Neuronal Nuclear Antibody (ANNA) IgG by IFA with Reflex to Titer & Immunoblot, Serum (INACTIVE as of 5/20/13.  Refer to 2007961)
Ordering Recommendation
Semi-Quantitative Indirect Fluorescent Antibody/Qualitative Immunoblot
1-9 days
New York DOH Approval Status
This test is New York DOH approved.
Submit With Order
ARUP Consult®
Disease Topics
Specimen Required
Patient Preparation
Serum separator tube. 
Specimen Preparation
Separate serum from cells ASAP or within 2 hours of collection. Transfer 1 mL serum to an ARUP Standard Transport Tube. (Min: 0.15 mL) 
Storage/Transport Temperature
Unacceptable Conditions
Plasma. Contaminated, heat-inactivated, hemolyzed, or lipemic specimens. 
After separation from cells: Ambient: 24 hours; Refrigerated: 2 weeks; Frozen: 1 year 
Reference Interval
Test Number
Reference Interval
 Neuronal Nuclear Ab (ANNA) IgG Scrn, IFA< 1:10
0050892Neuronal Nuclear Antibody (ANNA) IFA Titer, IgG (Do Not Use - Please Order (2007961) Paraneoplastic Antibodies (PCCA/ANNA) by IFA with Reflex to Titer and Immunoblot)< 1:10 No antibody detected
0051088Neuronal Nuclear Antibodies (ANNA) IgG, Immunoblot, Serum (INACTIVE as of 5/20/13. Refer to 2007963)
Test Number
Reference Interval
 Neuronal Nuclear Antibody IgG, Anti-HuRefer to report
 Neuronal Nuclear Antibody IgG, Anti-RiRefer to report

Interpretive Data
ANNA-1 (anti-Hu) and ANNA-2 (anti-Ri) are screened by immunofluorescence and confirmed by immunoblot detection of antibody reactive with a 35-40 kDa (ANNA-1) or a 55 kDa (ANNA-2) neuronal protein. ANNA-1 is present in patients with paraneoplastic syndromes (paraneoplastic sensory neuropathy or paraneoplastic encephalomyelitis) most commonly associated with small-cell lung carcinoma (SCLC). ANNA-2 is present in patients with midbrain encephalitis, cerebellar ataxia, eye movement disorders (usually opsoclonus), and occasionally myelopathy. Neoplasms most often associated with ANNA-2 are breast carcinoma and SCLC. ANNA-1 and ANNA-2 may be detectable before the associated neoplasm is detectable.

ANNA antibodies are screened by IFA. If the IFA screen shows reactivity at 1:10, the specimen will be titered to endpoint and confirmed (Hu or Ri) by immunoblot.

Compliance Statement D: This test was developed and its performance characteristics determined by ARUP Laboratories. The U.S. Food and Drug Administration has not approved or cleared this test; however, FDA clearance or approval is not currently required for clinical use. The results are not intended to be used as the sole means for clinical diagnosis or patient management decisions.

ANNA antibodies are screened by IFA. If the IFA screen is  1:10, then a titer and immunoblot (Hu and Ri) will be added. Additional charges apply.
CPT Code(s)
86255; if reflexed, add 86256 and 83516
Component Test Code*Component Chart NameLOINC
0050891Neuronal Nuclear Ab (ANNA) IgG Scrn, IFA11088-2
* Component test codes cannot be used to order tests. The information provided here is not sufficient for interface builds; for a complete test mix, please click the sidebar link to access the Interface Map.
  • Anti-Hu (Neuronal Nuclear Ab, Anti-Hu, IgG)
  • Anti-Ri (Neuronal Antibody IgG, Immunoblot Anti-Ri)
  • Hu Antibody (Neuronal Nuclear Ab, Anti-Hu, IgG)
  • Ri Antibody (Neuronal Antibody IgG, Immunoblot Anti-Ri)