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22365 Cutaneous Immunofluorescence, AB

Cutaneous Immunofluorescence, AB
Test Code: HMISC
Synonyms/Keywords
​Histology, Immunofluorescence Antibodies, Skin Biopsy, Surgical Pathology, Direct FA, IF, DIF
Test Components
​IgA IF, IgG IF, IgM IF, C3 IF, and Fibrinogen IF
Useful For
Aiding in the diagnosis of immunobullous disorders, vasculitis, lichenoid/interface dermatitis, and other inflammatory disorders. Common immunobullous disorders where utilization of this test is helpful include pemphigoid and all its variants, pemphigus and all its variants, linear IgA disease, dermatitis herpetiformis, lupus erythematosus, epidermolysis bullosa acquisita, porphyrias, and other atypical or mixed forms of immunobullous diseases.
 
In addition, a salt-split technique can be utilized in select cases to determine if immunoreactants bind to epidermal and/or dermal location within a subepidermal split to further refine diagnosis (for example, to help distinguish between bullous pemphigoid and epidermolysis bullosa acquisita).
Specimen Requirements
Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)		 Pediatric Minimum Volume
(no repeat)
​Tissue See Collection Processing Instructions​ ​ 4mm Punch or Shave Biopsy (involved or uninvolved)​ ​ ​
Collection Processing Instructions
DIF Collection Processing Instructions:
 
All Specimens must be accompanied by:
Properly filled out Histology Test Requisition Sheet to include:
·       Patient demographics, collection date, source of specimen.
·       Pertinent clinical history and whether the biopsy is perilesional, sun exposed/unexposed and/or involved/uninvolved.
·       Yellow neon sticker “Specimen for Direct Immunofluorescence DIF” or handwritten and highlighted in yellow if no stickers are available.
·       Electronic orders are acceptable as long as paperwork is included with the specimen and “Specimen for Direct Immunofluorescence DIF” is clearly stated.
 
 Criteria for handling Direct Immunofluorescence Specimens:
1.     Offsite Specimens:
a.      Place fresh specimen in a vial of Zeus fixative or Michel’s transport media immediately upon removal. Be certain that the tissue is immersed in the media and not stuck to the edge of the vial or cap before tightly placing cap on vial.
b.     Label vial with patient demographics.
c.      Attach Yellow neon sticker “Specimen for Direct Immunofluorescence DIF”
 
2.     Onsite Specimens:
a.      Place specimen on a blue filter paper. Fold paper to enclose the specimen inside it. Saturate it with normal saline and place in a properly labeled specimen container. Do not let tissue dry out, nor should specimen be floating in the saline solution.
b.     Container should be labeled with patient name, MHN, collection date and source of specimen.
c.      Attach Yellow neon sticker “Specimen for Direct Immunofluorescence DIF”
d.     Hand carry to histology or tube STAT. If tubing specimen call histology (1-6173) to notify them that it is being sent through the tube system.
e.      If specimen is submitted after normal clinic hours and placed in Zeus fixative, this should be clearly stated on the requisition form.
 
An additional formalin fixed biopsy is advantageous for complete interpretation
Acceptable Specimen Types
​Tissue
Specimen Stability Information
Specimen Type Temperature Time
​Tissue - Skin or Mucosa (Saline) Room Temperature/Ambient < 1 hour
​Tissue  - Skin or Mucosa (Zeus Transport Media) ​Room Temperature/Ambient ​5 days
Rejection Criteria
Formalin-fixed
Unlabeled
​Tissue Frozen and then Thawed
Tissue Transported in Expired, Cloudy, Crystalline, or Frozen Zeus Transport Media
Mismatched Tissue and Requisition Information​
Incomplete Requisition​
Performing Laboratory Information
Performing Location Day(s) Test Performed Analytical Time Methodology/Instrumentation
​Marshfield ​Monday - Friday ​2 days ​Direct Immunofluorescence
Test Information
Additional formalin fixed biopsy is advantageous for complete interpretation.
 
Note: A low frequency of false negative results may occur if tissues are stored in the Zeus fixative for periods longer than 5 days.
Reference Range Information
Performing Location Reference Range
Marshfield Interpretative Report​
Interpretation
The results include descriptor and interpretation of staining patterns.
 
