1050 Unit 4 Flashcards
1
Q
what is flow cytometry?
A
a powerful tool to identify and enumerate various cell populations
2
Q
what was flow cytometry first used for?
A
to perform CD4+ T-cell counts in HIV-infected individuals
3
Q
what does flow cytometry measures?
A
multiple properties of cells suspended in a moving fluid medium
4
Q
what happens as each cell or particle passes single file through a laser light source?
A
produces characteristic light pattern that is measured by multiple detectors for scattered light (forward and 90 degrees) and fluorescent emissions if the cell is stained with fluorochrome
5
Q
what is scattered light in a forward direction measure?
A
measure of cell size
6
Q
what does a side scatter determine?
A
a cells internal complexity or granularity
7
Q
what does a single parameter histogram show?
A
chosen parameter (x-axis) vs. number of events (y-axis)
8
Q
what does a dual-parameter dot plot show?
A
two parameters against each other
9
Q
what does a gate do?
A
isolates a particular region of cells for further analysis
10
Q
what is immunophenotyping?
A
laboratory technique that uses antibodies to identify cells by their characteristic antigen expression
11
Q
why is Quantification of an individuals lymphocyte populations essential?
A
in diagnosing such conditions in lymphomas, immunodeficiency diseases, unexplained infection, or acquired immune disease such as AIDs
12
Q
How are lymphoid and myeloid cells identified?
A
using monoclonal antibodies directed against specific surface antigens
13
Q
what method is used for immunophenotyping of lymphoid and myeloid populations?
A
flow cytometry
14
Q
why have clinical laboratories replaced manual immunoassay procedures with automated immunoassay procedures analyzers?
A
to allow more accurate, precise and sensitive testing of many analytes
15
Q
what are some factors to consider in determining which analyzer to use?
A
deciding whether a batch analyzer or a random-access analyzer can best serve testing needs.
16
Q
what is incorporated in all stages of the laboratory testing, Pre-analytical, analytical, and post-analytical?
A
automation
17
Q
what should be done once a new analyzer is purchased?
A
a thorough validation of all assays to be performed that must be done to ensure quality
18
Q
what should occur during a proper validation?
A
determination of accuracy, precision, reportable range, reference range, analytic sensitivity and analytical specificity
19
Q
what is accuracy?
A
refers to tests ability to measure what it actually claims to measure
20
Q
what is precision?
A
the ability to consistently reproduce the same result on a particular sample
21
Q
What are pros and cons of a automated analyzer?
A
CON–> costly
PRO–> reduce turnaround time and reduce error in testing process
22
Q
what are characteristics of flow cytometry?
A
– forward scatter of an interrupted beam of light
–side scatter of the interrupted beam of light
–fluorescence emitted from the cells
23
Q
Forward light scatter is an indicator of a cell’s what ?
A
size
24
Q
what is the single most important requirement for samples to be analyzed on a flow cytometer?
A
cells must be a single-cell suspension
25
what is the best explanation for a flow cytometers ability to detect several cells surface markers at the same time?
for each marker, a specific fluorochrome-antibody combination is used
26
what cell surface markers would be present on a population of T helper (Th) cells?
CD3 and CD4
27
If an analyzer consistently induces a positive test when the analyte in question is not present, this represents a problem with what?
specificity
28
what are some clinical applications for flow cytometry?
--fetal hemoglobin
--immunophenotyping of lymphocyte subpopulations
--enumeration of stem cells in a peripheral blood mononuclear cell product
29
the various signals generated by cells intersecting with a flow cytometry laser are captured by what?
photomultiplier tubes
30
analysis of flow cytometer data of cells can be filtered in many ways by using what method?
"gating" in a dot plot
31
A newer flow cytometry technology that has the potential to detect 100 analytes from on sample of blood is called what?
cytometric bead array
32
many flow cytometry laboratories now use the CD45 marker in combination with SSC in differentiating various populations of WBCs to replace what?
FSC + SSC
33
which cell surface marker is present on cells seen in hairy cell leukemia?
CD103
34
CD45 is a pan-leukocyte marker expressed on WBCs in varying levels or amounts of expression, based on what?
maturity and lineage of a cell
35
what best describes single-parameter histogram?
