RDS-A

2021

(CCP) KIT 34836160 4 01 20

Page 1 CAP # 8773259 - 02 SEQ # 01

Products:CCP
Results are due no later than midnight, Central Time:
Hospital Nacional Hipolito Unanue
Elizett Sierra Chavez
TEL# 51-989469955 FAX#
April 28, 2021
The due date that displays online is the most current due date.

Cyclic Citrullinated Peptide Antibody (Anti-CCP)

Survey Result Form
Important
Changes for this mailing are noted in the Important: Before You Begin section of the kit instructions.
Verify the accuracy of all reporting codes by reviewing the online result form or the Method Summary Page. For detailed exception code
information, see the Reporting Your Results section of the kit instructions.
Corrections can be made to this result form at any time prior to the due date. For results that are approved online, corrections must
also be done online. Faxed or mailed corrections will not be accepted.
© CAP 2021

Results - Cyclic Citrullinated Peptide Antibody (Anti-CCP)

Manufacturer Code Exception Code CCP-01 CCP-02

Qualitative
030 040
112 Absent 112 Absent
010 020 11
3102 219 Borderline 219 Borderline
33
113 Present 113 Present

Quantitative
Result Result
050
3102 080 100
070
11
14.4 11.9
Unit of 33
090 110
Measure Code (4) Fill if less than (4) Fill if less than
060 (5) Fill if greater than (5) Fill if greater than
117

Customer Contact Center 800-323-4040 option 1 (domestic)

or 001-847-832-7000 option 1 (international) APN2 7602

Generated on 04/03/2024 at 12:20 PM with Page Status Received

 RDS-A
2021

(CCP) KIT 34836160 4 02 63

Page 2 CAP # 8773259 - 02 SEQ # 01

Products:CCP
Results are due no later than midnight, Central Time:
Hospital Nacional Hipolito Unanue
Elizett Sierra Chavez
TEL# 51-989469955 FAX#
April 28, 2021

CCP-99 Paper Challenge (Ungraded)

A 64-year-old woman presents with pain in multiple finger joints, which has been slowly progressing for about 5 years. Her provider orders tests
in consideration of rheumatoid arthritis. The ESR is 10 mm/hr (normal), C-reactive protein is 3 mg/L (normal), rheumatoid factor is negative, and
the test for antibodies to cyclic citrullinated antibodies (anti-CCP) is positive at a moderately high level. The provider and patient are uncertain about
how to interpret the results, and the provider orders a repeat anti-CCP by sending another specimen to the original laboratory. At the same time, the
provider also sends another aliquot to another laboratory. The original laboratory again reports a moderately high positive result, but the second
laboratory reports a negative/normal anti-CCP result. Meanwhile, the patient has improved after treatment with ibuprofen, and the clinician feels
that the patient has osteoarthritis involving the fingers.

What is the most likely explanation of the discrepant laboratory results observed?
010
3529 Diagnosis of mild rheumatoid arthritis based on laboratory tests
3530 False-negative rheumatoid factor test
3531 Random variation between different laboratory test methods
3532 Presence of IgA, but not IgG, anti-CCP

Customer Contact Center 800-323-4040 option 1 (domestic)

or 001-847-832-7000 option 1 (international) APN3 18558

Generated on 04/03/2024 at 12:20 PM with Page Status Received

 RDS-A
2021

(CCP) KIT 34836160 4 03 06

Page 3 CAP # 8773259 - 02 SEQ # 01

Products:CCP
Results are due no later than midnight, Central Time:
Hospital Nacional Hipolito Unanue
Elizett Sierra Chavez
TEL# 51-989469955 FAX#
April 28, 2021

Alert! Refer to the master list in the kit instructions to report your unit of measure.

Results - RF, Isotype-Specific

Method Code Manufacturer Code Exception CCP-01 CCP-02
Code

IgM 010 020 030 11 040 110 Negative 050 110 Negative
Qualitative 33 111 Positive 111 Positive

IgM 060 080 090

11 100 120

Quantitative __ __ __ __ . __ __ __ __ __ . __
33
Unit of Measure Code 110
(4) Fill if less than 130
(4) Fill if less than
070 (5) Fill if greater than (5) Fill if greater than

IgA 140 150 160

11 170
110 Negative 180
110 Negative
Qualitative 111 Positive 111 Positive
33

IgA 190 210 220

11 230 250

Quantitative __ __ __ __ . __ __ __ __ __ . __
33

Unit of Measure Code 240 (4) Fill if less than 260 (4) Fill if less than
200 (5) Fill if greater than (5) Fill if greater than

IgG 270 280 290

11 300
110 Negative 310
110 Negative
Qualitative 111 Positive 111 Positive
33

IgG 320 340 350

11 360 380

Quantitative __ __ __ __ . __ __ __ __ __ . __
33
Unit of Measure Code 370
(4) Fill if less than 390
(4) Fill if less than
330 (5) Fill if greater than (5) Fill if greater than

Customer Contact Center 800-323-4040 option 1 (domestic)

or 001-847-832-7000 option 1 (international) APN4 59430

Generated on 04/03/2024 at 12:20 PM with Page Status Received

 KIT 34836160 4 04 49

Page 4 CAP # 8773259 - 02 SEQ # 01

Products:CCP
Hospital Nacional Hipolito Unanue
Elizett Sierra Chavez
TEL# 51-989469955 FAX#
April 28, 2021

Attestation/Use of Other Form

Attestation Statement
• As stated in the February 28, 1992 United States Federal Register under Subpart H 493-801 (b) (1), "the individual testing or examining
• the samples and the laboratory director must attest to the routine integration of the samples into the patient work load using the
• laboratory's routine methods." The laboratory director or designee and the testing personnel must sign on the result form.
• Retain a signed copy of this page in your laboratory for your records and inspection purposes.
• If your laboratory requires additional space for signatures, copy this form as needed.

We, the undersigned, recognizing that some special handling may be required due to the nature of proficiency testing (PT) materials, have as
closely as is practical, performed the analyses on these specimens in the same manner as regular patient specimens. We confirm that results were
not shared or PT specimens referred or tested outside our CLIA identification number.
Director (or Designee) (signature required) Survey Mailing Information (eg, CA2021)

010 030

Testing Personnel (signature required) Testing Personnel (signature required) Testing Personnel (signature required)

040 070 100

LIC- TM ANTONY DÁVILA

Use of Other
If applicable, use this section to list methodology information not found on the master lists or result form. For online entry, you can
enter only 255 characters. CAP Accreditation Program Participants: Do not use this section to make changes to your test/activity menu.
Update your test/activity menu using Organization Profile on cap.org via e-LAB Solutions Suite.
130

Signatures will not display when viewed online.

Customer Contact Center 800-323-4040 option 1 (domestic)

or 001-847-832-7000 option 1 (international) AO 50781

Generated on 04/03/2024 at 12:20 PM with Page Status Received