OS CONSENSOS PARA PESQUISA DE AUTOANTICORPOS EM CÉLULAS HEp-2 (FAN HEp-2): IMPLANTAÇÃO DAS DIRETRIZES NOS LABORATÓRIOS CLÍNICOS BRASILEIROS

Abstract

The search for autoantibodies in HEp-2 cells represents a relevant tool for diagnostic assistance in the investigation of autoimmune diseases, especially rheumatic diseases. This methodology, over the last years, underwent by intense process of improvement and standardization with the accomplishment of the Brazilian Consensus. The objective of this study was to evaluate the implantation of recommendations in the clinical laboratories that perform the methodology, 16 years after the accomplishment of the I Brazilian Consensus on ANA in HEp-2 cells. A research was conducted for the laboratories between February and October 2016. The laboratories were invited to answer questions that dealt with the guidelines of the Consensus, addressing technical aspects, quality control, reading of the slides, issuance of reports and educational programs. The study counted on the participation of 53 laboratories that jointly realize an estimate of 300,000 ANA by month. It has been identified that several medical specialties request the examination, and different professionals are responsible for the technical procedure and reading of the fluorescence slides. Consensus recommendations are being followed by all laboratories, in absolute by 58.5% of the laboratories. Regarding the technical procedure, 83.1% of the participants are screening at a 1:80 dilution and the title depletion, recommended by consensus, is being adopted by all participants. It was evidenced that 39.6% of the participants use more than one brand of kit and that 22.6% performs titration of the conjugate to each new kit and different lamp powers are used in laboratories with a predominance of 100 Watts. Regarding the reading of the slides, 94.3% stated that they observed the four cell compartments, 92.5% said to classify the chromosome metaphase plate negative or positive and 32.1% of the participants did not affirm to observe the cells in all phases of the cycle. In the issue of reports, 13.2% of the laboratories admitted to reporting only the name of the standard followed by the title, not presenting the descriptive report and 24.5% of the participants do not use education and quality control programs. Most laboratories were able to identify representative images of sets of patterns. The results presented here demonstrate consistent advances from the implementation of the ANA Consensus in Brazil, but also evidence the need for actions to implement continuing education programs.