--a chosen parameter is plotted versus the number of events
--chosen by operator
--y-axis = # of events
--x-axis = parameter to be analyzed
--usually extrinsic paraments
--operator can set a marker to isolate the positive event
--computer then calculates % of positive events within designated markers
36
what are characteristic of PNH?
--PNH could affect RBC and WBC counts
--patients with PNH usually present with symptoms such as hemolytic anemia
--flow cytometry can diagnose PNH by detecting missing anchor proteins
37
which type of analyzer allows one to measure multiple analytes from numerous samples, loaded at any time?
random access analyzer
38
operational considerations when selecting automated analyzers for a laboratory include what?
--reagent stability
--test menu
--stat capability
39
Analyzers use different methods for mixing, including magnetic stirring, rotation paddles, and forceful dispensing. whichever method is used, it is imperative that...
there is no splashing or carryover between samples
40
what are some benefits of automation?
--greater accuracy
--reduced turnaround time
--savings on reagents
41
if an analyzer gets different results each time the same sample is tested, what type of problem does this represent?
precision
42
what is hypersensitivity?
an exaggerated immune response to antigens that are usually not harmful
--results in cell destruction and tissue injury
43
Gel and Coombs devised a system that does what?
for classifying hypersensitivity reactions into four types based on the immunologic mechanism involved and the nature of the triggering antigen
44
why are hypersensitvity type I, II, and III considered antibody-mediated?
because they occur within minutes to hours after exposure to antigen, they are referred to as immediate reaction.
45
what is hypersensitivity type IV?
cell-mediated response involving T lymphocytes. Because the clinical manifestations do not appear until 24 to 72 hours after contact with antigen, type IV response is also referred to as delayed hypersensitivity
46
describe hypersensitivity type I
--involves production of IgE antibody to an allergen
--sensitization phase
--activation phase
--Degranulation of mast cells and basophils occurs,. with release of performed and newly synthesized chemical mediators that cause an inflammatory response
--Cytokines produced during the response can cause a late-phase response of prolonged inflammation
47
preformed mediators that are released from mast cells and basophils include what? what is their function?
--histamine
--eosinophil chemotactic factor of anaphylaxis
--neutrophil chemotactic factor
-- proteolytic enzymes (tryptase)
48
preformed mediators do what?
--cause contraction of smooth muscle in the bronchioles, blood vessels, and intestines
--increased capillary permeability
--chemotaxis of eosinophils and neutrophils
--decreased blood coagulability
49
describe newly synthesized mediators
--prostaglandins, leukotrienes, and PAF
-- potentiate the effects of histamine and other preformed mediators
50
clinical manifestations of type I hypersensitivity include what?
--localized wheal-and-flare skin reactions
--rhinitis (hay fever)
--allergic asthma
--systemic anaphylaxis (life-threatening)
--food allergies
51
susceptibility to allergies is based on what?
--genetic factors that affect immune response
--environmental influences such as exposure to infectious organisms
52
what is the treatment for allegies?
--with drugs such as antihistamines, decongestants, bronchodilators and corticosteroids
--monoclonal anti-IgE antibodies such as omalizumab have been used to block binding of IgE to mast cells and basophils in moderate to severe asthma
--allergy immunotherapy (AIT)
53
when allergen immunotherapy (AIT) used?
--administered to patients for whom drug therapy and environmental control measures are not successful
--goal of AIT is to induce immune tolerance by administering gradually increasing doses of the allergen through time
54
what is the preferred method of screening for allergies? Describe
--in vivo skin prick test
-- where very small amounts of potential allergens are inject under the skin
-positive test produces a wheal-and-flare reaction within 20 minutes
55
what method is used for testing allergies when the patient can not tolerate a skin test?
--in vitro testing by noncompetitive solid-phase immunoassays for allergen specific IgE can be performed
--in these assays, patient serum is incubated with a solid phase to which a specific allergen has been attached
--Binding is detected with in an enzyme-labeled anti-human IgE antibody and a colorimetric, fluorescent, or chemiluminescent substrate
56
what can solid-phase immunoassays for total serum IgE used for?
--used to monitor patients undergoing treatment with AIT or monoclonal anti-IgE
--used to detect patients with certain diseased characterized by elevated IgE (rather than allergens) is attached to solid phase
57
Describe type II hypersensitivity?
