Immunology investigations

Antinuclear factor (ANF or ANA)

Homogenous positive >1/160 found in SLE, rheumatoid arthritis (RA), mixed connective tissue disease (MCTD) and drug-induced lupus. All homogenous positive ANAs are tested for dsDNA antibodies and may be tested for reactivity to Crithidia. As well as in SLE, low titre homogenous ANA may be found in RA, Felty's syndrome, lupoid hepatitis, primary biliary cirrhosis (PBC) and less frequently in dermatomyositis, polyarteritis nodosa (PAN), chronic infection, neoplasm, pregnancy and healthy elderly people.

Nucleolar ANA found in scleroderma and Sjogren's syndrome.

Speckled ANA results are tested for antibodies to DNA and possibly ENA.

Extractable nuclear antigens (ENA)

 is a qualitative ELISA for antibodies to:

SS-A (Ro) found in 75% of Primary Sjögren's Syndrome and 50% SLE. It may be associated with Hepatitis C and cause transient neonatal SLE by passive transfer. Babies of 25% of mothers with anti SSA have congenital heart block.

SS-B (La) is found in 15% secondary Sjögren's syndrome.

Combined SS-A (Ro) and SS-B (La) or SS-B alone are the principle markers occurring in approximately 50% of Sjögren's syndrome and 10% of patients with SLE.

Scl-70 - found in Systemic Sclerosis.

Jo-1 - polymyositis and PIF.

Centromere antibodies are markers of CREST variant.

RNP and Sm antibodies are markers of SLE.

U1 snRNP is associated with SLE and MCTD.

Anti double stranded DNA antibodies

Normal Range - see result form from referred laboratory.

• a negative result does not exclude SLE since only positive in about 50% of SLE.

• a borderline result indicates possible SLE, other connective tissue disease or viral infection; suggest repeat anti-DNA with anti Sm.

• 50-200. Probable SLE.

• >200u/ml. Highly diagnostic of SLE.

Rheumatoid factor RF.

• 0-15 iu/ml = negative.

• 16 - 32 iu/ml = intermediate result, suggest repeat.

• >32 iu/ml = positive result.

Rheumatoid factor is also found in 15% of population after chronic infection or inflammation. A positive result only implies RA if there is joint pain/swelling.

AMA and anti M2 frequently found in PBC (in 95% with Pos ANA) and other liver diseases.

SMA frequently found in chronic active hepatitis and PBC.

Antibodies to gastric parietal cells are useful in the diagnosis of autoimmune gastritis and intrinsic factor antibodies in the diagnosis of pernicious anaemia.

Anti endomyseal antibodies to transglutaminase in gut cells are highly specific for coeliac disease.

Thyroid peroxidase antibodies. Only 3% of patients with autoimmune thyroiditis do not have antibodies to thyroid peroxidase.

Cardiolipin antibodies to IgG and IgM.

• Normal range - see result form from referral laboratory.

Weak positive (present in 2-5% of normal population) are found commonly after infection, especially HIV, and in connective tissue disorders. If found in the absence of thrombosis, repeat after 6 weeks.

Send away investigations

All other immunological tests (purple form) are performed by Regional Immunology at Manchester Royal Infirmary or elsewhere and will be referred via this laboratory. By sending them through us, there is a record of their despatch by this laboratory. Use the haematology request forms so that there is a bag to put the specimens in.

DO NOT SEND DIRECTLY BY TAXI

The web site of the Regional Immunology Service gives guidance on a range of tests

Regional Immunology A-Z of tests

Regional Immunology contact details

This is a list of the tests sent elsewhere and the laboratories to which they are sent. Click on the name of the laboratory to see its CPA status and contact details. It is best to call the UHSM laboratory to ask for results.

