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26118 Cutaneous Immunofluorescence Antibodies (IgG), Serum (CIFS)

Cutaneous Immunofluorescence Antibodies (IgG), Serum (CIFS)
Test Code: CIFSSO
Synonyms/Keywords
​Basement Membrane Antibodies
Bullous Pemphigoid
Cicatricial Pemphigoid
CII, Serum
Circulating IgG Basement Membrane Zone Antibody
Circulating Intercellular Ab Study
Epidermal Cell Surface Antibody
Epidermal Fluorescence Antibody
Epidermolysis Bullosa Acquisita
Epithelial Antibody
Herpes gestationis
IMF - Epidermal Fluorescent Ab
Indirect Immunofluorescence
Intercellular Substance Antibody
Pemphigoid
Pemphigus
Skin Basement Membrane Antibodies
Split-Skin Assay
Lupus Erythematosus (LE)
Bullous Lupus Erythematosus
Useful For
Confirming a diagnosis of pemphigoid, pemphigus, epidermolysis bullosa acquisita, or bullous lupus erythematosus.
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) ​Serum Separator Tube (SST) ​2 mL ​0.5 mL ​
Specimen Stability Information
Specimen Type Temperature ​Time
​Serum ​ ​ ​Refrigerated (preferred) ​14 days
Ambient ​14 days
​Frozen ​30 days
Rejection Criteria
​Gross Lipemia
Interference

​Results should be interpreted in conjunction with clinical information, histologic pattern, and results of direct immunofluorescence (IF) study. In particular, the finding of low titer (< or =1:80) anti-CS antibodies should not be used alone (ie, without histologic or direct IF support) to confirm a diagnosis of pemphigus.

Performing Laboratory Information
Performing Location Day(s) Test Performed Report Available Methodology/Instrumentation
​Mayo Clinic Laboratories ​Monday through Friday ​2 to 7 days ​Detection of IgG Anti-Intercellular Substance (ICS) and Anti-Basement Membrane Zone (BMZ) Antibodies by Indirect Immunofluorescence Technique Using Rhesus Monkey Esophagus Substrate and Human NaCl Split-Skin Substrate
Reference Lab
Mayo Clinic Laboratories
Test Information

IgG anti-basement zone (BMZ) antibodies are produced by patients with pemphigoid. In most patients with bullous pemphigoid, serum contains IgG anti-BMZ antibodies, while in cicatricial pemphigoid circulating IgG anti-BMZ antibodies are found in a minority of cases. Sensitivity of detection of anti-BMZ antibodies is increased when serum is tested using sodium chloride (NaCl)-split human skin as substrate.

Circulating IgG anti-BMZ antibodies are also detected in patients with epidermolysis bullosa acquisita (EBA) and bullous eruption of lupus erythematosus.

IgG anti-cell surface (CS) antibodies are produced by patients with pemphigus. The titer of anti-CS antibodies generally correlates with disease activity of pemphigus.

Reference Range Information
Performing Location Reference Range
​Mayo Clinic Laboratories ​Report includes presence and titer of circulating antibodies. If serum contains BMZ antibodies on split-skin substrate, patterns will be reported as: 1) epidermal pattern, consistent with pemphigoid or 2) dermal pattern, consistent with epidermolysis bullosa acquisita.
 
Negative in normal individuals
Interpretation

Indirect immunofluorescence (IF) testing may be diagnostic when histologic or direct IF studies are only suggestive, nonspecific, or negative.

Anti-cell surface (CS) antibodies correlate with a diagnosis of pemphigus.

Anti-basement zone (BMZ) antibodies correlate with a diagnosis of bullous pemphigoid, cicatricial pemphigoid, epidermolysis bullosa acquisita (EBA), or bullous eruption of lupus erythematosus (LE).

If serum contains anti-BMZ antibodies, the pattern of fluorescence on sodium chloride(NaCl)-split skin substrate helps distinguish pemphigoid from EBA and bullous LE. Staining of the roof (epidermal side) or both epidermal and dermal sides of NaCl-split skin correlates with the diagnosis of pemphigoid, while fluorescence localized only to the dermal side of the split-skin substrate correlates with either EBA or bullous LE. 