--involves production of IgG or IgM antibodies to antigens on the surface of the host cells
--can destroy the cells through complement-mediated cytolysis, opsonization, and phagocytosis or antibody dependent cellular cytotoxicity (ADCC)
--binding of the antibody to the cell surface antigen can result in dysfunction or overstimulation of the cell.
58
give examples of type II hypersensitivity that involves cell damage
--autoimmune hemolytic anemia
--transfusion reactions
--hemolytic of disease of the fetus and new born (HDFN)
59
what is myasthenia gravis?
--type II disorder
--antibody blocks binding of a ligand to cell receptors, causing dysfunction of the cells.
--in contrast, antibodies, in Graves disease stimulate cells after binding to their receptors
60
Describe the direct antiglobulin test (DAT)
--is used to screen for transfusion reactions, autoimmume hemolytic anemia and HDFN
--in this test, washed patient RBCs are combined with anti-human globulin and observed for agglutination, indicating the presence of IgG or complement components on the cells
61
Describe the indirect antiglobulin test (IAT)
--used in antibody screening and identification and in cross-matching of blood to prevent transfusion reactions
--also used to type patient RBCs for specific blood group antigens
--method detects in vitro binding of antibody to RBCs after addition of anti-human globulin to cause a visible agglutination reaction
62
what do cold agglutinins antigens do?
--bind to RBC at temperature below 30 C and cause:
----> blocking of small vessels on exposure to cold
---->red cell agglutination
---->production of hemolytic anemia
63
explain production of cold agglutinins antigens
--may be from unknown causes or may be associated with certain infections of B cells/plasma cell lymphoproliferative disorders
64
how can cold agglutinin titer be determined?
--by incubating patient serum with a dilute suspension of human type O RBCs overnight at 4 C and observing for agglutination
65
Describe Type III hypersensitivity
-- involves the formation IgG or IgM antibody that reacts with small antigen-antibody complexes and precipitates out and deposit on tissue
-C'bind vasoldilation and vasoperemeability increase
--macrophages and neutrophils migrate to the affected areas and release lysosomal enzymes, resulting in tissue damage
66
describe Arthus reaction
-characterized by depositing of antigen-antibody complexes in the blood vessels of the skin
--classic sample of type III reaction
--localized inflammation characterized by redness and edema
--peaks at 3 to 8 hours
67
describe type IV hypersensitivity
--cell mediated mechanism that involves the activation of Th1 cells to release cytokines
--therefore, macrophages and other immune cells are recruited to the area, where they induce an inflammatory reaction
--cytotoxic T cells may also cause damage to the target cells involved
--hypersensitivity peaks at 48 to 72 hours
68
Describe contact dermatitis
--low molecular weight compounds contact skin and has haptens sensitize Th1 cells
--example of type IV reaction
--results from exposure to chemicals released by plants (poison oak), metals (nickel), or hair/cosmetic components that act as haptens when bound to self-proteins
69
Describe hypersensitivity pneumonitis
--allergic disease of lung parenchyma characterized by inflammation of alveoli and interstitial space
--example of type IV reaction
--results mainly from occupational hazard to inhaled antigens. moldy hay, bacterial or fungal spores, pigeon droppings, compost
70
what is skin testing used for?
--to detect type IV hypersensitivity responses in contact dermatitis and tuberculin (PPD) testing
--also used to test for functional cell-mediated immunity to common antigens in patients suspected of having immunodeficiency diseases.
--positive results appear in 48 to 72 hours and indicate sensitization to the antigens used in test
71
describe interferon gamma release assays
--IGRAs
--provide an alternative to tuberculin skin testing to detect latent M. tuberculosis infection
--advantages: increased specificity, clearer result interpretation and faster turnaround time to results
71
describe interferon gamma release assays
--IGRAs
--provide an alternative to tuberculin skin testing to detect latent M. tuberculosis infection
--advantages: increased specificity, clearer result interpretation and faster turnaround time to results
72
what do all four types of hypersensitivity represent?
--defense mechanisms that stimulate an inflammatory response to cope with and react to an antigen that is seen as foreign.