Immunology-alphabetical list of tests
Test	Sample	Laboratory
Acid maltase	EDTA Store at 4oC if needed. Test within 48hr	Willink Laboratory-Manchester Childrens
Anti phospholipid Antibody	Clotted	MRI Immunology
Amyloid ab	Clotted	Sheffield
Acetylcholine receptors	Clotted 2ml separated	Sheffield
Adrenal cortex ab	Clotted	MRI Immunology
Amphiphysin ab	Clotted	Oxford
ANCA	Clotted	MRI Immunology
( c ) ANCA	Clotted	MRI Immunology
( p ) ANCA	Clotted	MRI Immunology
Anticardiolipin	red top clotted (best not yellow)	MRI Immunology
anti CCP (anti cyclic citrullinated peptide Ab)	Clotted	Sheffield PRU
Anti-Hu	Clotted	Oxford
Antinuclear ab	Clotted	Haematology, UHSM
Anti neutrophil antibodies	EDTA/clotted	PGI lab NBS, Bristol (1st class post)
Anti-topoisomerase-1 Ab	Clotted	MRI Immunology
APOE(apolioprotein E genotype)	EDTA whole blood	Biochemistry refers to Christie Biochemistry
ASOT (anti-strep or anti-staph titre)	Clotted	HPA
Aspergillus precipitins	Clotted	HPA
Atypical antibodies	Clotted	HPA
autoimmune hearing screen HS P70	Clotted	Cambridge Life Sciences
Avian precipitins	Clotted	HPA
Basal ganglia ab	Clotted (>1ml serum)	Dept Neurology, Queens Square
b2 Microglobulin	Clotted	Biochemistry, UHSM
BCR/ABL/ABC reaction	EDTA	Molec Diagnostic lab, MRI
Bence Jones protein	Clotted	Biochemistry, UHSM
B Cell subsets URGENT	EDTA room temp+FBC printout	MRI Immunology Send ASAP (Preferably not Friday)
C1 inhibitor (C1 esterase inhibitor)	Clotted	MRI Immunology
C1 inhibitor functional	citrate ON ICE	MRI Immunology (to arrive before 4pm, preferably not Friday)
C1q	Clotted, 7ml	Sheffield (fresh/frozen <2hours)
C2	Clotted	Sheffield
C282Y (Haemochromatosis Gene)	EDTA or Citrate red cells	Molec Diagnostic lab, MRI
C3	Clotted	Biochemistry, UHSM
C3 breakdown products	EDTA on ice	MRI Immunology
C4	Clotted	Biochemistry, UHSM
CA125	Clotted	Biochemistry, UHSM
CA199	Clotted	Biochemistry (sendaway)
Cardiac muscle ab	Clotted	MRI Immunology
Cardiolipin ab	Clotted	MRI Immunology
CCP (anti cyclic citrullinated peptide Ab)	Clotted	MRI Immunology
CD4 cell markers(must be known HIV +)	EDTA room temp	MRI Immunology, can be done on CSF (Pref not Friday)
CD55	EDTA	Leeds HMDS
CD59	EDTA	Leeds HMDS
Cell markers URGENT, pref not Friday	EDTA room temp+FBC printout, can be done on CSF	MRI Immunology
Centromere ab	Clotted	Haematology, UHSM
CH50	Serum separated on ice, ASAP, (EDTA on ice may be OK)	MRI Immunology
Coeliac	Clotted	MRI Immunology
Connective tissue disease screen (CTD)	Clotted	UHSM, MRI Immunology, Preston
Crithidia ab	Clotted	MRI Immunology
CRP	Clotted	Biochemistry, UHSM
Cryoglobulins	Clotted, @ 37oC	Biochemistry, UHSM
CV2 ab	Clotted	Oxford
Cystic fibrosis genetic test (F508)	EDTA	St Marys - Molecular genetics lab
Cytogenetics	Lithium Heparin	St Marys-cytogenetics lab
Direct antiblogulin test	EDTA	Blood bank
ds -DNA ab	Clotted	MRI Immunology
ENA ab (Sm,RNP,RO,LA )	Clotted	MRI Immunology
Endomyseum ab	Clotted	MRI Immunology
Erythropoetin	Clotted	Leeds Haem (first class post)
Esterase inhibitor	Clotted	MRI Immunology
