From: The ANA-reflex test as a model for improving clinical appropriateness in autoimmune diagnostics
ANA-IIF pattern on HEp-2 cells | Reflex test(s) |
---|---|
Nuclear homogeneous ≥1:160 | Antibodies to intracellular specific antigens (ENA) and to dsDNA/nucleosomes |
Nuclear speckled ≥1:160 | Anti-dsDNA and antibodies to intracellular specific antigens (ENA), possibly including anti-RNA polymerase III |
Nuclear Scl70-like ≥1:160 | Antibodies to intracellular specific antigens (ENA) (possibly including anti-PM/Scl) |
Cytoplasmic speckled ≥1:160 | Antibodies to intracellular specific antigens (ENA), including anti-tRNA synthetases and anti-P ribosomal |
Pleomorphic PCNA-like (any titre) | Anti-PCNA |
Centromere | No confirmation necessary if high titres. Execute specific test for anti-CENP B only in dubious cases (low titre or centromeric pattern not clearly recognizable) |