Human T-Lymphotropic Virus Type I and Type II Antibodies

Human T-Lymphotropic Virus Type I and Type II Antibodies

Synonym/acronym: HTLV-I/HTLV-II.

Common use

To test the blood for the presence of antibodies that would indicate past or current human T-lymphocyte virus (HTLV) infection. Helpful in diagnosing certain types of leukemia.

Specimen

Serum (1 mL) collected in a red-top tube. Place separated serum into a standard transport tube within 2 hr of collection.

Normal findings

(Method: Enzyme immunoassay) Negative.

Description

Human T-lymphotropic virus type I (HTLV-I) and type II (HTLV-II) are two closely related retroviruses known to remain latent for extended periods before becoming reactive. The viruses are transmitted by sexual contact, contact with blood, placental transfer from mother to fetus, or ingestion of breast milk. As with HIV-1 and HIV-2, HTLV targets the T4 lymphocytes. HTLV-I has been associated with adult T-cell leukemia/lymphoma (ATL) and myelopathy/tropical spastic paraparesis (HAM/TSP). Although it is believed HTLV-II may affect the immune system, it has been not been associated clearly with any particular disease or condition. Retrospective studies conducted by the American Red Cross demonstrated that a small percentage of transfusion recipients became infected by HTLV-positive blood. The results of this study led to a requirement that all donated blood units be tested for HTLV-I/HTLV-II before release for transfusion.

This procedure is contraindicated for

    N/A

Indications

  • Distinguish HTLV-I/HTLV-II infection from spastic myelopathy
  • Establish HTLV-I as the causative agent in adult lymphoblastic (T-cell) leukemia
  • Evaluate donated blood units before transfusion
  • Evaluate HTLV-II as a contributing cause of chronic neuromuscular disease

Potential diagnosis

Positive findings in:

  • HTLV-I/HTLV-II infection

Critical findings

    N/A

Interfering factors

    N/A

Nursing Implications and Procedure

Pretest

  • Positively identify the patient using at least two unique identifiers before providing care, treatment, or services.
  • Patient Teaching:   Inform the patient this test can assist with indicating a past or present HTLV infection.
  • Obtain a history of the patient’s complaints, including a list of known allergens, especially allergies or sensitivities to latex.
  • Obtain a history of the patient’s immune system, a history of high-risk behaviors, symptoms, and results of previously performed laboratory tests and diagnostic and surgical procedures.
  • Obtain a list of the patient’s current medications, including herbs, nutritional supplements, and nutraceuticals (see Effects of Natural Products on Laboratory Values).
  • Review the procedure with the patient. Inform the patient that specimen collection takes approximately 5 to 10 min. Address concerns about pain and explain that there may be some discomfort during the venipuncture.
  • Sensitivity to social and cultural issues,  as well as concern for modesty, is important in providing psychological support before, during, and after the procedure.
  • Note that there are no food, fluid, or medication restrictions unless by medical direction.

Intratest

  • Potential complications: N/A
  • Avoid the use of equipment containing latex if the patient has a history of allergic reaction to latex.
  • Instruct the patient to cooperate fully and to follow directions. Direct the patient to breathe normally and to avoid unnecessary movement.
  • Observe standard precautions, and follow the general guidelines in Patient Preparation and Specimen Collection. Positively identify the patient, and label the appropriate specimen container with the corresponding patient demographics, initials of the person collecting the specimen, date, and time of collection. Perform a venipuncture.
  • Remove the needle and apply direct pressure with dry gauze to stop bleeding. Observe/assess venipuncture site for bleeding or hematoma formation and secure gauze with adhesive bandage.
  • Promptly transport the specimen to the laboratory for processing and analysis.

Post-Test

  • Inform the patient that a report of the results will be made available to the requesting health-care provider (HCP), who will discuss the results with the patient.
  • Warn the patient that false-positive results occur and that the absence of antibody does not guarantee absence of infection, because the virus may be latent or not have produced detectable antibody at the time of testing.
  • Recognize anxiety related to test results, and be supportive of impaired activity related to weakness, perceived loss of independence, and fear of shortened life expectancy. Discuss the implications of positive test results on the patient’s lifestyle. Provide teaching and information regarding the clinical implications of the test results, as appropriate. Educate the patient regarding access to counseling services.
  • Social and Cultural Considerations: Counsel the patient, as appropriate, regarding risk of transmission and proper prophylaxis, and reinforce the importance of strict adherence to the treatment regimen, including consultation with a pharmacist.
  • Inform the patient that the presence of HTLV-I/HTLV-II antibodies precludes blood donation, but it does not mean that leukemia or a neurological disorder is present or will develop.
  • Inform the patient that subsequent retesting may be necessary.
  • Reinforce information given by the patient’s HCP regarding further testing, treatment, or referral to another HCP. Answer any questions or address any concerns voiced by the patient or family.
  • Depending on the results of this procedure, additional testing may be performed to evaluate or monitor progression of the disease process and determine the need for a change in therapy. Evaluate test results in relation to the patient’s symptoms and other tests performed.

Related Monographs

  • Related tests include CBC; hepatitis B, C, and D antigens and antibodies; and HIV-1/HIV-2.
  • Refer to the Immune System table at the end of the book for related tests by body system.
Full browser ?