--in many cases, antigen is not harmful, but the response to it results in tissue damage
73
What are immune mediators of all four types of hypersensitivity?
type I--> IgE
type II --> IgG or IgM
type III --> IgG or IgM
type IV --> T cells
74
What are synonyms of all four types of hypersensitivity?
type I --> anaphylactic
type II --> antibody-mediated cytotoxic
type III --> complex-mediated
type IV --> cell-mediated or delayed type
75
What are the timing's of all four types of hypersensitivity?
type I -->immediate
type II --> immediate
type III --> immediate
type IV --> delayed
76
What are the antigens of all four types of hypersensitivity?
type I --> heterologous
type II --> cell surface; autologous or heterologous
type III --> soluble: autologous or heterologous
type IV --> autologous or heterologous
77
what is a general characteristic of hypersensitivity reactions?
-- an exaggerated immune response to an antigen occurs
78
what is associated with an increase in IgE production?
--activation of Th2 cells
79
what would cause a positive DAT test?
--presence of IgG on RBCs
--presence of C3b or C3d on RBCs
a transfusion reaction caused by performed antibody
80
what are characteristics of type I hypersensitivity?
--release of performed mediators from mast cells
--cell-bound antibody bridged by antigen
--an inherited tendency to respond to allergens
81
what is associated with anaphylaxis?
build of IgG mast cells
82
what test should be performed to determine if patient is allergic to ryegrass?
skin prick test
83
what condition would result in hemolytic disease of the fetus and newborn?
prior exposure to foreign RBC antigen
84
what is the immune mechanism involved in type III hypersensitivity reactions?
deposition of immune complexes occurs in antibody excess
85
what is the immune phenomenon associated with the Arthus reaction?
deposition of immune complexes in blood vessels
86
what conclusion can be drawn about a patient whose total IgE level was determined to be 150 IU/mL
antigen specific testing should be done
87
what is the difference between type II and type III hypersensitivity reactions?
type II involves cellular antigens
88
two days after administration of the tuberculin skin test, a female health-care worker developed an area of redness and induration 12 mm in size at the injection site. This result means...
-- she has been exposed to M. tuberculosis
89
a young woman developed red, itchy papules on her wrist 2 days after wearing a new bracelet. what is this reaction caused by?
an inflammatory response induced by cytokines released from Th1 cells
90
Reactions to latex are caused by what?
--type I hypersensitivity
--type IV hypersensitivity
--skin irritations
91
In vitro methods to detect a cell-mediated response to M. tuberculosis measure production of what immunologic components?
--interferon gamma
92
what does an autoimmune diseases rest from?
--a loss of self-tolerance, delicate balance set up in the body to restrict the activity of T and B lymphocytes
93
How is immunologic tolerance achieved?
--achieved at two levels
--central tolerance affects potentially reactive B cells and T cells as they mature in the bone marrow and thymus, respectively
--peripheral tolerance occurs in the secondary lymphoid organs
94
what is autoimmune disease THOUGHT to result from?
--complex interactions between genetic makeup of an individual, exposure to environmental factors, and defects in immune regulation
95
what has been observed about autoimmune diseases?
--associations between certain HLA types or polymorphisms in non-MHC genes involved in the immune response
96
what triggers the development of autoimmunity in genetically susceptible individuals?
--sex hormones
--tissue injury
--exposure to microbial infections
97
In what ways do infectious microorganisms trigger the autoimmune response?
--molecular mimicry (resemblance to self-antigen)
--epitope spreading (induction of local inflammatory response that affects immune reactivity to unregulated antigens)
--presence of superantigens that can bind to class II MHC molecules and several TCRs. regardless of their antigen specificity
98
how can autoimmune diseases be classified?
--systemic
--organ specific
--depending on whether tissue destruction is localized or affect multiple organs
99
what are some examples of systemic classification of autoimmune disease?
--SLE
--RA
--Sjogren's syndrome
--SSc
--polymyositis
--dermatomyositis
--GPA
100
what are some examples of Specific organ classification of autoimmune diseases?
--Hashimotos thyroiditis
-- Graves disease
--type 1 diabetes mellitus
--celiac disease
--autoimmune hepatitis
--primary biliary cholangitis
--multiple sclerosis
--myasthenia gravis
--anti-GBM disease
101
what are strongly associated to specific autoantibodies?
