Medical term:

BTA

Abbreviation for:
bladder tumour antigen
Blood and Transplant Authority (formally, the NHS Blood and Transplant Authority) (Medspeak-UK)
botulinum toxin A
British Thyroid Association (Medspeak-UK)

antigen

(ant'i-jen) [ anti- + -gen]

Any substance capable of eliciting an immune response or of binding with an antibody. Cellular antigens are proteins or oligosaccharides that mark and identify the cell surface as self or nonself. Cell surface antigens can stimulate the production of antibodies by B lymphocytes and cytotoxic responses by white blood cells, e.g., granulocytes, monocytes, and lymphocytes.

Antigens on the body's own cells are called autoantigens. Antigens on all other cells are called foreign antigens. Matching certain types of tissue antigens is important for the success of an organ transplant. Inflammation occurs when neutrophils, monocytes, and macrophages encounter an antigen from any source during bodily injury. The antigen may be foreign or an autoantigen that has been damaged and therefore appears to be foreign. Reactions to antigens by T and B cells are part of the specific immune response. See: autoantigen; cytokine; histocompatibility locus antigen.

allogeneic antigen

An antigen that occurs in some individuals of the same species. Examples are the human blood group antigens.

alpha-fetoprotein antigen

See: alpha-fetoprotein.

Australia antigen

, Australian antigen

A term formerly used for hepatitis B surface antigen.

bladder tumor antigen

Abbreviation: BTA

A protein released into the urine by malignant cells in the bladder, studied as a possible marker of cancer of the urinary bladder. Because of the low prevalence of bladder cancer in the population at large, and the low positive predictive value of the test, the U.S. Preventive Services Task Force (2006) discouraged health care professionals and patients from using this screening test.

cancer antigen

Abbreviation: CA

A protein or carbohydrate that is either expressed by cancerous cells but not by healthy cells or is expressed by cancerous cells in much greater concentrations than by healthy cells. Cancer antigens are used in clinical medicine to screen body fluids for tumors or to follow the response of tumors to treatment. Since they stimulate the immune response, they are also used in the manufacture of antitumor vaccines. See: table

Note: several antigens on this list also detect benign diseases and conditions.

Antigen name or designation	Abbreviation	The tumor it detects
Alpha-fetoprotein	AFP	Nonseminomatous germ cell tumor
CA 15–3		Breast cancer
CA 19–9		Pancreatic cancer
CA 50		Gastrointestinal tract tumors
CA 125		Ovarian/peritoneal cancer
Carcinoembryonic antigen	CEA	Gastrointestinal tract tumors and tumors of solid internal organs
Human chorionic gonadotropin	HCG	Nonseminomatous germ cell tumors; choriocarcinoma
Microglobulin-beta 2 subunit	b2–M	Multiple myeloma
Neuron-specific enolase	NSE	Broad variety of cancers, including small cell carcinoma of lung
NY-BR-40 and others		Breast cancer
Prostate specific antigen	PSA	Prostate cancer
Urinary tumor associated antigen	UTAA	Melanoma

carcinoembryonic antigen

Abbreviation: CEA

A molecular marker found on normal fetal cells and in the bloodstream of patients with cancers of the colon, breast, lung, and other organs. Assays for CEA are used both to monitor the effectiveness of treatments for cancer and to provide prognostic information to patients.

CD antigen

See: cluster of differentiation

class I antigen

Any of the major histocompatibility molecules present on almost all cells except human red blood cells. These antigens are important in the rejection of grafts and transplanted organs.

class II antigen

Any of the major histocompatibility molecules present on immunocompetent cells.

cross-reacting antigen

An antigen having the ability to react with more than one specific antibody.

D antigen

The protein marker in the Rh group of antigens that stimulates the greatest immune response. See: Rh blood group.

