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Mononucleosis spot test

The mononucleosis spot test looks for two antibodies in the blood that appear during or after an infection with the virus that causes mono or mononucleosis.

Alternative Names

Monospot test; Heterophile antibody test; Heterophile agglutination test; Paul-Bunnell test; Forssman antibody test

How the test is performed

A blood sample is needed. For information on how this is done, see: Venipuncture

How to prepare for the test

No special preparation is necessary.

How the test will feel

When the needle is inserted to draw blood, you may feel moderate pain, or only a prick or stinging sensation. You may feel throbbing at the site of the needle stick for a few minutes after the blood is taken.

Why the test is performed

The mononucleosis spot test is done when symptoms of mononucleosis are present. Common symptoms include:

  • Fatigue
  • Fever
  • Large spleen (possibly)
  • Sore throat
  • Tender lymph nodes along the back of the neck

This test looks for antibodies that form in the body during the infection, called heterophile antibodies.

Normal Values

A negative test means there were no heterophile antibodies detected. Most of the time this means you do not have infectious mononucleosis.

Sometimes, the test may be negative because it was done too soon (within 1 to 2 weeks) after the illness started. Your health care provider may repeat the test to make sure you do not have mono.

A small number of people with mononucleosis may never have a positive test.

What abnormal results mean

A positive test means heterophile antibodies are present. These are most often a sign of mononucleosis. Your health care provider will also consider other blood test results and your symptoms.

Antibodies reach their peak levels in 2 to 5 weeks, and may be present for up to 1 year.

Rarely, the test may be positive even though you do not have mono. This is called a false-positive result and may occur in persons with:

  • Hepatitis
  • Leukemia or lymphoma
  • Rubella
  • Systemic lupus erythematosus (SLE)
  • Toxoplasmosis

What the risks are

Veins and arteries vary in size from one patient to another and from one side of the body to the other. Obtaining a blood sample from some people may be more difficult than from others.

Other risks associated with having blood drawn are slight but may include:

  • Excessive bleeding
  • Fainting or feeling light-headed
  • Hematoma (blood accumulating under the skin)
  • Infection (a slight risk any time the skin is broken)

References

Jenson HB. Epstein-Barr virus. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 246.

Schooley RT. Epstein-Barr virus infection. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 385.

Weber R. Pharyngitis. In: Bope ET, Kellerman RD, eds. Conn's Current Therapy 2012. 1st ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 1.

Updated: 5/15/2012

Linda J. Vorvick, MD, Medical Director and Director of Didactic Curriculum, MEDEX Northwest Division of Physician Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.


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