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What is an Adenosine Deaminase Test?

Adenosine deaminase test is a common biochemical test to determine Adenosine Deaminase (ADA) enzyme levels present in body fluids, including sputum, cerebrospinal fluids, pleural fluids, synovial fluids, ascites, and blood serum.

ADA is a crucial enzyme present in the body that performs the following functions:

  • Irreversible breakdown of purine (adenosine) helping with nucleic acid base turnover
  • Activating lymphocytes and other WBCs essential for the body’s immune response to infections attacking it
  • Differentiation of epithelial cells
  • Supporting the gestation process

ADA test analyses the levels of ADA enzymes within the pleural fluids or serum, which are synthesised at higher levels as an immune response during tuberculosis, and help in the early diagnosis of the disease.

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Frequently Asked Questions:

Uses of Adenosine Deaminase Test

The ADA test is primarily used to diagnose tuberculosis. The disease is caused by the Mycobacterium Tuberculosis bacterium that infects the lungs, resulting in the accumulation of excess pleural fluids or inflammation of the pleura. ADA enzyme is responsible for triggering T-lymphocytic response to the pathogenic invasion, causing an increase in the synthesis of this enzyme within the pleural cavity.

Understanding the Test Results of the Adenosine Deaminase Test

ADA activity higher than 43U/ml in the pleural fluids generally indicates pleural tuberculosis with 81- 100% sensitivity and above 83% specificity.

Higher ADA values also may be caused by health conditions, such as pulmonary embolism, lupus, lymphomas, sarcoidosis, and other parapneumonic and vascular diseases. However, in these cases, the ADA values are slightly higher.

Why Do You Need an Adenosine Deaminase Test?

Adenosine Deaminase testing is typically conducted to identify tuberculosis (TB) patients, but it can also be used to detect infections in the cerebrospinal and peritoneal fluids.

The test is also conducted to screen certain groups of people, such as: 

  • Health workers working with tuberculosis patients
  • People moving from tuberculosis-prone areas
  • Pregnant women
  • Children with a positive TB screening test result
  • Immuno-deficient patients

What Happens During an Adenosine Deaminase Test?

The ADA test involves collecting pleural fluid from the pleural cavity of the chest. This procedure involves inserting a needle between the pleural membranes surrounding the chest and lungs and draining the aspirate through the tube. This fluid is then sent to the lab for immunoassay.

Side effects may include pain at the injection site, fever, breathing difficulties, and chest pain.

Is ADA specific for tuberculosis?

Multiple studies have suggested the ADA test for early diagnosis of tuberculosis in conjunction with the AFB smear test to detect the presence of acid-fast bacteria in a patient’s bodily samples.

Generally, serum ADA levels are considered 92.7% sensitive and 88.1% specific in pulmonary TB patients. However, you must compare the levels with other tests to distinguish between TB and other pulmonary infections.

What is the ADA Normal Range?

The normal range of the Adenosine Deaminase test in males and females regardless of age is 40 units/L. Test results showing higher values are considered abnormal and indicates:

  • Pleural tuberculosis
  • Synovitis caused by rheumatoid arthritis
  • Pneumonia associated with tuberculosis
  • Tubercular ascites
  • Meningitis of tuberculosis
  • Lymphadenitis of tuberculosis

How Should You Prepare for the ADA Test?

There are no set rules for preparing for an ADA test. Fasting is not required before the test. However, if you are on any medication, you must inform your physician since certain chemicals, such as blood thinners, may interfere with the test. 

If you are undergoing the test, it is advisable to bring someone to accompany you home, as you might feel dizzy due to the anaesthetic used during the test.

How is the Sample Collected?

The sample for the ADA test is the pleural fluid collected by a registered medical professional by a procedure called thoracentesis. While the patient is seated with their ribs fully spread, the physician inserts a sterile needle to apply local anaesthesia. The aspirate is then drained into a tube aseptically, guided by an X-ray machine inside the pleural cavity. The procedure takes a minimum of 15 minutes.

What are the ADA Symptoms?

ADA deficiency symptoms are as follows:

  • Frequent diarrhoea
  • Sweating at night
  • Pneumonia
  • Frequent fevers
  • Chills
  • Unprecedented weight loss
  • Constant chest pain
  • Excessive skin allergies and rashes
  • Chronic cough

ADA-deficient children generally lag in their motor development compared to normal children.

How is ADA Deficiency Diagnosed?

ADA deficiency is generally detected through WBC counts and the analysis of vious immunoglobulin levels in T-cells, B-cells, and other natural killer cells of the immune system.

Biochemical genetic tests can establish a diagnosis of ADA deficiency. Biochemical analysis shows decreased ADA activity of less than 1% and increased levels of other dATP metabolites such as dAMP, dADP, and dATP in the erythrocytes.

Genetic analysis of probable mutations in the ADA genes confirms the disease.

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