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22587 Extractable Nuclear Antibodies

Extractable Nuclear Antibodies
Test Code: ENA
Synonyms/Keywords
​Extractable Nuclear Antigen, ENA, ANA Confirmatory​, ANA-subset, ANA​
​
Test Components
SSA, SSB, Sm, SmRNP, Ribonucleoprotein (RNP), Scl-70, JO1, dsDNA, Chromatin, Ribosomal P (RiboP), Centromere B​
 
Useful For
Antinuclear antibodies occur in connective tissue diseases including systemic lupus erythematosus (SLE), mixed connective tissue disease (MCTD), Sjogren's syndrome, and scleroderma. The ENA is recommended after a positive ANA IFA screen to identify the most common specific antibodies occurring in many of the connective tissue disorders. This method eliminates the false positive ANA IFA results due to naturally occurring autoantibodies that appear with most immunofluorescent detection.​
Specimen Requirements
Fasting Required Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)		 Pediatric Minimum Volume
(no repeat)
No​ Serum​ Red Top Tube (RTT) or Serum Separator Tube (SST) ​ ​ 1.0 mL​ 0.4 mL​ 0.3 mL​
Collection Processing Instructions

​Separate serum from cells within 2 hours of collection.

Specimen Stability Information
Specimen Type Temperature Time
Serum​ ​ Refrigerate​ 7 days​
Frozen > 7 days​
Rejection Criteria
Gross lipemia
Gross hemolysis​
Heat inactivated samples​
Performing Laboratory Information
Performing Location Day(s) Test Performed Analytical Time Methodology/Instrumentation
Marshfield​ Monday through Friday​ 1 day​ Multiplex Flow Immunoassay/Bio-Rad BioPlex 2200​
Test Information

The Extractable Nuclear Antibodies (ENA) assay detects the presence of autoantibodies in the blood that react with proteins in the cell nucleus. This test is primarily used to confirm the presence of specific antibodies as follow-up after a positive ANA IFA test (specifically with speckled pattern).  This test collectively screens for the extractable nuclear antibodies.  If the screen is positive, the following individual antibodies will be tested and reported:  dsDNA, Chromatin, Ribosomal P, SSA/Ro, SSB/La, Centromere B, Sm, SmRNP, RNP, Scl-70 and JO1.  ​

See the Mixed Connective Tissue Disease Panel Algorithm for further information on suggested ordering of this test.

Reference Range Information
Performing Location Reference Range
Marshfield​
Negative
 dsDNA (0.0-0.4)
Chromatin: Negative (<1.0)
Ribo P: Negative (<1.0)
SSA: Negative (<1.0)
SSB: Negative (<1.0)
Cent B: Negative (<1.0)
Sm: Negative (<1.0)
SmRNP: Negative (<1.0)
RNP: Negative (<1.0)
Scl 70: Negative (<1.0)
Jo1: Negative (<1.0) ​
Interpretation

​SSA/SSB: Positive result supports the diagnosis of Sjogren's syndrome or other connective tissue diseases.

Sm: Positive result supports diagnosis of SLE with renal involvement

RNP: Positive result supports diagnosis of mixed connective tissue disease, which resembles SLE but is not accompanied by renal involvement.

Scl-70: Positive result supports diagnosis of scleroderma

Jo-1: Positive result supports diagnosis of polymyositis

Outreach CPTs
CPT Modifier
(if needed)		 Quantity Description Comments
86038​ ​ ​1 ENA Screen​ ​
86225​
​

​1​
​Deoxyribonucleic Acid (DNA) antibody, native or double stranded
​if needed as reflex testing due to positive screen result
​86235
​

​10
​​Chromatin, Ribosomal P, SSA/Ro, SSB/La, Centromere B, Sm, SmRNP, RNP, Scl-70 and JO1
​if needed as reflex testing due to positive screen result​
Synonyms/Keywords
​Extractable Nuclear Antigen, ENA, ANA Confirmatory​, ANA-subset, ANA​
​
Test Components
SSA, SSB, Sm, SmRNP, Ribonucleoprotein (RNP), Scl-70, JO1, dsDNA, Chromatin, Ribosomal P (RiboP), Centromere B​
 
Ordering Applications
Ordering Application Description
​Centricity ​Extractable Nuclear Antibodies
​Cerner ​Extractable Nuclear Antibodies
If the ordering application you are looking for is not listed, contact your local laboratory for assistance.
Specimen Requirements
Fasting Required Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)		 Pediatric Minimum Volume
(no repeat)
No​ Serum​ Red Top Tube (RTT) or Serum Separator Tube (SST) ​ ​ 1.0 mL​ 0.4 mL​ 0.3 mL​
Collection Processing

​Separate serum from cells within 2 hours of collection.

Specimen Stability Information
Specimen Type Temperature Time
Serum​ ​ Refrigerate​ 7 days​
Frozen > 7 days​
Rejection Criteria
Gross lipemia
Gross hemolysis​
Heat inactivated samples​
Useful For
Antinuclear antibodies occur in connective tissue diseases including systemic lupus erythematosus (SLE), mixed connective tissue disease (MCTD), Sjogren's syndrome, and scleroderma. The ENA is recommended after a positive ANA IFA screen to identify the most common specific antibodies occurring in many of the connective tissue disorders. This method eliminates the false positive ANA IFA results due to naturally occurring autoantibodies that appear with most immunofluorescent detection.​
Test Components
SSA, SSB, Sm, SmRNP, Ribonucleoprotein (RNP), Scl-70, JO1, dsDNA, Chromatin, Ribosomal P (RiboP), Centromere B​
 
Reference Range Information
Performing Location Reference Range
Marshfield​
Negative
 dsDNA (0.0-0.4)
Chromatin: Negative (<1.0)
Ribo P: Negative (<1.0)
SSA: Negative (<1.0)
SSB: Negative (<1.0)
Cent B: Negative (<1.0)
Sm: Negative (<1.0)
SmRNP: Negative (<1.0)
RNP: Negative (<1.0)
Scl 70: Negative (<1.0)
Jo1: Negative (<1.0) ​
Interpretation

​SSA/SSB: Positive result supports the diagnosis of Sjogren's syndrome or other connective tissue diseases.

Sm: Positive result supports diagnosis of SLE with renal involvement

RNP: Positive result supports diagnosis of mixed connective tissue disease, which resembles SLE but is not accompanied by renal involvement.

Scl-70: Positive result supports diagnosis of scleroderma

Jo-1: Positive result supports diagnosis of polymyositis

For more information visit:
Performing Laboratory Information
Performing Location Day(s) Test Performed Analytical Time Methodology/Instrumentation
Marshfield​ Monday through Friday​ 1 day​ Multiplex Flow Immunoassay/Bio-Rad BioPlex 2200​
For billing questions, see Contacts
Outreach CPTs
CPT Modifier
(if needed)		 Quantity Description Comments
86038​ ​ ​1 ENA Screen​ ​
86225​
​

​1​
​Deoxyribonucleic Acid (DNA) antibody, native or double stranded
​if needed as reflex testing due to positive screen result
​86235
​

​10
​​Chromatin, Ribosomal P, SSA/Ro, SSB/La, Centromere B, Sm, SmRNP, RNP, Scl-70 and JO1
​if needed as reflex testing due to positive screen result​
For most current information refer to the Marshfield Laboratory online reference manual.