ANCA - Overview: Cytoplasmic Neutrophil Antibodies, Serum (2023)

Useful For

Suggests clinical disorders or settings where the test may be helpful

Evaluating patients suspected of having antineutrophil cytoplasmic antibody-associated vasculitis (granulomatosis with polyangiitis and microscopic polyangiitis, and eosinophilic granulomatosis with polyangiitis)

Method Name

A short description of the method used to perform the test


NY State Available

Indicates the status of NY State approval and if the test is orderable for NY State clients.


Reporting Name

Lists a shorter or abbreviated version of the Published Name for a test

Cytoplasmic Neutrophilic Ab, S


Lists additional common names for a test, as an aid in searching

ACPA (Anti-Neutrophil Cytoplasmic Antibodies)

ANCA (Antineutrophil Cytoplasmic Antibodies)

ANCA (Wegener's)

Anti-Neutrophil Cytoplasmic Ab Test

Anti-Neutrophil Cytoplasmic Antibodies

Anticytoplasmic Antibody

Anticytoplasmic Autoantibodies

Antineutrophil Cytoplasmic Antibodies (ACPA)

Autoantibodies to Proteinase 3

c-ANCA (Anti-Neutrophil Cytoplasmic Antibodies)

cANCA (Antineutrophil Cytoplasmic Antibodies)

Cytoplasmic Antibody

Cytoplasmic Neutrophil Antibodies

(Video) Anti Neutrophilic Cytoplasmic Antibodies (ANCA)

MPO (Myeloperoxidase Antibodies)

Myeloperoxidase Antibodies (MPO)

Neutrophil Cytoplasmic Antibodies


pANCA (Perinuclear Antineutrophil Cytoplasmic Antibody)

Perinuclear anti-neutrophil cytoplasmic antibody (pANCA)

Perinuclear Antineutrophil Cytoplasmic Antibody (pANCA)

PR3 (Proteinase 3) Antineutrophil Cytoplasmic Antibodies

Proteinase 3 (PR3) Antineutrophil Cytoplasmic Antibodies

Wegener's Disease

Wegener's Granulomatosis

Specimen Type

Describes the specimen type validated for testing


Additional Testing Requirements

When used for diagnosis, it is recommended that specific tests for proteinase 3, antineutrophil cytoplasmic antibodies (ANCA), and myeloperoxidase ANCA be performed in addition to testing for cytoplasmic ANCA and perinuclear ANCA.(1) This panel of tests is available; order VASC / Antineutrophil Cytoplasmic Antibodies Vasculitis Panel, Serum.

Specimen Required

Defines the optimal specimen required to perform the test and the preferred volume to complete testing

Collection Container/Tube:

Preferred: Serum gel

Acceptable: Red top

Submission Container/Tube: Plastic vial

Specimen Volume: 0.8 mL

Collection Instructions: Centrifuge and aliquot serum into plastic vial.


If not ordering electronically, complete, print, and send 1 of the following forms with the specimen:

-General Request (T239)

-Renal Diagnostics Test Request (T830)

Specimen Minimum Volume

Defines the amount of sample necessary to provide a clinically relevant result as determined by the Testing Laboratory

(Video) c-ANCA VS p-ANCA (Autoantibodies) | Autoimmune Diseases

0.4 mL

Reject Due To

Identifies specimen types and conditions that may cause the specimen to be rejected

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

Specimen Stability Information

Provides a description of the temperatures required to transport a specimen to the performing laboratory, alternate acceptable temperatures are also included

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

Useful For

Suggests clinical disorders or settings where the test may be helpful

Evaluating patients suspected of having antineutrophil cytoplasmic antibody-associated vasculitis (granulomatosis with polyangiitis and microscopic polyangiitis, and eosinophilic granulomatosis with polyangiitis)

Clinical Information

Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test

Antineutrophil cytoplasmic antibodies (ANCA) can occur in patients with small blood vessel vasculitis, including granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), or eosinophilic granulomatosis with polyangiitis (EGPA), collectively referred to as ANCA-associated vasculitis (AAV).(2) Detection of ANCA is a well-established diagnostic test for the evaluation of patients suspected of having AAV.(3) ANCA react with enzymes in the cytoplasmic granules of human neutrophils including proteinase 3 (PR3), myeloperoxidase (MPO), elastase, and cathepsin G amongst others. Of these, PR3-ANCA and MPO-ANCA are the best characterized in AAV. Antibodies to PR3-ANCA occur in patients with GPA and produce a characteristic pattern of granular cytoplasmic fluorescence on ethanol-fixed neutrophils called the cytoplasmic ANCA pattern. Antibodies to MPO-ANCA occur predominately in patients with MPA and produce a pattern of perinuclear cytoplasmic fluorescence on ethanol-fixed neutrophils called the perinuclear ANCA (pANCA) pattern.(4) EGPA may be pANCA positive with reactivity to MPO-ANCA or negative for ANCA. The pANCA pattern may also be observed in patients with inflammatory bowel disease, predominantly ulcerative colitis, usually in the absence of detectable MPO-ANCA reactivity.

