Oxford University Hospitals NHS Foundation Trust
Immunology

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Neutrophil Cytoplasmic Antibodies

Also known as: ANCA; MPO/PR3; c-ANCA; p-ANCA

Please note that all ANCA requests are screened in the Laboratory to ensure that testing is restricted to those patients whose presenting features suggest a high pre-test probability of small vessel vasculitis. ANCA requesting should be confined to patients presenting with:

  • Chronic necrotising large airways disease
  • Cavitating pulmonary nodules
  • Subglottic stenosis
  • Pulmonary-renal syndrome
  • Rapidly progressive glomerulonephritis
  • Cutaneous vasculitis accompanied by systemic symptoms
  • Mononeuritis multiplex

IgG antibodies directed against neutrophil enzymes systems are useful in the diagnosis and management of systemic necrotising vasculitis.

The main systemic necrotising vasculitides that are associated with a positive ANCA pattern are Granulomatous Polyangitis (GPA/Wegener's Granulomatosis), Microscopic Polyarteritis, Rapidly Progressive Glomerulonephritis and Churg-Strauss Syndrome.

Two major forms of pattern are seen: the cytoplasmic ANCA (cANCA) usually associated with autoantibodies against anti-proteinase 3, and the perinuclear (pANCA) pattern generally associated with myeloperoxidase auto-antibodies.

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% of patients with microscopic polyarteritis and pauci-immune glomerulonephritis, in addition to rheumatoid arthritis, SLE and ulcerative colitis

Samples from known ANCA positive patients are tested for MPO or PR3 antibody levels, as appropriate. New ANCA positives are analysed for ANCA specificity and levelsagainst both MPO and PR3.

Specimen requirements

Serum or plasma - 1ml

Cost

Price on application

Laboratory turnaround time

4 days

Laboratory method

Indirect Immunofluorescnce

Reference range/units

ANCA

Positive or Negative with pattern and titre

MPO Antibody Levels

>5.0 IU/ml = Positive

3.5-5 IU/ml = Equivocal

<3.5 I​U/ml = Negative

PR3Antibody Levels

>3.0IU/ml = Positive

2-3.0 IU/ml = Equivocal

<2.0 I​U/ml = Negative

Associated tests

MPO/PR3

Shipping and storage

UK and Ireland

Ambient temperature and first class post. Hays DX users please enquire via email below.

International

Ambient temperature if courier will deliver within 72 hours otherwise consider refrigerated transport. Freezing is not a requirement.

Ensure delivery Monday to Friday 09:00 - 17:30.

Further information and contact details

For further information, email immunology.office@nhs.net