Test ID: ANAP
Anaplasma phagocytophilum (Human Granulocytic Ehrlichiosis) Antibody, Serum
Secondary ID 
A test code used for billing and in test definitions created prior to November 2011
NY State Approved Indicates the status of NY State approval and if the test is orderable for NY State clients.
Useful For Suggests clinical disorders or settings where the test may be helpful
As an adjunct in the diagnosis of human granulocytic ehrlichiosis
Method Name A short description of the method used to perform the test
Immunofluorescence Assay (IFA)
Reporting Name A shorter/abbreviated version of the Published Name for a test; an abbreviated test name
Aliases Lists additional common names for a test, as an aid in searching
Human Granulocytic Anaplasmosis (HGA)
Human Granulocytic Ehrlichiosis (HGE)
Anaplasma phagocytophilum
Specimen Type Describes the specimen type needed for testing
Specimen Required Defines the optimal specimen. This field describes the type of specimen required to perform the test and the preferred volume to complete testing. The volume allows automated processing, fastest throughput and, when indicated, repeat or reflex testing.
Container/Tube:
Preferred: Red top
Acceptable: Serum gel
Specimen Volume: 0.5 mL
Specimen Minimum Volume Defines the amount of specimen required to perform an assay once, including instrument and container dead space. Submitting the minimum specimen volume makes it impossible to repeat the test or perform confirmatory or perform reflex testing. In some situations, a minimum specimen volume may result in a QNS (quantity not sufficient) result, requiring a second specimen to be collected.
Reject Due To Identifies specimen types and conditions that may cause the specimen to be rejected
| Hemolysis | Mild OK; Gross reject |
| Lipemia | Mild OK; Gross reject |
| Icterus | NA |
| Other | NA |
Specimen Stability Information Provides a description of the temperatures required to transport a specimen to the laboratory. Alternate acceptable temperature(s) are also included.
| Specimen Type | Temperature | Time |
|---|---|---|
| Serum | Refrigerated (preferred) | 14 days |
| Frozen | 14 days |
Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
Human granulocyte ehrlichiosis (HGE) is a zoonotic infection caused by a rickettsia-like agent. The infection is acquired by contact with Ixodes ticks carrying the HGE agent. The deer mouse is the animal reservoir and, overall, the epidemiology is very much like that of Lyme disease and babesiosis. HGE is most prevalent in the upper Midwest and in other areas of the United States that are endemic for Lyme disease. Since its first description in 1994, there have been approximately 50 cases of HGE described in the upper Midwest.
The cellular target in HGE cases is the neutrophil. The organisms exist in membrane-lined vacuoles within the cytoplasm of infected host cells. Ehrlichial inclusions, called morulae, contain variable numbers of organisms. Single organisms, wrapped in vacuolar membranes have also been observed in the cytoplasm. Ehrlichia species occur in small electron-dense and large electron-lucent forms, but a clear life cycle has not been elucidated.
Diagnosis of human ehrlichiosis has been difficult because the patient's clinical course is often mild and nonspecific, including fever, myalgias, arthralgias, and nausea. This is easily confused with other illnesses such as influenza or other tickborne zoonoses such as Lyme disease, babesiosis, and Rocky Mountain spotted fever. Clues to the diagnosis of ehrlichiosis in a patient with an acute febrile illness after tick exposure include laboratory findings of leukopenia or thrombocytopenia and elevated serum aminotransferase levels. However, these findings may also be present in patients with Lyme disease or babesiosis.
Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.
<1:64
Interpretation Provides information to assist in interpretation of the test results
A positive result of an immunoflourescence assay (IFA) test (titer > or = 1:64) suggests current or previous infection with human granulocytic ehrlichiosis. In general, the higher the titer, the more likely it is that the patient has an active infection.
Seroconversion may also be demonstrated by a significant increase in IFA titers.
During the acute phase of the infection, serologic tests are often nonreactive, PCR testing is available to aid in the diagnosis of these cases (see #84319 "Ehrlichia/Anaplasma, Molecular Detection, PCR, Blood").
Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
Previous episodes of human granulocytic ehrlichiosis may produce a positive serologic result.
In rare instances, clinical evidence of infection may also be derived by direct microscopic examination of Giemsa- or Diff-Quik-stained peripheral blood buffy coat smears, which may reveal clusters of round, dark-purple stained, small dots or clusters of dots (morulae) in the cytoplasm of polymorphonuclear cells. However, this is a very insensitive method.
Performance characteristics have not been established for hemolyzed or lipemic specimens.
Clinical Reference Provides recommendations for further in-depth reading of a clinical nature
Bakken JS, Dumler JS, Chen SM, et al: Human granulocytic ehrlichiosis in the upper Midwest United States. A new species emerging? JAMA 1994;272:212-218
Method Description Describes how the test is performed and provides a method-specific reference
The patient's serum is diluted and is placed in microscopic slide wells which have been coated with Anaplasma phagocytophilum-infected cells. After incubation, the slides are washed and a fluorescein isothiocyanate conjugate is added to each well. The slides are then read using a fluorescence microscope and significant fluorescent staining of intracellular organisms constitutes a positive reaction. (Dumler JS, Asanovich KM, Bakken JS, et al: Serologic cross-reactions among Ehrlichia equi, Ehrlichia phagcoytophilia, and human granulocytic ehrlichia. J Clin Microbiol 1995;33:1098-1103; Pancholi P, Kolbert CP, Mitchell PD, et al: Ixodes dammini as a potential vector of human granulocytic ehrlichiosis. J Infect Dis 1995;172:1007-1012)
Day(s) and Time(s) Test Performed Outlines the days and times the test is performed. This field reflects the day and time the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time required before the test is performed. Some tests are listed as continuously performed, which means assays are performed several times during the day.
Monday through Friday; 9 a.m.
Analytic Time Defines the amount of time it takes the laboratory to setup and perform the test. This is defined in number of days. The shortest interval of time expressed is "same day/1 day," which means the results may be available the same day that the sample is received in the testing laboratory. One day means results are available 1 day after the sample is received in the laboratory.
Maximum Laboratory Time Defines the maximum time from specimen receipt at Mayo Medical Laboratories until the release of the test result
Specimen Retention Time Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded
Performing Laboratory Location The location of the laboratory that performs the test
Test Classification Provides information regarding the medical device classification for laboratory test kits and reagents. Tests may be classified as cleared or approved by the US Food and Drug Administration (FDA) and used per manufacturer's instructions, or as products that do not undergo full FDA review and approval, and are then labeled as an Analyte Specific Reagent (ASR), Investigation Use Only (IUO) product, or a Research Use Only (RUO) product.
CPT Code Information Provides guidance in determining the appropriate Current Procedural Terminology (CPT) code(s) information for each test or profile. The listed CPT codes reflect Mayo Medical Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.
86666
LOINC® Code Information Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the result codes returned for this test or profile.
| Result ID | Reporting Name | LOINC Code |
|---|---|---|
| 81157 | Anaplasma phagocytophilum Ab, IgG,S | 23877-4 |
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