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Epic Code LAB1230024 Cutaneous Immunofluorescence Antibodies (IgG), Serum

Additional Codes

Mayo Code: CIFS

Reporting Name

Cutaneous Immfluor. Ab, S (IgG)

Performing Laboratory

Mayo Clinic Laboratories in Rochester

Clinical Information

IgG anti-basement membrane zone (BMZ) antibodies are produced by patients with pemphigoid. In most patients with bullous pemphigoid, serum contains IgG anti-BMZ antibodies, while in cicatricial pemphigoid circulating IgG anti-BMZ antibodies are found in a minority of cases. Sensitivity of detection of anti-BMZ antibodies is increased when serum is tested using sodium chloride-split primate skin as substrate.

 

Circulating IgG anti-BMZ antibodies are also detected in patients with epidermolysis bullosa acquisita and bullous eruption of lupus erythematosus.

 

IgG anti-cell surface (CS) antibodies are produced by patients with pemphigus. The titer of anti-CS antibodies generally correlates with disease activity of pemphigus.

Useful For

Confirming a diagnosis of pemphigoid, pemphigus, epidermolysis bullosa acquisita, or bullous lupus erythematosus

Specimen Type

Serum


Specimen Required


Collection Container/Tube:

Preferred: Red top

Acceptable: Serum gel

Submission Container/Tube: Plastic vial

Specimen Volume: 2 mL


Laboratory Test Directory Note:

COLLECTION NOTE: Volumes listed are in serum or plasma, draw approximately 2 1/2 times the requested volume in whole blood.

Specimen Minimum Volume

0.5 mL

Specimen Stability Information

Specimen Type Temperature Time Special Container
Serum Refrigerated (preferred) 14 days
  Frozen  30 days
  Ambient  14 days

Reject Due To

Gross hemolysis OK
Gross lipemia Reject
Gross icterus OK

Day(s) Performed

Monday through Friday

Reference Values

Report includes presence and titer of circulating antibodies. If serum contains basement zone (BMZ) antibodies on split-skin substrate, patterns will be reported as:

1) Epidermal pattern, consistent with pemphigoid

2) Dermal pattern, consistent with epidermolysis bullosa acquisita

 

Negative in normal individuals

Interpretation

Indirect immunofluorescence (IF) testing may be diagnostic when histologic or direct IF studies are only suggestive, nonspecific, or negative.

 

Anti-cell surface antibodies correlate with a diagnosis of pemphigus.

 

Anti-basement membrane zone (BMZ) antibodies correlate with a diagnosis of bullous pemphigoid, cicatricial pemphigoid, epidermolysis bullosa acquisita (EBA), or bullous eruption of lupus erythematosus (LE).

 

If serum contains anti-BMZ antibodies, the pattern of fluorescence on sodium chloride (NaCl)-split skin substrate helps distinguish pemphigoid from EBA and bullous LE. Staining of the roof (epidermal side) or both epidermal and dermal sides of NaCl-split skin correlate with the diagnosis of pemphigoid, while fluorescence localized only to the dermal side of the split-skin substrate correlates with either EBA or bullous LE.

Cautions

Results should be interpreted in conjunction with clinical information, histologic pattern, and results of direct immunofluorescence (IF) study. In particular, the finding of low titer (≤1:80) anti-cell surface antibodies should not be used alone (ie, without histologic or direct IF support) to confirm a diagnosis of pemphigus.

Clinical Reference

1. Beutner EH, Chorzelski TP, Kumar V, eds: Immunopathology of the Skin. 3rd ed. Wiley Medical Publication; 1987

2. Gammon WR, Briggaman RA, Inman AO 3rd, Queen LL, Wheeler CE: Differentiating anti-lamina lucida and anti-sublamina densa anti-BMZ antibodies by indirect immunofluorescence on 1.0 M sodium chloride-separated skin. J Invest Dermatol. 1984 Feb;82(2):139-144

3. Tirumalae R, Kalegowda IY: Role of BIOCHIP indirect immunofluorescence test in cutaneous vesiculobullous diseases. Am J Dermatopathol. 2020 May;42(5):322-328

Method Name

Indirect Immunofluorescence

Method Description

Frozen sections of primate esophagus and sodium chloride-split primate skin are overlaid with dilutions of patient's serum, incubated, covered with fluorescein-conjugated IgG antiserum, and interpreted with a fluorescence microscope.(Unpublished Mayo method)

Report Available

2 to 7 days

Test Classification

This test was developed, and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the US Food and Drug Administration.

CPT Code Information

88346

88350

LOINC Code Information

Test ID Test Order Name Order LOINC Value
CIFS Cutaneous Immfluor. Ab, S (IgG) In Process

 

Result ID Test Result Name Result LOINC Value
21539 Cell Surface Ab IgG 21352-0
21540 Basement Membrane IgG 29994-1
21541 Primate Esophagus IgG 66881-4
21542 Primate Split Skin IgG 45178-1
21638 Other 48767-8