This document discusses antinuclear antibodies (ANAs), which are autoantibodies that bind to contents of the cell nucleus. There are many subtypes of ANAs that bind to different nuclear proteins. Indirect immunofluorescence is the reference method for detecting ANAs using three tissues and viewing under fluorescence microscopy, where positive samples show apple-green fluorescence in distinctive patterns associated with particular antigens and diseases. ANA testing is important for diagnosing and managing autoimmune conditions but can also be present in normal individuals so results need accurate interpretation.
This document discusses autoantibodies known as antinuclear antibodies (ANA) that are directed against nuclear antigens. It covers the prevalence of ANA, various nuclear antigens they may be directed against like DNA and histones, mechanisms of autoimmunity and autoantibody production, roles of B cells and T cells, and methods of detecting ANAs. It also describes different patterns of ANA fluorescence and their associations with various autoimmune diseases.
This document discusses autoantibodies and methods for detecting anti-nuclear antibodies (ANA). ANAs are antibodies directed against nuclear and cytoplasmic antigens and are associated with various autoimmune diseases. The three main methods for detecting ANAs are indirect immunofluorescence assay using HEp-2 cells, ELISA, and multiplex bead immunoassays. The immunofluorescence assay is commonly used for initial screening due to its ability to detect multiple antigen patterns but has limitations. ELISA and bead assays allow detection of specific autoantibodies and have improved sensitivity and specificity compared to immunofluorescence.
This document discusses autoimmune diseases and provides an overview of key concepts. It covers mechanisms of autoimmunity like central and peripheral tolerance. It also discusses theories of autoimmunity such as susceptibility genes and environmental triggers. The document then describes the spectrum of autoimmune disorders including organ-specific and systemic diseases. It concludes by noting the diagnostic problems associated with autoimmune diseases.
This document discusses the diagnosis of autoimmune diseases. It describes several markers that provide evidence of autoimmune diseases, such as a positive family history, presence of other autoimmune diseases, infiltrating cells in affected tissues, and improvement with immunosuppressive drugs. It also discusses several mechanisms that can lead to autoimmunity, including antigenic alteration, sequestered antigens, molecular mimicry, and polyclonal B cell activation. Common diagnostic methods are also summarized, including initial laboratory evaluation, immunological studies, and detection of autoantibodies through enzyme-linked immunosorbent assays (ELISAs).
This document discusses antineutrophil cytoplasmic antibodies (ANCA). It notes that ANCA are autoantibodies related to inflammatory disorders and were first associated with Wegener's granulomatosis in 1985. The two main ANCA antigens are proteinase 3 and myeloperoxidase. ANCA testing can aid in diagnosing and monitoring ANCA-associated vasculitis conditions. However, increasing ANCA titers do not reliably predict disease relapses.
This document provides information on various types of leukemia and lymphomas. It discusses the classification, presentation, investigations, treatment and prognosis of acute lymphoblastic leukemia, chronic lymphoblastic leukemia, acute myeloid leukemia, chronic myeloid leukemia, chronic lymphocytic leukemia, Hodgkin's lymphoma and non-Hodgkin's lymphoma. Key differences between leukemia and lymphoma are also noted. The document contains detailed information on clinical features, pathogenesis, risk factors and management for each condition.
This document discusses antinuclear antibodies (ANAs), which are autoantibodies that bind to contents of the cell nucleus. There are many subtypes of ANAs that bind to different nuclear proteins. Indirect immunofluorescence is the reference method for detecting ANAs using three tissues and viewing under fluorescence microscopy, where positive samples show apple-green fluorescence in distinctive patterns associated with particular antigens and diseases. ANA testing is important for diagnosing and managing autoimmune conditions but can also be present in normal individuals so results need accurate interpretation.
This document discusses autoantibodies known as antinuclear antibodies (ANA) that are directed against nuclear antigens. It covers the prevalence of ANA, various nuclear antigens they may be directed against like DNA and histones, mechanisms of autoimmunity and autoantibody production, roles of B cells and T cells, and methods of detecting ANAs. It also describes different patterns of ANA fluorescence and their associations with various autoimmune diseases.
This document discusses autoantibodies and methods for detecting anti-nuclear antibodies (ANA). ANAs are antibodies directed against nuclear and cytoplasmic antigens and are associated with various autoimmune diseases. The three main methods for detecting ANAs are indirect immunofluorescence assay using HEp-2 cells, ELISA, and multiplex bead immunoassays. The immunofluorescence assay is commonly used for initial screening due to its ability to detect multiple antigen patterns but has limitations. ELISA and bead assays allow detection of specific autoantibodies and have improved sensitivity and specificity compared to immunofluorescence.
This document discusses autoimmune diseases and provides an overview of key concepts. It covers mechanisms of autoimmunity like central and peripheral tolerance. It also discusses theories of autoimmunity such as susceptibility genes and environmental triggers. The document then describes the spectrum of autoimmune disorders including organ-specific and systemic diseases. It concludes by noting the diagnostic problems associated with autoimmune diseases.
This document discusses the diagnosis of autoimmune diseases. It describes several markers that provide evidence of autoimmune diseases, such as a positive family history, presence of other autoimmune diseases, infiltrating cells in affected tissues, and improvement with immunosuppressive drugs. It also discusses several mechanisms that can lead to autoimmunity, including antigenic alteration, sequestered antigens, molecular mimicry, and polyclonal B cell activation. Common diagnostic methods are also summarized, including initial laboratory evaluation, immunological studies, and detection of autoantibodies through enzyme-linked immunosorbent assays (ELISAs).
This document discusses antineutrophil cytoplasmic antibodies (ANCA). It notes that ANCA are autoantibodies related to inflammatory disorders and were first associated with Wegener's granulomatosis in 1985. The two main ANCA antigens are proteinase 3 and myeloperoxidase. ANCA testing can aid in diagnosing and monitoring ANCA-associated vasculitis conditions. However, increasing ANCA titers do not reliably predict disease relapses.
This document provides information on various types of leukemia and lymphomas. It discusses the classification, presentation, investigations, treatment and prognosis of acute lymphoblastic leukemia, chronic lymphoblastic leukemia, acute myeloid leukemia, chronic myeloid leukemia, chronic lymphocytic leukemia, Hodgkin's lymphoma and non-Hodgkin's lymphoma. Key differences between leukemia and lymphoma are also noted. The document contains detailed information on clinical features, pathogenesis, risk factors and management for each condition.
