II. Indications
III. Mechanism
- Test for heterophile Antibody (Paul-Bunnell IgM)
- Not specific to EBV
- Uncommonly occurs in other conditions
- Heterophil Antibody agglutinates Red Blood Cells
- Horse RBCs (most sensitive) - used for slide test
- Bovine RBCs
- Sheep RBCs (least sensitive)
IV. Timing: Positive for Mononucleosis
-
False Negative Monospot common early in course
- Week 1: 25% False Negative Rate
- Week 2: 5-10% False Negative Rate
- Week 3: 5% False Negative Rate
- Positive Heterophile Antibody Tests
- Monospot positive at week 1 in 25% of patients
- Heterophile Antibodies are typically formed by 1 week of symptom onset
- But typically titers are too low for detection at this time
- Monospot positive by week 3 in >90% of patients
- Antibodies peak between weeks 2 and 5
- Monospot positive at week 1 in 25% of patients
- Heterophile Antibodies usually persist for 3 months
- Rarely antibodies persist up to 1 year
- Heterophile Antibody development is age specific
- Age under 2 years: <30% develop antibodies
- Age 2-4 years: <75% develop antibodies
- Age <12 years: <50% develop antibodies
- Age >12 years: >70% develop antibodies
- Adults >85% develop antibodies
V. Interpretation: Positive Test (>1:40 titer)
-
Infectious Mononucleosis (Epstein-Barr Virus)
- See Mononucleosis for approach to testing
- False Positive causes (uncommon)
VI. References
- Gantz in Noble (2001) Primary Care, Mosby, p. 268
- Ravel (1995) Lab Medicine, Mosby-Year, p. 263-4
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Related Studies
| Definition (CSP) | antibody produced by the introduction of heterophile antigen into a species which does not carry it. |
| Definition (MSH) | Antibodies elicited in a different species from which the antigen originated. These antibodies are directed against a wide variety of interspecies-specific antigens, the best known of which are Forssman, Hanganutziu-Deicher (H-D), and Paul-Bunnell (P-B). Incidence of antibodies to these antigens--i.e., the phenomenon of heterophile antibody response--is useful in the serodiagnosis, pathogenesis, and prognosis of infection and latent infectious states as well as in cancer classification. |
| Concepts | Immunologic Factor (T129) , Amino Acid, Peptide, or Protein (T116) |
| MSH | D000910 |
| SnomedCT | 56410003 |
| LNC | LP38397-3, MTHU002830 |
| English | Antibodies, Heterogenetic, Antibodies, Heterologous, Antibodies, Heterophil, Antibodies, Heterophile, Antibodies, Heterotypic, Antibodies, Xenogeneic, Antibodies, Xenogenic, Heteroantibodies, Heterogenetic Antibodies, Heterologous Antibodies, Heterophil Antibodies, Heterophile Antibodies, Heterotypic Antibodies, Xenoantibodies, Xenogeneic Antibodies, Xenogenic Antibodies, HETEROGENET ANTIBODIES, HETEROL ANTIBODIES, ANTIBODIES HETEROGENET, ANTIBODIES HETEROL, Antibodies, Heterophile [Chemical/Ingredient], heterophile antibody, heterophile ab, heterophil antibody, heterophile antibodies, Heterophile Ab, Heterophile Antibody, Heterophile antibody, Heterophil antibody, Heterophil antibody (substance) |
| Swedish | Heterofila antikroppar |
| Czech | protilátky heterofilní |
| Finnish | Heterofiiliset vasta-aineet |
| Italian | Anticorpi eterotipici, Anticorpi xenogenici, Xenoanticorpi, Anticorpi eterologhi, Eteroanticorpi, Anticorpi eterofili |
| Russian | ANTITELA GETEROGENNYE, ANTITELA GETEROTIPNYE, GETEROANTITELA, GETEROFIL'NYE ANTITELA, ANTITELA GETEROFIL'NYE, ANTITELA KSENOGENNYE, GETEROLOGICHNYE ANTITELA, KSENOANTITELA, АНТИТЕЛА ГЕТЕРОГЕННЫЕ, АНТИТЕЛА ГЕТЕРОТИПНЫЕ, АНТИТЕЛА ГЕТЕРОФИЛЬНЫЕ, АНТИТЕЛА КСЕНОГЕННЫЕ, ГЕТЕРОАНТИТЕЛА, ГЕТЕРОЛОГИЧНЫЕ АНТИТЕЛА, ГЕТЕРОФИЛЬНЫЕ АНТИТЕЛА, КСЕНОАНТИТЕЛА |
