Test Catalog

Test Id : TNFA

Tumor Necrosis Factor, Plasma

Useful For
Suggests clinical disorders or settings where the test may be helpful

Evaluation of patients with suspected systemic infection, in particular infection caused by gram-negative bacteria


Evaluation of patients with suspected chronic inflammatory disorders, such as rheumatoid arthritis, inflammatory bowel disease, ankylosing spondylitis, or cancers.

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

Tumor Necrosis Factor, P

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




Specimen Type
Describes the specimen type validated for testing

Plasma EDTA

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

Collection Container/Tube: Lavender top (EDTA)

Submission Container/Tube: Plastic vial

Specimen Volume: 0.5 mL

Collection Instructions:

1. Immediately after specimen collection, place the tube on wet ice.

2. Centrifuge at 1500 x g for 10 minutes and aliquot plasma into plastic vial.

3. Freeze specimen within 30 minutes.

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

0.3 mL

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

Gross hemolysis OK
Gross lipemia OK
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
Plasma EDTA Frozen (preferred) 21 days
Refrigerated 24 hours

Useful For
Suggests clinical disorders or settings where the test may be helpful

Evaluation of patients with suspected systemic infection, in particular infection caused by gram-negative bacteria


Evaluation of patients with suspected chronic inflammatory disorders, such as rheumatoid arthritis, inflammatory bowel disease, ankylosing spondylitis, or cancers.

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

Tumor necrosis factor-alpha (TNF-alpha) is a highly pleiotropic cytokine involved in a spectrum of physiological processes that control inflammation, anti-tumor responses, and homeostasis.(1-3) The main sources of TNF-alpha are macrophages and T cells; however, many other cell types such as B cells, neutrophils, and endothelial cells have been described to produce TNF-alpha. It is expressed as a type II transmembrane protein (mbTNF-alpha) but can be cleaved to its soluble form (sTNF-alpha) with increased biological activity. Targets for TNF-alpha include 2 type I transmembrane receptors, TNF receptor I (TNFR-I or CD120a) and TNF receptor II (TNFR-II or CD120b). (2, 3) TFNR-I is expressed on every cell type except erythrocytes while TNFR-II is found only on endothelial and immune cells and can be activated by mbTNF-alpha.(1-3)


Following infection, TNF-alpha produced by macrophages enhances the proliferation of T cells after stimulation with interleukin-2 (IL-2).(1) In the absence of IL-2, TNF-alpha induces the proliferation and differentiation of B cells. Due to its antitumor property, TNF-alpha can cause cell death via a number mechanisms and is also capable of chemotactic attraction of neutrophils. Additionally, it is capable of stimulating macrophages to produce acid phosphatase and collagenase, and osteoblasts to produce prostaglandin E2 and collagenase. These chemical mediators have been known to lead to bone resorption.(1-3)


Due to the significant proinflammatory and immunoregulatory functions of TNF-alpha, and the wide distribution of TNFRs, the deregulation TNF-alpha is associated with the development of several immunologic disorders and prediction of disease outcomes.(1-7) Indeed, elevated levels of TNF-alpha in serum or plasma levels have been able to predict severity in some infectious diseases such as sepsis in bacterial infections or poor outcomes in coronavirus 2019 infections.(6) In addition, TNF-alpha has been implicated in post-transplant reactions, pathological mechanisms in certain autoimmune diseases (eg, rheumatoid arthritis, inflammatory bowel disease, ankylosing spondylitis), and cancers.(1-5,7) With the FDA approval of biologic and biosimilar therapies targeting TNF-alpha in patients with these diseases, it is likely that measurement of TNF-alpha levels may be useful in management of treatment response.(4-9)

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.

< or =2.8 pg/mL

Clinical Reference
Recommendations for in-depth reading of a clinical nature

1. Varfolomeev E, Vucic D. Intracellular regulation of TNF activity in health and disease. Cytokine. 2018;101:26-32

2. Atretkhany KN, Gogoleva VS, Drutskaya MS, Nedospasov SA. Distinct modes of TNF signaling through its two receptors in health and disease. J Leukoc Biol. 2020 107:893-905

3. Salomon BL, Leclerc M, Tosello J, Ronin E, Piaggio E, Cohen JL. Tumor necrosis factor alpha and regulatory T cells in oncoimmunology. Front Immunol. 2018;9:444

4. Ridgley LA, Anderson AE, Pratt AG. What are the dominant cytokines in early rheumatoid arthritis? Curr Opin Rheumatol. 2018;30:207-214

5. Friedrich M, Pohin M, Powrie F: Cytokine networks in the pathophysiology of inflammatory bowel disease. Immunity. 2019;50:992-1006

6. Wilson JG, Simpson LJ, Ferreira AM, et al: Cytokine profile in plasma of severe COVID-19 does not differ from ARDS and sepsis. JCI Insight. 2020;5(17):e140289

7. Li Y, Yuan L, Yang J, et al:. Changes in serum cytokines may predict therapeutic efficacy of tofacitinib in rheumatoid arthritis. Mediators Inflamm. 2019 Oct24;2019:5617431

8. Salomon BL: Insights into the biology and therapeutic implications of TNF and regulatory T cells. Nat Rev Rheumatol. 2021;17:487-504

9. Willrich MAV, Murray DL, Snyder MR: Tumor necrosis factor inhibitors: clinical utility in autoimmune diseases. Trans Res 2015;165:270-282

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

The tumor necrosis factor (TNF)-alpha cytokine assay measures human cytokines in a 96-well spotted plate. The assay employs a sandwich immunoassay format where capture antibodies are coated on a single spot on the bottom of each well. Diluted samples, calibrators, and controls are added and to the plate. If present, TNF-alpha will bind to the capture antibodies. After incubation, a solution containing detection antibodies conjugated with electrochemiluminescent labels is added. After a final incubation, a buffer is added that creates the appropriate chemical environment for electrochemiluminescence. The plate is then read on the MSD QuickPlex SQ120. The machine applies a voltage that causes bound labels to emit measurable light. The MSD QuickPlex SQ120 measures the intensity of emitted light and correlates it to a set of standards of known quantity via a 4-point logistics curve fitting method.(Package Insert: Human TNF-alpha V-plex. Mesoscale Discovery; 2014)

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.


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.

1 to 8 days

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.


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
TNFA Tumor Necrosis Factor, P 3074-2
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.
63022 TNF, P 3074-2

Test Setup Resources

Setup Files
Test setup information contains test file definition details to support order and result interfacing between Mayo Clinic Laboratories and your Laboratory Information System.

Excel | Pdf

Sample Reports
Normal and Abnormal sample reports are provided as references for report appearance.

Normal Reports | Abnormal Reports

SI Sample Reports
International System (SI) of Unit reports are provided for a limited number of tests. These reports are intended for international account use and are only available through MayoLINK accounts that have been defined to receive them.

SI Normal Reports | SI Abnormal Reports

Test Update Resources

Change Type Effective Date
Test Status - Test Resumed 2023-01-26
Test Status - Test Down 2023-01-04
Test Status - Test Delay 2022-12-23