Immunological Testing

Question 1

what is immunology self reactivity?

Answer 1

breakdown of self-tolerance

Question 2

What are the factors influencing autoimmunity?

Answer 2

genetic factors, age, exogenous factors

Question 3

How is autoimmunity produced?

Answer 3

Organ specific or non-organ specific

Question 4

Describe the pathophys for organic specific autoimmunity

Answer 4

antibodies are directed at a single target organ. Form immune complexes that deposit in tissues and activate complement system which leads to inflammation. Causes tissue damage, lesion deposits in target organ, and tendency toward cancer development in target organ.

Question 5

Describe the pathophys for non organic specific autoimmunity

Answer 5

produce antibodies to nuclear or cytoplasmic antigen. form immune-complexes that deposit in tissues and form lesions. They activate complement system which leads to inflammation.

Question 6

what is sle?

Answer 6

chronic systemic inflammatory autoimmune disease that beings in young adulthood and is more common in women (10:1). It affects AA and hispanics more than whites.

Question 7

What are the symptoms of SLE?

Answer 7

arthritis, maialse, fever, weight loss, maculopapular rash, glomerluonephritis, nephritis, renal failure, alopeciea, anemia, purapura

Question 8

What is the screen for SLE?

Answer 8

ANA= antinuclear antibody screen. There are two methods present. IFA Hep-2 (fluorescent) and EIA (no flurosence)

Question 9

is ANA specific?

Answer 9

no, there is low diagnostic specificity because many of the antibodies associated with other autoimmune diseases. (2% of healthy persons test positive and 75% of elderly test positive)

Question 10

What does a positive ANA indicate?

Answer 10

a nuclear antibody is present. it is not specific because many diseases are associated with positive ANA. around 75% of elderly people will test positive.

Question 11

What is considered a “normal” titer for ANA

Answer 11

<1:40.

Question 12

Follow up testing for ANA…if original ANA was positive, and the titer was negative then what does that mean?

Answer 12

either no disease, in treatment, or in remission

Question 13

If the ANA titer is positive, then what additional follow up testing should you do?

Answer 13

Anti-dsDNA
Anti-histone
Anti-Sm

Question 14

Anti-dsDNA

Answer 14

if this is positive, there is a high indication that this is SLE

Question 15

Anti-histone is most often positive with…

Answer 15

drug induced lupus

Question 16

If Anti-sm if involved, then they are more likely to have what?

Answer 16

renal involvement.

Question 17

What is drug induced lupus?

Answer 17

a syndrome where SLE-like symptoms and antinuclear antibodies appear in patients taking certain drugs like procainamide, phenytoin, hydrazine, isoniazid. Patients will show rapid improvement once the drug is removed.

Question 18

What is RA?

Answer 18

chronic inflammatory autoimmune disease. It primarily affects joints leading to cartilage destruction and periarticular erosions into bone. Associated with multiple organ involvement in some patients: soft tissue, heart valves, myocardium, lungs and spleen.

Question 19

What is the pathophys for RA?

Answer 19

Immune complex deposits, leading to inflammatory activity in joints, loss of function, destruction, disability, deformity. Disease progression varies, with spontaneous remissions. mainly affects women

Question 20

What are the symptoms of RA?

Answer 20

malaise, fever, weight loss, joint pain, stiffness develops after periods of inactivity

Question 21

What is rheumatoid factor?

Answer 21

Autoantibody (most often IgM) that binds to Fc region of IgG.

Question 22

How will you screen for RA?

Answer 22

RF tests. Do a quantitate RF if test is negative.

Question 23

Does a positive RF confirm RA? Does a negative test r/o RA?

Answer 23

no to both

Question 24

How is disease progression monitored?

Answer 24

with ESR and CRP

Question 25

What is Hashimoto’s thyroiditis?

Answer 25

chronic autoimmune thyroiditis. Thyroid target of autoantibodies: antithyroglobulin antibody and anti-microsomal antibody. No thyroid hormone is produce, and that leads to hypothyroidism and goiter

Question 26

What is grave’s diseasE?

Answer 26

thyroid targets of autoantibodies: 
1. TSH receptor antibody (TRAB)
2. TSI
3. LATS
4. TPO
This stimulates hormone synthesis which causes hyperthyroidism, goiter, and exopthalamus.

Question 27

What is PBC?

Answer 27

Chronic autoimmune liver disease.

Question 28

What is the antibody target in PBC?

Answer 28

targets bile duct tissue of the liver.

Question 29

What are the will be elevated in PBC?

Answer 29

+ ANA, AMA and increased ALK phosphatase, and increased GGT

Question 30

What is the target in Autoimmune hepatitis/CAH?

Answer 30

attacks the hepatocyte (smooth muscle tissue)

Question 31

What is pernicious anemia?

Answer 31

antibody targets gastric mucosa preventing HCL, intrinsic factor, and pepsin secretion. You will see malabsorption and anemia.