Outreach CPTs
CPT Modifier
(if needed)		 Quantity Description Comments
​88346 ​ ​1 ​ ​
​88350 ​ ​1 ​ ​
Synonyms/Keywords
​Basement Membrane Antibodies
Bullous Pemphigoid
Cicatricial Pemphigoid
CII, Serum
Circulating IgG Basement Membrane Zone Antibody
Circulating Intercellular Ab Study
Epidermal Cell Surface Antibody
Epidermal Fluorescence Antibody
Epidermolysis Bullosa Acquisita
Epithelial Antibody
Herpes gestationis
IMF - Epidermal Fluorescent Ab
Indirect Immunofluorescence
Intercellular Substance Antibody
Pemphigoid
Pemphigus
Skin Basement Membrane Antibodies
Split-Skin Assay
Lupus Erythematosus (LE)
Bullous Lupus Erythematosus
Ordering Applications
Ordering Application Description
​Centricity ​Cutaneous Immfluor. Ab, Serum
​Cerner ​Cutaneous Immfluor. Ab, Serum
​COM ​Cutaneous Immfluor. Ab, Serum
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) ​Serum Separator Tube (SST) ​2 mL ​0.5 mL ​
Specimen Stability Information
Specimen Type Temperature ​Time
​Serum ​ ​ ​Refrigerated (preferred) ​14 days
Ambient ​14 days
​Frozen ​30 days
Rejection Criteria
​Gross Lipemia
Interference

​Results should be interpreted in conjunction with clinical information, histologic pattern, and results of direct immunofluorescence (IF) study. In particular, the finding of low titer (< or =1:80) anti-CS antibodies should not be used alone (ie, without histologic or direct IF support) to confirm a diagnosis of pemphigus.

Useful For
Confirming a diagnosis of pemphigoid, pemphigus, epidermolysis bullosa acquisita, or bullous lupus erythematosus.
Reference Range Information
Performing Location Reference Range
​Mayo Clinic Laboratories ​Report includes presence and titer of circulating antibodies. If serum contains BMZ antibodies on split-skin substrate, patterns will be reported as: 1) epidermal pattern, consistent with pemphigoid or 2) dermal pattern, consistent with epidermolysis bullosa acquisita.
 
Negative in normal individuals
Interpretation

Indirect immunofluorescence (IF) testing may be diagnostic when histologic or direct IF studies are only suggestive, nonspecific, or negative.

Anti-cell surface (CS) antibodies correlate with a diagnosis of pemphigus.

Anti-basement zone (BMZ) antibodies correlate with a diagnosis of bullous pemphigoid, cicatricial pemphigoid, epidermolysis bullosa acquisita (EBA), or bullous eruption of lupus erythematosus (LE).

If serum contains anti-BMZ antibodies, the pattern of fluorescence on sodium chloride(NaCl)-split skin substrate helps distinguish pemphigoid from EBA and bullous LE. Staining of the roof (epidermal side) or both epidermal and dermal sides of NaCl-split skin correlates with the diagnosis of pemphigoid, while fluorescence localized only to the dermal side of the split-skin substrate correlates with either EBA or bullous LE. 

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Performing Laboratory Information
Performing Location Day(s) Test Performed Report Available Methodology/Instrumentation
​Mayo Clinic Laboratories ​Monday through Friday ​2 to 7 days ​Detection of IgG Anti-Intercellular Substance (ICS) and Anti-Basement Membrane Zone (BMZ) Antibodies by Indirect Immunofluorescence Technique Using Rhesus Monkey Esophagus Substrate and Human NaCl Split-Skin Substrate
Reference Lab
Mayo Clinic Laboratories
For billing questions, see Contacts
Outreach CPTs
CPT Modifier
(if needed)		 Quantity Description Comments
​88346 ​ ​1 ​ ​
​88350 ​ ​1 ​ ​
For most current information refer to the Marshfield Laboratory online reference manual.