Department of Laboratory Medicine


Immunology Division


Alphabetical List of Tests / Panels:

A

  • ALPHA-1-ANTITRYPSIN
  • ALPHA-FETOPROTEIN
  • ANA
  • ANA REFLEXIVE PANEL
  • ANCA
  • ANTI-CARDIOLIPIN ANTIBODY
  • ANTI-CCP
  • ANTI-CENTROMERE ANTIBODY
  • ANTI-DNA ANTIBODY
  • ANTI-ENA SCREEN
  • ANTI-ENA IDENTIFICATION
  • ANTI-ENDOMYSIAL ANTIBODIES
  • ANTI-GLIADIN; IgG and IgA
  • ANTI-GLOMERULAR BASEMENT MEMBRANE
  • ANTI-HEMOPHILUS INFLUENZA B
  • ANTI-JO-1 ANTIBODY
  • ANTI-LIVER-KIDNEY-MICROSOME ANTIBODY
  • ANTI-MICROSOMAL ANTIBODY
  • ANTI-MITOCHONDRIAL ANTIBODY
  • ANTI-MYOCARDIAL ANTIBODY
  • ANTI-MYELOPEROXIDASE AUTOANTIBODIES
  • ANTI-NEURONAL ANTIBODY
  • ANTI-PARIETAL CELL ANTIBODY
  • ANTI-PCNA ANTIBODY
  • ANTI-PNEUMOCOCCAL CAPSULAR POLYSACCHARIDE
  • ANTI-PROTEINASE 3 AUTOANTIBODIES
  • ANTI-RNP ANTIBODY
  • ANTI-SCL-70 ANTIBODY
  • ANTI-Sm ANTIBODY
  • ANTI-Sm/RNP ANTIBODY
  • ANTI-SMOOTH MUSCLE ANTIBODY
  • ANTI-SSA/RO ANTIBODY
  • ANTI-SSB/LA ANTIBODY
  • ANTI-TETANUS TOXOID
  • ANTI-THYROGLOBULIN
  • ANTI-TISSUE TRANSGLUTMINASE IgA
  • ANTI-TISSUE TRANSGLUTMINASE IgG
  • APOLIPOPROTEINS A-1 & B
  • AUTOIMMUNE LIVER DISEASE AUTOANTIBODIES

B

  • BENCE JONES PROTEIN IDENTIFICATION
  • BENCE JONES QUANTITATIVE
  • BETA-HUMAN CHORIONIC GONADOTROPHIN (bhCG)

C

  • CARCINOEMBRYONIC ANTIGEN
  • C1 (C1q PROTEIN)
  • C3
  • C4
  • CH50
  • C1 ESTERASE INHIBITOR
  • C1 ESTERASE INHIBITOR PANEL
  • C1q BINDING
  • CERULOPLASMIN
  • COLD AGGLUTININ TITER
  • COLD AGGLUTININ IDENTIFICATION
  • COLD AGGLUTININ THERMALAMPLITUDE
  • CRYOFIBRINOGEN
  • CRYOGLOBULIN
  • CRYOGLOBULIN ID
  • CSF IgG INDEX
  • CSF IgG
  • CSF OLIGOCLONAL
  • CSF-SPECIFIC TRANSFERRIN

D

  • DNA BINDING

E

  • ELECTROPHORESIS, PROTEIN
  • ELECTROPHORESIS, PROTEIN REFLEXIVE PANEL
  • ESTRIOL, UNCONJUGATED (uE3)

H

  • HAPTOGLOBIN
  • HELICOBACTER PYLORI IgG ANTIBODIES

I

  • IMMUNE COMPLEXES
  • IMMUNOELECTROPHORESIS
  • IMMUNOFIXATION
  • IMMUNOGLOBULIN-A (IgA) Quant.
  • IMMUNOGLOBULIN-G (IgG) Quant.
  • IMMUNOGLOBULIN-M (IgM) Quant.
  • IMMUNOGLOBULIN-E (IgE) Quant.
     

N

  • N-TELOPEPTIDE in Urine

O

  • OLIGOCLONAL BANDING

P

  • PROTEIN ELECTROPHORESIS

R

  • RETINOL BINDING PROTEIN
  • RHEUMATOID FACTOR

S

  • SERUM AND BLOOD VISCOSITY

T

  • THYROID ANTIBODIES
  • TOTAL HEMOLYTIC COMPLEMENT, THC


Reference Chart of Tests / Panels:

TEST PANEL

METHOD
(See List of Method Abbreviations)

REFERENCE RANGE

SPECIMEN REQUIRED

CLINICAL UTILITY
(See List of Disease Abbreviations)
ALPHA-1-ANTITRYPSIN Neph 110-260 mg/dl 1.0 ml serum. Freeze. Protein level increased in acute phase response, pregnancy, estrogen therapy; decreased in patients with genetic deficiency which causes pulmonary and liver disease. Also may be depressed in nephrotic syndrome. Elevated levels found with tumors such as hepatomas, ovarian and testicular tumors and some stomach, pancreatic or biliary tract tumors.
ALPHA-FETOPROTEIN EIA Non-maternal serum:
0-8.5 ng/ml


Amniotic Fluid and Maternal serum: Varies with gestational age		 Non-maternal serum:
3 ml, refrigerate or freeze.