Reference Values

Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.


If positive for antineutrophil cytoplasmic antibodies, results are titered.


Provides information to assist in interpretation of the test results

Positive results for antineutrophil cytoplasmic antibodies (ANCA) demonstrate two main patterns namely, cytoplasmic and perinuclear in a compendium of small vessel vasculitis collectively referred to as ANCA-associated vasculitis (AAV) that includes granulomatosis with polyangiitis, microscopic polyangiitis, eosinophilic granulomatosis with polyangiitis.

Negative ANCA results do not rule out a diagnosis of AAV or irritable bowel disease.

(Video) ANCA (Anti Neutrophilic Cytoplasmic Antibody) pathology, vasculitis


Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances

Current recommendations suggest that testing for antineutrophil cytoplasmic antibodies (ANCA) by indirect immunofluorescence assay should not be relied upon exclusively to establish the diagnosis of granulomatosis with polyangiitis (GPA), microscopic polyangiitis, or eosinophilic granulomatosis with polyangiitis (see Interpretation).

Due to their lack of diagnostic specificities, all positive ANCA results must be confirmed using solid-phase immunoassays using proteinase 3-ANCA for cytoplasmic ANCA (cANCA) and myeloperoxidase-ANCA for perinuclear ANCA.

Changes in titer of cANCA should not be relied upon exclusively to either judge the disease activity of patients with GPA or determine the response to treatment. A decreasing titer of cANCA may lag behind the induction of clinical remission by several weeks in a patient with GPA, and a detectable titer of cANCA may persist indefinitely despite induction of a stable clinical remission of disease. Conversely, a slight increase in the titer of cANCA should not be interpreted to mean an exacerbation of disease without further clinical and laboratory evidence of disease progression.

Clinical Reference

Recommendations for in-depth reading of a clinical nature

1.Savige J, Gillis D, Benson E, et al: International consensus statement on testing and reporting of antineutrophil cytoplasmic antibodies (ANCA). Am J Clin Pathol. 1999 Apr:111(4);507-513

2. Kitching AR, Anders HJ, Basu N, et al: ANCA-associated vasculitis. Nat Rev Dis Primers. 2020 Aug;6(1);71

3. Ramponi G, Folci M, De Santis M, et al: The biology, pathogenetic role, clinical implications, and open issues of serum anti-neutrophil cytoplasmic antibodies. Autoimmun Rev. 2021 Mar;20(3):102759

4. Guchelaar NAD, Waling MM, Adhin AA, et al: The value of anti-neutrophil cytoplasmic antibodies (ANCA) testing for the diagnosis of ANCA-associated vasculitis, a systematic review and meta-analysis. Autoimmun Rev. 2021 Jan:20(1);102716

Method Description

Describes how the test is performed and provides a method-specific reference

Antibodies to cytoplasmic antigens in neutrophils are detected by an indirect immunofluorescent technique. Commercial and in-house slides prepared from human neutrophils are used as a substrate. IgG antibodies in serum specimens are detected after incubation of serum with the commercial and in-house slides by the addition of a fluorescein isothiocyante-labeled antihuman IgG reagent. All patient specimens are initially screened at 1:4 and 1:8 dilutions.(Package insert: NOVA Lite ANCA. Inova Diagnostics, Inc; 05/2018)

PDF Report

Indicates whether the report includes an additional document with charts, images or other enriched information


Day(s) Performed

Outlines the days the test is performed. This field reflects the day that the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time before the test is performed. Some tests are listed as continuously performed, which means that assays are performed multiple times during the day.

Monday through Saturday

Report Available

The interval of time (receipt of sample at Mayo Clinic Laboratories to results available) taking into account standard setup days and weekends. The first day is the time that it typically takes for a result to be available. The last day is the time it might take, accounting for any necessary repeated testing.

3 to 4 days

(Video) Anti-Neutrophil Cytoplasmic Antibody Profile - Determining Autoimmune Disorders (in Hindi)

Specimen Retention Time

Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded

14 days

Performing Laboratory Location

Indicates the location of the laboratory that performs the test



Several factors determine the fee charged to perform a test. Contact your U.S. or International Regional Manager for information about establishing a fee schedule or to learn more about resources to optimize test selection.

  • Authorized users can sign in to Test Prices for detailed fee information.
  • Clients without access to Test Prices can contact Customer Service 24 hours a day, seven days a week.
  • Prospective clients should contact their Regional Manager. For assistance, contact Customer Service.

