Should I be concerned if my blood work is normal but my Ana (Anemia) test is high?

From the Guidelines

Having a high ANA test with otherwise normal blood work is not necessarily cause for immediate concern, but it does warrant follow-up with your healthcare provider. ANA tests can be positive in approximately 15-20% of healthy individuals, especially in older adults and women, without indicating disease 1. However, elevated ANA levels can sometimes be an early sign of autoimmune conditions such as lupus, rheumatoid arthritis, or Sjögren's syndrome.

Key Considerations

• The significance of a positive ANA depends on several factors including how high the titer is (the level of antibodies detected), your specific symptoms, family history, and other clinical findings.
• If you're experiencing symptoms like joint pain, unexplained fatigue, skin rashes, or fever, these would be important to discuss with your doctor.
• Your physician may recommend additional, more specific autoantibody tests or monitoring over time to determine if the elevated ANA is clinically significant, as suggested by recent expert panel recommendations 1.

Next Steps

• Without symptoms, many doctors will simply monitor the situation rather than pursuing aggressive treatment based solely on lab values.
• It is essential to consider the pre-test probability and interpret results in the context of clinical circumstances, as emphasized in international recommendations for the assessment of autoantibodies to cellular antigens referred to as anti-nuclear antibodies 1.
• The choice of ANA assay method, such as IIFA on HEp-2 (or HEp-2000), can impact the results, and laboratory professionals should make realistic expectations about the available clinical information and the most appropriate assays and cut-off points pertinent to the level of care requesting the study 1.

From the Research

Understanding ANA Test Results

• A high ANA test result can be found in healthy individuals, and in most cases, it is benign 2.
• However, a subset of individuals with high ANA levels may be at risk for developing autoimmune diseases, such as systemic lupus erythematosus (SLE) 2, 3.
• ANA positivity can also be seen in non-autoimmune inflammatory diseases, including acute and chronic infections 4.

Factors Associated with High ANA Levels

• Female gender is associated with higher ANA levels, and this association holds in patients with autoimmune diseases, such as lupus and rheumatoid arthritis, as well as in healthy controls 2.
• Age is not significantly associated with ANA levels 2.
• High ANA levels have been correlated with metabolic abnormalities, inflammation, and immune dysfunction in healthy individuals 3.

Clinical Significance of ANA Test Results

• ANA titers higher than 1/500 are usually clinically significant, often found in spontaneous or drug-induced SLE and few other connective tissue diseases (CTD) 5.
• The presence of certain ANA specificities, such as anti-nDNA antibodies, can have prognostic significance and correlate with disease severity 5.
• The spectrum of ANA in SLE patients has been expanded, and some antibodies have been found to have organ specificity, such as GS-ANA in Felty's syndrome and RA 5.

Implications for Individuals with High ANA Levels

• Individuals with high ANA levels should be further examined for the subtype of ANA present in the serum to avoid misdiagnosis 3.
• ANA testing should be routine for healthy people, and those who have clinical symptoms should be further evaluated 3.
• The presence of high ANA levels in healthy individuals may indicate an increased risk of developing autoimmune diseases, and further monitoring and evaluation may be necessary 2, 3.