The document discusses minimal residual disease (MRD), which refers to small amounts of malignant cells that remain undetectable by conventional methods but can be detected using highly sensitive techniques like PCR. It provides an overview of techniques used for MRD detection in various hematologic malignancies, including morphology, immunophenotyping, cytogenetics, FISH, and PCR. The sensitivity and limitations of each technique is reviewed. Common genomic targets for MRD detection are discussed for several leukemias and lymphomas. The significance of accurately measuring MRD levels for prognosis, monitoring relapse risk, and guiding treatment is also summarized.
C-reactive protein (CRP) is a marker for inflammation that is produced by the liver and measured via a blood test. CRP levels rise in response to inflammation and can help diagnose bacterial infections. A rapid latex agglutination test is commonly used to measure CRP levels qualitatively, involving mixing patient serum with antibody-coated latex particles. If CRP is present, the particles will agglutinate, indicating a positive result. Precise reaction timing and controls are needed to get an accurate reading.
This document discusses leukemoid and leukoerythroblastic reactions. Leukemoid reactions involve a marked increase in white blood cell count (>50,000/cumm) in response to a stimulus like infection, with immature cells comprising less than 5% and being reversible. Leukoerythroblastic reactions involve immature cells in both the red and white cell lines in peripheral blood due to bone marrow disturbances from conditions like cancer metastases or myelofibrosis. The document differentiates these reactions from conditions like CML, CNL, and CLL based on factors like age of onset, clinical course, blood and bone marrow morphology, and presence of an underlying condition.
Autoimmune DIseases : Types, Mechanism, Diagnosis, TreatmentDr Mehul Dave
This is a presentation useful to learners of immunology as well as acadeicians. Useful in undergraduate as well as postgraduate courses. NEET students/Teachers can also get advantage of it.
This document summarizes information about Treponema pallidum, the causative agent of syphilis. It describes key details such as:
1. T. pallidum was discovered in 1905 by Schaudinn and Hoffmann in samples from syphilitic patients.
2. It is a thin, helically coiled bacterium that is difficult to view with conventional microscopy but can be seen with specialized staining techniques or darkfield microscopy.
3. Syphilis is diagnosed through direct visualization of T. pallidum, nontreponemal tests that detect antibodies to cardiolipins and treponemal tests that detect antibodies to T. pallidum antigens.
This document provides an overview of routine coagulation assays including PT, aPTT, fibrinogen, D-dimer, and mixing studies. It discusses the clinical utility and interpretation of these assays for monitoring coagulation and detecting coagulation disorders or abnormalities. Key points include that PT measures the extrinsic pathway and factors VII, X, and prothrombin, while aPTT is more sensitive to deficiencies in the intrinsic pathway and contact factors. D-dimer has high negative predictive value for ruling out VTE but low positive predictive value due to non-specific elevations. Mixing studies can help distinguish between factor deficiencies and inhibitors like lupus anticoagulant.
This document discusses mature lymphoproliferative disorders. It covers their classification, stages of maturation, B-cell development and lymphomagenesis. Molecular features of lymphomas include genetic alterations, infection, antigen stimulation and immunosuppression. Chromosomal translocations can activate proto-oncogenes by juxtaposing regulatory sequences. Tumor suppressor genes are also inactivated through deletion and mutation. Somatic hypermutation may introduce genetic changes involved in lymphomagenesis.
Common variable immune deficiency (CVID) is the most common and clinically significant primary antibody deficiency. It is defined by low levels of immunoglobulins IgG, IgA and/or IgM and impaired antibody production. Patients present with recurrent infections, autoimmunity, lymphoproliferation or malignancy. While the cause is unknown in most cases, genetic defects have been identified in a minority of patients. Treatment involves immunoglobulin replacement therapy, treatment of infections and complications, and monitoring for associated conditions. Prognosis has improved with treatment but morbidity and mortality remain higher than the general population.
I have listed out the LE cells structure and Microscopical examinaton of LE CELLS, Difference between tart cells and le cells, clinical symptoms and diagnostic procedure.
Systemic Lupus Erythematosus (SLE) is an inflammatory autoimmune disease characterized by excessive autoantibody production leading to tissue damage. It has a wide variety of clinical manifestations that can affect many different organ systems. Some key points:
- SLE predominantly affects women of childbearing age and has a strong genetic component. Certain genetic and environmental factors can increase risk.
- Clinical features include skin rashes, arthritis, kidney involvement ranging from mild proteinuria to severe nephritis, neurological/psychiatric symptoms, hematological abnormalities and involvement of other organs.
- Diagnosis is based on identifying a combination of clinical and laboratory criteria including high titers of antinu
Rheumatological diseases can affect the joints, skin, and internal organs. Some common types include rheumatoid arthritis, osteoarthritis, lupus, Sjogren's syndrome, and spondyloarthropathies like ankylosing spondylitis. Rheumatoid arthritis causes chronic inflammation of the synovium and can lead to joint deformity. Osteoarthritis is characterized by cartilage loss within a joint and associated bone changes. Systemic lupus erythematosus is a multi-system autoimmune disease affecting many organs, with a variety of potential manifestations.
This document summarizes a presentation on automation in urinalysis. It discusses the objectives of automating urinalysis, which are to standardize sample processing, biochemical testing, and microscopy analysis while also increasing efficiency. Several types of automated urinalysis systems are presented, including those for biochemical testing using test strips, automated microscopy using flow cytometry or digital imaging, and fully integrated systems. The advantages of automation including increased throughput and standardization are highlighted, as well as the principles of various automated testing methods.
Approach to a patient with positive ana levels (2)Mohit Aggarwal
This document discusses the approach to evaluating a patient with a positive ANA test result. It provides background on ANA testing and discusses the significance of various ANA patterns and titers. The document emphasizes that a positive ANA alone does not indicate a specific disease and must be interpreted based on the clinical context. It then reviews how to approach and evaluate common conditions associated with ANA positivity like SLE, Scleroderma, RA, and Sjogren's Syndrome.
1. HIV can cause a variety of hematological manifestations including anemia, leukopenia, thrombocytopenia, and coagulation disorders due to bone marrow infiltration and effects on hematopoietic progenitor cells.
2. The bone marrow in HIV/AIDS commonly shows hypercellularity, dysplasia of the erythroid and myeloid lineages, plasmacytosis, and lymphoid aggregates. Opportunistic infections also frequently involve the bone marrow.
