May 15, 2017




Clinical Hub,Tools & Resources,UWHC Lab Test Directory,Immunology

ANCA, reflex to MPO and PR3

ANCA, reflex to MPO and PR3 (HCANCAR) Immunology Lab Test

Name: ANCA, reflex to MPO and PR3

Test Name: ANCA, reflex to MPO and PR3

Health Link Test Code: HCANCAR

LIS Test Code: ANCAR

CPT Code(s): 86255; Add 86256 and 83520x2 if Positive

Test Component:

Anti-neutrophil cytoplasmic antibodies with pattern and titer results if Positive.  In addition anti-myeloperoxidase antibody (MPO) and anti-proteinase 3 antibody (PR3) ELISA testing will be performed if ANCA is Positive.

Methodology: Indirect Immunofluorescent Assay

Clinical Information:

Anti-neutrophil cytoplasmic antibodies are antibodies to cytoplasmic granules found in neutrophils. Cytoplasmic ANCA(C-ANCA) is typically associated with antibodies to proteinase (PR3), but a cytoplasmic pattern can be seen at low titers in association with antibodies to other granule proteins. Antibodies to PR3 are associated with Wegener's granulomatosis. C-ANCA antibodies are associated with active disease and disease that is systemic rather than limited to the nasal passages. Perinuclear ANCA (P-ANCA) is associated with antibodies to many differnt proteinases found in the cytoplasmic granules. The most common is myeloperoxidase (MPO). P-ANCA and MPO antibodies are associated with many different types of vasculitis including microscopic PAN and Churg-Strauss vasculitis. Patients with PAN may have P-ANCA antibodies but the proportion is lower (approximately 30%) and the levels are lower. Other diseases are known to be associated with P-ANCA including inflammatory bowel disease, SLE and chronic liver disease. When the P-ANCA on ethanol fixed slides is positive, the P-ANCA test will be repeated on formalin fixed slides to confirm the P-ANCA pattern before a titer is reported. In cases where the staining is suggestive of anti-nuclear antibodies, the laboratory will perform ANCA testing using the formalin fixed cells to determine whether the staining is truly cytoplasmic and not nuclear. Immunofluorescence testing for ANCA is recommended as a screen for antibodies to granule antigens. If you are following a patient with Wegener's granulomatosis or other type of vasculitis, it is recommended that you follow the specific MPO or PR3 antibody level by enzyme immunoassay rather than titer of ANCA.

Days Performed: Mon-Fri, dayshift.

In-Lab Turnaround Time: 2 - 7 days.

Stat In-Lab Turnaround Time: Not available stat.

Specimen: Blood

Collection Container: Red top

Also Acceptable: Red cap with yellow ring (SST)

Collection Volume: 3 mL

Pediatric Collection Volume: 1 mL

Stability Ambient:

Not acceptable

Stability Refridgerated:

7 days at 2-8°C

Stability Frozen:

No limit a -20°C or lower. Note: Avoid repeat freeze and thaw.

Sample Analyzed: Serum

Testing Volume: 1 mL

Pediatric Testing Volume: 0.3 mL

Specimen Processing:

Centrifuge and transfer cell free serum to plastic vial. Refrigerate

Specimen Transport:

Transport specimen to Laboratory. Transport with coolant pack if coming from clinic location.

Unacceptable Criteria:

Grossly hemolyzed and lipemic specimens are not recommended.


Normal Anti-Neurtrophil Cytoplasmic Ab (0 days and up): Negative


MPO and PR3 reflex testing will be added if ANCA is positive.

Interpretation Type: Expected Results

Additional Information:

A professional fee may be associated with this test in complex cases.