Studies submitted for complete examination with Immunofluorescence may include Light Microscopy. These results will be incorporated with the patient's clinical and laboratory data and a written surgical pathology report will be issued.
Outreach CPTs
CPT Modifier
(if needed)		 Quantity Description Comments
​88346 ​ 1 Immunofluroescence (IF) antibody​ ​First stain
​88350 ​ 4 ​Additional Immunofluroescence (IF) antibodies​ All other stains on the same specimen
Synonyms/Keywords
​Histology, Immunofluorescence Antibodies, Skin Biopsy, Surgical Pathology, Direct FA, IF, DIF
Test Components
​IgA IF, IgG IF, IgM IF, C3 IF, and Fibrinogen IF
Ordering Applications
Ordering Application Description
If the ordering application you are looking for is not listed, contact your local laboratory for assistance.
Specimen Requirements
Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)		 Pediatric Minimum Volume
(no repeat)
​Tissue See Collection Processing Instructions​ ​ 4mm Punch or Shave Biopsy (involved or uninvolved)​ ​ ​
Collection Processing
DIF Collection Processing Instructions:
 
All Specimens must be accompanied by:
Properly filled out Histology Test Requisition Sheet to include:
·       Patient demographics, collection date, source of specimen.
·       Pertinent clinical history and whether the biopsy is perilesional, sun exposed/unexposed and/or involved/uninvolved.
·       Yellow neon sticker “Specimen for Direct Immunofluorescence DIF” or handwritten and highlighted in yellow if no stickers are available.
·       Electronic orders are acceptable as long as paperwork is included with the specimen and “Specimen for Direct Immunofluorescence DIF” is clearly stated.
 
 Criteria for handling Direct Immunofluorescence Specimens:
1.     Offsite Specimens:
a.      Place fresh specimen in a vial of Zeus fixative or Michel’s transport media immediately upon removal. Be certain that the tissue is immersed in the media and not stuck to the edge of the vial or cap before tightly placing cap on vial.
b.     Label vial with patient demographics.
c.      Attach Yellow neon sticker “Specimen for Direct Immunofluorescence DIF”
 
2.     Onsite Specimens:
a.      Place specimen on a blue filter paper. Fold paper to enclose the specimen inside it. Saturate it with normal saline and place in a properly labeled specimen container. Do not let tissue dry out, nor should specimen be floating in the saline solution.
b.     Container should be labeled with patient name, MHN, collection date and source of specimen.
c.      Attach Yellow neon sticker “Specimen for Direct Immunofluorescence DIF”
d.     Hand carry to histology or tube STAT. If tubing specimen call histology (1-6173) to notify them that it is being sent through the tube system.
e.      If specimen is submitted after normal clinic hours and placed in Zeus fixative, this should be clearly stated on the requisition form.
 
An additional formalin fixed biopsy is advantageous for complete interpretation
Acceptable Specimen Types
​Tissue
Specimen Stability Information
Specimen Type Temperature Time
​Tissue - Skin or Mucosa (Saline) Room Temperature/Ambient < 1 hour
​Tissue  - Skin or Mucosa (Zeus Transport Media) ​Room Temperature/Ambient ​5 days
Rejection Criteria
Formalin-fixed
Unlabeled
​Tissue Frozen and then Thawed
Tissue Transported in Expired, Cloudy, Crystalline, or Frozen Zeus Transport Media
Mismatched Tissue and Requisition Information​
Incomplete Requisition​
Useful For
Aiding in the diagnosis of immunobullous disorders, vasculitis, lichenoid/interface dermatitis, and other inflammatory disorders. Common immunobullous disorders where utilization of this test is helpful include pemphigoid and all its variants, pemphigus and all its variants, linear IgA disease, dermatitis herpetiformis, lupus erythematosus, epidermolysis bullosa acquisita, porphyrias, and other atypical or mixed forms of immunobullous diseases.
 
In addition, a salt-split technique can be utilized in select cases to determine if immunoreactants bind to epidermal and/or dermal location within a subepidermal split to further refine diagnosis (for example, to help distinguish between bullous pemphigoid and epidermolysis bullosa acquisita).
Test Components
​IgA IF, IgG IF, IgM IF, C3 IF, and Fibrinogen IF
Reference Range Information
Performing Location Reference Range
Marshfield Interpretative Report​
Interpretation
The results include descriptor and interpretation of staining patterns.
 
Studies submitted for complete examination with Immunofluorescence may include Light Microscopy. These results will be incorporated with the patient's clinical and laboratory data and a written surgical pathology report will be issued.
For more information visit:
Performing Laboratory Information
Performing Location Day(s) Test Performed Analytical Time Methodology/Instrumentation
​Marshfield ​Monday - Friday ​2 days ​Direct Immunofluorescence
For billing questions, see Contacts
Outreach CPTs
CPT Modifier
(if needed)		 Quantity Description Comments
​88346 ​ 1 Immunofluroescence (IF) antibody​ ​First stain
​88350 ​ 4 ​Additional Immunofluroescence (IF) antibodies​ All other stains on the same specimen
For most current information refer to the Marshfield Laboratory online reference manual.