| French | Anticorps hétérologues, Xéno-anticorps, Anticorps hétérophiles, Anticorps hétérologue, Anticorps hétérotypiques, Hétéro-anticorps, Hétéroanticorps, Anticorps hétérophile, Xénoanticorps, Anticorps hétérogéniques, Anticorps xénogéniques, Anticorps hétérotypique, Anticorps xénogénique, Anticorps hétérogénique |
| Polish | Przeciwciała heterofilne |
| Japanese | 異種抗体, H-D抗体, Hanganutziu-Deicher抗体, P-B抗体, Paul-Bunnell抗体, 好異種抗体, 抗体-異種, 異原抗体, 異好性抗体, 異好抗体, 異種親和抗体 |
| Portuguese | Anticorpos Xenogeneicos, Reação de Paul-Bunnell, Anticorpos Heterófilos, Anticorpos Heterogenéticos, Anticorpos Heterólogos, Anticorpos Heterotípicos, Heteroanticorpos, Xenoanticorpos |
| Spanish | anticuerpo heterófilo (sustancia), anticuerpo heterófilo, Anticuerpos Heterologos, Anticuerpos Heterotipicos, Anticuerpos Xenogeneicos, Heteroanticuerpos, Xenoanticuerpos, Anticuerpos Heterogénicos, Anticuerpos Heterófilos |
| German | Antikörper, heterologe, Antikörper, heterophile, Antikörper, heterotypische, Antikörper, xenogene, Heteroantikörper, Heterologe Antikörper, Heterophile Antikörper, Xenoantikörper |
Ontology: Heterophile antibody screen (procedure) (C0201380)
| Concepts | Laboratory Procedure (T059) |
| SnomedCT | 24053005 |
| CPT | 86308 |
| English | Heterophile antibodies; screening, Heterophile antibody screen (procedure), HETEROPHILE ANTIBODIES SCREEN, Screening for heterophile antibodies, HETEROPHILE ANTIBODY SCREEN, Heterophile antibody screen |
| Spanish | detección selectiva de anticuerpos heterófilos (procedimiento), detección selectiva de anticuerpos heterófilos |
Ontology: Paul-Bunnell test (C0430272)
| Concepts | Laboratory Procedure (T059) |
| SnomedCT | 143203007, 165800008, 165796002, 143207008, 275709002, 302784008 |
| Dutch | Paul Bunnell test, Paul-Bunnell test |
| French | Réaction de Paul et Bunnell, Test de Paul-Bunnell |
| German | Paul Bunnell-Test |
| Italian | Test di Paul-Bunnell, Test di Paul Bunnell |
| Portuguese | Prova de Paul e Bunnell |
| Spanish | Prueba de Paul Bunnell, Prueba de Paul-Bunnell, prueba de Paul - Bunnell, SAI (procedimiento), prueba de Paul - Bunnell, SAI, prueba de Paul - Bunnell (procedimiento), prueba de Paul - Bunnell |
| Japanese | ポールバンネルテスト, ﾎﾟｰﾙﾊﾞﾝﾈﾙﾃｽﾄ |
| English | Paul Bunnell test, Paul-Bunnell test NOS, Test;Paul Bunnell, Paul-Bunnell test NOS (procedure), Paul-Bunnell test, PB - Paul-Bunnell test, Paul-Bunnell test (procedure) |
| Czech | Paul-Bunnellova reakce, Reakce dle Paula a Bunnella |
| Hungarian | Paul-Bunnell vizsgálat, Paul Bunnell vizsgálat |
Ontology: Monospot test (C0430435)
| Concepts | Laboratory Procedure (T059) |
| SnomedCT | 143203007, 165796002, 252408001 |
| English | Test;monospot, Monospot test, Monospot test (procedure), monospot test |
| Spanish | prueba de lugar único (para mononucleosis infecciosa), prueba de monospot (procedimiento), prueba de monospot |
Ontology: Mononucleosis heterophile test (C0853935)
| Concepts | Laboratory Procedure (T059) |
| Italian | Test della mononucleosi con anticorpo eterofilo |
| Japanese | 単核細胞症異染性試験, ﾀﾝｶｸｻｲﾎﾞｳｼｮｳｲｾﾝｾｲｼｹﾝ |
| Czech | Vyšetření na heterofilní protilátky u mononukleózy |
| English | Mononucleosis heterophile test |
| Hungarian | Heterofil mononucleosis vizsgálat |
| Dutch | mononucleose heterofieltest |
| Portuguese | Teste heterófilo de mononucleose |
| Spanish | Prueba heterófila de la mononucleosis |
| French | Réaction de Paul Bunnell Davidsohn |
| German | Mononucleosis heterophilus Test |