Maternal serum:
3 ml, refrigerate or freeze.
(Must provide gestational age and maternal weight. For more information call lab.)

Amniotic Fluid:
1 ml minimum. Refrigerate. Do not freeze.




Increased levels of Alpha-Fetoprotein (AFP) occur in normal pregnancy. Abnormally high concentrations in maternal serum and amniotic fluid are associated with neural tube defects. Abnormally low levels in pregnancy suggest Downs syndrome.
ANA
(Anti-Nuclear Antibody) 		IFA 1:40 or neg.
(age <40 yrs.)

1:80 or neg.
(age >40 yrs.) 		2.0 ml serum. Freeze or refrigerate. Antibodies to nuclear constituents form in SLE (>90% of untreated cases) and other autoimmune diseases. Low titer ANAs occur in 5-15% of normals, especially in older females.
ANA REFLEXIVE PANEL (See ANA, Anti-SSA,
Anti-DNA, and Anti-ENA) 		Negative 2.0 ml serum. Freeze or refrigerate. The panel includes ANA and anti-SSA, with automatic follow-up of DNA-Binding and ENA Screen/ID on positive ANAs. This panel is useful in differentiating between SLE and other autoimmune diseases associated with above antibodies.
ANCA
(Anti-Neutrophil Cytoplasmic Antibodies)
(P-ANCA: see Anti-MPO Autoantibodies)
(C-ANCA: see Anti-PR3 Autoantibodies) 		IFA Negative 0.5 ml serum. Freeze or refrigerate. ANCAs are autoantibodies directed against antigens which are present predominantly in the lysosomal granules of neutrophilic polymorpho-nuclear leukocytes. ANCAs are useful for assessing disease activity and for the diagnosis of vasculitis, pulmonary, and renal diseases, and have been suggested as one of the key tests for classification of vasculitis.

The cytoplasmic pattern (C-ANCA) is detected in the majority of patients with active Wegener's granulomatosis (>90%), is rarely found in other diseases and is almost always due to antibodies against proteinase-3 (see Anti-PR3 Autoanti-bodies).

The perinuclear pattern (P-ANCA) is observed in Wegener's granulomatosis and in idiopathic necrotizing and crescentic glomerulonephritis as well as in periarteritis with glomerulonephritis. P-ANCA is usually due to antibodies against myelo-peroxidase (see Anti-MPO Autoantibodies).

Titers of both patterns appear to be indicative of the disease severity and activity.
ANTI-CARDIOLIPIN ANTIBODY
(See also Lupus Inhibitor)		 EIA 0-9 GPL
0-9 MPL 		1.0 ml serum. Freeze or refrigerate. Antibodies to the phospholipid, cardiolipin, found in about half of patients with SLE, and in diseases such as syphilis which give a positive VDRL. Test useful in detecting patients with lupus anticoagulant, recurrent thrombosis and recurrent miscarriages.
ANTI-CCP
EIA Negative:
<20 U
Weak positive:
20-39 U
Moderate Positive:
40-59 U
Strong Positive:
>59 U
 0.5 ml serum. Freeze. Click on test link for more information.
ANTI-CENTROMERE ANTIBODY
(included in ANA) 		IFA Negative 0.5 ml serum. Freeze or refrigerate. Antibodies to centromere (region of the chromosome joining the two chromatids) are markers for CREST syndrome of scleroderma, and sometimes occur with Raynaud's disease. All ANA tests in lab also include screen for Anti-Centromere.
ANTI-DNA ANTIBODY
(DNA-Binding) 		EIA Negative:
15 U/ml
Borderline positive:
15-30 U/ml
Low Positive:
30-60 U/ml
Positive:
60-200 U/ml
Strongly Positive:
>200 U/ml 		0.3 ml serum. Freeze or refrigerate. Antibodies to double-stranded (native) DNA form in SLE; elevated DNA binding seen in SLE flares (especially with glomerulonephritis).
ANTI-DNA ANTIBODY (Crithidia screen) IFA Negative 0.5 ml serum. Freeze or refrigerate. See above.
ANTI-ENA SCREEN CIE and EIA Negative
(If positive, ANTI-ENA ID will be done at no additional charge) 		1.0 ml serum. Freeze or refrigerate. Antibodies to acidic, saline-extractable nuclear antigens (ENA) occur in many systemic rheumatic diseases. (See below)
ANTI-ENA IDENTIFICATION
(RNP, Sm, SSA/Ro, SSB/La) 		EIA and CIE Negative (Performed on same sample as screen) High titers of antibody to RNP (Ribonucleo-protein) seen in 95-100% mixed connective tissue disease. Low titers seen in SLE and related disorders.