--presence of certain autoimmune diseases and are useful in their diagnosis
--examples
--anti-dsDNA antibodies are found in SLE
--anti-CCP antibodies are seen in RA
--antibodies against the TSH receptor that is specific to Graves disease
102
describe anti-nuclear antibodies
--ANAs
--found in majority of patients with SLE and significant number of patients with other systemic autoimmune rheumatic diseases
103
what method is most commonly used in ANA testing?
--IIF using the human epithelial cell line HEp-2 a the substrate
104
what are some of the main fluorescence pattern observed in IIF test?
--homogenous
--speckled
--nuclear
--centromere
--discrete nuclear dots
--each pattern is correlated with the presence of certain ANAs and should be followed up by confirmatory tests to more specifically characterize the antibodies
105
describe rheumatoid factor?
--autoantibody directed against the Fc potion of IgG molecules
--found in patients with rheumatoid arthritis but not limited to, can appear in patients with other autoimmune diseases involving connecting tissue
106
what are strongly associated to anti-neutrophil cytoplasmic antibodies?
--ANCAs
--with autoimmune syndromes involving vasculitis
107
how are anti-neutrophil cytoplasmic antibodies routinely detected?
-- by IIF using ethanol - or formalin-fixed leukocytes as the substrate
108
what fluorescence patterns can be seen in anti-neutrophil cytoplasmic antibodies?
--c-ANCA
--p-ANCA
109
what may contribute to autoimmunity?
--molecular mimicry
--increased expression of class II MHC antigens
--polyclonal activation of B cells
110
how can SLE be distinguished from RA?
--presence of anti-dsDNA antibodies
111
what would support a diagnosis of drug-induced lupus?
--anti-histone antibodies
112
A speckled pattern of staining of the nucleus of IIF may be caused by what?
--Anti-SS-A/Ro antibody
113
what would be considered a significant finding in Graves disease?
--antibody to TSH receptor
114
What characteristic would distinguish multiple sclerosis?
--destruction of the myelin sheath of axons caused by presence of antibody
115
Blood was drawn from a 25 year old woman with suspected SLE. A FANA screen was performed, and a speckled pattern resulted, what action would be taken next?
--perform an assay for specific ANAs
116
what mechanism is used to achieve peripheral tolerance?
--lack of costimulatory signal to autoreactive T cells in the lymph nodes
117
what does epitope spreading refer to?
--expansion of the immune response to unrelated antigens
118
Anti-CCP is specifically associated with what autoimmune disease?
--Rheumatoid arthritis
119
what autoantibodies are strongly associated with granulomatosis with polyangiitis (Wegener's granulomatosis)?
--ANCA
120
A technologist performs an IIF test for ANCAs and observes that there is an intense fluorescent staining of the nuclear lobes of the neutrophils. How can this type of staining be differentiated from an ANA?
--perform the test on formalin-fixed leukocytes
--perform IIF with HEp-2 cells
--perform an ELISA for ANCAs
121
A 20 year old woman made an appointment to see her physician because she was experiencing intermittent diarrhea. Laboratory testing revealed that she also had an iron-deficiency if the patient has celiac disease, her doctor should order what laboratory test?
--Anti-tTG
122
Anti-mitochondrial antibodies are strongly associated with what?
--primary biliary cholangitis
123
Describe c-ANCA
---->a diffuse, granular staining of the cytoplasm of the neutrophils
----> mainly caused by antibodies against PR3 and seen in the vast majority of patients with active systemic GPA
124
Describe p-ANCA
---->characterized by fluorescence surrounding the nuclear lobes of ethanol-fixed neutrophils
---->caused by antibodies to positively charged antigens such as MPO
125
what does PNH stand for?
