® Wieslab AB August 2012

Wieslab Request form – Autoimmune diagnostics

501ANCA for Systemic Vasculitis (GPA (formerly WG), MPA)PR3-ANCA, Capture PR3-ANCA, MPO-ANCA, Capture MPO-ANCA

Additional testing for positive ANCAC-ANCA, P-ANCA (IIF) IgG-subclass determination of anti-PR3 or anti-MPO PiZ determination of alpha-1-antitrypsin

ANCA follow up testing of Systemic vasculitisPR3-ANCA, Capture PR3-ANCA

MPO-ANCA, Capture MPO-ANCA

ANCA expanded analysisPR3-ANCA, Capture PR3-ANCA, MPO-ANCA, Capture MPO-ANCA, IIF-ANCA,ANCA-panel (BPI, Azurozidine, Cathepsin G, Elastase, Laktoferrin, Lysozyme)

Antiphospholipid syndromeANA screen, anti-dsDNA (ELISA), anti-Cardioiolipin, anti-Beta-2-glycoprotein 1

Autoimmune hepatitisANA screen, smooth muscle antibodies (SMA), liver/kidney microsomes antibodies (LKM), mitochrondrial antibodies (AMA) and SLA/LP

Hepatitis - expanded analysisLKM-1, LC-1, Mitochondria (type M2)

Celiac diseaseEndomysium IgA, Gliadin IgA, Transglutaminase IgA, IgA quantification

Complement deficiencyComplement function (Classical, alternative and lectin pathways (MBL and the Ficolin 3 pathways)) C3, C4, C3d, C1q, properdin. Expanded analysis is performed when complement function is decreased.

Congenital heart blockENA screen (SSA/SSB), anti-Ro52, anti-SSA p200

Connective tissue disease – undifferentiatedPR3-ANCA, capture PR3-ANCA, MPO-ANCA, capture MPO-ANCA, ANA screen(HEp-2 cells), ENA screen, anti-dsDNA, anti-cardiolipin, anti-beta 2 glycoprotein 1,anti-CCP

Cystic fibrosisBPI-ANCA IgA+ IgG

DiabetesIslet cell antibodies, GAD-65, IA2, Insulin

Drug induced lupusANA screen, IIF-ANCA, anti-histones, anti-cardiolipin

Glomerulonephritis Anti-GBM (Goodpasture (GP), PR3-ANCA, Capture PR3-ANCA, MPO-ANCA, Capture MPO-ANCA, anti-dsDNA (ELISA), ANA screen, IgA Fibronectin complex, anti-Streptolysin O, anti-PLA 2-R

Complement analysisClassical, alternative and lectin pathways (MBL- och Ficolin 3-pathway),C3, C4, C3d, C1q. Expanded analysis when complement function is decreased.

Anti-Entactin IgG+IgM

Hereditary angioedema (HAE) C1-inactivator (C1-esterase inhibitor or C1-INH), C3, C4, C1q, Complement function (Classical and alternative patways and lectin pathway (MBL- and Ficolin 3 patways), Expanded analysis is performed at decreased levels of C1-INH or the complement function.

Inflammatory bowel diseasesASCA IgA+IgG, IIF ANCA

If IIF-ANCA is positive, a follow-up with ANCA expanded analysis is recommended.

Multiple Sclerosis/Neuromyelitis optica (Devic’s syndrome)anti-Aquaporin 4 (NMO), anti-MBP, anti-MOG

Myasthenia gravisStriated muscle antibodies, Acetylcholine receptor (anti-AChR) antibodies. Supplementary addition in case of negative result of anti-AChR: Anti-MuSK. Supplementary addition in case of positive result of anti-AChR: Anti-titin.

Neuropathy – unclear/Guillain-Barré syndromeAntibodies against gangliosides (GM1, asialo GM1, GQ1b, GD1a, and GD1b, GM2), anti-MAG and anti-Sulfatide IgM.

Paraneoplastic neurological diseasesanti-Hu, anti-Yo, anti-Ri, anti-Tr, anti-Ta, anti-Ma-1, anti-VGKC, anti-AMPA-R1, anti-AMPA-R2

Pemphigus/Pemphigoid (Bullous dermatosis)Anti-skin (IIF - basement mebrane and intercellular substance), anti-BP180, anti-BP230, anti-desmoglein 1 and anti-desmoglein 3

Polymyositis/DermatomyositisANA screen, ENA screen (Jo-1, nRNP), PL-7, PL-12, EJ, PM/Scl, Mi-2, SRP

Rheumatoid arthritis (RA)ANA screen (HEp-2 cells), anti-CCP and Rheumatoid factor IgM and IgA

Sjögren’s syndromeANA screen, ENA screen (SSA/SSB)

Scleroderma/systemic sclerosisANA screen, ENA screen (Scl-70)

Scleroderma-Expanded analysis Antibodies against Fibrillarin, Th/To, RNA polymerase, I, II, III, PM/Scl.

Sudden deafnessAnti-HSP-70, ANA screen (HEp-2 cells), anti-cardiolipin, IIF-ANCA

Systemic lupus erythematosus (SLE)ANA screen (HEp-2 cells), anti-dsDNA (ELISA), ENA screen (Sm), anti-cardiolipin

Complement analysisClassical, alternative and lectin pathways (MBL- och Ficolin 3-pathway),C3, C4, C3d, C1q. Expanded analysis when complement function is decreased.

Thyroid diseaseAntibodies against thyroglobulin (TG), thyroid peroxidase (TPO) and TSH receptor.