Antibodies to Sm found in 25-30% of SLE. SSB (Sjogren's syndrome B) antibodies are seen in 30-60% of primary SS and SS associated with SLE and scleroderma but uncommonly in SS associated with rheumatoid arthritis.

Precipitating antibodies to SSA (Sjogren's syndrome A) antigen (acidic nucleoprotein located largely in cell cytoplasm, not the nucleus, of many cells) occur in >70% primary Sjogren's syndrome (SS), 30-40% SLE, especially subacute cutaneous lupus, about 9% SS with rheumatoid arthritis. Also found in neonatal and maternal serum in cases of neonatal lupus, which is manifest by either rash or congenital heart block.
ANTI-ENDOMYSIAL ANTIBODIES IFA

Negative 0.5 ml serum. Freeze or refrigerate. Endomysial IgA antibodies are found in patients with active in gluten sensitive enteropathies (either celiac disease or dermatitis herpetiformis ) but virtually no other condition. Approximately 70% of patients with dermatitis herpetiformis and over 90% of patients with active celiac disease will demonstrate endomysial IgA antibodies.

A high anti-endomysial titer supports the diagnosis of celiac disease. In addition the levels of the anti-endomysial antibody parallel the response to diet. The test is thus useful in both the diagnosis of celiac disease and monitoring response to treatment with a gluten free diet.
ANTI-GLIADIN; IgG and IgA EIA For IgG :
<20 U = Negative;
20-60 U = Indeterminate;
61-90 U = Low positive;
>90 U = Positive.

For IgA :
<20 U = Negative;
20-30 U = Low positive;
>30 U = Positive 		0.5 ml serum. Freeze or refrigerate. Gliadin IgA and IgG antibodies are detected in sera of patients with gluten sensitive enteropathy. Gliadin IgG antibodies seem to be more sensitive but are less specific markers for disease; gliadin IgA antibodies are less sensitive but more specific. A significant proportion of celiac patients are IgA deficient.
ANTI-GLOMERULAR BASEMENT MEMBRANE EIA Negative:
0-10 EU
Borderline:
11-20 EU
Positive:
>21 EU 		0.5 ml serum. Freeze. Antibodies to GBM are frequently seen in patients with goodpastures' syndrome. The EIA method is more sensitive than the traditional immunofluorescence method, and correlates well with renal biopsy results.
ANTI-HEMOPHILUS INFLUENZA B EIA <0.15 mg/L Non-protective;
0.15-1.00 mg/L Indeterminate; >1.00 Antibodies present		 2.0 ml serum. Freeze or refrigerate. Measurement of antibody to HIB may aid in the assessment of immunocompetence.
ANTI-JO-1 ANTIBODY EIA Negative:
0-5.0 SD
(0-6.1 U/ml)
Indeterminate:
5.1-12.0 SD
(6.1-12.4 U/ml)
Positive:
>12.0 SD
(>12.4 U/ml) 		0.5 ml serum. Freeze or refrigerate. Antibodies to Jo-1 appear in approximately 30% of patients with polymyositis, especially in association with interstitial lung disease.
ANTI-LIVER-KIDNEY-
MICROSOME ANTIBODY 		IFA Negative 0.5 ml serum Freeze or refrigerate. Antibodies to liver-kidney microsomes (LKM) are associated with some forms of autoimmune liver disease. Subtyping the specific type of anti-LKM staining (e.g. LKM1, LKM2) is best done by other methods (e.g. Western Blot), and is not done in this laboratory.
ANTI-MICROSOMAL ANTIBODY
(See also Anti-Thyroglobulin Antibody) 		EIA Negative 0.5 ml serum. Freeze or refrigerate. Antibodies to thyroid microsomal antigen and protein (thyroglobulin) are markers for human auto-immune thyroid disease. One or both antibodies are present in almost all Hashimoto goiters, 90% of primary myxedema, 70-90% Graves' Disease. In thyrotoxicosis, high titers (Thyroglobulin >1:640; Microsomal >1:6400) indicate more severe disease, tendency to relapse, or concomitant destructive thyroiditis.
ANTI-MITOCHONDRIAL ANTIBODY IFA Negative 0.5 ml serum. Freeze or refrigerate. High titers of antibody to components of mitochondria often seen in primary biliary cirrhosis. Low titers suggest other liver diseases.
ANTI-MYOCARDIAL ANTIBODY IFA Negative 0.5 ml serum. Freeze or refrigerate. Antibodies to myocardium components suggest cardiac injury (Dressler syndrome) or rheumatic fever.
ANTI-MYELOPEROXIDASE AUTOANTIBODIES
(Anti-MPO, P-ANCA) 		EIA Normal:
0-9 U/ml

