Effective Tuesday, December 11, 2012, the University of Iowa Hospitals and Clinics core clinical chemistry laboratory will begin offering two panels of serologic testing for Epstein-Barr Virus (EBV) on the BioRad Bioplex 2200 analyzer.  The turnaround time is 3 hrs or less from receipt in laboratory.  These tests will include an interpretative result and table derived from large retrospective study of EBV serology panel results (Klutts JS et al., J Clin Microbiol 47: 3204-3410, 2009).

• Specimen type: 4.5 mL red top tube
• Minimum requirements (Adult): 3 mL whole blood from one red top tube
• Minimum requirements (Peds): TWO red top microtainer (pediatric patients)
• Test Availability: 24 hours/day, 7 days a week (including holidays)
• Turnaround Time: 3 hour upon receipt in laboratory

Details on the tests are as follows:

(1) Epstein-Barr Virus Acute Panel (LAB7810)

The acute panel contains tests for heterophile IgM (equivalent to Monospot) and viral capsid antibody (VCA) IgM and is intended for workup of possible acute EBV infection.  Heterophile IgM is relatively less sensitive than VCA IgM in acute EBV infection.  Negative results for both VCA IgM and heterophile antibody rule out acute EBV infection with high sensitivity.

The EBV acute panel yields 4 possible patterns of results that have the following likely interpretations (equivocal results being treated as negative in the table):

Heterophile IgM	VCA IgM	Likely Interpretation
Neg	Neg	No acute EBV infection
Neg	Pos	Acute EBV infection
Pos	Pos	Acute EBV infection
Pos	Neg	Unusual pattern, difficult to interpret

The core laboratory will continue to offer Monospot (LAB327) which provides the most rapid turnaround for acute EBV infection.

(2) Epstein-Barr Virus, Full AB Panel (LAB4584)

The EBV full panel contains tests for heterophile IgM antibody, VCA IgM, VCA IgG, and EBV nuclear antigen (EBNA) IgG.  The full EBV panel is intended to clarify or confirm equivocal or negative Monospot tests (especially in patients at risk for splenic rupture) or for assessment of EBV infection in immunocompromised patients (including transplant recipients).

The EBV panel yields 16 possible patterns of results that have the following likely interpretations (equivocal results being treated as negative in the table):

Heterophile IgM	VCA IgM	VCA IgG	EBNA IgG	Likely Interpretation
Neg	Neg	Neg	Neg	EBV naïve
Neg	Pos	Neg	Neg	Primary acute EBV infection
Pos	Neg	Neg	Neg	Primary acute EBV infection
Pos	Pos	Neg	Neg	Primary acute EBV infection
Neg	Pos	Pos	Neg	Primary acute EBV infection
Pos	Neg	Pos	Neg	Primary acute EBV infection
Pos	Pos	Pos	Neg	Primary acute EBV infection
Neg	Pos	Neg	Pos	Recov/react EBV infection1
Neg	Pos	Pos	Pos	Recov/react EBV infection1
Pos	Neg	Pos	Pos	Recov/react EBV infection1
Pos	Pos	Neg	Pos	Recov/react EBV infection1
Pos	Pos	Pos	Pos	Recov/react EBV infection1
Neg	Neg	Pos	Neg	Past EBV infection (not active)
Neg	Neg	Pos	Pos	Past EBV infection (not active)
Pos	Neg	Neg	Pos	Unknown significance2
Neg	Neg	Neg	Pos	Unknown significance1

¹ Recovery from EBV infection or reactivated EBV infection
² Uncommon patterns of unknown clinical significance

Questions should be directed to Matthew Krasowski, MD, PhD, medical director of the Clinical Chemistry Laboratory (384-9380, matthew-krasowski@uiowa.edu).