Anti-Neutrophil Cytoplasmic Antibody with Reflex to Titer and MPO/PR-3 Antibodies
Ordering Recommendation
Preferred panel for managing patients with a known diagnosis of vasculitis. May be assistive in evaluating suspected vasculitis. Preferred reflex panel for the workup of suspected vasculitis is ANCA-Associated Vasculitis Profile (ANCA/MPO/PR-3) with Reflex to ANCA Titer (2006480).
Semi-Quantitative Indirect Fluorescent Antibody/Semi-Quantitative Multiplex Bead Assay
2-5 days  
New York DOH Approval Status
This test is New York DOH approved.
Submit With Order
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: 0.5 mL)  
Storage/Transport Temperature
Unacceptable Conditions
CSF, plasma, urine, or other body fluids. Contaminated, hemolyzed, or severely lipemic specimens.  
After separation from cells: Ambient: 48 hours; Refrigerated: 2 weeks; Frozen: 1 year (avoid repeated freeze/thaw cycles)  
Reference Interval
Test Number Components Reference Interval
 Anti-​Neutrophil Cytoplasmic Antibody, IgG < 1:20: Not significant
0050526Myeloperoxidase Antibody Negative: 19 AU/mL or less
Equivocal: 20-​25 AU/mL
Positive: 26 AU/mL or greater
0050527Serine Protease 3 Antibody Negative: 19 AU/mL or less
Equivocal: 20-​25 AU/mL
Positive: 26 AU/mL or greater
Interpretive Data
Neutrophil cytoplasmic antibodies (C-ANCA=granular cytoplasmic staining, P-ANCA=perinuclear staining) are found in the serum of over 90% of patients with certain necrotizing systemic vasculitides, and usually in less than 5% of patients with collagen vascular disease or arthritis. Approximately 90% of patients with a P-ANCA pattern by IFA have antibodies specific for myeloperoxidase (MPO). Approximately 85% of patients with a C-ANCA pattern by IFA have antibodies specific for serine proteinase 3 (PR-3).  
Specimens are screened by IFA on ethanol-fixed neutrophils, formalin-fixed neutrophils, and HEp-2 slides that allow differentiation of C- and P-ANCA patterns.

If screen is positive, then titer and MPO/PR-3 antibodies will be added to aid in antibody determination. Additional charges apply.
CPT Code(s)
86255; if reflexed, add 86256; 83516 x2
Component Test Code*Component Chart NameLOINC
0050811Anti-Neutrophil Cytoplasmic Ab, IgG29967-7
* 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.
  • (Perinuclear Antineutrophil Cytoplasmic Antibody
  • ACPA
  • ANCA
  • ANCA Panel, IgG
  • Anti-Neutrophil Cytoplasmic Ab Test
  • Anti-Neutrophil Cytoplasmic Antibodies Panel, IgG
  • Anticytoplasmic Antibody
  • Antineutrophil Cytoplasmic Antibodies (ACPA)
  • Autoantibodies to Proteinase 3
  • c ANCA (Anti-Neutrophil Cytoplasmic Antibody with Reflex to Titer & MPO/PR-3 Antibodies)
  • c-ANCA
  • Cytoplasmic Neutrophil Antibodies
  • MPO)
  • p ANCA
  • P-ANCA
  • pANCA
  • PR3
  • Proteinase 3