3. HIV is associated with increased risk of aggressive B-cell lymphomas such as diffuse large B-cell lymphoma. Lymphomas in HIV often involve extranodal sites and the bone marrow.
This document summarizes a seminar presentation on laboratory diagnosis of HIV. It discusses specimen collection, storage and transport. Screening tests covered include ELISA and rapid tests. Confirmatory tests discussed are Western blot and nucleic acid-based tests like PCR. Molecular assays for detecting HIV RNA are also summarized, including quantitative PCR and viral load determination. National testing strategies, reference laboratories, legal and ethical issues are also briefly covered.
Common pitfalls in bone marrow biopsy based diagnostic approachspa718
1. Bone marrow biopsy is the gold standard for diagnosing many hematological diseases but can have pitfalls in interpretation if not done or interpreted properly.
2. Key factors that can limit interpretation include inadequate clinical information, small or distorted specimen, limited staining, and insufficient experience.
3. Specialized ancillary tests like cytogenetics, immunophenotyping, and immunohistochemistry are often needed to make an accurate diagnosis when morphology is inconclusive or to differentiate between possible conditions.
4. A systematic approach incorporating clinical findings and additional test results is important to avoid common pitfalls like misdiagnosing infiltration, fibrosis, or focal lesions.
The document discusses the complement system and related diseases. It provides an overview of the complement cascade including the classical, alternative, and lectin pathways. It describes the biological functions of complement including opsonization, initiation of inflammation, and direct lysis of bacteria. The document also discusses complement receptors, regulation of complement activation, disorders associated with complement deficiency such as increased risk of infection, and laboratory assessment of complement levels.
Rheumatoid arthritis is an autoimmune disease that causes long-term inflammation of the joints. It most commonly affects the joints in the hands, wrists, elbows, knees, and feet. Abnormal antibodies can be found in the blood of people with rheumatoid arthritis, including rheumatoid factor which is present in 80% of patients. Patients who are diagnosed with rheumatoid arthritis but do not test positive for rheumatoid factor are described as having seronegative rheumatoid arthritis.
Complement components C3 and C4 are measured to help diagnose and monitor systemic lupus erythematosus (SLE). Low levels of C3 and C4 indicate activation of the classical complement pathway and an active SLE flare, while low C4 with normal C3 could indicate a genetic deficiency. The antinuclear antibody (ANA) test screens for autoantibodies that target nuclear antigens and is positive in 95% of SLE cases, though it is not specific to SLE. Additional tests for extractable nuclear antigens (ENA) like anti-Sm and anti-dsDNA antibodies can help determine the specific autoimmune disease when ANA is positive. The anti-dsDNA antibody test in particular helps diagnose SLE when A
The document discusses minimal residual disease (MRD), which refers to small amounts of malignant cells that remain undetectable by conventional methods but can be detected using highly sensitive techniques like PCR. It provides an overview of techniques used for MRD detection in various hematologic malignancies, including morphology, immunophenotyping, cytogenetics, FISH, and PCR. The sensitivity and limitations of each technique is reviewed. Common genomic targets for MRD detection are discussed for several leukemias and lymphomas. The significance of accurately measuring MRD levels for prognosis, monitoring relapse risk, and guiding treatment is also summarized.
C-reactive protein (CRP) is a marker for inflammation that is produced by the liver and measured via a blood test. CRP levels rise in response to inflammation and can help diagnose bacterial infections. A rapid latex agglutination test is commonly used to measure CRP levels qualitatively, involving mixing patient serum with antibody-coated latex particles. If CRP is present, the particles will agglutinate, indicating a positive result. Precise reaction timing and controls are needed to get an accurate reading.
This document discusses leukemoid and leukoerythroblastic reactions. Leukemoid reactions involve a marked increase in white blood cell count (>50,000/cumm) in response to a stimulus like infection, with immature cells comprising less than 5% and being reversible. Leukoerythroblastic reactions involve immature cells in both the red and white cell lines in peripheral blood due to bone marrow disturbances from conditions like cancer metastases or myelofibrosis. The document differentiates these reactions from conditions like CML, CNL, and CLL based on factors like age of onset, clinical course, blood and bone marrow morphology, and presence of an underlying condition.
Autoimmune DIseases : Types, Mechanism, Diagnosis, TreatmentDr Mehul Dave
This is a presentation useful to learners of immunology as well as acadeicians. Useful in undergraduate as well as postgraduate courses. NEET students/Teachers can also get advantage of it.
This document summarizes information about Treponema pallidum, the causative agent of syphilis. It describes key details such as:
1. T. pallidum was discovered in 1905 by Schaudinn and Hoffmann in samples from syphilitic patients.
2. It is a thin, helically coiled bacterium that is difficult to view with conventional microscopy but can be seen with specialized staining techniques or darkfield microscopy.
3. Syphilis is diagnosed through direct visualization of T. pallidum, nontreponemal tests that detect antibodies to cardiolipins and treponemal tests that detect antibodies to T. pallidum antigens.
This document provides an overview of routine coagulation assays including PT, aPTT, fibrinogen, D-dimer, and mixing studies. It discusses the clinical utility and interpretation of these assays for monitoring coagulation and detecting coagulation disorders or abnormalities. Key points include that PT measures the extrinsic pathway and factors VII, X, and prothrombin, while aPTT is more sensitive to deficiencies in the intrinsic pathway and contact factors. D-dimer has high negative predictive value for ruling out VTE but low positive predictive value due to non-specific elevations. Mixing studies can help distinguish between factor deficiencies and inhibitors like lupus anticoagulant.
This document discusses mature lymphoproliferative disorders. It covers their classification, stages of maturation, B-cell development and lymphomagenesis. Molecular features of lymphomas include genetic alterations, infection, antigen stimulation and immunosuppression. Chromosomal translocations can activate proto-oncogenes by juxtaposing regulatory sequences. Tumor suppressor genes are also inactivated through deletion and mutation. Somatic hypermutation may introduce genetic changes involved in lymphomagenesis.
Common variable immune deficiency (CVID) is the most common and clinically significant primary antibody deficiency. It is defined by low levels of immunoglobulins IgG, IgA and/or IgM and impaired antibody production. Patients present with recurrent infections, autoimmunity, lymphoproliferation or malignancy. While the cause is unknown in most cases, genetic defects have been identified in a minority of patients. Treatment involves immunoglobulin replacement therapy, treatment of infections and complications, and monitoring for associated conditions. Prognosis has improved with treatment but morbidity and mortality remain higher than the general population.