Factor V Leiden (see Senior in coagulation)	EDTA or Citrate red cells	MRI or Exeter
Farmers lung precipitins	Clotted	HPA
Fragile X chromosome	Lithium heparin	St Marys-cytogenetics lab
G202210A - Prothrombin gene variant	EDTA or Citrate red cells	MRI or Exeter
GAD	Clotted	Oxford
Galactose-1-Put	Lithium heparin	Willink Laboratory-Manchester Childrens
Ganglioside Ab	Clotted	Oxford
Ganglioside GM1	Clotted	Oxford
Gastric parietal cell	Clotted	Haematology, UHSM
Genetics Molecular	EDTA	St Mary's molecular genetics
Gliadin ab	Clotted	MRI Immunology
Glomerular basement membrane ab	Clotted	MRI Immunology
Glutamic Acid decarboxylase ab	Clotted	Oxford
GM1	Clotted	Oxford
GPC	Clotted	Haematology, UHSM
GQ1b	Clotted	Oxford
GQ2b	Clotted	Oxford
GT1a	Clotted	Oxford
G6PD Assay	EDTA	Haematology, MRI
Haemochromatosis Gene(HFE,C282Y,H63D)	EDTA (15ml)	Royal Exeter and Devon
Haemophilus antibodies, HIB	Clotted	HPA
Helicobactor	Clotted	HPA
HLA B27	EDTA	Blood bank
HLA DQ2 (for coeliac disease)	EDTA	BTS Bristol: 1st Class post, keep at Room Temperature
Homocystene	EDTA (sep within 4hr if on ice)	Contact Biochemistry
Hu -anti	Clotted	Oxford
IgD	Clotted	Sheffield
IgE	Clotted	MRI Immunology
IgG,IgM and IgA subclasses	Clotted	Biochemistry, UHSM
IgM ab to ganglioside GM1	Clotted	Oxford
IL6	Clotted	MRI Immunology
Infectious mononucleocytosis	EDTA pref, or clotted	Haematology, UHSM
Insulin ab	Clotted	Sheffield
Intrinsic factor ab	Clotted	Haematology, MRI, Cobbett House
Islet cell ab	Clotted	MRI Immunology
Itraconazole levels	Clotted	HPA (mycology)
IVF egg donors	Lithium Heparin	RMCH
JAK 2	EDTA (20ml , can fridge overnight)	Royal Exeter and Devon
Jo-1	Clotted	MRI Immunology
Karyotypes	Lithium Heparin	St Marys-cytogenetics lab
La	Clotted	MRI Immunology
LATS(long acting thyroid stimulator	Clotted	Firs Lab, Cardiff
LE cells (Old name for ANA test)	Clotted	Haematology, UHSM
LKM	Clotted	Haematology, UHSM
LKM1	Clotted	MRI Immunology
Lymphocyte subsets	EDTA URGENT+FBC printout	MRI Immunology
Long acting thyroid stimulating hormone	Clotted	Firs Lab, Cardiff
M2	Clotted	MRI Immunology
Mannose binding protein	Clotted	Biochemistry sendaway
Ma ab	Clotted	Oxford
MA2 ab	Clotted	Oxford
MAG	Clotted	Oxford
Mast cell tryptase(inc time of anaph shock)	Clotted	MRI Immunology
MCAD (medium chain acylcoenzyme A)	Clotted	Willink Laboratory-Manchester Childrens
Metatetrahydrofolate genetic test	2 tubes citrate/EDTA whole blood	Addenbrooks, Cambridge
Mitochondria ab	Clotted	Haematology, UHSM
MM screen (multiple myeloma)	Clotted	Biochem (for WIGS and WEPS)
Molecular Genetics -(inc for cystic fibrosis)	EDTA	St Marys- molecular genetics
MPO	Clotted	MRI Immunology
Multiple myeloma	Clotted	Biochemistry, UHSM
Myelin Associated Glycoprotein ab	Clotted	Oxford
Neonatal IgG,IgM	Clotted	Biochemistry, UHSM
Neuronal nuclei	Clotted	Oxford
Neutrophil cytoplasmic ab	Clotted	MRI Immunology
Neutrophil function	Lithium Heparin 5ml	MRI Immunology, must receive within 4hrs
Ovaries ab	Clotted	MRI Immunology
Paraneoplastic ab	Clotted	Oxford
Paraprotein identification/quantitation	Clotted	Biochemistry, UHSM