--Paroxysmal Nocturnal Hemoglobinuria
126
describe sensitization phase of type I hypersensitivity
IgE binds to high affinity FcerERI receptors on mast cells and basophils
127
describe the activation phase of type I hypersensitivity
receptors become cross-linked when allergens binds to adjacent IgE moleculef
128
describe fluidics
--allows for cell transport in flow cytometry
129
describe laser light source
for all illumination and identification in flow cytometry
130
what are the 2 intrinsic parameters in flow cytometry
--forward scatter (FSC)
--side scatter (SSC)
131
what are the optics and photodetectors for in flow cytometry?
signal detection
132
what use does the computer have in flow cytometry?
data management
133
explain intrinsic parameters of flow cytometry
--2 values can be used to characterize different cell types
--using whole blood, WBC (lymphocytes, monocytes, and granulocytes) can be differentiated from each other based on intrinsic parameters
134
explain extrinsic parameters of flow cytometry
-- cells require addition of fluorescent probe for their detection
--fluorescent-labeled antibodies bound to the cell are interrogated by the laser/lasers of the cytometery concurrently with measurements with cells FSC and SSC
135
describe principle of hydrodynamic focusing within the flow cytometer
--cells pass in a single file line through the interaction of the laser light source
--each cell is interrogated by light source that typically consists of one or more small air-cooled lasers
136
describe the concept of fluorescence in flow cytometry
--used to analyte physiological and chemical properties of cells
--also used to analyze other biological particles in urinalysis analyzers
137
what are 5 clinical applications for flow cytometry
1) identifies markers for diagnosis and monitoring of leukemia and lymphomas
2)enumerates peripheral blood CD4+ T cells to classify stages of HIV
3) enumerates CD34+ cells in stem cell transplantation
4) determine DNA content or ploidy status of tumor cells
5) help diagnosis in inherited diseases
138
describe batch analyzers
--can examine multiple samples but can only measure for one analyte at a time
139
describe random access analyzer
-measure numerous analytes of multiple samples
140
describe dual parameter dot plot
--both parameters on the x-axis are chosen by operator
--lysed whole blood is analyzed on CD45 (x-axis) and SSC (y-axis)
--operator then draws "gate" to isolate population of interest for further analysis
141
describe analytical sensitivity
--lowest measurable amount of analyte
142
describe analytical specificity
--assays ability to generate a negative result when the analyte is not present
143
describe reportable range
--range of values that will generate a positive result for specimens assayed by the test procedure
144
describe reference interval
--value range found in healthy individuals who do not have the condition that is detected by the assays
145
describe sensitization phase of type I hypersensitivity
--APCs process allergens and present them to Th cells
--TH2 cells induce and regulate production of allergen specific IgE
--IgE binds to FceRi receptors on mast cells and basophils
146
describe activation phase of type I hyper sensitivity
--allergens cross links adjacent cell-bound IgEs
-- mast cells and basophils degranulate (triggered by calcium influx)
--chemical mediators are released and bind to target organs
-- allergy symptoms are produced
147
what are the preformed mediators released in type I hypersensitivity?
--histamine (most predominant)
--eosinophil chemotactic factor of anaphylaxis (ECF-A)
--heparin
--neutrophil chemotactic factor
--proteases
148
what are the newly synthesized mediators released in type I hypersensitivity?
--platelet activating factor (PAF)
--prostaglandin (PG) D2
--leukotrienes (LT) = B4, C4, D4, and E4
--cytokines
149
what are common allergens found in type I hypersensitivity ?
--pollen
--mold spores
--animal dander
--dust mites
--insect venom
--certain foods
--certain drugs
--latex
150
what are two other ways to test for allergens?
--allergen specific IgE testing
--Total IgE testing
151
describe allergen specific IgE testing
--> RAST
-->enzyme methods are now used to detect IgE to specific allergen in patient serum
152
describe total IgE testing
--RIST
--enzymes are now used to detect the total concentration of IgE in patient serum
153
describe anaphylaxis
--more severe type of allergic reaction that involves multiple organs
--triggered by glycoproteins or large polypeptides
--severity of reaction depends on number of times exposed
--multiple exposures result in accumulation of IgE on surface of mast cells and basophils
154
what are 3 effects of antibodies in type II hypersensitivity?
--cell destruction
--inhibtion of cell function
--increase of cell function
155
what 3 things cause cell damage in type II hypersensitivity?
--activation of classical pathway of complement and cell lysis
--opsonization and phagocytosis of the cell
--antibody-dependent cell-mediated cytotoxicity
156
what are some type II hypersensitivity diseases?