I have listed out the LE cells structure and Microscopical examinaton of LE CELLS, Difference between tart cells and le cells, clinical symptoms and diagnostic procedure.
Systemic Lupus Erythematosus (SLE) is an inflammatory autoimmune disease characterized by excessive autoantibody production leading to tissue damage. It has a wide variety of clinical manifestations that can affect many different organ systems. Some key points:
- SLE predominantly affects women of childbearing age and has a strong genetic component. Certain genetic and environmental factors can increase risk.
- Clinical features include skin rashes, arthritis, kidney involvement ranging from mild proteinuria to severe nephritis, neurological/psychiatric symptoms, hematological abnormalities and involvement of other organs.
- Diagnosis is based on identifying a combination of clinical and laboratory criteria including high titers of antinu
Rheumatological diseases can affect the joints, skin, and internal organs. Some common types include rheumatoid arthritis, osteoarthritis, lupus, Sjogren's syndrome, and spondyloarthropathies like ankylosing spondylitis. Rheumatoid arthritis causes chronic inflammation of the synovium and can lead to joint deformity. Osteoarthritis is characterized by cartilage loss within a joint and associated bone changes. Systemic lupus erythematosus is a multi-system autoimmune disease affecting many organs, with a variety of potential manifestations.
This document summarizes a presentation on automation in urinalysis. It discusses the objectives of automating urinalysis, which are to standardize sample processing, biochemical testing, and microscopy analysis while also increasing efficiency. Several types of automated urinalysis systems are presented, including those for biochemical testing using test strips, automated microscopy using flow cytometry or digital imaging, and fully integrated systems. The advantages of automation including increased throughput and standardization are highlighted, as well as the principles of various automated testing methods.
Approach to a patient with positive ana levels (2)Mohit Aggarwal
This document discusses the approach to evaluating a patient with a positive ANA test result. It provides background on ANA testing and discusses the significance of various ANA patterns and titers. The document emphasizes that a positive ANA alone does not indicate a specific disease and must be interpreted based on the clinical context. It then reviews how to approach and evaluate common conditions associated with ANA positivity like SLE, Scleroderma, RA, and Sjogren's Syndrome.
1. HIV can cause a variety of hematological manifestations including anemia, leukopenia, thrombocytopenia, and coagulation disorders due to bone marrow infiltration and effects on hematopoietic progenitor cells.
2. The bone marrow in HIV/AIDS commonly shows hypercellularity, dysplasia of the erythroid and myeloid lineages, plasmacytosis, and lymphoid aggregates. Opportunistic infections also frequently involve the bone marrow.
3. HIV is associated with increased risk of aggressive B-cell lymphomas such as diffuse large B-cell lymphoma. Lymphomas in HIV often involve extranodal sites and the bone marrow.
This document summarizes a seminar presentation on laboratory diagnosis of HIV. It discusses specimen collection, storage and transport. Screening tests covered include ELISA and rapid tests. Confirmatory tests discussed are Western blot and nucleic acid-based tests like PCR. Molecular assays for detecting HIV RNA are also summarized, including quantitative PCR and viral load determination. National testing strategies, reference laboratories, legal and ethical issues are also briefly covered.
Common pitfalls in bone marrow biopsy based diagnostic approachspa718
1. Bone marrow biopsy is the gold standard for diagnosing many hematological diseases but can have pitfalls in interpretation if not done or interpreted properly.
2. Key factors that can limit interpretation include inadequate clinical information, small or distorted specimen, limited staining, and insufficient experience.
3. Specialized ancillary tests like cytogenetics, immunophenotyping, and immunohistochemistry are often needed to make an accurate diagnosis when morphology is inconclusive or to differentiate between possible conditions.
4. A systematic approach incorporating clinical findings and additional test results is important to avoid common pitfalls like misdiagnosing infiltration, fibrosis, or focal lesions.
The document discusses the complement system and related diseases. It provides an overview of the complement cascade including the classical, alternative, and lectin pathways. It describes the biological functions of complement including opsonization, initiation of inflammation, and direct lysis of bacteria. The document also discusses complement receptors, regulation of complement activation, disorders associated with complement deficiency such as increased risk of infection, and laboratory assessment of complement levels.
Rheumatoid arthritis is an autoimmune disease that causes long-term inflammation of the joints. It most commonly affects the joints in the hands, wrists, elbows, knees, and feet. Abnormal antibodies can be found in the blood of people with rheumatoid arthritis, including rheumatoid factor which is present in 80% of patients. Patients who are diagnosed with rheumatoid arthritis but do not test positive for rheumatoid factor are described as having seronegative rheumatoid arthritis.
Complement components C3 and C4 are measured to help diagnose and monitor systemic lupus erythematosus (SLE). Low levels of C3 and C4 indicate activation of the classical complement pathway and an active SLE flare, while low C4 with normal C3 could indicate a genetic deficiency. The antinuclear antibody (ANA) test screens for autoantibodies that target nuclear antigens and is positive in 95% of SLE cases, though it is not specific to SLE. Additional tests for extractable nuclear antigens (ENA) like anti-Sm and anti-dsDNA antibodies can help determine the specific autoimmune disease when ANA is positive. The anti-dsDNA antibody test in particular helps diagnose SLE when A
Laboratory investigation of dengue in Jeddahhosammadani
The document discusses laboratory diagnosis of dengue hemorrhagic fever. It describes dengue virus characteristics and various diagnostic techniques used including virus isolation, serological tests like ELISA and hemagglutination inhibition, and molecular detection of dengue virus RNA through reverse transcription PCR. It provides details of specific diagnostic tests and procedures used at the Jeddah Regional Laboratory.
Body Fluid reporting & interpretation has many inherent challenges right from sample collection, selection of tests, test method validation, appropriate reference intervals & clinical decision limits. Recent published articles & guidelines clarify most of the above mentioned concerns for all laboratory to adopt & implement.
Lab diagnosis of ctd By Dr Arif Iqbal MD Dermatology UCMS & GTBH7867878678
This document discusses laboratory diagnosis of connective tissue diseases through detection of antinuclear antibodies. It provides details on the sensitivity and specificity of various antinuclear antibody tests for different diseases. Indirect immunofluorescence is the standard technique for antinuclear antibody detection while ELISA is also commonly used. The document outlines the clinical significance and interpretation of several specific antinuclear antibodies including anti-DNA, anti-histone, anti-RNP, anti-Ro, and anti-La antibodies.
