of antibodies to MPO and pauci-immune necrotizing glomerulonephritis. However, positive p-ANCA results are not specific for anti-MPO antibodies. Positive ANCA results (p-ANCA and, rarely, c-ANCA) may occur in patients with diseases other than WG or vasculitis, including Goodpasture’s syndrome, lupus erythematosus, rheumatoid arthritis, and Sjogren’s Syndrome. - Reference Range:
Qualitative (screening): Negative for the presence of ANCA (Anti-Neutrophil Cytoplasmic Antibodies)
Semi-Quantitative (titer): Less than 1:20 = not significant - Day Run:
Mon, Thu - Time Run:
6:00 am - Time Reported:
5:00 pm - Test Type:
IMMUNOLOGY
