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ANA, IFA, Cascade and Rheumatoid Arthritis Panel 2, with Reflexes
Test Code94954
CPT Codes
83520, 86038, 86200, 86431
Includes
ANA Screen,IFA, Reflex Titer/Pattern,and Reflex to Multiplex 11 Ab Cascade
Rheumatoid Factor
Cyclic Citrullinated Peptide (CCP) Antibody (IgG)
Mutated Citrullinated Vimentin (MCV) Antibody
The ANA, IFA, Cascade and Rheumatoid Arthritis Panel 2, with Reflexes begins with an ANA Screen, IFA.
If ANA Screen, IFA is positive, then ANA Titer and Pattern will be performed at an additional charge (CPT code(s): 86039).
Additionally, five antibodies will be performed at an additional charge: dsDNA (CPT code(s): 86225), Sm/RNP (CPT code(s): 86235), RNP (CPT code(s): 86235), Sm (CPT code(s): 86235), and Chromatin (CPT code(s): 86235).
If any of those five antibodies are positive, the cascade stops and the results are reported. If all five of those antibodies are negative, four additional antibodies will be performed at an additional charge: SSA (CPT code(s): 86235), SSB (CPT code(s): 86235), Scl-70 (CPT code(s): 86235), Jo-1 (CPT code(s): 86235).
If any of those four antibodies are positive, the cascade stops and the results are reported. If all four of those antibodies are negative, the following two additional antibodies will be performed at an additional charge: Ribosomal P (CPT code(s): 83516) and Centromere B (CPT code(s): 86235).
Please note the cascade stops upon the first positive antibody result(s) found in a group and an interpretive message is applied based on this information. It is possible that antibodies in subsequent groups are also positive, but will not be added, billed, or reported. Please contact your local Quest Diagnostics Laboratory if you are interested in adding this additional testing.
Rheumatoid Factor
Cyclic Citrullinated Peptide (CCP) Antibody (IgG)
Mutated Citrullinated Vimentin (MCV) Antibody
The ANA, IFA, Cascade and Rheumatoid Arthritis Panel 2, with Reflexes begins with an ANA Screen, IFA.
If ANA Screen, IFA is positive, then ANA Titer and Pattern will be performed at an additional charge (CPT code(s): 86039).
Additionally, five antibodies will be performed at an additional charge: dsDNA (CPT code(s): 86225), Sm/RNP (CPT code(s): 86235), RNP (CPT code(s): 86235), Sm (CPT code(s): 86235), and Chromatin (CPT code(s): 86235).
If any of those five antibodies are positive, the cascade stops and the results are reported. If all five of those antibodies are negative, four additional antibodies will be performed at an additional charge: SSA (CPT code(s): 86235), SSB (CPT code(s): 86235), Scl-70 (CPT code(s): 86235), Jo-1 (CPT code(s): 86235).
If any of those four antibodies are positive, the cascade stops and the results are reported. If all four of those antibodies are negative, the following two additional antibodies will be performed at an additional charge: Ribosomal P (CPT code(s): 83516) and Centromere B (CPT code(s): 86235).
Please note the cascade stops upon the first positive antibody result(s) found in a group and an interpretive message is applied based on this information. It is possible that antibodies in subsequent groups are also positive, but will not be added, billed, or reported. Please contact your local Quest Diagnostics Laboratory if you are interested in adding this additional testing.
Preferred Specimen
4 mL serum
Minimum Volume
2 mL
Instructions
Allow blood to clot (10-15 minutes) at room temperature. Centrifuge and separate from cells.
Transport Container
Transport tube
Transport Temperature
Room temperature
Specimen Stability
Room temperature: 4 days
Refrigerated: 7 days
Frozen: 21 days
Refrigerated: 7 days
Frozen: 21 days
Reject Criteria (Eg, hemolysis? Lipemia? Thaw/Other?)
Gross hemolysis • Grossly lipemic • Grossly icteric
Methodology
Enzyme Linked Immunosorbent Assay (ELISA) • Immunofluorescence Assay (IFA) • Immunoturbidimetric
Setup Schedule
Set up and Report available: See individual assays
Reference Range
See Laboratory Report
Clinical Significance
This test can be helpful in the diagnosis of autoimmune rheumatic diseases. Specimens with positive results for antinuclear antibodies (ANA) by indirect immunofluorescence assay (IFA) are subsequently tested for a series of ANA-specific autoantibodies in cascade tiers. The first tier focuses on autoantibodies associated with systemic lupus erythematosus (SLE) and mixed connective tissue disease; the second tier detects autoantibodies seen in Sjogren syndrome, systemic sclerosis and polymyositis; and the third tier includes markers of the limited form of systemic sclerosis and neuropsychiatric SLE. This screen also includes the following markers of rheumatoid arthritis: rheumatoid factor, anti-cyclic citrullinated peptide antibody and anti-mutated citrullinated vimentin antibody.
Note that the cascade stops with the first tier in which a positive antibody result is observed. Therefore, even if an antibody included in a subsequent tier is present, it will not be reported with this test. If the ANA IFA result is positive but all the specific autoantibodies tested in the cascade antibody tests are negative, the patient may still have an autoimmune disease other than those typically associated with the antibodies tested.
Note that the cascade stops with the first tier in which a positive antibody result is observed. Therefore, even if an antibody included in a subsequent tier is present, it will not be reported with this test. If the ANA IFA result is positive but all the specific autoantibodies tested in the cascade antibody tests are negative, the patient may still have an autoimmune disease other than those typically associated with the antibodies tested.
Performing Laboratory
Quest Diagnostics Nichols Institute Chantilly
14225 Newbrook Dr
Chantilly, VA 20153