--transfusion reactions
--hemolytic disease of newborn
--autoimmune hemolytic anemia
--anti-GBM disease
--Hashimotos disease
157
what testing is performed in type II hypersensitvity
--direct antiglobulin test (DAT)
--indirect antiglobulin test (IAT)
158
what are some cold agglutinin diseases?
--cold agglutination syndrome
--mycoplasma pneumonia
--infectious mononucleosis
159
describe cold agglutinin syndrome
--chronic
---->gradual onset and chronic course
----> elderly
---->monoclonal kappa light chains
---->also may be due to presence of lymphoma
--post infectious
---->commonly follows mycoplasma pneumonia and infectious mononucleosis
--high titer of cold agglutinins
--large amounts of C3d
160
describe mycoplasma pneumonia
--cold agglutinins occur 2 to 3 weeks of onset
--abnormal cold agglutinins occur at peak around 12 to 15 days
--symptoms: jaundice, pallor, splenomegaly, some have hemoglobnuria
--
161
describe infectious mononucleosis
--antibody is usually detectable in vitro up to temperatures of 25 C
--50% have anti-i present
162
describe serum sickness
--type III reaction
--caused by passive immunization of humans with animal serum
--produces antibodies against foreign animal protein
--causes immune complexes to form and deposit in patients `
163
what are some symptoms of serum sickness
--headache
--fever
--nausea
--joint pain
--rashes
--lymphadenopathy
164
what are some examples of Type III hypersensitivity disease?
--serum sickness
--arthus reaction
--SLE
--RA
--reactions to bee stings
--drug reactions`
165
what tests are performed in type III hypersensitivity
--testing for ANAs
--fluorescent staining of tissue sections
--testing for RA factor
--testing complement levels
166
what are some example of type IV hypersensitivity
--contact dermatitis
--hepatitis pneumonia
--mycobacterium tuberculosis
--mycobacterium leprae
--phenomytosis
--leishmania species
--herpes simplex virus
167
what tests are performed on type IV hypersensitivity
--patch test (antigen applied to skin surface)
--skin testing for immunodeficiencies
--Mantoux method (antigen injected intradermally)
--interferon gamma release assay (measure production of IFN-gamma) by patient
168
describe quantiferon TB gold plus assays
--patient blood is incubated in special tubes with MTB antigens
--plasma is tested for IFN-gamma
169
describe T spot TB test
patient mononuclear cells are incubated w/ MTB antigens and tested for IFN-gamma by ELISPOT
170
describe tuberculin test
--to identify bacteria of M. tuberculosis complex
--has limitations
---->false positive can occur in patient who received the BCG vaccine or infected with nontuberculosis myobacterium
---->test requires visit from patient to read skin reaction in 48 to 72 hours
171
describe and list effects of SLE on the body
--systemic lupus erythematosus
--chronic systemic inflammatory that affect multiple organs
--patients develop numerous autoantibodies
--immune complexes form, triggering complement activation, chemotaxis of neutrophils and inflammation
--joint involvement
--renal involvement
172
list five types of autoantibodies found in lupus and describe pattern seen in each in immunofluorescence testing
1)anti-dsDNA (lupus specific) = homogenous
2)anti-ssDNA = not detectable
3) anti-histones and antinucleosomes = homogenous patterns
4)antibodies to centromeres or anti-nucleosome = speckled (centromeres) and can be anything for nucleosomes
5)Anti-ENA (anti-sm, anti-RNP are coarse speckled; anti-SS-A and anti-SS-B are fine speckled)
173
what are some symptoms of Rheumatoid arthritis
--joints, tendons, and bursae discomfort
--malaise
--fatigue
--fever
--weight loss
--muscle spasms
--limitation in movement
174
describe how RA factor is formed?
--produced through bystander effect of nonspecific polyclonal activation of B cells or an antigen-driven specific subset of B cells
175
what are tests performed for RA factor?
--manual agglutination using charcoal or latex particles coated with IgG
---->limitation: only detects IgM isotype
--ELISA
--CLIA
--nephelometric
---->can detect other RA factors
---->automated, has greater precision and sensitivity
176
what is Hashimotos thyroiditis
--immune destruction of the thyroid gland produces hypothyroidism
177
what are symptoms of hashimotos and laboratory findings?
