ANCA testing should primarily be undertaken in patients presenting with symptoms suggestive of a small vessel vasculitis.
The main systemic necrotising vasculitides that are associated with a positive ANCA pattern are:
Granulomatous Polyangiitis (GPA)
Rapidly Progressive Glomerulonephritis
Eosinophilic Granulomatous Polyangiitis (EGPA).
(In accordance with the revised 2017 international consensus on testing of ANCAs)
For urgent/rapid testing (vasculitis screen MPO,PR3 and GBM) please telephone the Immunology laboratory.
Ambient (8 - 24 degrees Celsius)
100 uL serum - minimum, 1 mL serum - preferred. Store in fridge
Any positive ANCA detected by indirect immunofluorescence will automatically be reflexed for specific testing for anti-MPO and anti-PR3.
Anti-neutrophil Cytoplasmic Antibody
Two major forms of pattern are seen: the cytoplasmic ANCA (cANCA) usually associated with autoantibodies against anti-proteinase 3 (PR3), and the perinuclear (pANCA) pattern generally associated with myeloperoxidase (MPO) autoantibodies.
Note ‘false positives’ may occur in diseases which may mimic systemic vasculitis e.g. infective endocarditis, tuberculosis, non-Hodgkin’s lymphoma, acquired immune deficiency syndrome.
P-ANCA (of anti-MPO specificity) are found in up to 50 percent of patients with microscopic polyarteritis and pauci-immune glomerulonephritis, in addition to rheumatoid arthritis, SLE and ulcerative colitis.
– Not detected
– Positive and pattern
Indirect Immunofluorescence on formalin fixed neutrophils.
ANCA are screened at 1 in 20.
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