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Order Code ALDG2 Autoimmune Liver Disease Panel, Serum


Ordering Guidance


For evaluating patients at-risk for antinuclear antibody-associated systemic autoimmune rheumatic disease, particularly systemic lupus erythematosus, Sjogren syndrome, or mixed connective tissue disease, order CTDC / Connective Tissue Disease Cascade, Serum.



Specimen Required


Supplies: Sarstedt Aliquot Tube, 5 mL (T914)

Container/Tube:

Preferred: Serum gel

Acceptable: Red top

Submission Container/Tube: Plastic vial

Specimen Volume: 1.5 mL

Collection Instructions: Centrifuge and aliquot serum into a plastic vial.


Useful For

Evaluating patients with suspected autoimmune liver disease, specifically autoimmune hepatitis or primary biliary cholangitis

 

Evaluating patients with liver disease of unknown etiology

Profile Information

Test ID Reporting Name Available Separately Always Performed
AMA Mitochondrial Ab, M2, S Yes Yes
NAIFA Antinuclear Ab, HEp-2 Substrate, S Yes Yes
SMAS Smooth Muscle Ab Screen, S Yes Yes

Reflex Tests

Test ID Reporting Name Available Separately Always Performed
SMAT Smooth Muscle Ab Titer, S No No

Testing Algorithm

If smooth muscle antibody (SMA) screen is positive, then the SMA titer will be performed at an additional charge.

 

For more information see First-Line Screening for Autoimmune Liver Disease Algorithm.

Method Name

AMA: Enzyme Immunoassay (EIA)

NAIFA, SMAS, SMAT: Indirect Immunofluorescence

Reporting Name

Autoimmune Liver Disease Panel, S

Specimen Type

Serum

Specimen Minimum Volume

1.1 mL

Specimen Stability Information

Specimen Type Temperature Time
Serum Refrigerated (preferred) 21 days
  Frozen  21 days

Reject Due To

Gross hemolysis Reject
Gross lipemia Reject
Gross icterus OK
Heat-treated specimen Reject

Reference Values

MITOCHONDRIAL ANTIBODIES (M2)

Negative: <0.1 Units

Borderline: 0.1-0.3 Units

Weakly positive: 0.4-0.9 Units

Positive: ≥1.0 Units

Reference values apply to all ages.

 

ANTINUCLEAR ANTIBODIES

Negative: <1:80

 

SMOOTH MUSCLE ANTIBODIES

Negative

If positive, results are titered.

Reference values apply to all ages.

Method Description

Mitochondrial Antibodies:

This method is an enzyme immunosorbent assay that detects both IgG and IgM antibodies to M2 antigens. A dilution of patient serum is added to the wells coated with M2 antigen and incubated. After incubation and washing, all unbound human antibodies are washed away, and enzyme-conjugated IgG and IgM anti-human is added. The enzyme conjugate binds to the antibody complex. Excess enzyme-conjugate is washed away, and substrate is added. After incubation, the enzyme substrate reaction is stopped. The complete assay is measured on a spectrophotometer plate reader. The intensity of the color generated is proportional to the amount of IgG and IgM specific antibody in the sample.(Package insert: Kallestad Anti-Mitochondrial Kit. Bio-Rad Laboratories; 10/2014)

 

Antinuclear Antibodies:

Antibodies to nuclear antigens in a human epithelial type 2 (HEp-2) cell line by an indirect immunofluorescent technique. Commercial slides prepared from HEp-2 cells are used as a substrate. IgG antibodies in serum specimens are detected after incubation of serum with the commercial slides by the addition of a fluorescein isothiocyanate (FITC)-labeled antihuman-IgG reagent. All patient specimens are initially screened at 1:80.(Package insert: NOVA Lite DAPI ANA. Inova Diagnostics; 06/2018)

 

Smooth Muscle Antibody:

The patient's serum in 1:20 and 1:40 dilutions is added to fresh tissue from mouse stomach/kidney and incubated; fluorescein-conjugated antiglobulin is then added. The slides are read with a fluorescence microscope.(Package insert: Kallestad Mouse Stomach/Kidney. Bio-Rad Laboratories, Inc; 06/2015)

Day(s) Performed

Monday through Saturday

Performing Laboratory

Mayo Clinic Laboratories in Rochester

CPT Code Information

86381

86039

86015

86015-Titer (if appropriate)

Forms

If not ordering electronically, complete, print, and send a Gastroenterology and Hepatology Test Request (T728) with the specimen.