New: Antineutrophil Cytoplasmic Antibodies (ANCA) and Anti-Cyclic Citrullinated Peptide Antibodies (ACPA) testing now available at community labs

To: Ordering Clinicians (Medical Practitioners, Registered Nurses in the Extended Class, as applicable pursuant to Ontario Regulation 45/22 under the Laboratory and Specimen Collection Centre Licensing Act)
Category: Physician Services, Primary Health Care Services, Registered Nurse in the Extended Class
Written by: Laboratories and Diagnostics Branch, Health Programs and Delivery Division
Date issued: August #, 2023
Bulletin Number: 230801

Overview

The Community Access Pilot for Laboratory Services currently extended for the 2023-24 fiscal year will now include Antineutrophil Cytoplasmic Antibodies (ANCA) and Anti-Cyclic Citrullinated Peptide Antibodies (ACPA) testing to the updated list of services. Please refer to Table 1.

These tests will now be available to patients at no-cost through community laboratories.

ANCA testing

ANCA (Antineutrophil Cytoplasmic Antibodies) testing is used to diagnose ANCA-associated vasculitides – rare but serious life and organ threatening conditions.

The Community Access Pilot will now include two tests to detect ANCA: Proteinase 3 (PR3) and Myeloperoxidase (MPO) when performed using a high-quality, antigen-specific immunoassay method of ANCA detection for patients in whom there is clinical suspicion of ANCA-associated vasculitis, as per the Canadian Vasculitis Network Guidelines.

Clinicians practicing Pediatrics and all its subspecialties, Internal Medicine and all its subspecialties, Dermatology, Neurology, Ear Nose Throat and Ophthalmology can order these ANCA tests – Proteinase 3 (PR3) and Myeloperoxidase (MPO).

ACPA (or Anti-CCP) testing

ACPA (Anti-Cyclic Citrullinated Peptide Antibodies) testing is used to diagnose Rheumatoid Arthritis. It is more specific than Rheumatoid Factor in Rheumatoid Arthritis and therefore more effective in predicting erosive disease.

Clinicians practicing Pediatrics and all its subspecialties, Internal Medicine and all its subspecialties and Dermatology can order ACPA testing.

Repeat testing

Ordering Clinicians are advised not to order repeat testing:

  • within 1 year if ACPA test results are negative
  • if ACPA test results are positive

Table 1: Updated List of Services

Name of Test Collection and/or Testing Clinical Indications for Ordering
Trichomonas – Nucleic Acid Amplification Test (NAAT) Testing Only Polymerase Chain Reaction (PCR) test (NAAT) only-no changes to existing clinical guidance.
Gonorrhea (NAAT) Testing Only PCR test (NAAT) only-no changes to existing clinical guidance.
Chlamydia
(NAAT)		 Testing Only PCR test (NAAT) only-no changes to existing clinical guidance.
C. difficile-EIA stool antigen and Toxin A/B Testing Only Enzyme Immunoassay (EIA) as initial screen. If EIA results for antigen and toxin A/B are concordant, confirmatory NAAT is not needed.
C. difficile-Confirmatory (NAAT) Testing Only NAAT for confirmatory testing only.
Apolipoprotein B Collections and Testing As per the 2021 Canadian Cardiovascular Society (CCS) Guidelines
Lipoprotein a [Lp(a)] Collections and Testing As per the 2021 Canadian Cardiovascular Society (CCS) Guidelines
Celiac tissue Transglutaminase Immunoglobulin A (tTG-IgA) Collections and Testing For the purposes of the Pilot, should be ordered for the diagnosis of celiac disease only with the following criteria:
  • Indicated in clients over 2 years of age.
  • Should only be tested while client is on a gluten containing diet.
If client is IgA deficient (see "serum IgA" test below), additional testing required will not be funded through this Pilot.
Celiac serum IgA Collections and Testing Used alongside Celiac tTG-IgA to determine whether a client is IgA deficient.
N-Terminal-pro hormone B-type Natriuretic Peptide (NT-proBNP) Collections and Testing Clinically indicated only in clients with suspected heart failure.
Antineutrophil Cytoplasmic Antibodies (ANCA): PR3 and MPO Collections and Testing
  • Canadian Vasculitis Network Guidelines; as per disease activity
  • Ordering Clinicians are restricted to Clinicians practising Pediatrics and all its subspecialties, Internal Medicine and all its subspecialties, Dermatology, Neurology, Ear Nose Throat (ENT) and Ophthalmology
Anti-Cyclic Citrullinated Peptide Antibodies (ACPA) Collections and Testing
  • If negative, do not repeat within 1 year
  • If positive, do not repeat
  • Ordering Clinicians are restricted to Clinicians practising Pediatrics and all its subspecialties, Internal Medicine and all its subspecialties, and Dermatology

Additional information

For further information about the Community Access Pilot for Laboratory Services, please email CommunityLabs@ontario.ca or call 416-326-2158.

Keywords/Tags

Community Access Pilot; Community Laboratories; Laboratory Services; Patient Access

Contact information

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