26339 Epstein-Barr Virus DNA Detection and Quantification, Plasma (EBVQN)

EBV DNA, EBV, EBV DNA level, EBV DNA PCR, EBV DNA quant, EBV PCR, EBV quant, EBV viral load, Epstein-Barr virus, Infetious mononucleosis, PTLD, Epstein-Barr Virus DNA Detection/Quant

Diagnosis of Epstein-Barr virus (EBV)-associated infectious mononucleosis in individuals with equivocal or discordant EBV serologic marker test results

Diagnosis of posttransplant lymphoproliferative disorders (PTLD), especially in EBV-seronegative organ transplant recipients receiving antilymphocyte globulin for induction immunosuppression and OKT-3 treatment for early organ rejection

Monitoring progression of EBV-associated PTLD in organ transplant recipients

This test should not be used to screen asymptomatic patients.

1. ​Centrifuge blood collection tube per manufacturer's instructions (eg, centrifuge within 2 hours of collection for BD Vacutainer tubes). 

2. Aliquot plasma into plastic vial.  

Ship specimen frozen on dry ice only.  If shipment will be delayed for more than 24 hours, freeze plasma at -20 to -80 degrees C (up to 84 days) until shipment on dry ice.

​Serial determination of plasma specimens from organ transplant recipients may be necessary to monitor increasing (risk of development of posttransplant lymphoproliferative disorders: PTLD) or decreasing (treatment efficacy) levels of Epstein-Barr virus (EBV) DNA.

Nonsymptomatic EBV viremia or viral shedding may occur occasionally in healthy individuals. Therefore, this test should be used only for patients with a clinical history and symptoms consistent with EBV infection, and test results must be interpreted in the context of patient's clinical history, signs, and symptoms.

Due to potential differences in assay performance, serial monitoring of a patient's EBV viral load should be performed using the same exact assay. On average, this assay quantifies EBV DNA in plasma 3-fold (about 0.48 log IU/mL)  higher than the laboratory-developed quantitative EBV DNA assay previously performed at Mayo Clinic Laboratories due to differences in the specimen extraction method and design in the amplification primers and probes for the viral target sequences.

Primary infection with Epstein-Barr virus (EBV), a DNA virus in the Herpesviridae family, may cause infectious mononucleosis resulting in a benign lymphoproliferative condition characterized by fever, fatigue, sore throat, and lymphadenopathy. Infection occurs early in life, and, by 10 years of age, 70% to 90% of children have been infected with this virus. Usually, infection in children is asymptomatic or mild and may be associated with minor illnesses such as upper respiratory tract infection, pharyngitis, tonsillitis, bronchitis, and otitis media.

The target cell for EBV infection is the B lymphocyte. Immunocompromised individuals lacking antibody to EBV are at risk for acute EBV infection that may cause lymphoproliferative disorders in organ transplant recipients (posttransplant lymphoproliferative disorders: PTLD) and AIDS-related lymphoma. The incidence of PTLD ranges from 1% for renal transplant recipients to as high as 9% for heart/lung transplants and 12% for pancreas transplant patients.

EBV DNA can be detected in the blood of patients with this viral infection, and increasing serial levels of EBV DNA in plasma have been shown to correlate highly with subsequent (in 3-4 months) development of PTLD in susceptible patients. Organ transplant recipients who are seronegative (at risk for primary EBV infection) for EBV (most often children) who receive antilymphocyte globulin for induction immunosuppression and OKT-3 treatment for early organ rejection are at highest risk for developing PTLD when compared to immunologically normal individuals with prior EBV infection.

The quantification range of this assay is 35 to 100,000,000 IU/mL (1.54 log to 8.00 log IU/mL), with a limit of detection (95% detection rate) at 19 IU/mL.

 Increasing levels of Epstein-Barr virus (EBV) DNA in serial plasma specimens of a given organ transplant recipient may indicate possible development of posttransplant lymphoproliferative disorder (PTLD).

An "Undetected" result indicates that EBV DNA is not detected in the plasma specimen (see Cautions). If clinically indicated, repeat testing in 1 to 2 months is recommended.

A result of "<35 IU/mL" indicates that the EBV DNA level present in the plasma specimen is below 35 IU/mL (1.54 log IU/mL), and the assay cannot accurately quantify the EBV DNA present below this level.

A quantitative value (reported in IU/mL and log IU/mL) indicates the EBV DNA level (ie, viral load) present in the plasma specimen.

A result of ">100,000,000 IU/mL" indicates that the EBV DNA level present in the plasma specimen is above 100,000,000 IU/mL (8.00 log IU/mL), and this assay cannot accurately quantify the EBV DNA present above this level.

An "Inconclusive" result indicates that the presence or absence of EBV DNA in the plasma specimen could not be determined with certainty after repeat testing in the laboratory, possibly due to polymerase chain reaction inhibition or presence of interfering substance. Submission of a new specimen for testing is recommended if clinically indicated.