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The page below is a sample from the LabCE course Autoimmune Diseases and Antinuclear Antibody Testing: Methods and Staining Patterns. Access the complete course and earn ASCLS P.A.C.E.-approved continuing education credits by subscribing online.

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Description of Unusual or Atypical Speckled Patterns (continued)

Speckled ANA pattern called Nuclear Matrix

This pattern is characterized by coarse granular speckled staining in the nucleus of the interphase cells. The nucleoli do not stain and the speckles tend to outline the nucleoli. Follow-up testing to rule-out antibodies to the extractable nuclear antigens (ENAs) such as Sm or U1-RNP is recommended. Nuclear matrix antibodies are not specific for a single SARD. In the ICAP recommendations this pattern is grouped with the large coarse speckled pattern AC-5.

This pattern is reported as "ANA positive, Speckled; titering is necessary."

Midbody ANA pattern (AC-27)

In this pattern there is no staining in the early interphase cells; however, by late interphase fine speckling is present. In metaphase the speckling is located in chromosomal area and is very similar to centromere staining. As the cells progress into anaphase and telophase, staining is seen in the intercellular bridge. No follow-up testing is necessary.

This pattern is reported as "ANA positive, Midbody; titering is optional."

Other unusual speckled ANA patterns

Unusual speckled ANAs are not limited to the few mentioned here. Over 150 different autoantigens have been identified in SLE patients alone. When an unusual pattern is encountered, remember to go back to basics, positive or negative and, if positive, what major group best describes it: Homogeneous, Speckled, Nucleolar, et al.

Unusual other speckled ANA patterns are commonly reported as "unusual speckled, include titer with no follow-up recommendation."