The document discusses and compares traditional and advanced techniques for detecting autoantibodies in autoimmune diseases. It describes several methods including indirect immunofluorescence (IIF), ELISA, line blot, and multiplex bead-based immunoassays. IIF using HEp-2 cells is considered the reference standard for initial ANA screening due to its ability to detect over 100 targets, but it has limitations like subjectivity. ELISA and line blots are useful for confirming specific autoantibodies. Newer multiplex bead-based assays allow simultaneous detection of multiple autoantibodies and have advantages like automation, but may miss some targets. The optimal testing approach depends on the clinical scenario and usually involves initial screening by IIF followed
This document presents a case of a 30-year-old female with a 3 month history of fever, 2 month history of multiple joint pains and swelling, and 1 month history of rash over her face and body. Physical examination revealed a febrile patient with erythematous rash, joint swelling and limitation of movement. Laboratory tests showed pancytopenia, elevated ESR and creatinine, low complement levels, and positive ANA and dsDNA antibodies. A renal biopsy was consistent with lupus nephritis. Based on her presentation and test results, the patient was diagnosed with systemic lupus erythematosus.
This document describes a case of systemic lupus erythematosus (SLE) in a 30-year-old female patient presenting with fever, joint pain, and rash. On examination, the patient showed malar rash, joint swelling, and limitation of movement. Tests found anemia, renal dysfunction, positive ANA and dsDNA antibodies. A renal biopsy was consistent with lupus nephritis. Based on the characteristic rash, joint and renal involvement, positive serology, and biopsy results, the patient was diagnosed with SLE. The document then provides background information on SLE, including causes, clinical manifestations, diagnostic evaluation and criteria, management, and pathology findings.
This document summarizes autoantibody patterns, associated diseases, and diagnostic testing strategies for various autoimmune conditions. It lists common autoantibodies found in systemic lupus erythematosus, mixed connective tissue disease, progressive systemic sclerosis, primary Sjögren's syndrome, autoimmune hepatitis, primary biliary cirrhosis, drug-induced lupus, and other conditions. It also provides information on screening tests, specific assays, and interpretation guidelines to help clinicians evaluate patients for autoimmune diseases.
Immunoassay basic concepts for clinical pathologistDr. Rajesh Bendre
Immunoassays as technique have evolved considerably since the invention of Radioimmunoassay, monoclonal antibody, Recombinant technology & successfully achieved automation. However, many of the hormonal assays still lack standardization and/or Harmonization resulting in significant variability in test results. Using alternate methods, adopting procedures for sample pre-treatment, serial dilution of sample are some of the ways to troubleshoot these discrepant result
EXAMENES DE LABORATORIO EN ENFERMEDADES REUMATICAS INGLESFIREYAHWEH
Laboratory evaluation of rheumatic diseases involves immunologic testing to detect autoantibodies, inflammatory markers, and other biomarkers that can aid in diagnosis. Serology testing plays a critical role by identifying circulating autoantibodies. Autoantibody screening assays using techniques like indirect immunofluorescence, ELISA, and immunodiffusion can detect antibodies associated with various rheumatic diseases. A positive ANA screening should be followed by specific antibody testing to confirm results and make a accurate diagnosis.
Técnicas en Diagnóstico de Meningitis Tuberculosa y FarmacogenéticaAche Stroker
This document discusses techniques for diagnosing tuberculous meningitis. It describes direct diagnostic techniques that detect the causal agent and indirect techniques that detect the host's immune response. Adenosine deaminase (ADA) is an indirect diagnostic technique discussed in detail. ADA levels are often elevated in tuberculosis and other diseases. The document outlines the principle, definition, and determination of the ADA technique. Studies comparing ADA to polymerase chain reaction and examining ADA cutoff levels for diagnosing tuberculous meningitis in cerebrospinal fluid are summarized.
Challenges in interpreting serum protein electrophoresis. Requires an approach to recognize pattern within the various protein fractions & differentiate systemic inflammatory response from abnormal antibody production due to neoplastic disorders.Presence of M-band does not always correlate with plasma cell disorders but can be seen some lymphomas, chronic leukaemias, systemic amyloidosis hence need further ancillary tests for diagnosis of aetiology for the M-band.
RA factor and it's tests. This file has contain bulk of knowledge about immune system and method.
All tests and their symptoms.
Share your suggestions about this in comments section.
Thank you.
Keep gaining knowledge everywhere.
This document discusses a case of a 58-year-old woman presenting with recurrent eye pain and redness in both eyes. On examination, she was found to have diffuse anterior scleritis in the right eye and posterior scleritis, with a history of rheumatoid arthritis. The document then provides an overview of scleritis, including classification, pathogenesis, diagnostic approach, and treatment strategies depending on the type of scleritis and any underlying conditions. Treatment may involve NSAIDs, corticosteroids, immunosuppressants like methotrexate, or biologics, sometimes with surgical intervention for necrotizing scleritis. Non-infectious scleritis can indicate serious systemic diseases.
Special Investigations for Biomedical StudentsSri Lakshman
Western blot is used to detect specific proteins in tissue or cell extracts. It involves separating proteins by electrophoresis, transferring them to a membrane, and using antibodies to identify a target protein. ELISA detects specific antigens or antibodies and is used for diseases screening like HIV, syphilis, and Lyme disease. PCR amplifies specific DNA sequences and is used to detect pathogens and for disease diagnosis. Plasmid fingerprinting identifies bacteria by comparing their plasmid profiles.
Autoimmune diseases occur when the immune system attacks the body's own tissues and organs. There are several mechanisms that normally prevent this, including central tolerance in the thymus and bone marrow, and peripheral tolerance by regulatory T cells. A failure of these tolerance mechanisms can result in autoimmune diseases. Genetic and environmental factors also contribute to predisposing individuals. Autoimmune diseases can be organ-specific or affect multiple systems. Diagnosis involves detecting elevated levels of autoantibodies through various tests. Treatment aims to suppress immune induction and restore tolerance, as well as inhibit effector mechanisms causing organ damage.
Autoimmune liver disease is a heterogenous group of disorders. Laboratory diagnosis plays an important role in early diagnosis. Availability of transfected cells(F-Actin HEK cells) & cell based assays have increased the test specificity significantly.
