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IMMUNOLOGY & SEROLOGY, SERO LEARNINGS: WVMC EDITION, T3 T4 TSH,…

- - - - 🦠
        
        Transfusion reaction
        
        AIHA
        
        Hashimoto's :red_cross:
        
        Goodpasture's :red_cross:
        
        Myasthenia Gravis :red_cross:
        
        HDN
        
        ITP
        
        AIHA
        
        WAIHA
        associated diseases:
        
        viral or respiratory infections, such as infectious mononucleosis, cytomegalovirus,
        
        chronic active hepatitis
        
        immunoproliferative diseases
        such as chronic lymphocytic leukemia and lymphomas.
        
        Anemia = clearing of Ab-coated cell by liver and spleen
        
        Cold Agglutinins
        associated disease:
        
        Mycoplasma pneumonia and infectious mononucleosis.
        
        chronic lymphocytic leukemia, non Hodgkin’s lymphoma, myelodysplastic syndrome
        
        connective tissue diseases such as systemic lupus erythematosus.
        
        Cold reacting Abs are IgM specific to Ii blood groups
        
        organ specific autoimmune disease = :red_cross:
  - - - 🦠
        
        Contact dermatitis
        
        Tuberculin test
        
        Farmer’s lung
        
        GVHD
  - - - 🦠
        
        RA
        
        SLE
        
        Serum sickness
        
        Arthus reaction
  - - - 🦠
        
        Bee sting
        
        Sinusitis (Hay fever)
        
        Asthma
        
        Tests for Allergy
        
        RadioImmunoSorbent Test
        (RIST)
        
        measures TOTAL serum IgE lvl
        
        RadioAllergoSorbent Test
        (RAST)
        
        measures ALLERGEN-SPECIFIC IgE
        
        Skin Test
        
        Treatment
        
        Antibody therapy
        
        Hyposensitization ‼️
        
        Drugs (NSAIDs, antihistamines, epi)
- - - - 🦠Hyper IgM syndrome
      - 🦠Selective IgA deficiency
        
        most common congenital immunodeficiency
        
        Washed RBCs
      - 🦠Bruton X-linked agammaglobulinemia
      - 🦠Ataxia-telangiectasia
    - - 🦠DiGeorge syndrome
    - - 🦠ADA/ PNP
      - 🦠Bare Lymphocyte Syndrome
      - 🦠WAS
        
        Triad of microthtrombocytopenia, eczema, immunodeficiency
      - SCID = most severe immunodeficiency
- - - - HLA-DRB1 alleles / PTPN22 gene polymorphisms
        
        Rheumatoid factor (+)
        
        Anti-CCP (Cyclic Citrullinated Peptides)
      - Type III
        
        🩻Pathogenesis:
        Deposition of immune complexes (RF & Anti CCP) sa joints = inflammation → formation of pannus = inflam granular tissue nga gainvade sa cartilage & sa joint space (where jan si synovial fluid) and take note nga may proinflam cytokines nga present sa synovial fluid like TNF-a which stimulates WBCs nga magadto sa site & WBCs have enzymes (matrix metalloproteinases) causing → degradation of proteins sa cartilage
        💥 Bursitis → Joint pain → Joint dysfunction → Osteoporosis
        
        Sjogren’s syndrome secondary to RA
        
        Felty’s syndrome
    - - Highly specific for SLE
        
        Anti–dsDNA**
        
        Anti–Sm (smith)**
        
        LOW C3!!!!! die to C3-nephritic factor
        
        LOW CH50 (diagnostic)
      - Type III
        
        🩻Pathogenesis:
        Accumulation of IgG against dsDNA = large complex = deposited sa glomerulus specifically sa Glomerular Basement Membrane (GBM); due to deficiencies of px with lupus, hindi siya dali maclear sang phagocytes → inflammatory response / activation of complement = so maadto si PMNs sa site of inflam dapos ma degranulate/ release of cytokines then tissue dmg
        💥 Diffuse proliferative glomerulonephritis → Renal failure → 🪦
      - Increased chance of SLE with these HLA types
        
        HLA-A1, B8, DR3
        
        TITER
        1:80 (IIF)
        has a current or previous ANA
        
        TREATMENT
        
        hydroxychloroquine
  - - - 🦠 Autoimmune Hepatitis
        
        Chronic Active Hepatitis
        
        Anti-smooth muscle cell
      - 🦠 Primary Biliary Cirrhosis
        
        Antimitochondrial antibodies (AMA)
    - - 🦠 Goodpasture’s Syndrome
        
        Antibody to an antigen in the renal and pulmonary basement membranes
        
        Type II
        
        Complement- and Fc receptor–mediated inflammation
    - - 🦠 Scleroderma
        
        ANA: anti-Scl-70, anticentromere antibody
    - - 🦠 Addison’s Disease
        
        Antibody to adrenal cells
    - - 🦠 Rheumatic fever
        
        Streptococcal antibodies that cross-react with myocardial/ kidney tissue
        
        Type II
    - - 🦠 Diabetes Mellitus
        
        Type 1 DM
        
        Type IV
        
        🩻
        Inflammation due to
        
        🧪
        FBS: > 126 mg/dL
        RBS: > 200 mg/dL
        OGTT: > 200 mg/dL
        HbA1c: > 6.5%
        