Borderline:
10-19 U/ml

Positive:
>19 U/ml 		0.5 ml serum. Freeze. Originally, it was suspected that myeloperoxidase (MPO) is the main target antigen of P-ANCA, but later it became evident that only about 10% of P-ANCA findings are due to anti-MPO antibodies. Anti-MPO antibodies proved highly sensitive and specific for idiopathic and vasculitis-associated crescentic glomerulonephritis, and also for classic polyarteritis nodosa, Churg-Strauss syndrome, and the polyangiitis overlap syndrome without renal involvement.
ANTI-NEURONAL ANTIBODY EIA Serum:
0-54 STU
CSF:
1.0 STU 		1.0 ml serum or 2.0 ml CSF. Freeze. Elevated serum or CSF antibody levels may be helpful in the diagnosis of neuropsychiatric systemic lupus erythematosus (SLE).
ANTI-PARIETAL CELL ANTIBODY IFA Negative 0.5 ml serum. Freeze or refrigerate. Antibodies to parietal cells usually seen in atrophic gastritis, 80% of pernicious anemia. Low titers sometimes seen in elderly (with no symptoms of gastritis or pernicious anemia.)
ANTI-PCNA ANTIBODY
(See ENA Screen/ID) 		CIE Negative See ENA Screen/ID. See ENA Screen/ID clinical utility.
ANTI-PNEUMOCOCCAL CAPSULAR POLYSACCHARIDE EIA <4.0 mg/L = Non protective;
4.0–10.0 mg/L = Indeterminate;
>10.0 mg/L = Antibodies present		 0.5 ml serum. Freeze. Determination of a patient’s level of antibody to pneumococcal capsular polysaccharide post vaccination may aid the assessment of immunocompetence.
ANTI-PROTEINASE 3 AUTOANTIBODIES
(Anti-PR3, C-ANCA) 		EIA Normal:
0-9 U/ml

Borderline:
10-19 U/ml

Positive:
>19 U/ml 		0.5 ml serum. Freeze. Anti-PR-3 antibodies are of similar diagnostic value for Wegener's granulomatosis as anti-DNA antibodies for systemic lupus erythematosus. In a recent study, including 277 patients with WG and 1657 control patients, the specificity of anti-PR-3 antibodies for WG was determined to be 98%.

The sensitivity of anti-PR-3 antibodies depended on disease activity and extent. It was found to be 93% for patients with active generalized disease, 60% for patients with active locoregional symptomatology and 40% for patients in remission.

In follow-up studies it was demonstrated that autoantibody changes paralleled changes in disease activity and helped to distinguish relapses of WG from other intercurrent illnesses.
ANTI-RNP ANTIBODY
(See ENA Screen/ID) 		EIA Negative See ENA Screen/ID. See ENA Screen/ID clinical utility.
ANTI-SCL-70 ANTIBODY EIA Negative 0.5 ml serum. Freeze or refrigerate. Antibodies to DNA-topoisomerase, found in 20-25% of progressive systemic sclerosis with diffuse scleroderma.
ANTI-Sm ANTIBODY
(See ENA Screen/ID) 		EIA
 Negative:
3.0 SD
(1.5 EU)
Indeterminate:
3.0-30.0 SD
(1.6-10.8 EU)
Positive:
>30.0 SD
(>10.9 EU) 		See ENA Screen/ID. See ENA Screen/ID clinical utility.
ANTI-Sm/RNP ANTIBODY
(See ENA Screen/ID) 		EIA Negative:
3.0 SD
Indeterminate:
3.0-10.0 SD
Low Positive:
10.1-30.0 SD
Mod. Positive:
30.1-120 SD
Strng Positive:
>120 SD 		See ENA Screen/ID. See ENA Screen/ID clinical utility.
ANTI-SMOOTH MUSCLE ANTIBODY IFA Negative 0.5 ml serum. Freeze or refrigerate. High titers of antibodies to smooth muscle (>1:160) suggest autoimmune chronic active hepatitis. Antibodies also occur in other liver diseases: in 50% primary biliary cirrhosis, and in low titers in acute infectious hepatitis and alcoholic cirrhosis. Also found in infectious monomucleosis and other viral infections.
ANTI-SSA/RO ANTIBODY (Can be ordered alone, also see ENA Screen/ID) EIA Negative:
0-5.0 SD
Weakly Positive:
5.1-10.0 SD
Moderately Positive:
10.1-20.0 SD
Strongly Positive:
>20.0 SD 		0.5 ml serum. See ENA Screen/ID clinical utility.
ANTI-SSB/LA ANTIBODY (See ENA Screen/ID) EIA Negative See ENA Screen/ID. See ENA Screen/ID clinical utility.
ANTI-TETANUS TOXOID EIA >3.8 mg/L = Positive 0.1 ml serum. Freeze or refrigerate.  
ANTI-THYROGLOBULIN HA Negative 0.5 ml serum. Freeze or refrigerate. See Anti-Microsomal antibody clinical utility.
ANTI-TISSUE TRANSGLUTMINASE  IgA EIA <20 U = Negative;

20-30 U = Low positive;

