ANCA By IF (C - ANCA & P - ANCA)

Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is the term used for a group of diseases that include granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), and eosinophilic granulomatosis with polyangiitis (EGPA). Patients with ANCA-associated vasculitis may develop antineutrophil cytoplasmic antibodies.

Detection of antineutrophil cytoplasmic antibodies is an established diagnostic procedure for assessing patients who may have ANCA-associated vasculitis.

Human neutrophils' cytoplasmic granules contain a variety of enzymes, notably:

• Proteinase 3 (PR3), 
• Myeloperoxidase (MPO), 
• Elastase, 
• Cathepsin G, amongst many others, which ANCA reacts with.

The most well-characterised enzymes out of these are PR3-ANCA and MPO-ANCA. Patients with GPA often have autoantibodies against PR3-ANCA, resulting in the cANCA pattern, a distinctive granular cytoplasmic illumination trend on ethanol-fixed neutrophils.

MPA Patients are more likely to have antibodies against MPO-ANCA, which cause the perinuclear anti-neutrophil cytoplasmic antibody (p-ANCA) characteristic of perinuclear cytoplasmic excitation on ethanol-fixed neutrophils.

EPGA may be inconclusive for ANCA, or it can be p-ANCA positive with reaction to MPO-ANCA. Patients with ulcerative colitis, the most common form of irritable bowel syndrome, may also have the ANCA pattern, typically lacking substantial MPO-ANCA sensitivity.

If you exhibit autoimmune vasculitis, your doctor might recommend an ANCA test. These signs include:

• Fever
• Fatigue
• Loss of weight
• Aches in the joints or muscles

Your symptoms may also impact one or more particular organs in your body. Organs that are frequently impacted, and the symptoms they bring on are as follows:

Eyes

• Redness
• Distorted/absence of vision

Ears

• An earache with ringers (tinnitus)
• Loss of hearing

Sinuses

• Headache
• Stuffy nose
• Nose bleeds

Skin

• Rashes
• Ulcers

Lungs

• Cough
• Difficulty breathing
• Chest pain

Kidneys

• Urine with blood in it
• Foamy urine
• Tingling and numbness in various body parts

The fluorescence pattern of the cells can be classified as either cytoplasmic (c-ANCA) or perinuclear (p-ANCA). One of the two ANCA testing categories may be used in a laboratory:

• Indirect Immunofluorescence (IIF) – You can determine if you have autoantibodies or not by receiving a positive or negative result through this test.
• Enzyme-Linked Immunosorbent Assay (ELISA) – This test aids in locating a specific protein in neutrophils.

However, to diagnose GPA, MPA, or EGPA, the indirect immunofluorescence assay should not be the only method used. Any positive ANCA findings must be validated utilising solid-phase immunoassays employing PR3-ANCA (c-ANCA) or MPO-ANCA owing to the absence of clinical specificity.
 

Medically reviewed by Dr Srikanth M, Haematologist , Apollo Hospitals Cancer Centre Nandanam,Chennai

Frequently asked questions

When should you get tested?

You should undergo the test: When your doctor suspects the symptoms of a vascular autoimmune disease, which includes fever, muscle aches, weight loss, and decreased kidney or pulmonary function. When your doctor needs to differentiate between Crohn's disease and ulcerative colitis due to the symptoms you might be experiencing, such as constant or sporadic diarrhoea and stomach pain that could be related to inflammatory bowel disease.

What happens during an ANCA test?

During the procedure, a medical practitioner uses a needle to draw blood from the vein in the arm. The blood sample is taken into a tube or vials once the needle has been placed. Usually, the procedure takes only a few minutes.

What may I anticipate following an ANCA test?

After the blood test, you might need to refrain from exercising for a few hours.

Does the test involve any risks?

The test does not pose any risk. Even though you can have minor discomfort or bruising where the syringe was inserted, most side effects are transient.

How is the treatment monitoring done?

Modern induction therapy using corticosteroids, cyclophosphamide, and rituximab yields remission frequencies of about 80%. Moreover, the treatment monitoring is based on the adverse effects of prolonged immunosuppression in the patients. After determining the ideal time frame, the treatment is customised to meet each patient's demands.