Immunology Exam 3 Flashcards
RID: Mancini Endpoint Method
Measurement taken to exact endpoint (time that reading becomes stable)
RID: Fahey Timed Diffusion Method
Read at a pre-determined time (often 18 hours). Use semi-log paper and plot ring diameter vs concentration
Flocculation vs Agglutination
- Agglutination is clumping of insoluble antigen using soluble antibody.
- Flocculation is precipitation of soluble components out of solution.
Complement Fixation Controls
Antigen Control: hemolysis
Complement Control: hemolysis (100% and 50% titer)
Cell Control: no hemolysis
Patient serum control: hemolysis
Common Label Enzymes
- Horseradish Peroxidase
- Beta-galactosidase
- Alkaline phosphatase
Most common radiographic label
Iodine 125
Type I Hypersensitivity
Ig Mediator: IgE
Cells involved: Mast cells, basophils, eosinophils
Chemical Mediators: Histamine
Examples: Anaphylaxis
RIST Testing
RadioImmunoSorbenT Immunoassay
- Competitive binding
- Double antibody technique
- Correlates with eosinophil count
RAST Testing
RadioAllergoSorbent Test
- Disks with specific allergens
- Tests for IgE directly
Type II Hypersensitivity
Ig Mediator: IgG (sometimes IgM)
Cells involved: RBCs, WBCs, platelets
Chemical Mediators: Complement cascade
Examples: Autoimmune hemolytic anemia, Graves disease
Type III Hypersensitivity
Ig Mediator: IgG or IgM
Cells involved: host tissue cells (“innocent bystander” process)
Chemical Mediators: complement, immune complexes
Examples: Rheumatoid arthritis (IgM against own IgG), Glomerulonephritis (ASO-SO complex)
Type IV Hypersensitivity
Ig Mediator: None–cell mediated
Cells involved: Cytotoxic T Cells (CD8)
Notes: “Delayed Hypersensitivity”, often result of cross-reactivity
Examples: Graft v. Host Disease, Poison Ivy
Systemic Lupus Erythematosus (SLE)
Autoantibodies against basement membranes in the vascular system
Symptoms: poly arthritis, skin rash
Testing: LE Cells, Anti-nuclear antibodies (ANA)
LE Cell
Seen on peripheral smear, a cell nucleus that has been phagocytosed by another WBC
ANA Principle of test
- Indirect Fluorescent Immunoassay (double-antibody technique)
- Only the nucleus reacts with the auto-antibody
- Combination of observed patterns helps diagnose
ANA: Homogenous Pattern
Solid Color
- Anti-nDNA (nucleolar DNA aka all DNA)
- Most associated with SLE
ANA: Peripheral Pattern
Outer Circle
- Anti-dsDNA
- SLE and Sjorgren’s
ANA: Speckled Pattern
Granular/Lumpy
- Anti-RNP
- SLE, RA, Sjorgren’s
ANA: Nucleolar Pattern
Blotchy/Radioactive
- Anti-RNA
- Scleroderma, Sjorgren’s, SLE
ANA: Centromere Pattern
Fuzzy bisecting line
- Anti-centromere
- Very specific for CREST, a progressive systemic sclerosis
Anti-nDNA for SLE
Crithidia luciliae (must spell)
- Fluorescence stains the nucleus and kinetoplast
- two bright spots = positive test
Scleroderma
- Rare autoimmune disease affecting blood vessels and connective tissues
- Fibrous degenerations
- CREST variant is most common
CREST
- Calcinosis - calcium deposits in skin
- Raynaud’s phenomenon - spasm of blood vessels from cold or stress
- Esophageal dysfunction - acid reflux and decreased motility
- Sclerodactyly - thickening and tightening of skin on the fingers and hands
- Telangiectasias - dilation of capillaries, red marks on the skin
Sjogren’s
Autoimmune disorder associated with deficient moisture production in the mouth, eyes, and mucous membranes
Cold Agglutinins
- Anti-I or Anti-i specificity (capitalization matters)
- Produced in adults during primary atypical pneumonia (Mycoplasma pneumonia, which can’t be cultured)
Cold Agglutinin Titers
- Draw patient serum
- Clot at 37C, then separate from cells
- Serial dilutions of the serum
- Add Group O washed cells
- Incubate overnight, read at 24 hrs
- Titer = last tube with agglutination
Immunoelectrophoresis: NHS
“Normal Human Serum”
Immunoelectrophoresis: P
“Patient”
Tumor Markers: TSA
Tumor-specific Antigens
Tumor Markers: TAA
Tumor-associated Antigens
Alpha-fetoprotein
Hepatocelular Carsinoma
CA 125
Ovarian Cancer
Human epididymis protein 4
Epithelial Ovarian Cancer
PSA
Prostate Cancer
CEA
Colorectal Cancer, Breast Cancer (late stage)
Beta-hCG (tumor marker)
Oncofetal, teratoma
CA 19-9
Biliary tract cancers
CA 15-3
Breast metastasis
CA 27-29
Breast cancer recurrence
Her2/neu
Invasive breast cancer
Thyroglobulin (Tg) (tumor marker)
Thyroid Cancer
PKU
Buildup: Phenylpyruvate
Deficiency: Phenylalanine hydroxylase
MSUD
Buildup: leucine, isoleucine, and valine
Deficiency: carboxylation of branched keto acids
Homocystinuria
Buildup: homocystine and methionine
Deficiency: cystathionine-B synthase
Hypothyroidism
- failure of thyroid to produce T3 or T4
- test for T4 and TSH
Congenital Adrenal Hyperplasia
- Deficiency in enzymes that make steroid hormones
- problems making gender-related hormones
- Heterozygous (mild) and homozygous (severe) forms
Hemoglobinopathies
Abnormal hemoglobin production
- Sickle Cell Anemia
- Thalassemia
- HB S/C Disease
Cystic Fibrosis
Lung congestion and infection
- Test for trypsin in blood
- Confirm with sweat chloride test
Fatty acid oxidation disorders
Deficiency of short and long chain enzymes
Galactosemia
Buildup: Galactose
Deficiency: Galactose-1-Phosphate uridyltransferase (GALT)
