Test Catalog

Test Id : ANA2

Antinuclear Antibodies (ANA), Serum

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

Evaluating patients suspected of having a systemic rheumatic disease

Testing Algorithm
Delineates situations when tests are added to the initial order. This includes reflex and additional tests.

See Connective Tissue Disease Cascade (CTDC) in Special Instructions.

Special Instructions
Library of PDFs including pertinent information and forms related to the test

Method Name
A short description of the method used to perform the test

Enzyme-Linked Immunosorbent Assay (ELISA)

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

Antinuclear Ab, S

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



Antinuclear Antibody, Serum


ANA (order test ANA2)

ANA (Antinuclear Antibodies)

Antinuclear Antibodies (ANA), HEp-2 substrate, Serum

FANA (Fluorescent Antinuclear Antibodies)

LE (Lupus Erythematosus) Prep

ANA Screen

Testing Algorithm
Delineates situations when tests are added to the initial order. This includes reflex and additional tests.

See Connective Tissue Disease Cascade (CTDC) in Special Instructions.

Specimen Type
Describes the specimen type validated for testing


Ordering Guidance

If suspicious of connective tissue disorder, see CTDC / Connective Tissue Disease Cascade, Serum.


If suspicious of autoimmune liver disease, see ALDG / Autoimmune Liver Disease Panel, Serum.

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


Preferred: Serum gel

Acceptable: Red top

Specimen Volume: 0.5 mL

Special Instructions
Library of PDFs including pertinent information and forms related to the test


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

-General Request (T239)

-Gastroenterology and Hepatology Client Test Request (T728)

-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

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

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 a systemic rheumatic disease

Testing Algorithm
Delineates situations when tests are added to the initial order. This includes reflex and additional tests.

See Connective Tissue Disease Cascade (CTDC) in Special Instructions.

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

Measurement of antinuclear antibodies (ANA) in serum is the most commonly performed screening test for patients suspected of having a systemic rheumatic disease, also referred to as connective tissue disease.(1) ANA occur in patients with a variety of autoimmune diseases, both systemic and organ-specific. They are particularly common in the systemic rheumatic diseases, which include lupus erythematosus (LE), discoid LE, drug-induced LE, mixed connective tissue disease, Sjogren syndrome, scleroderma (systemic sclerosis), CREST (calcinosis, Raynaud phenomenon, esophageal dysmotility, sclerodactyly, telangiectasia) syndrome, polymyositis/dermatomyositis, and rheumatoid arthritis.(1)


The diagnosis of a systemic rheumatic disease is based primarily on the presence of compatible clinical signs and symptoms. The results of tests for autoantibodies including ANA and specific autoantibodies are ancillary. Additional diagnostic criteria include consistent histopathology or specific radiographic findings. Although individual systemic rheumatic diseases are relatively uncommon, a great many patients present with clinical findings that are compatible with a systemic rheumatic disease and large numbers of tests for ANA are ordered to eliminate the possibility of a systemic rheumatic disease.


See Connective Tissue Disease Cascade (CTDC) in Special Instructions.

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 =1.0 U (negative)

1.1-2.9 U (weakly positive)

3.0-5.9 U (positive)

> or =6.0 U (strongly positive)

Reference values apply to all ages.

Provides information to assist in interpretation of the test results

A large number of healthy individuals have weakly-positive antinuclear antibody (ANA) results, many of which are likely to be clinical false-positives; therefore, second-order testing of all positive ANA yields a very low percentage of positive results to the specific nuclear antigens.


A positive ANA result at any level is consistent with the diagnosis of systemic rheumatic disease, but a result greater than or equal to 3.0 U is more strongly associated with systemic rheumatic disease than a weakly-positive result.


Positive ANA results greater than 3.0 U are associated with the presence of detectable autoantibodies to specific nuclear antigens. The nuclear antigens are associated with specific diseases (eg, anti-Scl 70 is associated with scleroderma) and can be detected with second-order testing.

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

Some patients without clinical evidence of an autoimmune disease or a systemic rheumatic disease may have a detectable level of antinuclear antibody (ANA). This finding is more common in women than men, and the frequency of a detectable ANA in healthy women over 40 years old may approach 15% to 20%. ANA may also be detectable following viral illnesses, in chronic infections, or in patients treated with many different medications.

Supportive Data

In a study performed in the Mayo Clinic immunology antibody laboratory, more than 75% of patients with a systemic rheumatic disease had antinuclear antibody (ANA) results greater than 3.0 U and the positive predictive value of these results for a systemic rheumatic disease was greater than 85%. Weakly positive ANA results were not a strong indicator of systemic rheumatic disease. The likelihood of finding an autoantibody to a specific nuclear antigen on a second-order testing increased directly with the level of ANA: 92% of sera that had detectable autoantibodies on second-order testing had an ANA level greater than 3.0 U.(2)


An ANA result of greater than or =3.0 U is the cutoff for CTDC / Connective Tissue Disease Cascade, Serum, a test algorithm designed to evaluate patients with signs and symptoms consistent with connective tissue diseases and the preferred initial test for these patients.


Results of tests for ANA performed by ELISA in the immunology antibody laboratory show that ELISA and traditional indirect immunofluorescence methods for ANA are substantially equivalent.

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

1. Kavanaugh A, Tomar R, Reveille J, et al: Guidelines for use of the antinuclear antibody test and tests for specific autoantibodies to nuclear antigens. Pathol Lab Med 2000;124:71-81

2. Homburger HA, Cahen YD, Griffiths J, Jacob GL: Detection of antinuclear antibodies: comparative evaluation of enzyme immunoassay and indirect immunofluorescence methods. Arch Pathol Lab Med 1998;122:993-999

Special Instructions
Library of PDFs including pertinent information and forms related to the test

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

The method used to detect antinuclear antibody (ANA) is enzyme-linked immunosorbent assay (ELISA). A HEp-2 lysate supplemented with various purified antigens (double-stranded deoxyribonucleic acid [dsDNA], histone, SS-A [Ro], SS-B [La] Smith, RNP, Scl-70, Jo-1, plus centromere antigen) are coated onto microtiter plate wells. A dilution of patient serum is added to the well and incubated. After washing to remove unbound serum protein, an enzyme-conjugated antihuman-IgG antibody is added to detect human IgG bound to the microtiter plate well. After incubation and washing to remove unbound conjugate, a substrate to the enzyme is added to the well. After incubation, the enzyme substrate reaction is stopped. The complete assay is measured on a spectrophotometer plate reader. The optical density measured is proportional to the antibody present in the patient serum. Testing is performed on the Agility instrument by Dynex.(Package insert: ELISA kits, Bio-Rad Laboratories, Hercules CA 07/14)

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.

1 day

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 has been cleared, approved, or is exempt by the US Food and Drug Administration and is used per manufacturer's instructions. Performance characteristics were verified by Mayo Clinic in a manner consistent with CLIA requirements.

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

Test Id Test Order Name Order LOINC Value
ANA2 Antinuclear Ab, S 94875-2
Result Id Test Result Name Result LOINC Value
Result LOINC Value Tooltip
ANA2 Antinuclear Ab, S 94875-2

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