Epstein-Barr Virus, Full Ab Panel

Label Mnemonic:	EBVPAN
Epic code:	LAB4584
Order form:	Laboratory Requisition
Supply order:	Supply Order Form
Billing:	Billing Policies
CPT code:	86308 (Heterophile), 86664 (EBNA), 86665x2 (VCA IgG and IgM)

Specimen(s):

Plasma

Collection Medium:

BD Gold SST 5 mL Vacutainer

Minimum:

3.0 mL whole blood or TWO Microtainer^® devices.

Testing Schedule:

24 hrs/day, 7 days a week, including holidays.

Turn Around Time:

3 hours (upon receipt in laboratory)

Reference Range:

Reference ranges changed effective 12/11/2012.

Reference range for all analytes (Heterophile IgM, VCA IgG, VCA IgM, 
EBNA):
  0.8 AI or less: Negative
  0.9-1.0 AI: Indeterminate
  1.1 AI or greater: Positive

Interpretive Data:

Epstein-Barr virus (EBV) is the etiologic agent of infectious 
mononucleosis. EBV infection can be difficult to diagnose by 
laboratory testing; however, the majority of acute infections can be 
recognized by testing the patient's serum for heterophile antibodies 
(e.g., by the "Monospot" latex agglutination assay), which usually 
appear within the first 3 weeks of illness, but then decline rapidly 
within a few weeks. Heterophile antibodies are found in a very high 
percentage of infants and older children with acute mononucleosis.  
However, heterophile antibodies do not develop in approximately 10% of 
adults.  In cases where EBV is suspected but the heterophile antibody 
is not detected, evaluation of a panel of 4 EBV antibodies can be 
useful:
   Heterophile IgM
   Viral capsid antigen (VCA) IgG
   VCA IgM
   EBV nuclear antibody (EBNA)

Infection with EBV usually occurs early in life, typically as 
infectious mononucleosis. Other disorders due to EBV infection have 
been recognized, including Burkitt's lymphoma and nasopharyngeal 
carcinoma. EBV infection may also cause lymphoproliferative syndromes, 
especially in patients who have undergone renal or bone marrow 
transplantation and in those who have AIDS. 

Presence of VCA IgM antibodies indicates recent primary infection with 
EBV. The presence of VCA IgG antibodies indicates infection sometime 
in the past. Antibodies to EBNA develop 6 to 8 weeks after primary 
infection and are usually detectable for life. Over 90% of the normal 
adult population have IgG class antibodies to VCA and EBNA. Few 
patients who have been infected with EBV will fail to develop 
antibodies to the EBNA (approximately 5%-10%).

EBV serology pattern interpretation is adapted from the findings in J. 
Clin. Microbiol. 47(10): 3204-3210, 2009.  The table below has the 
likely interpretations of the 16 patterns possible from the four 
assays in the EBV panel.  For purposes of classification, 
indeterminate/equivocal results are considered negative in the table 
below.  Results should always be interpreted in conjunction with 
patient history and physical examination.

Heterophile  VCA  VCA  EBNA
    IgM      IgM  IgG  IgG  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  Recovery from/reactivation of EBV infection
    Neg      Pos  Pos  Pos  Recovery from/reactivation of EBV infection
    Pos      Neg  Pos  Pos  Recovery from/reactivation of EBV infection
    Pos      Pos  Neg  Pos  Recovery from/reactivation of EBV infection
    Pos      Pos  Pos  Pos  Recovery from/reactivation of EBV infection
				
    Neg      Neg  Pos  Neg  Past EBV infection
    Neg      Neg  Pos  Pos  Past EBV infection
				
    Pos      Neg  Neg  Pos  Unknown*
    Neg      Neg  Neg  Pos  Unknown*

* These two patterns are uncommon and have unknown significance.

Comments:

Reference:
Klutts JS et al. Evidence-based approach for interpretation of Epstein-Barr virus serological patterns. J. Clin. Microbiol. 47(10): 3204-3210.

Methodology:

Multiplex Flow Immunoassay

Sample Processing:

Centrifuge at a speed and time necessary to get barrier separation of plasma/serum and cells within 1 hour of collection. Send specimen in original tube. Do Not transfer to another tube.
Each sample must be labeled with at least TWO full patient identifiers (First/Last Name & DOB are sufficient for non-UIHC affiliated clients) to avoid sample rejection/delays.

Sample Storage:

Refrigerate.
All sample storage requirements are intended for delivery to UIHC within 24 hours of collection for testing. If samples won't arrive in this time period, please call the UIHC Core Lab for alternative storage/shipping instructions (319-356-3527).

Transport Instructions:

Place labeled specimen into zip-lock type biohazard bag; seal bag.
Place completed requisition into outside pocket of bag.
Transport in cooler with refrigerated coolant packs.