III. Mechanism

  1. Test for heterophile Antibody (Paul-Bunnell IgM)
    1. Not specific to EBV
    2. Uncommonly occurs in other conditions
  2. Heterophil Antibody agglutinates Red Blood Cells
    1. Horse RBCs (most sensitive) - used for slide test
    2. Bovine RBCs
    3. Sheep RBCs (least sensitive)

IV. Timing: Positive for Mononucleosis

  1. False negative Monospot common early in course
    1. Week 1: 25% False Negative Rate
    2. Week 2: 5-10% False Negative Rate
    3. Week 3: 5% False Negative Rate
  2. Positive Heterophile Antibody Tests
    1. Monospot positive at week 1 in 25% of patients
      1. Heterophile Antibodies are typically formed by 1 week of symptom onset
      2. But typically titers are too low for detection at this time
    2. Monospot positive by week 3 in >90% of patients
    3. Antibodies peak between weeks 2 and 5
  3. Heterophile Antibodies usually persist for 3 months
    1. Rarely antibodies persist up to 1 year
  4. Heterophile Antibody development is age specific
    1. Age under 2 years: <30% develop antibodies
    2. Age 2-4 years: <75% develop antibodies
    3. Age <12 years: <50% develop antibodies
    4. Age >12 years: >70% develop antibodies
    5. Adults >85% develop antibodies

VI. References

  1. Gantz in Noble (2001) Primary Care, Mosby, p. 268
  2. Ravel (1995) Lab Medicine, Mosby-Year, p. 263-4

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Ontology: Heterophile Antibodies (C0003248)

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, ポールバンネルテスト
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, タンカクサイボ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