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Quest Diagnostics

ANA Screen, IFA, with Reflex to Titer and Pattern

Quest Diagnostics

Sample type: Serum

Requires fasting: No

Phlebotomy required

Details

ANA Screen, IFA, with Reflex to Titer and Pattern - This immunofluorescence assay (IFA) is often ordered as part of an initial diagnostic evaluation of individuals with clinical suspicion of autoimmune diseases associated with antinuclear antibodies (ANAs).

Reflex testing uses predefined clinical logic to automatically order one or more follow-up tests based on the initial test results. Reflex tests are performed automatically without the intervention of the ordering practitioner. They are conducted using the same sample your Patient already provided. If reflex tests are required, there will be additional charges.

Initial test
  • Antinuclear Antibodies Screen (IFA)
Possible reflex biomarkers
  • ANA Titer
  • ANA Pattern

Estimated days for results: Results should be available in 2 - 5 business days after the sample is collected

Details
ANA Screen, IFA, with Reflex to Titer and Pattern - This immunofluorescence assay (IFA) is often ordered as part of an initial diagnostic evaluation of individuals with clinical suspicion of autoimmune diseases associated with antinuclear antibodies (ANAs). 

The American College of Rheumatology (ACR) recommends IFA on human epithelial type 2 (HEp-2) cells as the gold standard method for ANA testing because of its overall high sensitivity [1].

ANAs are associated with several autoimmune diseases, such as systemic lupus erythematosus, systemic sclerosis, mixed connective tissue disease, polymyositis, primary biliary cholangitis, rheumatoid arthritis, juvenile rheumatoid arthritis, Sjogren syndrome, and autoimmune hepatitis. The laboratory evaluation for individuals with clinical suspicion of these autoimmune diseases often begins with an ANA screen.

Knowing the ANA titer can be helpful in interpreting positive ANA results. A titer of at least 1:40 is considered positive, but low-positive titers are not uncommon in healthy individuals. Higher titers are generally associated with greater likelihood of autoimmune disease [2]. When results are positive, various fluorescent staining patterns observed in the nucleus or the cytoplasm can aid in the differential diagnosis and guide selection of further testing for specific autoantibodies. The International Consensus on Antinuclear Antibody Pattern provides guidance on interpretation and reporting of IFA staining patterns with HEp-2 cells [3].

Individuals with negative results on the ANA IFA usually also have negative results on specific ANAs. Therefore, subserology testing is generally not recommended in individuals without positive ANA IFA results and clinical suspicion of relevant autoimmune disease [4]. However, Jo-1 antibody may be detected in ANA IFA-negative patients with some types of myositis, and SSA antibody may be detected in some ANA IFA-negative patients with lupus or Sjogren syndrome [4].

The results of this test should be interpreted in the context of pertinent clinical and family history and physical examination findings.

References
1. Methodology of testing for antinuclear antibodies (position statement). 2009. American College of Rheumatology. Updated December 2019. Accessed May 15, 2023.
2. Tozzoli R, et al. Am J Clin Pathol. 2002;117(2):316-324.
3. Chan EK, et al. Front Immunol. 2015;6:412.
4. Yazdany J, et al. Arthritis Care Res (Hoboken). 2013;65(3):329-339.

What type of sample is required for this test?
1 mL serum

Test Resources
For more information, please consult your healthcare provider.

2–5 business days

ANA Screen: Negative
  • Autoimmune

Blood Draw Options with Fullscript
Fullscript offers several convenient phlebotomy options to complete your lab testing:

Quest Diagnostics Patient Service Centers (PSC)

  • Location: Visit a nearby Quest Diagnostics Patient Service Center.
  • Cost: $10 sample collection fee (paid during lab order checkout).
  • Scheduling: Schedule your appointment here. Appointments are recommended to reduce wait times. Walk-ins are accepted, but may experience delays. Aim to arrive 10 minutes before your appointment.
  • Collection Instructions:
    • Bring a valid ID.
    • Bring your digital or printed requisition form, available in the Labs tab of your Fullscript account.
  • Check-in: Scan the QR code from your confirmation email or follow kiosk instructions.
  • More Info: Quest Diagnostics blood draw guide

Getlabs Mobile Phlebotomy

  • Location: Sample collection at your home or office.
  • Cost: $85 sample collection fee (paid during lab order checkout).
  • Availability: Available in most locations – enter your ZIP code during checkout to confirm.
  • Scheduling: Schedule your appointment here through your Fullscript account.
  • Collection Instructions:
    • Have your digital or printed requisition form and valid ID ready.
    • Your phlebotomist will contact you by phone to coordinate arrival.
  • More Info: Getlabs blood draw guide
 Specimen
  • Preferred Specimen(s): 1 mL serum 
  • Alternative: NA 
  • Minimum Volume: 0.5 mL 
  • Collection Instructions: NA 
 Storage and shipping instructions
  • Transport Container: Transport tube 
  • Transport Temperature: Room Temperature 
  • Specimen Stability: 
    • Room temperature: 4 days 
    • Refrigerated: 7 days 
    • Frozen: 30 days 
  • Reject Criteria: 
    • Gross hemolysis • Grossly lipemic • Microbial contamination may interfere 
State restrictions:

Patient can't order this test if they are located in Hawaii, Puerto Rico, New Jersey, New York, or Rhode Island

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