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CLS 1113 Introduction to Clinical Laboratory Practices

CLS 1113 Introduction to Clinical Laboratory Practices. Autoimmunity Chapter 12. Auto Immune Processes. Immune recognition and reaction against the individual’s own cells Body establishes self-tolerance mechanisms to distinguish between self and non-self determinants:

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CLS 1113 Introduction to Clinical Laboratory Practices

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  1. CLS 1113Introduction to Clinical Laboratory Practices Autoimmunity Chapter 12

  2. Auto Immune Processes • Immune recognition and reaction against the individual’s own cells • Body establishes self-tolerance mechanisms to distinguish between self and non-self determinants: • Autoimmunity is the breakdown of these mechanisms.

  3. Systemic Lupus Erythematosus • Chronic Systemic inflammatory disease • Multiple system autoimmune disorder • Complement fixing complexes of antibody with DNA, etc. are deposited in the kidney, skin, joints and choroid plexus • Cause is unknown • Possible: genetic, hormonal, environmental, and drug-induced

  4. Incidence of SLE • 1 in every 2000 • Females: 1 in 700 • Black females: 1 in 245 • 20-40 years of age • Disease can go in and out of remission

  5. Signs and Symptoms • Disease of acute and chronic inflammation • Life-threatening renal, cardiac, respiratory, or central nervous system involvement • The disease is highly variable • Periods of disease and remission • Person to person

  6. Signs and Symptoms • Arthritis • Joint pain • Sensitivity to opportunistic infections • Swollen Lymph Nodes • Renal Involvement • Caused by high levels of immune complexes in the blood that are deposited into renal tissue. • Acute/Chronic Glomerulonephritis

  7. Signs and Symptoms • Pregnancy • Increased incidence of premature delivery and spontaneous abortion • Passive antibody transfer • Cardiac Involvement • Pericarditis • Tachycardia • Ventricular enlargement

  8. Signs and Symptoms • Photosensitive rash • Any skin exposed to ultraviolet light • 30-40% of patients • “Lupus” (wolf-like)

  9. SLE: Immunologic Theories • Polyclonal B cell activation • B cells stimulated in a non-specific fashion • Specifically B cells with the CD5 marker • Increase in number and become activated • System is stimulated directly by specific antigens • Estrogens enhance B-cell activation • There appears to be a decrease in the number of T cells and complement levels

  10. Laboratory Findings • Presence of antinuclear antibodies • Antibody to nuclear antigens: DNA, histones, etc. • 28 different autoantibodies • Formation of Immune complexes • Deposition of immune complexes in tissues • Decreased levels of Complement

  11. Common Laboratory Tests Antinuclear Antibodies • Screening Test • Fluorescent Antinuclear Antibodies - FANA • Very sensitive • NOT very specific • 5% • 10-30% • 2%

  12. Antinuclear Antibodies • The antibodies react with the whole nucleus or just part. • Define pattern • They are nonspecific enough that they can react with human DNA and other animal tissues

  13. Examples of Antinuclear Antibodies • Anti-ds-DNA: Double-stranded DNA • Anti-ss-DNA: Single-stranded DNA • Anti-nucleolar: Nucleolar Protein • Anti-Sm: RNA nuclear antigen • Anti-SS-A Ro: Protein complex • Anti-RNP: Nuclear RNA

  14. Fluorescent Antinuclear Antibody Test • Human or animal cells are fixed to the slide

  15. Common Laboratory Tests • Double diffusion patterns with a mixture of antigens in the central well

  16. Treatment • For fever and arthritis: anti-inflammatory drugs • For skin ailments: topical steroids • For systemic disorders: corticosteroids (Prednisone) • Steroids are lymphotoxic to B cells and T cells.

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