ANA Cascade (ANA, IFA with Reflex to Titer and Pattern, and Reflex to 11 Ab Cascade)
The ANA Cascade is a blood test that screens for antinuclear antibodies (ANAs) using immunofluorescence. A positive screen automatically reflexes to titer and pattern reporting, and then to a tiered series of more specific autoantibody tests.
About this test
The test measures antinuclear antibodies using immunofluorescence on HEp-2 cells. If the screen is positive, the sample is further tested for titer and staining pattern, and then, in tiers, for a series of disease-specific autoantibodies linked to conditions such as lupus, mixed connective tissue disease, Sjogren syndrome, systemic sclerosis, and polymyositis.
Quest describes this cascade design as a way to add specificity once a general ANA screen is positive: because ANAs can appear in other conditions or in people without autoimmune disease, testing for specific autoantibodies can help support a diagnosis. Negative ANA IFA results are usually associated with negative results on most of the clinically important specific autoantibodies, so Quest notes that further immunoassay testing is generally not pursued without a positive screen and clinical suspicion, with the exception of Jo-1 and SSA antibodies, which can occasionally appear despite a negative ANA IFA.
Who might consider this test?
- Results are read alongside clinical and family history and examination findings, not on their own.
Test details
| Quest code | 16814 |
|---|---|
| Methodology | Immunofluorescence Assay |
| Sample type | 1 mL serum |
| Collection | Quest patient service center |
Related tests and panels
Measures antinuclear antibodies (ANA) by immunofluorescence, a marker related to…
Quest resources
Additional details
What this test looks at
The starting analyte is the ANA Screen, IFA, which reports antinuclear antibodies detected by immunofluorescence on HEp-2 cells. A positive screen reflexes first to titer and pattern, then, in cascading tiers, to a series of additional antibodies; the cascade stops as soon as a tier comes back positive.
How it's often used alongside other tests
Because the cascade is built to add specificity once ANA is positive, it is ordered as a single test rather than as separate follow-up orders. A clinician interprets the ANA screen, titer, pattern, and any specific autoantibodies that come back together, alongside a person's history and exam findings.
This test isn't orderable through the store yet. Requesting it tells us you want it and puts you on the list to be told when that changes — there is no charge and no commitment, and requesting does not place an order.
Laboratory results should always be interpreted by a licensed clinician who knows your health history. This page is information about a test, not medical advice.
Frequently asked questions
What does the ANA Cascade measure?
It starts by measuring antinuclear antibodies in serum using immunofluorescence on HEp-2 cells. If that screen is positive, the same sample is further tested for titer and staining pattern, then for a tiered series of specific autoantibodies.
How is the sample collected?
The test uses a 1 mL serum sample from a routine blood draw.
Do I need to prepare for this test?
No preparation instructions are listed for this test, though people follow any instructions their ordering clinician provides.
What happens if the initial ANA screen is negative?
Quest notes that negative ANA IFA results are usually associated with negative results on the clinically important specific autoantibodies, so the cascade generally does not proceed to further tiers without a positive screen, apart from Jo-1 and SSA antibodies, which may occasionally be detected despite a negative screen.
Why does the test reflex through several tiers instead of reporting one result?
The cascade design tests for specific autoantibodies only after a positive general screen, which Quest describes as a way to add specificity once autoimmune disease is suspected; testing stops at whichever tier first comes back positive.