Pathology Handbook

Anti Nuclear Antibovies

Synonyms

ANA
ANF
LE cells

Clinical Indications

  • SLE (including SLE overlap syndromes)
  • Sjogren's syndrome
  • CREST
  • Scleroderma
  • Systemic sclerosis
  • Autoimmune liver disease

Please note: a positive result is not diagnostic as antibodies can be present in normal individuals and are detected with greater frequency in elderly patients. In normal adults (18-65 years) approximately 5% will have a positive ANA at 1/80. Antinuclear antibodies are also associated with viral infections and chronic inflammatory disorders, however, high titres are usually clinically significant

Test Includes

Detection of IgG autoantibodies against various cell nuclear proteins

Request Form 

Request via ICE

Availability

Assay performed daily Monday to Friday

Specific Criteria

It is essential to give relevant clinical information

Turnaround Time

All tests are performed on the next routine working day after receipt of the sample

Specimen

Serum

Volume

7 ml

Container

Vacutainer red top

Collection

Samples should be transported to the laboratory immediately

Lab Handling

Aliquot and store at 4-8°C prior to testing and at -20°C or below for up to 1 month after receipt.

Causes for Rejection

Unlabelled/inadequately labelled sample.
Inadequately completed request form.
Delay in sample reaching laboratory

Reference Range

Sera are screened at a dilution of 1/80 (paediatric samples at 1/40). In general terms a titre of greater or equal to 1/160 (1/40 for paediatric samples) are considered clinically significant and will be referred for further testing including ENA and dsDNA as appropriate.

Below are listed some of the most common ANA patterns with their most common clinical association (please note this is not a comprehensive list):

Homogenous - SLE, Drug induced lupus, RA and Juvenile Chronic Arthritis.

Coarse speckled - SLE and SLE overlap syndromes

Fine speckled - Common pattern found in may diseases including SLE, MCTD, Sjogren's syndrome and scleroderma.

Centromere - CREST 

Few nuclear dots - Autoimmune and viral liver disease

Multiple nuclear dots - 6% of patients with PBC often with Sjogren's. Rare pattern in SLE and chronic inflammatory diseases.

Nucleolar -

1. Homogenous - polymyositis/scleroderma overlap syndrome
2. Clumpy - High specificity for systemic sclerosis (found in 5% of patients).
3. Speckled - High specificity for systemic sclerosis (found in 30% of patients)