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18 INNOSC Theranostics and Pharmacological Sciences, 2022, Vol. 5, No. 2 Govender and Hodkinson

Table 2. ANCA testing according to indication guidelines per department
Department Total 1999 Guideline indication Common non-guideline indications
requests No Yes
n=790 n=598 n (%) n=192 n (%)
Cardiology 4 4 (100) 0 (0) Valvular heart disease
Critical care 22 15 (68.2) 7 (31.8) AKI, seizures, encephalopathy
Dermatology 10 6 (60.0) 4 (40.0) Non-specific rash
Otolaryngology 31 27 (87.1) 4 (12.9) Sensory-neural hearing loss, vocal cord paralysis
Gastroenterology 3 3 (100) 0 (0) IBD
General Medicine 272 173 (63.6) 99 (36.4) AKI, stroke
Nephrology 30 15 (50.0) 15 (50.0) AKI
Neurology 100 70 (70.0) 30 (30.0) Stroke, encephalopathy
Obgyn 25 20 (80.0) 5 (20.0) Recurrent pregnancy losses, POF
Ophthalmology 105 83 (79.1) 22 (20.9) Uveitis, optic neuritis
Orthopedics 28 28 (100) 0 (0) Trigger finger, CTS, arthritis
Psychiatry 2 2 (100) 0 (0) Encephalopathy, psychosis
Pulmonology 35 32 (91.4) 3 (8.6) ILD, poorly controlled asthma, PHT
Rheumatology 25 23 (92.0) 2 (8.0) Raynaud’s phenomenon, arthritis
Surgery 95 94 (98.9) 1 (1.1) CLI, vascular aneurysms
Trauma 3 3 (100) 0 (0) ICA dissection, TBI
Abbreviations: AKI: Acute kidney injury, CLI: Critical limb ischemia, CTS: Carpal tunnel syndrome, IBD: Inflammatory bowel disease,
ICA: Internal carotid artery, ILD: Interstitial lung disease, Obgyn: Obstetrics and gynecology, PHT: Pulmonary hypertension, POF:
Premature ovarian failure, TBI: Traumatic brain injury.

Table 3. Details of ten patients with anti-neutrophil cytoplasmic antibody-associated vasculitis

Gender Age Ethnicity Department AAV type MPO PR3 Guideline indication
M 55 Mixed Medicine GPA Neg Neg Yes
F 49 Mixed Medicine RLV Pos Neg Yes
F 37 Mixed Medicine RLV Pos Neg Yes
M 81 Caucasian Medicine RLV Pos Neg Yes
F 71 Mixed Medicine RLV Pos Neg Yes
M 39 Mixed Medicine, Nephrology RLV Neg Pos Yes
F 58 African Medicine, Nephrology RLV Neg Neg Yes
F 58 Mixed Nephrology RLV Neg Neg Yes
F 29 Mixed Nephrology RLV Neg Neg Yes
F 68 Mixed Medicine RLV Neg Neg Yes
Abbreviations: AAV: Anti-neutrophil cytoplasmic antibody-associated vasculitis, F: Female, GPA: Polyangiitis, M: Male,
MPO: Anti-myeloperoxidase antibody, Neg: Negative, Pos: Positive, PR3: Anti-proteinase 3 antibody, RLV: Renal limited vasculitis.

lower than what has been described elsewhere due ZAR208,275 on tests for non-indicated clinical
to the high number of false positive tests observed conditions.
in our setting. The sensitivity, specificity, PPV,
and NPV were 50.0%, 95.1%, 35.7%, and 97.2%, 4. Discussion
respectively. The total estimated cost of ANCA tests Due to its multi-system heterogeneous presentation,
throughout the year amounted to ZAR274,046, insidious onset, and rarity, small vessel vasculitis
with ZAR17,490 spent on duplicate testing and poses a diagnostic challenge. As a result, the ANCA

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