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CLINICAL IMMUNOLOGY

Test Name

        Sample

Test Interference

Remarks

  • ANA (antinuclear Ab) by IIF

serum

 

Screening  for autoimmune diseases

  • ANA titer

serum

Increase by smoking, contraceptives.

Not affected by steroids.

>1:320 is diagnostic for SLE

  • Anti-centromere Ab

serum

 

Positive in CREST syndrome

  • Anti-C1q esterase inhibitor

Serum

Assay immediately

 

Diagnostic for Angio-oedema

  • Annticardiolipin (IgG)

serum

 

Diagnosis of antiphospholipid syndrome

  • Annticardiolipin (IgM)

serum

 

Diagnosis of antiphospholipid syndrome

  • ANCA (antineutrophil cytoplasmic antibody)

Serum

 

c-ANCA is positive in Wegner’s granulomatosis

p-ANCA is positive in vasculitis, polyarteritis nodosa, ulcerative colitis

  • Anti-nDNA

serum

 

Diagnostic for SLE

  • Anti-nDNA titer by IIF

serum

 

For follow up of SLE every 10-15 days when positive

  • AMA (anti-mitochondrial antibody)

serum

 

Diagnostic for primary biliary cirrhosis

  • Antimicrosomal antibody

serum

 

Positive in autoimmune thyroiditis

  • Anti-thyroglobulin antibody

serum

 

Positive in autoimmune thyroiditis

 

  • Antiparietal cell antibody

serum

 

Non specific test

  • Antiphospholipid (IgG)
  • Antiphospholipid (IgM)

serum

 

 

  • Anti-Smooth muscle antibody

serum

 

Non specific test

  • b2 microglobulin

Serum, urine

Renal insufficiency, inflammatory syndrome, hepatobiliary syndrome

Used for follow up of multiple myeloma, lymphoma

  • Cold agglutinins

Contact the Lab

 

 

  • Complement 3 (C3)

Serum

Assay immediately

Increases in acute inflammatory conditions

Used for follow up of immune complex diseases e.g. SLE

  • Complement 4 (C4)

serum

Same as C3

Same as C3

  • Cryoglobulin

Contact the Lab

 

Considered negative after 7 days

  • Immunoglobulins: IgG

serum

Decrease by plasmin

Half life 21 days

  • Immunoglobulins: IgA

serum

Decrease by phenytoin

Half life 6 days

  • Immunoglobulins: IgM

serum

 

Half life 5 days

  • Immunofixation,  immunoelectrophoresis

Serum, urine

Non secretory myeloma

Diagnosis of multiple myeloma.

  • Intracellular killing test for phagocytosis

Contact the Lab.

 

Test for neutrophil intracellular killing function

  • Microalbumin in urine

Contact the Lab.

 

 

  • Rheumatoid factor (RF) qualitative by LATEX agglutination

serum

Lipemia, cryoglobulinemia, circulating immune complexes

Screening test for rheumatoid arthritis

  • Rheumatoid factor titer by agglutination test

serum

Increase by Methyldopa therapy

 

  • Rheumatoid factor by Rose Waaler test

serum

Circulating immune complexes

Specific for rheumatoid arthritis

HEPATITIS MARKERS

  • HAV-Ab IgM

serum

May  persist positive up to 6 months after acute infection

Diagnostic of acute hepatitis A infection

  • HBsAg

serum

Detected in serum 12-14 weeks after exposure.

 

Diagnostic of acute hepatitis B infection

  • HBsAb (titer)

serum

 

Becomes positive after 6 months of infection,

  detects immunity

  • HBcAb (IgM)

serum

May persist positive up to 6 months after acute infection

Diagnostic of acute hepatitis B infection

  • HBcAb (total)

serum

 

Diagnostic of past &chronic hepatitis B infection

  • HBeAg

serum

Detected in serum 12-14 weeks of infection

Indication of activity of hepatitis B infection

  • HBeAb

serum

 

Prognostic marker , measured after 3 months of acute infection

  • HCV-Ab

serum

Hypergammaglobulinaemia gives false+ve results

Needs confirmation by RIBA or PCR

  • HIV-Ab

serum

 

Confirmed by Western Blot done by Ministry of Health when positive.

TUMOR MARKERS

  • a-fetoprotein

serum

  • Increase with hepatitis and liver cirrhosis, hepatobiliary diseases, pregnancy, fetal abnormalities

Screening of high risk group , diagnosis of HCC and germ cell tumors.

  • C15.3

serum

Increases with benign breast & liver tumors

Used for follow up of breast cancer every 3 months.

  • C19.9

serum

Increases with pancreatitis , ulcerative colitis, inflammatory bowel diseases

Used for staging & follow up of colon cancer 1-2 months after surgery, then after every 3 months.

  • CA 125

serum

Increases in pregnancy,ovarian cysts,endometriosis, inflammatory bowel diseases

Used for follow up of ovarian cancer.

  • CEA

serum

Increases with cigarette smoking, initial rise with chemotherapy

 

Used for follow up of GIT malignancy, one month after surgery then after every 3 months

  • Total PSA

serum

Inceases after PR examination, catheterization, prostatic massage or biopsy (Transrectal)

Used for screening every year after the age of 50 ys, staging, diagnosis, follow up of prostate cancer every 3-6 months.

  • Free PSA

 

 

Done to all patients with PSA

Polymerase Chain Reaction (PCR)

  • HBV-DNA by PCR (quantitative)

Contact the Lab

Heparin

Diagnosis & follow up every 3 months after therapy

  • HCV-RNA (qualitative)

Contact the Lab

Heparin

Confirm the diagnosis of HCV infection

  • HCV-RNA (quantitative)

Contact the Lab

Heparin

Follow up every 3 months after therapy

  • TB DNA by PCR

Contact the Lab

Heparin

Diagnosis of TB in blood, sputum, bronchial lavage, all body fluids

  • Serologic Typing of HLA- ABC

Contact the Lab

If patient is on renal dialysis, it is preferable to do serologic typing within 24 hrs of the last dialysis session

Typing for HLA type I before renal or bone marrow transplantation

  • Serologic typing of HLA-DR

Contact the Lab

If patient is on renal dialysis, it is preferable to do serologic typing within 24 hrs of the last dialysis session

Typing for HLA -DR before renal or bone marrow transplantation

  • Serologic typing of HLA-B27

Contact the Lab

 

Diagnosis of ankylosing spondylitis, acute anterior uveitis,Reiter’s syndrome

  • Molecular Typing of HLA-B

2 ml whole blood on EDTA Contact the Lab

 

Typing for HLA-B before renal or bone marrow transplantation

  • Moleclar Typing of HLA-DR

2 ml whole blood on EDTA Contact the Lab

 

Typing for HLA- DR before renal or bone marrow transplantation