Test Classification

Provides information regarding the medical device classification for laboratory test kits and reagents. Tests may be classified as cleared or approved by the US Food and Drug Administration (FDA) and used per manufacturer instructions, or as products that do not undergo full FDA review and approval, and are then labeled as an Analyte Specific Reagent (ASR) product.

This test was developed, and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the US Food and Drug Administration.

CPT Code Information

Provides guidance in determining the appropriate Current Procedural Terminology (CPT) code(s) information for each test or profile. The listed CPT codes reflect Mayo Clinic Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.

CPT codes are provided by the performing laboratory.

86036 x2

86037-Titer (if appropriate)

LOINC® Information

Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the order and results codes of this test. LOINC values are provided by the performing laboratory.

Test Id Test Order Name Order LOINC Value
ANCA Cytoplasmic Neutrophilic Ab, S 87427-1
Result Id Test Result Name Result LOINC Value

Applies only to results expressed in units of measure originally reported by the performing laboratory. These values do not apply to results that are converted to other units of measure.

3114 c-ANCA 14277-8
3119 p-ANCA 17357-5
(Video) Anca test in hindi // C Anca Test // A anca Test // Anti-Neutrophil Cytoplasmic Antibodies In Hindi


What is the normal range for anti-neutrophil cytoplasmic antibody ANCA? ›

Negative: ≤19 AU/mL. Equivocal: 20-25 AU/mL. Positive: ≥26 AU/mL.

How do you read ANCA test results? ›

If ANCA is positive and ASCA (anti-Saccharomyces cerevisiae antibodies) is negative, then it is likely that you have ulcerative colitis (UC). If ANCA is negative and ASCA is positive, then it is likely that you have Crohn disease (CD). A person who is negative for ANCA and/or ASCA may still have UC, CD, or another IBD.

What is a normal result for ANCA? ›

ANCA profile test is performed using ANCA Enzyme-Linked Immunosorbent Assay (ELISA). The normal value of ELISA is 0.00 - 0.22 units/ml.

What does a positive ANCA test indicate? ›

A positive result means that ANCAs were found in your blood sample. This may mean you have autoimmune vasculitis. Your test results will also show which type of ANCAs were found. This can help diagnose the type of vasculitis you have.

Is ANCA positive in lupus? ›

Background Antineutrophil cytoplasm antibodies (ANCA) are known to occur in some patients with systemic lupus erythematosus (SLE), with a prevalence of 15 to 20% [1]. The perinuclear pattern (pANCA) predominates in this setting. Among SLE patients, ANCA positivity is more frequent in those with LN.

Is rheumatoid arthritis ANCA positive? ›

Background/Purpose: Anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitis (AAV) with rheumatoid arthritis (RA) has been reported rarely, and, studies have found ANCA positivity in RA.

What are the symptoms of ANCA autoimmune disease? ›

What symptoms do patients develop? AAV may present with constitutional symptoms suggestive of chronic inflammatory disease (fatigue, weight loss, fever, night sweats, myalgia, or polyarthralgia) or with specific features of end-organ involvement.

What are ANCA levels? ›

ANCA levels are useful to monitor disease activity but should not be used by themselves to guide treatment. A significant increase in ANCA titres, or the reappearance of ANCA, should alert the clinicians and lead to a stricter patient control.

Is ANCA positive in Crohn's? ›

ANCA have been detected in the inflammatory bowel diseases (ulcerative colitis (UC) and Crohn's disease (CD)) [7,8], in autoimmune-mediated liver diseases [9–11], in rheumatoid arthritis (RA) [12,13], and in systemic lupus eythematosus (SLE) [14,15]. Usually, the p-ANCA type is found, but the antigen is not MPO [7].

What is ANCA in kidney disease? ›

How does vasculitis affect the kidneys? The kidneys are packed with millions of highly specialised tiny blood vessels called glomeruli (pleural for glomerulus). These are very vulnerable to attack in ANCA vasculitis and can become inflamed, swollen and can even burst. This is called glomerulonephritis.

What is a high C Anca titer? ›

Higher antineutrophil cytoplasmic antibody (C-ANCA) titers are associated with increased overall healthcare use in patients with sinonasal manifestations of granulomatosis with polyangiitis (GPA) Am J Rhinol Allergy.

Which ANCA is positive in ulcerative colitis? ›

Serum anti-proteinase 3 antineutrophil cytoplasmic antibody (PR3-ANCA) is a disease-specific antibody against granulomatosis with polyangiitis. PR3-ANCA is a useful serological marker for disease severity in ulcerative colitis (UC).

