We investigated the performance of ANA-ELISA for CTDs screening and diagnosis and comparing it to the conventional ANA-IIF. ANA-ELISA is a solid-phase immune assay includes 17 ANA-targeted recombinant antigens; dsDNA, Sm-D, Rib-P, PCNA, U1-RNP (70, A, C), SS-A/Ro (52 and 60), SS-B/La, Centromere B, Scl-70, Fibrillarin, RNA Polymerase III, Jo-1, Mi-2, and PM-Scl. During the period between March till December 2016 all requests for ANA from primary, secondary, and tertiary care centers were processed with both techniques; ANA-IIF and ANA-ELISA. The electronic medical record of these patients was reviewed looking for CTD diagnosis documented by the Senior rheumatologist. SPSS 22 is used for analysis. Between March and December 2016, a total of 12,439 ANA tests were requested. 1457 patients were assessed by the rheumatologist and included in the analysis. At a cut-off ratio ≥ 1.0 for ANA-ELISA and a dilutional titre ≥ 1:80 for ANA-IIF, the sensitivity of ANA-IIF and ANA-ELISA for all CTDs were 63.3% vs 74.8% respectively. For the SLE it was 64.3% vs 76.9%, Sjogren’s Syndrome was 50% vs 76.9% respectively. The overall specificity of ANA-ELISA was 89.05%, which was slightly better than ANA-IIF 86.72%. The clinical performance of ANA-ELISA for CTDs screening showed better sensitivity and specificity as compared to the conventional ANA-IIF in our cohort.

Lactic acidosis is an extremely rare paraneoplastic manifestation of hematological malignancies, and often carries an extremely poor prognosis. Mantle cell lymphoma is an aggressive and rare form of non-Hodgkin lymphoma. To the best of our knowledge, it is extremely rare to have severe lactic acidosis in patients with mantle cell lymphoma. In this article, we are reporting a rare case of mantle cell lymphoma diagnosed with typical cluster differentiation (CD markers) in bone marrow examination with persistent lactic acidosis refractory to intravenous hydration that responded well to chemotherapy. Malignant lactic acidosis is a medical emergency that needs rapid evaluation and identification that shows improved prognosis after the introduction of chemotherapy.

Al-Radideh et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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BackgroundAntinuclear antibody (ANA) detection by indirect immunofluorescence technique (ANA-IIF) is the standard test for connective tissue disease (CTD) screening for last 5 decades, which has low specificity and it is labour intensive. ANA detection by fluoroenzyme immunoassay (ANA-Elia) has been developed recently as an alternative method to include 17 ANA-targeted recombinant antigens.ObjectivesCompare the sensitivity and specificity of the new ANA-Elia with conventional ANA-IIF.MethodsRandomly selected 1458 patient’s sera from primary and secondary health care were tested for both the standard ANA-IIF (Diasorin S.P.A, saluggia, Italy) and the new ANA-Elia (Phadia GMbH, Ferieiburg, Germany). ANA-Elia is fluoroenzyme immunoassay performed on the Phadia-250 automated platform. It contains 17 ANA-targeted recombinant antigens; dsDNA, Sm-D, Rib-P, PCNA, U1-RNP (70, A, C), SS-A/Ro (52 and 60), SS-B/La, Centromere B, Scl-70, Fibrillarin, RNA Polymerase III, Jo-1, Mi-2, and PMscl. Result with ratio >1.0 considered positive for the new technique. For ANA-IIF our lab cut off for positive test is ≥1:80. Patients were evaluated in our rheumatology clinic for fulfilling the correspondent international clinical criteria for various connective tissue diseases.Results75.7% were females with mean age of 43±13 years. 201 (11.5%) patients confirmed to have clinical CTD as follow: 142 SLE, 24 Sjogren’s syndrome, 15 scleroderma, 7 MCT, 10 Myositis and 10 undifferentiated CTD. The specificity of ANA-Elia at cut off ratio of >1 and ANA-IIF at titer of ≥1:80 was almost equal, 88.5% and 87.6% respectively. However, ANA-Elia has higher sensitivity (74.5%) as compared to ANA-IIF (61.6%). At a higher cut off ratio of >2 and titer of ≥1:160, the specificity improved to 93.6%–92.6% respectively.ANA-EliaANA-IIF >1>2≥1:80≥1:160 Sensitivity74.5%67.6%61.6%50.7%Specificity88.5%93.6%87.6%92.6%ConclusionsThe ANA testing with the newly developed, use friendly, fully automated and less labour intense method of ANA-Elia can replace the standard conventional ANA-IIF with better specificity.Disclosure of InterestNone declared