Evaluation of auto antibodies and hematological parameters in patients with anti-nuclear antibody positive summary

Introduction and Aim: The prevalence of systemic autoimmune diseases in the population is between 1 and 2% and it is an important cause of morbidity and mortality. Therefore, early diagnosis of systemic autoimmune diseases is important. ANA test is useful for diagnostic purposes in patients with clinical findings supporting systemic autoimmune diseases, to exclude certain diseases in patients with suspicious clinical findings and to classify patients with autoimmune diseases. The indirect immunofluorescence (IIF) method using HEp-2 cells is the most sensitive and gold standard method used in ANA detection. The titer and staining pattern is important in the results of the ANA test. Current guidelines suggest 1/160 ANA titer as the main cut-off value for the diagnosis of systemic autoimmune disease. The high titer of ANA is cautionary for autoimmune disease, but it is not diagnostic tool by itself. In order to reveal the antigen type in patients with ANA positivity IIF test is suggested and to confirm the IIF test; Immunoblot and ELISA test are recommended. The purpose of our study; It was aimed to evaluate the risk of development of cytopenias according to ANA titers by evaluating the ANA titer, determining the ANA staining patterns, and evaluating the ANA subtypes in patients with ANA positive. Method: In this study, 622 patients who were found to be positive for 1/160 titer and above ANA test, using IFA method were included. The results of people over the age of 18 with at least 3 ANA subtypes were studied among anti-ds DNA and ENA profile (SS-A, SS-B, SCL-70, anti-SM, SM-RNP, anti centromere, ENA nucleosome, anti-ribosomal-P protein) were reviewed retrospectively. Patients demographic and laboratory data were compared with ANA titers and staining patterns. Results: Out of 622 patients with ANA positive, 539 (86,7%) were female and 83 (13.3%) were male. The average age of the patients was found to be 46,7. 565 (90,8%) of these patients showed nuclear pattern, 56 (9%) showed cytoplasmic pattern and 1 (0,16%) mitotic staining pattern. Titer 1/160 in 168 subjects (27%), titer 1/320 in 153 subjects (24,5%), titer 1/640 in 101 subjects (16,2%), titer 1/1280 in 79 subjects (12,7%) and 1/2560 titer in 121 subjects (19,4%) was determined. When the titres of 1/640 and above were compared with the titers below 1/640, no significant relationship was found with the hemoglobin, leukocyte, thrombocyte, creatinine, AST, ALT, CRP, Anti-TG, Anti-TPO, CCP, C3 and C4 values. A positive correlation was found between ANA titer and sedimentation, RF and AMA, while a negative correlation was found with leukocyte, hemoglobin and C3. Conclusion: ANA positivity was found more frequently in women in our study. The age distribution was found to be 46.7, consistent with the literature. Systemic autoimmune diseases are more common as the ANA titer increases. Nuclear homogeneous and fine speckled staining, which is the most common IFA staining pattern, was found in our study. The most common ANA subtype was SSA and SSB positivity. It is thought that studying anti-dsDNA and anti-ENA profile with immunoblot and ELISA method will be clinically useful in early diagnosis and follow-up of patients with ANA positivity in patients with suspected systemic autoimmune disease. Keywords: autoimmune disease, antinuclear antibody, IFA, ELISA