H antigen

A flagellar protein present on the surface of some enteric bacilli such as Escherichia coli. The antigen is important in classifying these bacilli.

hepatitis antigen

The original term for the Australian antigen, now called hepatitis B surface antigen (HBsAg). Its discovery made possible the differentiation of hepatitis B from other forms of viral hepatitis.

hepatitis B core antigen

Abbreviation: HBcAg

A protein marker found on the core of the hepatitis B virus (HBV). HBV antigen does not circulate in the blood but is found only in liver cells infected by HBV. HBcAg stimulates the production of a protective antibody, immunoglobulin M (IgM-anti-HBc), which appears in the blood shortly before the onset of symptoms. Tests for this antibody are used with other blood tests in the diagnosis of acute and chronic hepatitis B infection. During the convalescent stage of hepatitis B infection, IgM anti-HBc is replaced by another antibody, IgG anti-HBc, which remains in the blood for years. See: hepatitis B e antigen; hepatitis B surface antigen.

hepatitis B e antigen

Abbreviation: HBeAg

A polypeptide from the hepatitis B viral core that circulates in the blood of infected people and indicates that the patient is highly infectious. It is released when viral DNA is actively replicating.

hepatitis B surface antigen

Abbreviation: HBsAg

The glycoprotein found on the surface of the hepatitis B viral envelope. It is the first marker of infection with the hepatitis B virus. If HBsAg is still found in blood samples 6 months after infection with the virus, chronic and potentially contagious infection with hepatitis B is present. See: hepatitis B core antigen; hepatitis B e antigen.

hepatitis C core antigen

A protein released by the hepatitis C virus (HCV) into the bloodstream of infected patients. Because hepatitis C core antigen is detectable in the blood before HCV antibodies are produced, it can be used as a marker of early infection, e.g., in donated blood or plasma. It can also measure the response of HCV infection to treatment protocols; antigen levels drop with effective treatment.

histocompatibility locus antigen

Abbreviation: HLA

Any of the multiple antigens present on all nucleated cells in the body that identify the cells as self. Immune cells compare these antigens to foreign antigens, which do not match the self and therefore trigger an immune response. These markers determine the compatibility of tissue for transplantation.

They are derived from genes at seven sites (loci) on chromosome 6, in an area called the major histocompatibility complex (MHC); each histocompatibility antigen is divided into one of two MHC classes.

In humans, the proteins created in the MHC are called human leukocyte antigens (HLA) because these markers were originally found on lymphocytes. Each gene in the MHC has several forms or alleles. Therefore, the number of different histocompatibility antigens is very large, necessitating the identification and matching of HLAs in donors and recipients involved in tissue and organ transplantation. (The identification of HLAs is called tissue typing.)

The identification of HLA sites on chromosome 6 has enabled researchers to correlate the presence of specific histocompatibility and certain autoimmune diseases (e.g., insulin-dependent diabetes mellitus, multiple sclerosis, some forms of myasthenia gravis, rheumatoid arthritis, and ankylosing spondylitis).

Synonym: human leukocyte antigen See: major histocompatibility complex

human leukocyte antigen

Histocompatibility locus antigen.

H-Y antigen

A histocompatibility antigen located on the cell membrane. It has a primary role in determining the sexual differentiation of the male embryo.

K antigen

A capsular antigen present on the surface of some enteric bacilli. The antigen is important in classifying these bacilli.

lymphogranuloma venereum antigen

An antigen used in a skin test for lymphogranuloma venereum.

mumps skin test antigen

A standardized suspension of sterile formaldehyde-inactivated mumps virus. It is used in diagnosing mumps.

nuclear antigen

An antigen present in the cells of patients with certain types of connective tissue disorders. Corticosteroids can be very helpful in treating patients with high concentrations of nuclear antigen.

O antigen

A surface antigen of some enteric bacilli. The antigen is important in classifying these bacilli.

oncofetal antigen

An antigen that is normally expressed in the fetus and may reappear in the adult in association with certain tumors. Examples include alpha-fetoprotein and carcinoembryonic antigens.

