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HelpTest Code CIFS Cutaneous Immunofluorescence Antibodies, IgG, Serum
Reporting Name
Cutaneous Immfluor. Ab, S (IgG)Useful For
Confirming the presence of IgG antibodies to diagnose of pemphigoid, pemphigus, epidermolysis bullosa acquisita, or bullous lupus erythematosus
Performing Laboratory
Mayo Clinic Laboratories in Rochester
Specimen Type
SerumSpecimen Required
Collection Container/Tube:
Preferred: Serum gel
Acceptable: Red top
Submission Container/Tube: Plastic vial
Specimen Volume: 2 mL
Collection Instructions: Centrifuge and aliquot serum into a plastic vial.
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 |
Reference Values
Report includes presence and titer of circulating antibodies. If serum contains basement membrane zone 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
Day(s) Performed
Monday through Friday
Test Classification
This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. It 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) | 104835-4 |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| 21539 | Cell Surface Ab IgG | 104831-3 |
| 21540 | Basement Membrane IgG | 104836-2 |
| 21541 | Primate Esophagus IgG | 66881-4 |
| 21542 | Primate Split Skin IgG | 104832-1 |
| 21638 | Other | 48767-8 |
Clinical Information
Immunoglobulin G 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.
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 correlates 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;82(2):139-144
3. Tirumalae R, Kalegowda IY. Role of BIOCHIP indirect immunofluorescence test in cutaneous vesiculobullous diseases. Am J Dermatopathol. 2020;42(5):322-328
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 daysSpecimen Retention Time
30 daysReject Due To
| Gross hemolysis | OK |
| Gross lipemia | Reject |
| Gross icterus | OK |
Method Name
Indirect Immunofluorescence