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Test Code ENA Extractable Nuclear Antibodies

Useful For

Antinuclear antibodies occur in connective tissue diseases including systemic lupus erythematosus (SLE), mixed connective tissue disease (MCTD), Sjogren’s syndrome, and scleroderma. The ENA is recommended after a positive ANA IFA screen to identify the most common specific antibodies occurring in many of the connective tissue disorders. This method eliminates the false positive ANA IFA results due to naturally occurring autoantibodies that appear with most immunofluorescent detection.

Synonyms/Keywords

Extractable Nuclear Antigen, ENA, ANA Confirmatory, ANA-subset, ANA
 

Specimen Requirements

Fasting Required Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)		 Pediatric Minimum Volume
(no repeat)
No Serum Red Top Tube (RTT) or Serum Separator Tube (SST)   1.0 mL 0.4 mL 0.3 mL

Collection/Processing Instructions

Separate serum from cells within 2 hours of collection.

Specimen Stability Information

Specimen Type Temperature Time
Serum Refrigerate 7 days
Frozen > 7 days

Rejection Criteria

Gross lipemia
Gross hemolysis
Heat inactivated samples

Test Components

SSA, SSB, Sm, SmRNP, Ribonucleoprotein (RNP), Scl-70, JO1, dsDNA, Chromatin, Ribosomal P (RiboP), Centromere B
 

Test Information

The Extractable Nuclear Antibodies (ENA) assay detects the presence of autoantibodies in the blood that react with proteins in the cell nucleus. This test is primarily used to confirm the presence of specific antibodies as follow-up after a positive ANA IFA test (specifically with speckled pattern).  This test collectively screens for the extractable nuclear antibodies.  If the screen is positive, the following individual antibodies will be tested and reported:  dsDNA, Chromatin, Ribosomal P, SSA/Ro, SSB/La, Centromere B, Sm, SmRNP, RNP, Scl-70 and JO1. 

 

See the Mixed Connective Tissue Disease Panel Algorithm for further information on suggested ordering of this test.

Interpretations

  • SSA/SSB: Positive result supports the diagnosis of Sjogren's syndrome or other connective tissue diseases.
  • Sm: Positive result supports diagnosis of SLE with renal involvement
  • RNP: Positive result supports diagnosis of mixed connective tissue disease, which resembles SLE but is not accompanied by renal involvement.
  • Scl-70: Positive result supports diagnosis of scleroderma
  • Jo-1: Positive result supports diagnosis of polymyositis

Reference Range Information

Performing Location Reference Range
Marshfield

Negative  

dsDNA (0.0-0.4)

Chromatin: Negative (<1.0)

Ribo P: Negative (<1.0)

SSA: Negative (<1.0)

SSB: Negative (<1.0)

Cent B: Negative (<1.0)

Sm: Negative (<1.0)

SmRNP: Negative (<1.0)

RNP: Negative (<1.0)

Scl 70: Negative (<1.0)

Jo1: Negative (<1.0)

Marshfield Labs Performing Department

Marshfield Labs Immunodiagnostics

Performing Information

Performing Location Day(s) Test Performed Analytical Time Methodology/Instrumentation
Marshfield Monday through Friday 1 day Multiplex Flow Immunoassay/Bio-Rad BioPlex 2200

CPT Codes

CPT Modifier
(if needed)		 Quantity Description Comments
86038   1 ENA Screen  
86225
 		 1 Deoxyribonucleic Acid (DNA) antibody, native or double stranded if needed as reflex testing due to positive screen result
86235   10 Chromatin, Ribosomal P, SSA/Ro, SSB/La, Centromere B,Sm, SmRNP, RNP, Scl-70 and JO1 if needed as reflex testing due to positive screen result

Outreach CPT Codes

CPT Modifier
(if needed)		 Quantity Description Comments
86038   1 ENA Screen  
86225
 		 1 Deoxyribonucleic Acid (DNA) antibody, native or double stranded if needed as reflex testing due to positive screen result
86235
 		 10 Chromatin, Ribosomal P, SSA/Ro, SSB/La, Centromere B, Sm, SmRNP, RNP, Scl-70 and JO1 if needed as reflex testing due to positive screen result

Ordering Applications

Ordering Application Description
Centricity Extractable Nuclear Antibodies
Cerner Extractable Nuclear Antibodies