>30 U = Positive 		0.5 ml serum. Freeze or refrigerate. Presence of anti-tissue transglutaminase antibodies suggests the possibility of certain gluten sensitive enteropathies such as celiac disease and dermatitis herpetiformis. IgA anti-tissue transglutaminase and anti- endomysial antibodies are thought to be the same antibodies. Gliadin, the alcohol soluble fraction of it is not uncommon for celiac patients to be IgA deficient, which can result in false negative serologic tests in biopsy confirmed celiac patients. To compensate for this, we also offer testing for IgG classes of celiac antibodies such as gliadin and reticulin.
ANTI-TISSUE TRANSGLUTMINASE IgG EIA <20 U = Negative;
20-30 U = Low positive;
>30 U = Positive 		0.5 ml serum. Freeze or refrigerate. See Anti-Tissue Transglutaminase IgA clinical utility.
APOLIPOPROTEINS A-1 & B Neph Apolipoprotein A-1: Female (18-69 yrs) = 115 - 206 mg/dl; Male (18-69 yrs) = 107 - 187 mg/dl

Apolipoprotein B: Female (18-69 yrs) = 61 - 150 mg/dl; Male (18-69 yrs) = 63 - 152 mg/dl 		0.5 ml serum. Freeze or refrigerate. Apo A-1 determination are useful in assessing the risk of atherosclerotic diseases. Apo A-1 is generally low in persons with atherosclerotic vascular disease. A low Apo A-1 level can be a risk factor for atherosclerosis even if Apo B is normal. The ratio of Apo B/A-1 may be the best parameter for estimating the risk of atherosclerosis. Apo B determination is useful in the differential diagnosis of hyperlipoproteinemia as a replacement for the complicated determination of LDL (b) cholesterol by ultracentrifugation.
AUTOIMMUNE LIVER DISEASE AUTOANTIBODIES IFA Negative 0.5 ml serum. Freeze. Anti-mitochondrial antibodies (AMA) are present in high titers in approximately 90% of patients with primary biliary cirrhosis, and present in lower titers in 7-30% of patients with chronic active hepatitis, but rarely are found in extrahepatic jaundice.

High titers of antibodies to smooth muscle (ASMA) suggest a diagnosis of chronic active hepatitis. Low titers of ASMA occasionally occur in acute infectious hepatitis, alcoholic cirrhosis, malignancies, viral infections such as infectious mononucleosis and occasionally in normal healthy individuals.
BENCE JONES PROTEIN IDENTIFICATION IFIX No monoclonal component 50 ml urine (random or 24 hr specimen). Refrigerate. Monoclonal light chains in urine (Bence Jones protein) found in multiple myeloma (50%). About 20% of the myeloma patients have Bence Jones proteinuria only, without an intact immunoglobulin spike.
BENCE JONES QUANTITATIVE
(Protein Electrophoresis) 		AEP No Bence Jones 60 ml urine (24 hr specimen). Record total volume, interval. Refrigerate. See above. Test to be performed only on patients with Bence Jones protein previously identified in this lab.
BETA-HUMAN CHORIONIC GONADOTROPHIN (bHCG) EIA Non-maternal (Tumor marker) samples:
0-5 mIU/ml

Maternal serum bHCG results do not have a reference range. 		2.0 ml serum. Freeze or refrigerate. During pregnancy, HCG is generally approximately 50 mIU /ml (IU/l) in the week after conception, and doubles every 1.5–3 days for the first six weeks. Then shows a gradual decrease after the first trimester. Unusually low or rapidly declining levels may indicate an abnormal condition such as an ectopic pregnancy or impending spontaneous abortion.

Clinical applications for the HCG beta assay as a tumor marker include the diagnosis and management of hydatidiform mole and choriocarcinoma. The HCG beta assay is a valuable tool also in the diagnosis, staging and management of patients with testicular and ovarian germ-cell tumors.
CARCINOEMBRYONIC ANTIGEN
(CEA) 		EIA 0-5 ng/ml 2.0 ml serum or plasma. Freeze. Avoid hemolysis. Levels of circulating CEA are of value in monitoring treatment of some gastrointestinal, breast and other malignancies. Elevated CEA following treatment strongly indicates occult metastatic and/or residual disease. Rising levels may indicate progressive malignant disease or poor therapeutic response; declining levels indicate favorable response. CEA levels increased in heavy smokers and in condictions such as cirrhosis, ulcerative colitis, diverticulitis, rectal polyps and some benign tumors.
C1 (C1q PROTEIN) RID 12-25 mg/dl 1.0 ml serum. Freeze (send on dry ice). Low levels of C1 (the first functional unit of the classical complement pathway) indicate immunodeficiency and/or autoimmune disease (especially SLE). The C1q protein level is increased in active rheumatoid arthritis. In hereditary angioedema the C1q level is normal; in acquired angioedema with C1 esterase inhibitor deficiency, C1q is low.
C3 Neph 60-150 mg/dl 0.6 ml serum. Freeze w/in 2 hrs. After blood draw (send on dry ice). Low levels of C3 (complement component of classical or alternative pathways), occur in diseases such as SLE, vasculitis and some forms of glomerulonephritis. Congenital C3 deficiency has also been reported. Elevated C3 levels may occur in inflammation as an acute phase reactant.
C4 Neph 12-40 mg/dl 0.6 ml serum. Freeze w/in 2 hrs. After blood draw (send on dry ice). Low levels of C4 (complement component of classical pathway) are indicative of SLE if seen with high ANA and high anti-DNA. Very low C4, with low CH50 and normal C3, suggests hereditary deficiency of C4 or C1 esterase inhibitor.
CH50
(THC/Total Hemolytic Complement) 		Hemolytic Assay 80-160 units/ml 0.5 ml serum. Freeze w/in 2 hrs. After blood draw (send on dry ice). Low levels of hemolytic complement activity indicate activation or congenital deficiency of the complement system, and occur in SLE and other immune complex diseases. Patients with deficiencies of the complement system develop either immune complex disease or recurrent infections. High levels of activity seen as a non-specific acute phase reactant with many conditions.
C1 ESTERASE INHIBITOR
(C1 inactivator)