Synonym: oncofetal protein

onconeural antigen

An antigen found on the surface of cancer cells that closely resembles antigens found on nerve cells. Antibodies formed by immune cells against onconeural antigens cause paraneoplastic syndromes.

p24 antigen

The core protein of the human immunodeficiency virus (HIV). The presence of p24 antigen in the blood is a marker of uncontrolled HIV replication. p24 antigenemia is encountered in the acute retroviral syndrome before host immune response and in advanced acquired immunodeficiency syndrome when the immune system has been destroyed. When p24 antigen is detected in the blood, the HIV viral load is high and the person is highly infectious.

proliferating cell nuclear antigen

Abbreviation: PCNA

A protein complex released by cells actively synthesizing DNA. In the blood, PCNAs can be used as markers of disease activity in autoimmune and inflammatory illnesses, malignancies, and other conditions marked by rapid cell replication.

prostate-specific antigen

Abbreviation: PSA

A nonspecific marker of abnormalities in the prostate gland, including prostatic infection, inflammation and prostate cancer. PSA circulates in the blood and can be detected by blood tests. PSA levels have been used to screen for prostate cancer, but are neither sensitive nor specific for detecting the disease.

CAUTION!

Elevations in PSA levels may prompt invasive testing (such as with biopsies) that may detect indolent cancers as well as aggressive ones. Side effects of prostate biopsy include urinary incontinence and erectile dysfunction.

See: prostate cancer.

protective antigen

The protein made by Bacillus anthracis, which binds to cell membranes and allows the lethal components of anthrax toxin to enter and kill cells.

soluble antigen

An antigen dissolved in a liquid. A soluble antigen is recognized by B lymphocytes but cannot be detected by T lymphocytes until it has been processed by an antigen-presenting cell. See: T cell.

T-dependent antigen

An antigen that can stimulate an antibody response only in the presence of helper T cells.

thymus dependent antigen

Any of the foreign antigens that require B lymphocyte stimulation by T cells before production of antibodies and memory cells can occur.

thymus independent antigen

Any of the foreign antigens capable of stimulating B cell activation and the production of antibodies without T cell interaction. Most of these antibodies fall into the IgM class. A few memory cells are created.

T independent antigen

Either of two types of antigens that stimulate B cell production of antibodies without the presence of T cells. TI-1 antigens (e.g., lipopolysaccharides from gram-negative organisms) stimulate production of both specific (monoclonal) and nonspecific (polyclonal) antibodies and promote the release of cytokines from macrophages that enhance the immune response. TI-2 antigens, which result in monoclonal antibody production, may require the presence of cytokines. See: B cell; T cell

transplantation antigen

The commonly used term for any of the histocompatibility antigens that cause the immune system of one individual to reject transplanted tissue.

tumor-specific antigen

An antigen produced by certain tumors. It appears on the tumor cells but not on normal cells derived from the same tissue.

antigenic (-jen'ik) antigenically (-i-k(a-)le) antigenicity (-je-nis'i-te)

bladder tumor antigen

Abbreviation: BTA

Bladder Cancer Markers, Urine

Synonym/acronym: Nuclear matrix protein (NMP) 22, BTA, cytogenic marker for bladder cancer.

Common use

To assist in diagnosing bladder cancer.

Specimen

Urine (5 mL), unpreserved random specimen collected in a clean plastic collection container for NMP22 and Bard BTA; urine (30 mL), first void specimen collected in fixative specific for FISH testing.

Normal findings

(Method: Enzyme immunoassay for NMP22 and bladder tumor antigen [BTA], fluorescence in situ hybridization [FISH] for cytogenic marker)

NMP22: Negative: Less than 6 units/mL, borderline: 6 to 10 units/mL, positive: Greater than 10 units/mL

BTA: Negative

Cytogenic Marker: Negative

Description

Cystoscopy is still considered the gold standard for detection of bladder cancer, but other noninvasive tests have been developed, including several urine assays approved by the U.S. Food and Drug Administration. Compared to cytological studies, these assays are believed to be more sensitive but less specific for detecting transitional cell carcinoma. FISH is a cytogenic technique that uses fluorescent-labeled DNA probes to detect specific chromosome abnormalities. The FISH bladder cancer assay specifically detects the presence of aneuploidy for chromosomes 3, 7, and 17 and absence of the 9p21 loci, findings associated with transitional cell cancer of the bladder.

