ANA Cascade (ANA, IFA with Reflex to Titer and Pattern, and Reflex to 11 Ab Cascade)
Test Code
Clinical Significance
ANA Cascade (ANA, IFA with Reflex to Titer and Pattern, and Reflex to 11 Ab Cascade) - This test can be helpful in the diagnosis of autoimmune rheumatic diseases. Specimens with positive results for antinuclear antibodies (ANAs) on the immunofluorescence assay (IFA), performed on human epithelial type 2 (HEp-2) cells, are subsequently tested for a series of disease-specific autoantibodies in cascade tiers. The first tier focuses on autoantibodies associated with systemic lupus erythematosus (SLE) and mixed connective tissue disease; the second tier detects autoantibodies seen in Sjogren Syndrome, progressive systemic sclerosis, and polymyositis; and the third tier includes markers ...
Test Resources
Test FAQ
Tests for Autoimmune Diseases (ANA)Test Details
If ANA Screen, IFA is positive, then ANA Titer and Pattern will be performed at an additional charge (CPT code(s): 86039).
Additionally, five antibodies will be performed at an additional charge: dsDNA (CPT code(s): 86225), Sm/RNP (CPT code(s): 86235), RNP (CPT code(s): 86235), Sm (CPT code(s): 86235), and Chromatin (CPT code(s): 86235).
If any of those five antibodies are positive, the cascade stops and the results are reported.
If all five of those antibodies are negative, four additional antibodies will be performed at an additional charge: SSA (CPT code(s): 86235), SSB (CPT code(s): 86235), Scl-70 (CPT code(s): 86235), Jo-1 (CPT code(s): 86235).
If any of those four antibodies are positive, the cascade stops and the results are reported.
If all four of those antibodies are negative, the following two additional antibodies will be performed at an additional charge: Ribosomal P (CPT code(s): 83516) and Centromere B (CPT code(s): 86235).
Please note the cascade stops upon the first positive antibody result(s) found in a group and an interpretive message is applied based on this information. It is possible that antibodies in subsequent groups are also positive, but will not be added, billed, or reported. Please contact your local Quest Diagnostics Laboratory if you are interested in adding this additional testing.
Methodology
Reference Range(s)
| ANA Screen | Negative |
| ANA Titer | |
| <1:80 | Negative |
| 1:80 | Low antibody level |
| >1:80 | Elevated antibody level |
Alternative Name(s)
Preferred Specimen(s)
1 mL serum
Transport Container
Transport tube
Transport Temperature
Room temperature
Specimen Stability
- Room temperature: 4 days
- Refrigerated: 7 days
- Frozen: 30 days
Reject Criteria
Gross hemolysis • Grossly lipemic • Grossly icteric • Microbial contamination may interfere
Setup Schedule, Minimum Volume
Refrigerated: 7 days
Frozen: 30 days