Functional assay







Quantitative protein level


EIA







RID


Normal:
>68%
Borderline:
41-67%
Abnormal:
40%


15-28 mg/dl


0.5 ml EDTA plasma or serum (Freeze w/in 6 hrs. After blood draw for serum; send on dry ice).


0.5 ml serum. (EDTA plasma OK, send on dry ice) 		C1 Esterase Inhibitor is either decreased (heterozygous) or absent (homozygous) in patients with hereditary angioedema (HAE). With decreased inhibitor protein, C1 esterase activity increases, resulting in subnormal levels of C4. For confirmation of HAE, order C1 esterase inhibitor quantitative protein level. To differentiate between HAE and acquired angioedema, also order C1 level. Patients with acquired form have low C1; in HAE, C1 protein level is normal. About 15% of HAE have a dysfunctional C1 esterase inhibitor, with a normal protein but depressed functional level.
C1 ESTERASE INHIBITOR PANEL (Includes functional and quantitative tests)       This panel is useful in diagnosis of HAE (see above).
C1q BINDING
(See Immune Complexes) 		       
CERULOPLASMIN Neph 22.0-66.0 mg/dl 0.5 ml serum. EDTA plasma is OK. Decreased levels of ceruloplasmin have been linked to protein malnutrition, severe liver disease and most significantly in Wilson's disease.
COLD AGGLUTININ TITER HA 1:8 5.0 ml EDTA whole blood. Refrigerate. Do not spin or freeze. Titers of cold agglutinin antibodies >1:64 are associated with mycoplasma pneumonia, infectious mononucleosis and other viral infections. Antibody usually appears in serum about 10th day after initial infection and reaches maximum in about three weeks. High titers (1:1000 or higher) occur with autoimmune hemolytic anemia. Monoclonal cold agglutinins occur in lymphoreticular neoplasms.
COLD AGGLUTININ IDENTIFICATION IFIX No monoclonal component 5.0 ml EDTA whole blood. Monoclonal cold agglutinin antibodies may occur in lymphoreticular neoplasms, whereas post-infectious cold agglutinins are polyclonal (see above).
COLD AGGLUTININ THERMALAMPLITUDE HA   5.0 ml EDTA whole blood. Refrigerate. The cold agglutinin is run at 3 different temperatures: 4°C, room temperature, and 31°C. Cold agglutinins that are reactive at 31°C are more likely to be clinically significant.
CRYOFIBRINOGEN Precipitation upon refrigeration. Solubilization upon incubation. Negative at both 3 days and 10 days for each sample type. A 10 ml red top tube, a 5ml Blue top and a 5 ml green top are to be drawn and must be maintained at 37°C while clotting. Cryrofibrinogenemia refers to the presence of cold-precipitatable proteins in plasma but not in serum. Cryofibrinogen may be associated with malignancy, thromboembolic disease (usually in the skin, lung, and myocardium), or various inflammatory conditions.
CRYOGLOBULIN Precipitation (Refrigerated Centrifugation) Negative 5.0 ml serum; draw 10 ml red top tube; clot & separate serum at 37°C. Refrigerate. Do not freeze. Immunoglobulins which precipitate in the cold are classified as 3 types:

Type 1: monoclonal IgG, IgM or IgA (found in myelomas, lymphomas, Waldenstrom's macroglobulinemia);

Type II: monoclonal IgG, IgM or IgA mixed with polyclonal IgG (found in rheumatoid arthritis, Sjogren's syndrome, macroglobulinemia, lymphoproliferative disorders, some viral infections);