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Individual analyses on the reverse sideSelect test package

Specimen Collection InformationTake a venous or capillary blood sample in a tube without additive, let the sample clot and centrifuge it. The sample can be kept in a refrigerator while waiting for transport. Send 1-3 ml serum by ordinary mail. This will be enough for one or several analyses.

Requesting Doctor

Telephone:

Sample Date

Type of specimen Serum EDTA-plasma Liquor (CSF) .........................

Patient IdentificationContact Information / Billing Information

Street Address Lundavägen 151, S-21224 Malmö, Sweden

ContactT +46 (0)40 - 53 76 60F +46 (0)40 - 43 28 90

Send to

Wieslab AB, Box 50117, 202 11 Malmö, Sweden

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Wieslab Request form – Autoimmune diagnostics

® Wieslab AB August 2012 W-002-GB00 www.wieslab.com

Orders/Requests

Please send: ............... Request forms ............... Guide to Autoimmunity ............... Quick guides

Mark for analysis

ANCA antibodies

Phospholipid antibodies

Complement analysis (serum + EDTA-plasma)

Nuclear antibodies

020 ANA screen on HEp-2 cells:

Positive ANA, patterns 7 and 8,

is supplemented by:

ANA titration, ENA screen, dsDNA(ELISA) and anti-histones (pattern 7)

021 ANA titration on HEp-2 cells

020 Centromeres

022 dsDNA (ELISA):

Positive dsDNA is supplemented with analysis on Crithidia

023 dsDNA (Crithidia)

700 EJ

024 ENA screen (Sm, nRNP, SSA, SSB, Scl-70, Jo-1)

600 Fibrillarin

098 Histones

030 Jo-1

440 Mi-2

026 nRNP (snRNP, U1-RNP)

480 PL-7

490 PL-12

710 PM/Scl (P100 + P75)

450 RNA Polymerase I / II / III

031 rRNP (P-protein)

029 Scl-70 (100)

025 Sm

430 SRP (signal recognition particle)

027 SSA (Ro60)

032 SSA 52 (Ro 52 kDa protein)

034 SSA p200

028 SSB (La)

720 Th/To

Rheumatoid arthritis - antibodies

070

IgA-RF 068

069

Other analyses

095 Anti-HSP-70

103 PiZ analysis of alpha 1 antitrypsin

240 Streptolysin O antibodies

900/910 C3, C4

920 C1q

930 C3d (EDTA-plasma)

945 Complement function:

Classical, alternative and lectin (MBL and Ficolin 3) pathways

946 Ficolin 3-pathway

890 anti-C1q

Amphiphysin 1

ANNA-3

Aquaporin 4 (NMO)

Calcium channel antibodies (VGCC)

Neurology - antibodies

730

874

880

845

CV2/CRMP-5 870

546 Ganglioside antibodies – IgG + IgM: AsialoGM1, GM1, GQ1b, GD1a, GD1b, GM2

220 Hu (ANNA-1)

875 NMDA receptor

093 Myelin associated glycoprotein (MAG)

882 Myelin basic protein (MBP)

884 Myelin basic protein (MOG)

830

Organ/tissue specific antibodies

079 Acetylcholine receptor:

Positive AChR is supplemented with Titin

Negative AChr is supplemented with MuSK

514 ASCA IgA + IgG

086 Adrenal cortex antibodies

556 BP180 IgG + IgA

557 BP230 IgG + IgA

280 Collagen VII

559 Desmoglein 1 and 3

410/420 Desmoplakin I / II

071 Endomysium IgA

089 GAD65 (Glutamic acid decarboxylase)

519 Gliadin IgA

111 IA-2 (Islet cell antigen 2)

110 Insulin

770 Intrinsic factor (INF)

090 Islet cell antibodies

558 Laminin 5 IgG + IgA

825 Liver cytosol antigen

083 Liver/kidney microsomal abs (LKM)

820 Liver/kidney microsomal type 1 abs (LKM-1)

084 Mitochondrial antibodies (AMA)

290 Mitochondrial antibodies type M2

960 MuSK

087 Parietal cell antibodies

092 Skin (Intercellular substance, Basement membrane)

800 SLA/LP

082 Smooth muscle antibodies (SMA)

780 Steroid 21 hydroxylase (S21HY) antibodies

085 Striated muscle antibodies

865 Thyroglobulin antibodies

091 Thyroid peroxidase (TPO) antibodies

965 Titin

120 Total IgA quantification

074 Transglutaminase antibodies – IgA

860 TSH receptor antibodies

Nephrology - antibodies

518 Entactin IgG + IgM

001 Goodpasture abs (GBM)

100 IgG-subclass determination of Goodpasture (GBM) antibodies

007 IgA Fibronectin complex

245 PLA 2-R

097 Tubular basement membrane abs (TBM)

CCP (cyclic citrullinated peptide)

IgM-RF

Potassium channel complex (VGKC) (serum/liquor)

760 Purkinje cell antibodies (Tr)

761 Purkinje cell antibodies (PCA-2)

750 Ri (Nova 1, ANNA-2)

355 Sulfatide IgM

790 Ta (Ma-2)

740 Yo (Purkinje cell abs, PCA-1)

517 Beta 2 glycoprotein 1 IgG + IgM

516 Cardiolipin IgG + IgM

040 ANCA Panel:

Azurocidin, BPI, Cathepsin G, Elastase, Lactoferrin and Lysozyme

536 BPI-ANCA IgA + IgG

016 Capture MPO-ANCA

012 Capture PR3-ANCA

102 IgG-subclass determination of MPO-ANCA

101 IgG-subclass determination of PR3-ANCA

008 IIF-ANCA (C- och P-ANCA)

014 MPO-ANCA

010 PR3-ANCA