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ANCA/MPO/PR3 Antibodies

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Also known as: ANCA Antibodies; cANCA; pANCA; Serine Protease 3; MPO; PR3; Anticytoplasmic Autoantibodies; 3-ANCA; PR3-ANCA; MPO-ANCA
Formal name: Antineutrophil Cytoplasmic Antibodies; Myeloperoxidase Antibodies; Proteinase 3 Antibodies

At a Glance

Why Get Tested?

To help detect, aid in the diagnosis of, and sometimes monitor certain forms of the autoimmune disorder systemic vasculitis (inflammation of blood vessels)

To help distinguish between Crohn disease (CD) and ulcerative colitis (UC), the two most common types of inflammatory bowel disease (IBD); as an adjunct to other IBD testing

When to Get Tested?

When you have symptoms such as fever, muscle aches, and weight loss that your health practitioner thinks may be due to a vascular autoimmune disorder; sometimes to monitor response to therapy

When you have symptoms such as persistent or intermittent diarrhea and abdominal pain that your health practitioner suspects may be due to an IBD; when your health practitioner wants to distinguish between CD and UC

Sample Required?

A blood sample drawn from a vein in your arm

Test Preparation Needed?

None

The Test Sample

What is being tested?

Antineutrophil cytoplasmic antibodies (ANCA) are autoantibodies produced by a person's immune system that mistakenly target and attack proteins within the person's neutrophils (a type of white blood cell). ANCA testing detects and measures the amount of these autoantibodies in the blood. Two of the most common types or subsets of ANCA are the autoantibodies that target the proteins myeloperoxidase (MPO) and proteinase 3 (PR3).

For the test, an individual's blood sample is mixed with neutrophils and the mixture is placed on a slide and treated with a fluorescent stain. If ANCA are present, they will produce a pattern of fluorescence that can be seen under a microscope. The pattern may be identified as cytoplasmic or cANCA, perinuclear (pANCA), or atypical ANCA (X-ANCA). Alternatively, the laboratory may test for myeloperoxidase antibodies or proteinase 3 antibodies directly using an ELISA assay. A combination of both fluorescence and ELISA tests are often done when working up suspected cases of vasculitis.

ANCA may be present in several autoimmune disorders that cause inflammation, tissue damage, and organ failure:

  • Systemic vasculitis is a group of disorders associated with damage and weakening of blood vessels. It can cause tissue and organ damage due to the narrowing and obstruction of blood vessels and the subsequent loss of blood supply. It can also produce areas of weakness in blood vessel walls, known as aneurysms, which have the potential to rupture. The symptoms experienced by a person with systemic vasculitis depend upon the degree of autoimmune activity and the parts of the body involved. A few types of systemic vasculitis are closely associated with the production of ANCA:
    • Granulomatosis with polyangiitis (Wegener granulomatosis)
    • Microscopic polyangiitis
    • Eosinophilic granulomatosis with polyangiitis (Churg Strauss syndrome)
    • Polyarteritis nodosa (PAN)
  • (For more information on these specific conditions, see the article on Vasculitis).

    cANCA/PR3 antibodies are most frequently seen in granulomatosis with polyangiitis and pANCA/ MPO antibodies are most often associated with microscopic polyangiitis. However, both may be seen in all three types with varying degrees of reactivity.

  • Ulcerative colitis (UC) is a type of inflammatory bowel disease (IBD) associated with swollen and damaged tissues in the lining of the colon. UC can be difficult to distinguish from Crohn disease (CD), another type of IBD that can affect any part of the intestinal tract. The presence of atypical ANCA is generally associated with UC (80% of patients), while only 20% of CD patients may be positive.

How is the sample collected for testing?

A blood sample is obtained by inserting a needle into a vein in the arm.

NOTE: If undergoing medical tests makes you or someone you care for anxious, embarrassed, or even difficult to manage, you might consider reading one or more of the following articles: Coping with Test Pain, Discomfort, and Anxiety, Tips on Blood Testing, Tips to Help Children through Their Medical Tests, and Tips to Help the Elderly through Their Medical Tests.

Another article, Follow That Sample, provides a glimpse at the collection and processing of a blood sample and throat culture.

Is any test preparation needed to ensure the quality of the sample?

No test preparation is needed.

The Test

Common Questions

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Article Sources

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NOTE: This article is based on research that utilizes the sources cited here as well as the collective experience of the Lab Tests Online Editorial Review Board. This article is periodically reviewed by the Editorial Board and may be updated as a result of the review. Any new sources cited will be added to the list and distinguished from the original sources used.