Type III: mixed polyclonal immunoglobulins, usually IgG and IgM, (found in SLE, rheumatoid arthritis, Sjogren's syndrome and other chronic inflammatory diseases, infectious mononucleosis and other viral infections). About 50% of cryoglobulins are Type III.
CRYOGLOBULIN ID IFIX No monoclonal component 5.0 ml serum, handled as above. This test identifies the immunoglobulin class and clonality of cryoglobulin components.
CSF IgG INDEX
(IgG/Albumin Ratio) 		Neph 0.34-0.66 1.0 ml CSF and1.0 ml serum drawn within 48 hrs. of one another. Freeze or refrigerate. An increase in the CSF index (ratio of CSF to serum IgG and albumin levels) occurs in neurological disorders such as multiple sclerosis, neurosyphilis, subacute sclerosing panencephalitis, CNS infections, CNS SLE, and in any condition causing relative increases in CSF IgG production.
CSF IgG Neph 0.5-6.1 mg/dl 1.0 ml CSF See CSF IgG index.
CSF OLIGOCLONAL Isoelectric Focusing with Immunofixation Negative 1.0 ml CSF + 0.5 ml serum. Freeze. Click on test link for more information.
CSF-SPECIFIC TRANSFERRIN IFIX Negative 1.0 ml CSF Refrigerate. Cerebrospinal fluid (CSF) leakage most commonly presents as otorrhea or rhinorrhea. Electrophoresis and immunofixation of CSF for transferrin has shown two isoforms in the beta region, where in the serum and other body fluids only one is observed. The slower unique isoform is diagnostic for CSF and its presence in a bodily fluid other than known CSF indicates that leakage has occurred.
DNA BINDING
(See Anti-DNA Antibodies) 		       
ELECTROPHORESIS, PROTEIN:
Serum












Urine



Cerebrospinal fluid

AEP

T.P.:
6.0-8.2 g/dl
Albumin:
3.5-4.9 g/dl
Alpha 1:
0.1-0.3 g/dl
Alpha 2:
0.3- 0.7g/dl
Beta:
0.6-1.0 g/dl
Gamma:
0.4-1.4 g/dl

No spike



Gamma: 16%

0.5 ml serum. Refrigerate.











25.0 ml 24 hr. or Random urine. Refrigerate.

5.0 ml CSF. Freeze.



Electrophoretic separation of proteins is used to evaluate hypo or hyperproteinemia, to screen for and quantify serum monoclonal gammopathies (see immunofixation), to screen for Alpha-1-antitrypsin deficiency. Characteristic patterns occur in nephrotic syndrome, inflammatory states and other conditions.



Urine electrophoresis is useful to screen for and quantitate Bence Jones protein.

The relative percent of gamma to total protein in spinal fluid is increased in multiple sclerosis (MS) and other demyelinating diseases, subacute sclerosing panencephalitis, and other inflammatory and infectious disorders of the CNS.
ELECTROPHORESIS, PROTEIN REFLEXIVE PANEL
(See electrophoresis, protein: serum) 		      Panel includes: protein levels; interpretation of the electrophoretic pattern ; and identification of any monoclonal components using immunofixation.
ESTRIOL, UNCONJUGATED (uE3) Send out EIA Estriol levels varies with gestational age. They are used as one factor in a multivariant analysis to calculate the prenatal risk of Down syndrome. Serum (2 ml - min volume 1 ml), collected between 15-20 weeks gestation is the preferred specimen type. Determining the serum levels of the unconjugated estriol provides a sensitive indicator of fetal well-being and placental function. Estriol in combination with bHCG and AFP and several maternal factors including gestational age, maternal age, race, weight, and diabetes can be used to estimate the prenatal risk for Down syndrome.
HAPTOGLOBIN Neph 100 - 300 mg/dL 0.5 ml serum. Freeze or refrigerate. Decreased haptoglobin has been reported in hemolytic disease, megaloblastic anemia and hemolytic transfusion reaction.
HELICOBACTER PYLORI IgG ANTIBODIES EIA <0.90 = Negative; 0.91-1.09 = Equivocal;
>1.10 = Positive. 		0.5 ml serum. Freeze or refrigerate. The presence of H. pylori specific IgG antibodies in human serum only provides evidence of past or present infection.
IMMUNE COMPLEXES
(C1q-Binding)

Fluid phase

Solid phase


RIA

EIA


0-9%

0-8 mcg aggregated human IgG (AHG) equivalents/ml 		1.0 ml serum. Freeze (send on dry ice). Circulating immune complexes (complement-binding IgG and IgM type) are measured by C1q binding. High binding occurs with diseases such as SLE and RA in which glomerulonephritis or vasculitis are clinical features. The fluid phase C1q assay is elevated in active RA and Sjogren's syndrome. The solid phase assay better reflects activity of SLE.
IMMUNOELECTRO-PHORESIS
(done by Immunofixation)
(See below) 		       
IMMUNOFIXATION

Serum




Urine

IFIX




IFIX

No monoclonal component



No Bence Jones Protein

0.5 ml serum. Refrigerate.