What autoimmune disease is ANCA? ›

ANCA vasculitis is an autoimmune disease affecting small blood vessels in the body. It is caused by autoantibodies called ANCAs, or Anti-Neutrophilic Cytoplasmic Autoantibodies. ANCAs target and attack a certain kind of white blood cells called neutrophils.

What are symptoms of autoimmune inflammatory vasculitis? ›

Vasculitis symptoms include rashes that look like red spots (purpura), lumps (nodules) or sores (ulcers) on the skin, headaches with visual changes, shortness of breath, cough, and numbness or weakness in the hand or foot. Some patients may have joint pain, fatigue, or nose and sinus problems.

How does ANCA affect kidneys? ›

Renal vasculitis, also called ANCA glomerulonephritis, is an autoimmune disease that causes your white blood cells to attack the glomeruli, the tiny blood vessels that filter blood in your kidneys. This causes swelling and damage to the capillaries (blood vessels).

Can infection cause positive ANCA? ›

Less frequently, ANCA induction can occur due to infections such as amebiasis, endocarditis, tuberculosis, malaria, human immunodeficiency virus infection, and hepatitis C virus (HCV) infection [2, 4]. Because autoimmune and infectious diseases may present similarly, ANCA positivity must be carefully interpreted [5].

Can people test positive for ANCA and not have vasculitis? ›

Conclusion: A significant proportion of patients with a positive C-ANCA/PR3 or P-ANCA/MPO do not have evidence of vasculitis, particularly those with low-medium ELISA antibody titers. Using a higher threshold of ANCA titers may be required to improve specificity.

Is ANCA vasculitis a critical illness? ›

Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a small vessel vasculitis often leading to critical illness by multi-organ failure.

What diseases cause positive ANCA? ›

It can be caused by infections such as hepatitis B, Hepatitis C, Human Immune deficiency virus (HIV), or endocarditis. It can also be caused by autoimmune conditions such as SLE, rheumatoid arthritis, and Sjögren syndrome.

Can stress cause ANCA vasculitis? ›

Summary: In patients with a devastating form of vasculitis who are in remission, stress can be associated with a greater likelihood of the disease flaring, according to a new study.

Does ANCA vasculitis cause joint pain? ›

These symptoms usually develop later and include a shooting pain in the muscles (myalgia) and joints (arthralgia), as well as intense muscle loss in the hands and/or feet.

How long do people with ANCA vasculitis live? ›

The age median was 52 years (min – 12; max – 75). The overall mortality rate was 18.5%. Mean survival time was 126.6 months (95% confidence interval [CI] = 104.5 to 148.6) limited to 154.6 months for the longest-surviving patient.

Does ANCA affect the brain? ›

Many different types of vasculitis can affect the blood vessels in the brain (called Central Nervous System Vasculitis (CNS)) including the ANCA associated vasculitides, Takayasu Arteritis and Giant Cell Arteritis.

What foods should be avoided with ANCA vasculitis? ›

If you do not need a special diet, you should aim to cut down on starchy foods – bread, potatoes, rice and pasta, replacing these with fresh fruit and vegetables. You should also avoid processed food and grain fed meat.

How do you treat ANCA? ›

Great progress has been made in the last 2 decades in the treatment of antineutrophil cytoplasmic autoantibody (ANCA) vasculitis. Once associated with a very high mortality rate, current induction therapy with the combination of corticosteroids and cyclophosphamide or rituximab results in remission rates around 80%.

What are the three types of ANCA vasculitis? ›

The antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAV) are three separate conditions – granulomatosis with polyangiitis (GPA; formerly known as Wegener's granulomatosis), microscopic polyangiitis (MPA), and eosinophilic granulomatosis with polyangiitis (EGPA; previously known as Churg-Strauss ...

What is vasculitis of the legs? ›

Vasculitis is a general term used to describe a disease that leads to inflammation of blood vessels. When the blood vessels of your legs become inflamed, this is called vasculitis of the legs. The blood vessels in your legs start to weaken and can either grow or shrink in size.

What organ is involved in ANCA vasculitis? ›

ANCA-associated vasculitides (AAVs) are small-vessel vasculitides (SVV) that commonly affect the kidney, the lung, the ear-nose-throat (ENT) system, the skin, and peripheral nervous system (PNS) [1].

What drugs are associated with ANCA vasculitis? ›

Drug-induced antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis has been classically associated with cocaine (alone or contaminated with levamisole), antithyroid drugs (propylthiouracil, methimazole, carbimazole) and hydralazine; minocycline often mimics medium-vessel vasculitis, with ANCA positivity.

What is the most common ANCA associated vasculitis? ›

Microscopic polyangiitis is the most common ANCA–associated small-vessel vasculitis, and is characterized by the presence of ANCA and few or no immune deposits in the involved vessels.


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