Diagnosing PM/DM is challenging due to rarity of the disease, their similar clinical presentation and the possibility of overlap syndromes. A comprehensive strategy for serological testing comprises of parallel determination of both MSA and MAA thereby reducing the time to diagnosis. Current immunoassays techniques (Immunoblot) targeting MAA & MSAs have –
The ability to include many parameters simultaneously which ensures higher detection rate; Become readily accessible & hence an opportunity for laboratories to contribute significantly in the disease diagnosis. MSA are highly specific for PM/DM, and many of them are also associated with a unique clinical subset of PM/DM, making them useful clinical diagnostic/prognostic biomarkers & continue to evolve.
Interpretative lab reports having test specific comments & notes is becoming a need & tool for clinical interface. Various quality guidelines have also included interpretative & advisory services as part of checklist & scope for laboratory accreditation. However, every laboratory needs to strategize methodology along with its LIMS, ways for implementation.
This document provides guidelines for blood and blood component transfusion. It discusses the various blood components, quality control parameters, rationale for transfusion in different clinical settings, transfusion guidelines including blood group shifting, use of leukoreduced and irradiated blood products, and the impact of oral antiplatelet therapy. It aims to update best practices for blood transfusion safety.
Cardiac biomarkers have evolved over last 20 years. From enzymes like CPK,SGOT,LDH, the focus shifted to CPKMB mass & currently to high sensitive Troponins. Similarly the definition of AMI also evolved and included these markers in guidelines. Natriuretic peptides (BNP & Nt-proBNP) are good markers for heart failure. however, ACS in renal failure continues to have diagnostic challenges.
Preanalytical quality control practices in clinical laboratoryDr. Rajesh Bendre
Preanalytical variables contribute maximally to lab errors. However, these variables are most difficult to control as they include human dependency for phlebotomy skills & pretest patient conditioning. Quantifying & monitoring these variables is also more challenging. Use of checklists, continuous training, competency assessments, internal audits & clinician education for appropriate test utilization form some of the tools for improving the preanalytical processes.
Anti-Mullerian Hormone (AMH) -Novel Biomarker & its ApplicationsDr. Rajesh Bendre
Serum anti-Mullerian hormone (AMH) is a unique biomarker that has a critical role in folliculogenesis as well as steroidogenesis within ovaries. Secretion from preantral and early antral follicles renders AMH as the earliest marker to show ovarian reserve decline.
challenges in interpreting abnormal hemoglobin study- the key is to correlate with patient age, ethnicity,RBC indices & morphology findings. Two tier approach for correct characterization of abnormal hemoglobins of HPLC &/or capillary electrophoresis.
Maternal screening for fetal Aneuploidy- Update on Laboratory TestsDr. Rajesh Bendre
Maternal screening for aneuploidy disorders using maternal serum hormonal immunossay levels & statistical risk algorithm is recommended to be used as a universal process as per ACOG & SOGC. Maternal blood has circulating fetal DNA which can be targeted in screening molecular tests like Non-Invasive prenatal testing(NIPT) for identifying aneuploidy. However, confirmatory tests still are cytogenetics (karyotyping) based tests using sample from amniocentesis or CVS.
Common Diagnostic pitfalls with coagulation disorders lies in addressing challenges in preanalytical processes & implementation of algorithms as per newer guidelines.
Laboratory offering TDM for Immunosuppressive Drugs needs to understands their pharmacodynamics & clinical applications so that the results value add in the patient care
Diagnosis of Inflammatory bowel disease have challenges including differentiating from Irritable bowel disease using noninvasive biomarkers. Fecal calprotectin is a novel fecal marker which meets the diagnostic & monitoring requirements for IBD.
Aligning & implementation of ISO15189:2012 requirements in clinical laboratory includes enlisting & mapping the exact activities to be performed with each clause, having done the same it acts as a road map for monitoring & continuous improvement
In the continuous quality journey, Controlling laboratory Errors is an integral part & focusing on analytical, post-analytical process is the first step. Developing a reporting culture followed by thorough analysis and implementation of appropriate corrective, preventive actions is required.
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We look into the evolution of health informatics and its applications in the healthcare industry.
HIMMS TIGER resources are available to assist Health Informatics education.
Indian Health universities, IT Education institutions, and the healthcare industry must proactively collaborate to start health informatics courses on a big scale. An advocacy push from various stakeholders is also needed for this goal.
Health informatics has huge employment potential and provides a big business opportunity for the healthcare industry. A big pool of trained health informatics manpower can lead to product & service innovations on a global scale in India.
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"Market Research it too text-booky, I am in the market for a decade, I am living research book" this is what the founder I met on the event claimed, few of my colleagues rolled their eyes. Its true that one cannot over look the real life experience, but one cannot out beat structured gold mine of market research.
Many 0 to 1 startup founders often overlook market research, but this critical step can make or break a venture, especially in health tech.
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Sudharsan Srinivasan
Operational Partner Pitchworks VC Studio
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Example of Market Research working
Innovaccer, founded by Abhinav Shashank in 2014, focuses on improving healthcare delivery through data-driven insights and interoperability solutions. Before launching their platform, Innovaccer conducted extensive market research to understand the challenges faced by healthcare organizations and the potential for innovation in healthcare IT.
Identifying Pain Points: Innovaccer surveyed healthcare providers to understand their difficulties with data integration, care coordination, and patient engagement. They found widespread frustration with siloed systems and inefficient workflows.
Competitive Analysis: Analyzed competitors offering similar solutions in healthcare analytics and interoperability. Identified gaps in comprehensive data aggregation, real-time analytics, and actionable insights.
Regulatory Compliance: Ensured their platform complied with HIPAA and other healthcare data privacy regulations. This compliance was crucial to gaining trust from healthcare providers wary of data security issues.
Customer Validation: Conducted pilot programs with several healthcare organizations to validate the platform's effectiveness in improving care outcomes and operational efficiency. Gathered feedback to refine features and user interface.
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Autoimmune diseases diagnostic challenges
1. Autoimmune Diseases-
Diagnostic Challenges & Reporting
Dr Rajesh V Bendre
MD(PATH), DNB(PATH), DPB
Chief Pathologist & Head of Laboratory & Blood Bank Services,
Jaslok Hospital & Research Centre, Mumbai
3. AUTOIMMUNITY VS. AUTOIMMUNE DISEASE
Autoimmunity
Existence of harm-less self-
reactive lymphocytes and
antibodies
Potentially reversible
Incidence higher in older
age
Significance unclear,
possibly physiological
Antibody are usually IgM
with low avidity
Autoimmune disease
Dependent on genetic viral
and hormonal factors
Features of severe tissue
damage
Clinical symptoms
Protracted course but
usually fatal
Familiar clustering
Antibody are often IgG
with high avidity
5. 2. Specific Autoantibody Reactivity
– ENA-
Test methods- ELISA, CLIA,
RIA, Immunoelectrophoresis
and Immunoblotting.