Sources Used in Current Review

(© 1995–2014). Cytoplasmic Neutrophil Antibodies, Serum. Mayo Clinic Mayo Medical Laboratories [On-line information]. Available online at http://www.mayomedicallaboratories.com/test-catalog/Overview/9441 through http://www.mayomedicallaboratories.com. Accessed April 2014

Schlaberg, R. and Tebo, A. (Reviewed 2014 March). Inflammatory Bowel Disease – IBD. ARUP Consult [On-line information]. Available online at http://www.arupconsult.com/Topics/IBD.html through http://www.arupconsult.com. Accessed April 2014

Rowe, W. and Lichtenstein, G. (Updated 2013 November 25). Inflammatory Bowel Disease. Medscape Reference [On-line information]. Available online at http://emedicine.medscape.com/article/179037-overview through http://emedicine.medscape.com. Accessed April 2014

Ghazi, L. (Updated 2014 January 13). Crohn Disease. Medscape Reference [On-line information]. Available online at http://emedicine.medscape.com/article/172940-overview through http://emedicine.medscape.com. Accessed March 2014.

Basson, M. (Updated 2013 May 27). Ulcerative Colitis. Medscape Reference [On-line information]. Available online at http://emedicine.medscape.com/article/183084-overview through http://emedicine.medscape.com. Accessed March 2014.

(Reviewed 2012 December). Inflammatory Bowel Disease Differentiation Panel. Quest Diagnostics [On-line information]. Available online at http://www.questdiagnostics.com/testcenter/testguide.action?dc=TS_IBD_Differention_Panel through http://www.questdiagnostics.com. Accessed April 2014

Walfish, A. and Sachar, D. (Revised 2012 December). Crohn Disease. Merck Manual for Healthcare Professionals [On-line information]. Available online through http://www.merckmanuals.com. Accessed March 2014.

Furata, S. and Jayne, D. (2014). Emerging Therapies in Antineutrophil Cytoplasm Antibody-Associated Vasculitis. Medscape Multispecialty from Curr Opin Rheumatol. 2014;26(1):1-6. [On-line information]. Available online at http://www.medscape.com/viewarticle/821352 through http://www.medscape.com. Accessed April 2014

(2011 April 1). What is Vasculitis? National Heart, Lung, and Blood Institute. [On-line information]. Available online at http://www.nhlbi.nih.gov/health/health-topics/topics/vas/ through http://www.nhlbi.nih.gov. Accessed April 2014

Bronfenbrener, R (October 12, 2012) Antineutrophil Cytoplasmic Autoantibody, Cytoplasmic (c-ANCA). Medscape Reference. Available online at http://emedicine.medscape.com/article/2086572-overview through http://emedicine.medscape.com. Accessed May 2014.

Millet A, et. al. Antineutrophil Cytoplasmic Antibody-Associated Vasculitides. Ann Rheum Dis. 2013;72(8):1273-1279. Available online at http://www.medscape.com/viewarticle/809119 through http://www.medscape.com. Accessed May 2014.

Pagana, K. D. & Pagana, T. J. (© 2011). Mosby's Diagnostic and Laboratory Test Reference 10th Edition: Mosby, Inc., Saint Louis, MO. Pp 90-91.

Shah A, Bylund DJ, McCallum RM. (2011) Vasculitis, in Henry's Clinical Diagnosis by Laboratory Methods, 22nd ed. McPherson RA, Pincus MR, eds. Elsevier-Saunders: Philadelphia.Chap 52, Pp 991-1002.

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Sources Used in Previous Reviews

(2009 March). Vasculitis. National Heart Lung and Blood Institute [On-line information]. Available online at http://www.nhlbi.nih.gov/health/dci/Diseases/vas/vas_whatis.html through http://www.nhlbi.nih.gov. Accessed June 2010.

(© 2006-2010). MPO/PR-3 (ANCA) Antibodies : 0050707. ARUP's Laboratory Test Directory [On-line information]. Available online at http://www.aruplab.com/guides/ug/tests/0050707.jsp through http://www.aruplab.com. Accessed June 2010.

(Updated 2009 August). Vasculitis – ANCA. ARUP Consult [On-line information]. Available online at http://www.arupconsult.com/Topics/ANCA.html?client_ID=LTD through http://www.arupconsult.com. Accessed June 2010.

Borigini, M.J. (Updated 2009 May 31). Necrotizing Vasculitis. MedlinePlus Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/000432.htm. Accessed June 2010.

Mayo Clinic Staff (2009 October 10). Vasculitis [On-line information]. Available online at http://www.mayoclinic.com/health/vasculitis/DS00513/METHOD=print through http://www.mayoclinic.com. Accessed June 2010.

Revelo, P. and Tebo, A. (Updated 2009 August). Goodpasture Syndrome - Anti-GBM Disease. (ARUP Consult) [On-line information]. Available online at http://www.arupconsult.com/Topics/GoodpastureSyndrome.html?client_ID=LTD# through http://www.arupconsult.com. Accessed June 2010.

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Trevisin, M. et. al. (2008 March 10). Antigen-Specific ANCA ELISAs Have Different Sensitivities for Active and Treated Vasculitis and for Nonvasculitic Disease. Medscape from American Journal of Clinical Pathology. 2008;129(1):42-53 [On-line information]. Available online at http://www.medscape.com/viewarticle/568996 through http://www.medscape.com. Accessed June 2010.

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Pagana, K. D. & Pagana, T. J. (© 2007). Mosby's Diagnostic and Laboratory Test Reference 8th Edition: Mosby, Inc., Saint Louis, MO. Pp 88-89.

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