--fatigue
--dry skin
--weight gain
--brittle hair
--formation of goiter
--normal or high TSH
--low free T4
--anti-TPO
--anti-Tg
178
Describe Graves’ disease
—AITD characterized by hyperthyroidism
—TRAbs produced
— low TSH and high FTH
—antibodies to TPO and Tg may be produced
179
What are symptoms of Graves’ disease
—nervousness
— Weight loss
— rapid heartbeat
— goiter
—exophthalmos
—bulging eyes
180
What are the 4 criteria for being considered diabetic
1) fasting glucose : > 126 mg/dL -more than once
2) random plasma glucose: > 200mg/dL with classic symptoms
3) oral glucose tolerance: > 200 mg/dL - 2 hour sample with 75 g of glucose load
4) hemoglobin A12 value (HbA1C) greater than 6.5%
181
What testing is completed for T1D
—serological testing
—tests for antibodies to glutamic acid decarboxylase
—1A-2A screening
—ICA screening
182
describe granulomatosis with polyangiitis
--rare, involving inflammation of small to medium blood vessels (vasculitis)
--HLA-DPB1*0401 = Caucasians
--HLA-DRB1*0901 and 1501 = asians and african americans
--severe treated with glucocorticoid and cyclophosphamide
--anti CD20 monoclonal antibody rituximab
183
what is key diagnostic of granulomatosis with polyangiitis?
--anti-neutrophil cytoplasmic antibody (ANCA)
184
what are symptoms of granulomatosis with polyangiitis?
--initial: inflammation of respiratory tract
--fever
--malaise
--arthralgias
--anorexia
--weight loss
--runny nose
--rhinitis
--sinusitis
--oral and nasal ulcers
--renal involvement
185
describe celiac disease
--affect on small intestine and organs
--gluten contains alcohol soluble components called gliadin --> resistant to digestive enzymes
--tissue transglutamine (tTG) --> intestinal enzyme that converts to glutamine residue in gliadin to glutamic acid
--posses one of two
---->HLA-DQ2 (most common)
---->HLA-DQ8
186
what are symptoms of celiac disease?
--abdominal pain
--diaherra
--short stature
--arthritis
--arthragalia
--osteoporosis
--iron deficiency
187
what are tests for celiac disease
--serological testing
--detection of IgA to + TG
--rapid point of care assays
--anti-tTG
--EMA tests (costly and labor intensive)
188
what are three major forms of autoimmune liver disease?
--autoimmune hepatitis
--primary biliary cholangitis (PBC)
--primary sclerosing cholangitis
189
describe autoimmune hepatitis
-- (AIH)
--targets hepatocytes
--immune-mediated liver disease that can lead to end stage liver failure
--AIH-1 (positive for SMA and ANA, maybe D-ANCA) ---AIH-2 (produce antibodies against LKM-T)
190
what are symptoms of autoimmune hepatitis?
--fatigue
--nausea
--weight loss
--abdominal pain
--itching
--rash
--jaundice
191
what are the 3 criteria's that may be used to diagnose primary biliary cholangitis
1) AMA present
2) elevated serum alkaline phosphotase levels
3)liver biopsy shows destructive cholangitis and interlobular bile duct injurt
** 2 out 3 to qualify
192
what are symptoms of primary biliary cholangitis
--fatigue
--itchy skin
--abdominal pain
--dry eyes and mouth
--jaundice
--greasy stools
193
what treats primary biliary cholangitis
ursodeoxycholic acid
194
testing of primary biliary cholangititis
detecting AMAs
--IIF
--immunoblotting with mitochondrial preparations
--ELISA
--fluorescent microbead immunoassay
195
what is autoantibody of anti-glomerular basement membranes disease
GBM
196
what is the autoantibody of autoimmune hepatitis
smooth muscle
197
what is the autoantibody of celiac disease
tTG, gliadin peptides, endomysium
198
what is the autoantibody of Graves diseae
TSH receptors
199
what is the autoantibody of Hashimotos thyroiditis
TPO,Tg
200
what is the autoantibody of MS
myelin base membrane
201
what is the autoantibody MG
acetylcholine receptors
202
what is the autoantibody of primary biliary cholangitis
mitochondria
203
what is Type 1 diabetes autoantibodies
?
pancreatic islet cells, IA-2, GAD