ELISA (monospecific with
purified antigen) &
Immunoblotting are used for
antibodies to DNA, Sm Ag,
U1RNP, SS-A, SS-B, and Scl-70.
Antithyroid antibodies are
usually done by CLIA.
Acetylcholine receptor & MUSK
antibodies are diagnosed using
immunoprecipitation reaction by
RIA.
Laboratory Diagnosis
1. Screening Tests for detection of
systemic autoimmnune diseases for the
last four decades has been the
detection of autoantibodies using
Indirect Immunoflorescence(IIF)
technique with whole cell substrates
eg. ANA, DNA, ANCA
Antinuclear antibodies (ANA) using
HEP-2 cells includes most nuclear and
cytoplasmic antigens, this test can
provide much information regarding
the possible autoantibody system(s)
present, given the pattern of reactivity
seen in the positive ANA.
This can then be utilized to direct
which additional tests the clinician
should order.
6. ANA by Indirect Immunofluorescence
Uses Hep2 cells –
Detects ANA of clinical relevance
Titers asssociation with clinical relevance
Reduce fading,special Mounting Medium
Optimum Antigen Expression
Significant Mitotic Cells
Large Nuclear size
Pattern correlates with the antibody
specificity and direct immunofluorescence
findings in the skin biopsy material.
7. Guidelines for the Laboratory Use of Autoantibody Tests
Test for antinuclear and anticytoplasmic
antibodies (ANA) only in patients with
symptoms of autoimmune rheumatic disease
(ARD),
Weak ANA reactivity may be present in many
non-rheumatic patients and even in “healthy”
control subjects (upto 15%).
To diagnose ARD, screen for ANA using
indirect immunofluorescence (IIF) on HEp-2
cells, and specify immunohistochemical pattern
(nuclear, cytoplasmic, mitotic) and quantity
(titer, concentration).
Consider sample screening dilution for ANA
testing as 1:80 or 1:100
As decision-making levels: negative if <1:80,
low positive from 1:80 to 1:100, and positive if
1:160 or more.
Do not use ANA titer or concentration to
monitor ARD.
Use ELISA-ANA screening test only when your
procedure has shown good clinical and analytic
correlation with the IIF method.
Indian J Med Res 126, July 2007, pp 34-38
8. ANA Patterns
Pattern Ab Directed Against Associations
Homogeneous or
diffuse nuclear
staining
Chromatin
Histones
Occasionally DS DNA
SLE
Drug induced
SLE
Rim or peripheral
staining
DS DNA SLE
Speckled nuclear
pattern
(Fine or Coarse)
Non-DNA nuclear constituents
(Extractable nuclear antigens-ENA):
Sm
Ku
U1RNP
Ro/SS-A
La/SS-B
SCLE, Mixed
connective
tissue disorders
Nucleolar Nucleolar RNA
Systemic
sclerosis
Centromere Anti- centromere
CREST
syndrome
Nuclear dots Sp-100 (nuclear pore proteins)
Primary biliary
cirrhosis, SLE
Cytoplasmic
speckled
Histidyl-tRNA synthetase (Jo-1)
Anti-mitochondrial, anti-golgi
Anti-lysosomal
Myositis
10. Dense fine speckled
pattern. Mitotic cells
show a fine granular
solid staining. Resting
cells show a very fine,
diffuse speckled stain.
ANA- DFS 70 Pattern
11. Guidelines for laboratory
- Use of DsDNA Tests
Two Types of Antibodies
dSDNA
Specific for SLE, react with both ssDNA and dsDNA
occur in up to 70% of SLE patients, Pathogenic antibodies
ssDNA
not specific for SLE , recognize purine and pyrimidine basis
occur in other autoimmune rheumatic disorders
Test for anti-dsDNA antibody only in ANA-positive patients in whom
SLE is suspected clinically, using the IIF on Crithidia luciliae or ELISA
methods.
Use the ELISA to monitor anti dsDNA–positive SLE patients
Am J Clin Pathol 2002;117:316-324
Method Antibody
avidity
Sensitivity &
Specificity
Farr assay (RIA) ++++ 44%
96%
CLIFT ++ 27.4%
95.9%
ELISA
-Conventional dsDNA
-- NcX-dsDNA
+++
41.8%, 97.0%
59.8% , 97.0%
12. Antibody (tested
using ELISA)
Sensitivity
(%)
Specificity
(%)
Disease association
Ro (SS-A) 61 80-93 SLE, Sjogren syndrome
La (SS-B) 27-35 88-97 SLE, Sjogren syndrome
Sm 34-45 88-100 SLE
RNP 39-64 84-97 SLE, MCD
CENP-B 40-45 85-90 scleroderma
Scl-70 47-58 82-93
Scleroderma systemic
sclerosis
Jo-1 42-47 87-94 Myositis
U1-RNP 35-40 85-90 MCD
Histones 75-80 88-95 SLE-Drug induced
DFS-70 New New Non Rheumatic diseases
RNA Polymerase III New New Systemic sclerosis
Antibody (tested
using
Immunoblot)
Sensitivity
(%)
Specificity
(%)
Disease association
Fibrillarin New New Systemic sclerosis
PM-scl New New Myositis
Pl-12 New New Myositis
Guidelines for laboratory
- Use of ENA Tests
13. ENA
Major clinical
associations
CIEP ELISA IB
CommentsSens Spec Sens Spec Sens Spec
SS-A Sjogren’s syn 85-95 50-60 90-97 45-50 70-85 40-50 Conformational epitopes on 52- and 60-kDa SS-A
antigen best detected by CIEP; IB is unreliable
because of denaturation of epitopes by SDS-PAGESLE 25-30 50-60 35-60 45-50 10-15 40-50
SS-B Sjogren’s syn 70-80 60-70 75-85 50-60 90-95 55-65 Linear epitopes on 48-kDa SS-B best detected by
IB; CIEP less sensitive but more specificSLE 10-15 50-55 20-30 45-50 30-35 40-50
Sm SLE 30-35 98-100 35-50 95-99 30-35 95-99
ELISA specificity may be improved by use of
highly purified or recombinant antigens;
U1 RNP Mixed CTD 90-95 60-75 95-98 50-60 80-85 55-65 ELISA specificity may be improved by use of
highly purified or recombinant antigens; IB is more
specific than ELISASLE 15-35 55-75 50-60 50-55 30-40 55-70
Scl-70 Scleroderma 25-35 95-99 30-45 80-90 40-55 90-95
CIEP is less sensitive because of the low negative
charge on Scl-70 antigen at pH 8.0-8.4
SLE 0-5 0-5 20-25 15-25 10-20 5-10
Anti-Scl-70 antibodies detected by ELISA in SLE
may not be “false positives”; rather, may identify a
subgroup of patients at high risk of pulmonary
hypertension and renal disease