NMP22: Nuclear matrix proteins (NMPs) are involved in the regulation and expression of various genes. The NMP identified as NuMA is abundant in bladder tumor cells. The dying tumor cells release the soluble NMP into the urine. This assay is quantitative.

Bladder tumor antigen\ (BTA): A human complement factor H-related protein (hCFHrp) is thought to be produced by bladder tumor cells as protection from the body’s natural immune response. BTA is released from tumor cells into the urine. This assay is qualitative.

This procedure is contraindicated for

N/A

Indications

Detection of bladder carcinoma
Management of recurrent bladder cancer

Potential diagnosis

Increased in bladder carcinoma.

Critical findings

Bladder carcinoma
It is essential that critical findings be communicated immediately to the requesting health-care provider (HCP). A listing of these findings varies among facilities.
Timely notification of a critical finding for lab or diagnostic studies is a role expectation of the professional nurse. The notification processes will vary among facilities. Upon receipt of the critical finding the information should be read back to the caller to verify accuracy. Most policies require immediate notification of the primary HCP, hospitalist, or on-call HCP. Reported information includes the patient’s name, unique identifiers, critical finding, name of the person giving the report, and name of the person receiving the report. Documentation of notification should be made in the medical record with the name of the HCP notified, time and date of notification, and any orders received. Any delay in a timely report of a critical finding may require completion of a notification form with review by Risk Management.

Interfering factors

NMP22: Any condition that results in inflammation of the bladder or urinary tract may cause falsely elevated values.
BTA: Recent surgery, biopsy, or other trauma to the bladder or urinary tract may cause falsely elevated values. Bacterial overgrowth from active urinary tract infection, renal or bladder calculi, gross contamination from blood, and positive leukocyte dipstick may also cause false-positive results.
Cytogenic marker: Incorrect fixative, gross contamination from blood, bacterial overgrowth from active urinary tract infection, inadequate number of bladder cells in specimen.

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 procedure can assist in establishing a diagnosis of bladder disease.
Obtain a history of the patient’s complaints, including a list of known allergens.
Obtain a history of the patient’s genitourinary system, symptoms, and results of previously performed laboratory tests and diagnostic and surgical procedures.
Note any recent procedures that can interfere with test results.
Obtain a list of the patient’s current medications including herbs, nutritional supplements, and nutraceuticals (see Effects of Natural Products on Laboratory Values online at DavisPlus).
Review the procedure with the patient. Address concerns about pain and explain that there should be no discomfort during the procedure. Inform the patient that specimen collection takes approximately 5 min, depending on the cooperation and ability of the patient.
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
Instruct the patient to cooperate fully and to follow directions.
Observe standard precautions, and follow the general guidelines in Patient Preparation and Specimen Collection. Positively identify the patient, and label the appropriate specimen containers with the corresponding patient demographics, initials of the person collecting the specimen, date and time of collection.
Obtain urine specimen in a clean plastic collection container. 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 HCP, who will discuss the results with the patient.
Recognize anxiety related to test results, and be supportive of fear of shortened life expectancy. Discuss the implications of abnormal 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. Provide contact information, if desired, for the American Cancer Society (www.cancer.org) or the National Cancer Institute (www.cancer.gov).
Reinforce information given by the patient’s HCP regarding further testing, treatment, or referral to another HCP. The greatest risk factor for bladder cancer is smoking. Inform the patient of smoking cessation programs as appropriate. 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 biopsy bladder, cytology urine, cystoscopy, IVP, and US bladder.
Refer to the Genitourinary System table at the end of the book for related tests by body system.

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