Parietal cell ab	Clotted	Haematology, UHSM
Paternity testing-only if good clinical reason	Clotted	St Marys - molecular genetics (NHS work only)
Paternity testing-Private	Clotted	Suggest Cellmark Diagnostics, Tel 01235528609
Paul Bunnell's test (for glandular fever)	EDTA pref, or clotted	Haematology, UHSM
Pemphigus & pemphigoid	Clotted	MRI Immunology
Philidelphia Chromosome	bone marrow,lithium hep	Christie oncological cytogenetics tel 446 3165
Phospholipid antibody	Clotted	MRI Immunology
PIVKA II	Clotted	St Thomas's, London
Platelet autoantibodies	Clotted & EDTA	UHSM Blood bank
Pneumococcal antibodies	Clotted	HPA
PR3	Clotted	MRI Immunology
Prothrombin Gene Variant(see Senior in coag)	EDTA or Citrate red cells	MRI - S Keeney/Exeter
PTV - Prothrombin gene variant (see Senior)	EDTA or Citrate red cells	MRI - S Keeney / Exeter
Purkinje cell cytoplasm	Clotted	Oxford
Quantiferon - for TB gamma quantiferon test	special set of tubes -contact MRI	MRI Immunology
RAST	Clotted	MRI Immunology
Reticulin ab	Clotted	MRI Immunology
Rheumatoid factor ab	Clotted	Haematology, UHSM
Ri ab	Clotted	Oxford
Ribosomal ab	Clotted	MRI Immunology
RNP	Clotted	MRI Immunology
Ro	Clotted	MRI Immunology
Rubella	Clotted	HPA
Salivary duct ab	Clotted 2ml, separated	Sheffield
SCAT (old name for rheumatoid factor test)	Clotted	Haematology, UHSM
Scl-70	Clotted	MRI Immunology
Serum tryptase	Clotted	MRI Immunology
Skin ab	Clotted	MRI Immunology
Sm (Smith ab)	Clotted	MRI Immunology
Smooth muscle ab	Clotted	Haematology, UHSM
Striated muscle ab	Clotted	Sheffield
Sulphatide ab	Contact Haematology	Oxford
TB Quantiferon (Keep at RT, send asap)	special set of tubes -contact MRI	MRI Immunology (Test within 16 hours, don’t send Friday)
T cell gene rearrangement analysis	EDTA (send within 24 hrs)	Leeds HMDS
T Cell subsets URGENT	EDTA room temp+FBC printout	MRI Immunology ASAP (Preferably not Friday)
TCR genes (CD55,CD59)	EDTA	Leeds HMDS
Testes ab	Clotted	MRI Immunology
Thyroid microsomes (TPO)	Clotted	Biochemistry, UHSM
Thyroid peroxidase	Clotted	Biochemistry, UHSM
Thyroid stimulating hormone-long acting	Clotted	Firs lab,Cardiff
Tissue typing (says transplant lab on form)	Clotted(non urg) Hep(urgent)	MRI Transplant Lab( if overnight Li Hep-RT, serum,EDTA-4C
Topoisomerase-1 Ab	Clotted	MRI Immunology
Toxoplasmosis screen	Clotted	HPA
TPO	Clotted	Biochemistry, UHSM
TPMT( Thiomethyl purine transferase)	Contact Haematology	London
Tryptase serum(include time of anph shock)	Clotted	MRI Immunology
TSH receptor antibodies	Clotted	Firs lab,Cardiff
Transglutaminase	Clotted	MRI Immunology
TTG (Tissue Transglutaminase)	Clotted	MRI Immunology
Tumour Markers (CA199, CA125)	Clotted	Biochemistry, UHSM
Vasculitis screen 1	Clotted	MRI Immunology
Vasculitis screen 2	Clotted	Biochemistry, UHSM
Vasculitis screen 3	Clotted	Haematology, UHSM
VDRL	Clotted	HPA
Vit K levels	Clotted	St Thomas's, London
Voltage ab gated Calcium (Ca) channel	Clotted	Oxford
Voltage ab gated potassium (K) channel	Clotted	Oxford
Yo antibody	Clotted	Oxford