Jo-1 PM/DM 25-40 95-99 35-45 90-95 60-90 95-99
Anti-Jo-1 antibodies stain the cytoplasm of HEp-2
cells and may be reported as“ANA negative”
Guidelines for laboratory
- Use of ENA Tests
19. ANCA- International Consensus
Statement
Laboratories screen for ANCA by indirect IF, and that
any sera with cytoplamic or perinuclear
fluorescence or nuclear fluorescence that might
mask an ANCA should be tested for MPO and
PR3 by ELISA. Am J Clin Pathol. 1999;111:507-13
20. When an autoimmune liver disease is suspected based on clinical, biochemical or histological pattern, autoantibody
testing of ANA, ASMA, LKM-1 and AMA can clearly help with the diagnosis. Titres can vary throughout the course of
the disease and, therefore, a negative test or a low titre should not exclude a diagnosis; repeat testing may be appropriate
during the initial workup. In adults, a titre of 1:40 or greater is considered positive for pathology, whereas in children, a
cut-off of 1:20 or greater for ANA and ASMA, and 1:10 or greater for LKM-1 are considered positive
Autoimmune Hepatitis
21. Smooth Muscle Antibodies
SMA of the VGT pattern is considered specific for AIH-
1.
Actin: a globular protein and exists as either G-actin
(monomeric) 46kD or F-actin (polymerized into
filaments) 34kD
F - actin: the biologically active form and is the
specific autoantigen of autoimmune hepatitis
Anti-smooth muscle F-actin antibodies are
predominantly IgG
Other cytoplasmic antibodies creating interference in
ASMA reporting (often related to G-actin)– vimentin,
tropomyosin, endomysium, elastic fibres
New ASMA mosaic slide includes VSM cells specific for
F-actin
22. Types of LKM Antibodies
Type Immunofluorescence Pattern Antigen Specificity Disease Association
LKM1 Liver; evenly staining cytoplasmic P4502D6, 50kD Autoimmune hepatitis
fluorescence kidney; proximal tubules
LKM2 Liver; same as LKM 1 P4502C9, 50kD TienilicAcid and
Kidney; same as LKM1 associated hepatitis
LKM3 Liver; primate-specific uridine diphosphate Hepatitis D
Kidney; primate-specific glucuronosyltranferases
Kidney Liver
23. Autoantibodies in Primary Biliary Cirrhosis
Antimitochondrial antibodies ~ 95 %
-Antibodies against oxo-acid dehydrogenase E2 subunits are nearly 100% specific
Antinuclear antibodies ~ 50%
Antibodies against gp210 and Sp100 are nearly 100%
specific but present in only 20% to 30% of cases
Anti-Mitochondrial
Antibodies (M2) on
Kidney/Stomach
Substrate
24. Case study
45-yr F presented to GP with 9 mths H/o mild arthralgia predominantly
affecting the proximal interphalangeal joints. She had presented 12 months
earlier with an erythematous rash over her cheeks and nose. The rash was
slightly oily and It seemed to respond to a topical antibiotic. The
development of joint symptoms raised some doubt about the diagnosis of
the rash, which appeared to be confirmed when an ANA test was reported
as positive at a titre of 1:80 with speckled pattern.
The residual rash was consistent with acne rosacea and the ANA was
thought to be insignificant and coincidental finding.
The patient was referred to a rheumatologist. O/E- No other clinical
features of lupus. On further Radiological investigations- Early nodal
changes seen on some of the asymptomatic distal interphalangeal joints.
Also patient had strong family history of hand osteoarthritis.
25. 18 yr M – 3mths of malaise, lethargy, anorexia, weight loss and the recent
development of painful swollen hands. The patient had been well, other
than for severe acne treated over the previous 12 months with minocycline,
with a good response
On examination he was thin and had mild synovitis of the
metacarpophalangeal and proximal interphalangeal joints of both hands.
There was no rash, blood pressure was normal and he had no other clinical
features of lupus.
Investigations - mild lymphopenia and elevated ESR, CRP and IgG levels.
ALT and AST levels were slightly raised. ANA test positive at 1:640, with a
diffuse and speckled pattern, and dsDNA antibody level was elevated. Tests
for ASMA and AMA negative.
Diagnosis- Minocycline-induced SLE
He was treated with cessation of minocycline and a small dose of
prednisolone. Over the next three months he made a complete recovery,
with withdrawal of treatment, although the ANA remained weakly positive.
Case study
26. CONCLUSION
ANA includes many autoantibodies directed towards many nuclear (DNA &
nucleoplasm) & cytoplasmic antigens, which are maximally screened & detected
by using Hep-2 cells in indirect immunofluorescence method, but, not all of these
are always clinically relevant antibodies.
Thus, there is a possibility of patients having ANA positive by indirect
immunofluorescence method but negative results on immunoblot.
ANA Immunoblot assays are more sensitive for Ro52/SSb , Scl 70,while poorly
sensitive for dsDNA, hence such patients require further follow-up with
Monspecific Nuclear Antigen ELISAs based on clinical correlation for exact
categorization & diagnosis.
All weak Positive ANA results- are recommended to be correlated clinically &
repeated after 4-6 weeks OR followed up for further testing with Monospecific
Nuclear Antigen ELISA or Panels for confirmation of specific Autoantibodies.
27. CONCLUSION
• dsDNA- shift to ELISA along with antinucleosomal antibody
• ANCA- shift to ELISA with purified antigens for MPO, PR3
• ASMA- Report on IIF with F-actin specificity
• AMA,LKM1- Report on IIF using multiple tissue substrate & pattern
recognition
Please remember it is important ‘to treat the
patient and not the serology’.