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Test Code Cutaneous Immunof, AB Cutaneous Immunofluorescence, AB

Important Note

Order as "HMISC"

Useful For

Aiding in the diagnosis of immunobullous disorders, vasculitis, lichenoid/interface dermatitis, and other inflammatory disorders. Common immunobullous disorders where utilization of this test is helpful include pemphigoid and all its variants, pemphigus and all its variants, linear IgA disease, dermatitis herpetiformis, lupus erythematosus, epidermolysis bullosa acquisita, porphyrias, and other atypical or mixed forms of immunobullous diseases.  

 

In addition, a salt-split technique can be utilized in select cases to determine if immunoreactants bind to epidermal and/or dermal location within a subepidermal split to further refine diagnosis (for example, to help distinguish between bullous pemphigoid and epidermolysis bullosa acquisita).

Synonyms/Keywords

Histology, Immunofluorescence Antibodies, Skin Biopsy, Surgical Pathology, Direct FA, IF, DIF, Cutaneous Immunofluorescence, AB

Specimen Requirements

Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)		 Pediatric Minimum Volume
(no repeat)
Tissue See Collection Processing Instructions   4mm Punch or Shave Biopsy (involved or uninvolved)    

Acceptable Specimen Types

Tissue

Collection/Processing Instructions

DIF Collection Processing Instructions:  

 

All Specimens must be accompanied by:

Properly filled out Histology Test Requisition Sheet to include:       

  • Patient demographics, collection date, source of specimen.       
  • Pertinent clinical history and whether the biopsy is perilesional, sun exposed/unexposed and/or involved/uninvolved.       
  • Yellow neon sticker "Specimen for Direct Immunofluorescence DIF" or handwritten and highlighted in yellow if no stickers are available.       
  • Electronic orders are acceptable as long as paperwork is included with the specimen and "Specimen for Direct Immunofluorescence DIF" is clearly stated.    

 

Criteria for handling Direct Immunofluorescence Specimens:

1. Offsite Specimens:

a. Place fresh specimen in a vial of Zeus fixative or Michel's transport media immediately upon removal. Be certain that the tissue is immersed in the media and not stuck to the edge of the vial or cap before tightly placing cap on vial.

b. Label vial with patient demographics.

c. Attach Yellow neon sticker "Specimen for Direct Immunofluorescence DIF"   

2. Onsite Specimens:

a. Place specimen on a blue filter paper. Fold paper to enclose the specimen inside it. Saturate it with normal saline and place in a properly labeled specimen container. Do not let tissue dry out, nor should specimen be floating in the saline solution.

b. Container should be labeled with patient name, MHN, collection date and source of specimen.

c. Attach Yellow neon sticker "Specimen for Direct Immunofluorescence DIF"

d. Hand carry to histology or tube STAT. If tubing specimen call histology (1-6173) to notify them that it is being sent through the tube system.

e. If specimen is submitted after normal clinic hours and placed in Zeus fixative, this should be clearly stated on the requisition form.  

An additional formalin fixed biopsy is advantageous for complete interpretation

Specimen Stability Information

Specimen Type Temperature Time
Tissue - Skin or Mucosa (Saline) Room Temperature/Ambient < 1 hour
Tissue  - Skin or Mucosa (Zeus Transport Media) Room Temperature/Ambient 5 days

Rejection Criteria

Formalin-fixed
Unlabeled
Tissue Frozen and then Thawed
Tissue Transported in Expired, Cloudy, Crystalline, or Frozen Zeus Transport Media
Mismatched Tissue and Requisition Information
Incomplete Requisition

Test Components

IgA IF, IgG IF, IgM IF, C3 IF, and Fibrinogen IF

Test Information

Additional formalin fixed biopsy is advantageous for complete interpretation.  

 

Note: A low frequency of false negative results may occur if tissues are stored in the Zeus fixative for periods longer than 5 days.

Interpretations

The results include descriptor and interpretation of staining patterns.  

 

Studies submitted for complete examination with Immunofluorescence may include Light Microscopy. These results will be incorporated with the patient's clinical and laboratory data and a written surgical pathology report will be issued.

Reference Range Information

Performing Location Reference Range
Marshfield Interpretative Report

Marshfield Labs Performing Department

Marshfield Labs Histology

Performing Information

Performing Location Day(s) Test Performed Analytical Time Methodology/Instrumentation
Marshfield Monday - Friday 2 days Direct Immunofluorescence

CPT Codes

CPT Modifier
(if needed)		 Quantity Description Comments
88346   1 Immunofluroescence (IF) antibody First stain
88350   4 Additional Immunofluroescence (IF) antibodies All other stains on the same specimenother stains on the same specimen

Outreach CPT Codes

CPT Modifier
(if needed)		 Quantity Description Comments
88346   1 Immunofluroescence (IF) antibody First stain
88350   4 Additional Immunofluroescence (IF) antibodies All other stains on the same specimen