50 ml urine. Refrigerate. 		Immunofixation permits identification of monoclonal spikes in serum, and aids in evaluation of myelomas, Waldenstrom's macroglobulinemia, and polyclonal gammopathies. Spikes detected in urine electrophoresis are identified as Bence Jones protein by immunofixation. Excretion of monoclonal light chains occurs in myeloma, primary amyloidosis and some other immunoproliferative diseases.
IMMUNOGLOBULIN-A (IgA)
IMMUNOGLOBULIN-G (IgG)
IMMUNOGLOBULIN-M (IgM)
(Quantitative) 		Neph Adult (>17 yoa) ranges:
IgA:
80-500 mg/dl
IgG:
725-1750 mg/dl
IgM:
40-350 mg/dl 		1.0 ml serum (for IgG, IgA and IgM)
(Min. 0.3 ml serum for each.) 		Diffuse polyclonal increases in IgG, IgA and IgM occur in acute and chronic inflammation, and in chronic liver disease. In the myelomas a specific immunoglobulin is elevated (IgG in IgG myeloma, etc.) Decreases occur in some congenital or acquired immunodeficiency diseases, and in conditions causing protein loss or metabolic dysfunction.
IMMUNOGLOBULIN-E (IgE)
(Quantitative) 		Neph Adult (>20 yoa) range:
0-300 IU/ml
(0-690 ng/ml) 		0.5 ml serum. Freeze or refrigerate. Increased levels of serum IgE suggest reaginic hypersensitivity or atopic disease. Levels above 20 units/ml in infants indicate possible atopic hypersensitivity. In adults, levels above 350 units/ml seen in allergic disease. High levels (>750 units/ml) strongly suggest major atopic disease.
N-TELOPEPTIDE in Urine EIA Adult Males:
14 - 87 nM BCE/mM Creatinine.

Premenopausal females:
5-65 nM BCE/mM Creatinine. 		Single urine collection other than a first morning void or a 24 hour urine collection. Urinary NTx levels can be used to monitor the response to treatment of patients with diagnosed osteoporosis and Paget's disease.
OLIGOCLONAL BANDING AEP No Oligoclonal bands 5 ml CSF and 0.5 ml serum (drawn same day). Freeze or refrigerate. Oligoclonal bands originating in CSF appear in the gamma region (on agarose electrophoresis) and occur in about 90% of patients with MS at some time during the course of the disease. Banding also occurs in CNS inflammatory and infectious processes such as subacute sclerosing panencephalitis, neurosyphilis and viral or bacterial encephalitis. To confirm the oligoclonal bands originate in the CSF, a serum specimen must be tested simultaneously and found to contain no (or different) bands.
PROTEIN ELECTROPHORESIS
(See Electrophoresis, Protein) 		       
RETINOL BINDING PROTEIN Neph 2.1 - 6.4 mg/dl 1.0 ml serum. Freeze or refrigerate. Low RBP levels have been observed in 80% of retinitis pigmentosa patients. Decreased levels of RBP has also been associated with chronic liver disease. Increased levels of RBP can be seen in chronic renal disease.
RHEUMATOID FACTOR LA/Neph Negative
(1:20 or less) 		1.0 ml serum or synovial fluid. Freeze or refrigerate. In the latex fixation test, IgM class anti-IgG (rheumatoid factors) are detected. These antibodies are usually present in rheumatoid arthritis. They also may be present in SLE, Sjogren's syndrome, scleroderma, polymyositis, chronic infectious diseases (leprosy, TB, bacterial endocarditis), and in some cases of hypergammaglobulinemia, liver disease, sarcoidosis and syphilis. Incidence of rheumatoid factors in normals is about 5%, increasing with age.
SERUM AND BLOOD VISCOSITY Serum viscosity is measured relative to water, using a semiautomated viscoelastometer in the Coagulation division. Ratio of serum to water =
1.4 – 1.9 at room temperature, with a tendency for lower values at 37°C. 		1.0 mL serum, plasma or whole blood, handled as a cryoglobulin. The primary purpose of measuring serum viscosity is to diagnose hyperviscosity syndrome, a condition in which the viscosity of serum reaches very high levels, resulting in low perfusion of vital organs and high risk of thrombosis.
THYROID ANTIBODIES
(See Anti-Microsomal, Anti-Thyroglobulin Antibodies) 		       
TOTAL HEMOLYTIC COMPLEMENT, THC
(SEE CH50) 		The ability of complement, when activated by antigen-antibody complexes, to produce hemolysis of sheep red blood cells, forms the basis for the CH50 test. 80-160 units/ml 0.5 ml serum. Send on dry ice (Complement activity decreases unless the sample is kept frozen at -70°C). CH50 (Total Hemolytic Complement) is a functional hemolytic assay which demonstrates the integrity of the entire classical complement system and serves as a screen for many diseases in which serum complement levels are abnormal. Abnormal results may be followed with tests for specific complement components.

Last updated: 7/23/09

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