        Anti - insulin
        
        Islet cell antibodies
        
        Anti–IA-2 and anti–IA-2βA**
        
        Antibody to glutamic acid phosphatase (GAD)**
        
        Type 2 DM
    - - 🦠 Hashimoto’s Thyroiditis /
        Chronic Lymphocytic Thyroiditis**
        
        Anti - thyroglobulin (Tg)
        
        Anti - thyroid peroxidase (TPO)**
        
        🩻
        
        Hypothyroidism
        
        Goiter (irregular, rubbery)
        
        🧪
        FT4 ⬇; T3/T4 ⬇; TSH ↔️⬆️;
      - 🦠 Graves Disease /
        Basedow’s disease
        Diffuse Toxic Goiter**
        
        Thyroid-stimulating hormone receptor antibodies (TSHRAbs)**
        
        Anti - thyroglobulin (Tg)
        
        Anti - thyroid peroxidase (TPO)
        
        Type II
        
        🩻
        
        Hyperthyroidism (Thyrotoxicosis)
        
        Goiter (enlarged, diffuse, firm)
        
        Antibody-mediated stimulation of TSH receptors
        
        🧪
        FT4 ⬆; T3/T4 ⬆; TSH ⬇
    - - 🦠 Celiac disease
        
        Antitransglutaminase (tTG)
        
        Antibodies to deamidated gliadin peptides (DGPs)
        
        Endomysial antibodies
        
        Type IV
        
        🩻
        When gliadin passes the epithelial barrier of the intestines, it triggers an immune response because ang gliadin dapat jan lang siya sa lumen since resistant siya to digestive enzymes. Since foreign, ipick up siya kang APCs, present kay CD4+ which produces cytokines that activate CD8+ → inflam → villi injury
    - - 🦠 Sjögren’s syndrome
        
        ANA (speckled/ diffuse)
        
        RF
        
        Anti SSA Ro & SSB LA
        
        Anti Salivary duct antibodies
        
        Anti Lacrimal gland antibodies
        
        Inflammation sa salivary kag lacrimal glands
        = dryness of mouth & eyes
        
        Schimer’s test
    - - 🦠 Pernicious Anemia
        
        Parietal cell antibody pp
        
        Intrinsic factor antibody
        
        Type II
        
        Neutralization of intrinsic factor, decreased absorption of vitamin B12
    - - 🦠 Multiple Sclerosis
        
        Type IV
        
        Inflammation mediated by TH1 and TH17 cytokines, myelin destruction by activated macrophages
        
        Anti - Myelin Basic Protein**
      - 🦠 Myasthenia gravis
        
        Antibodies to acetylcholine receptors (AChR)**
        
        Anti-muscle-specific kinase (MuSK)
        
        Antibody to the lipoprotein LRP4
        
        Type II
        
        Antibody inhibits acetylcholine binding, down-modulates receptors
    - - RBC
        
        🦠 Autoimmune HA
        
        Type II
        
        Opsonization and phagocytosis of RBCs
      - Platelets
        
        🦠 Autoimmune TTP
        
        Type II
        
        Opsonization and phagocytosis of platelets
- - - - TSH
  - - - Turbidimetry
        
        light blocked
    - - CheMiluminescence
        
        emission of light as it returns to ground state
    - - Reflectance spectrophotometry
        
        light reflected
        Medium: Dry chem
        
        Eg: CRP
  - - - potential charge
- - - - CA 19-9
      - CEA
      - CA 15-3
      - TPSA
      - CA 125
      - hCG
    - - TSH
      - FT3
      - FT4
      - T3
      - T4
    - - C3
      - ASOT
      - CRP
        
        hsCRP
      - Ferritin
      - RF
    - - HBsAg
      - HBeAg
      - HBcAg
      - Anti HBc IgM
      - Anti HBc IgG
      - Anti HBs
    - - Prolactin
      - Progesterone
      - Procalcitonin
      - FSH
      - Testosterone
  - - - S. typhi IgG
      - S. typhi IgM
    - - IgG
      - IgM
      - NS1
    - - Non-treponemal
        
        Rapid Plasma Reagin
        RPR
        
        Must be confirmed by Treponema pallidum Particulate Agglutination (TP PA)
        
        Venereal Disease Research Laboratory
        VDRL
      - Treponemal
        
        Anti-TP
        
        Latent stage
        
        No visble signs/ symptoms/ neurosyphilis
        
        Primary stage
        
        Chancre (3-6 weeks)
        
        Tertiary stage
        
        Multiple organ failure
        (10-30 yrs)
        
        Secondary stage
        
        Skin rashes/ mucous membrane lesions
        Condylomata lata or Condyloma latum (sores in the mouth vagina/ anus)
- - - - Diarrhea
        
        E. histolytica
        
        Giardia lamblia
        
        E. coli (O157:H7)
        
        HAV & HEV
        
        V. cholera
        
        Shigella
        
        Norovirus & Rotavirus
      - Polio (Poliomyelitis)
    - - Rheumatic fever
        
        Scarlet fever
        
        Post-streptococcal Glomerulonephritis
        
        tonsils > heart ❤️‍🩹 > kidneys = mimicry
        
        STSS
        
        Erysipelas
- - - - Total PSA
- - - - RA**
        
        Type 1 DM
        
        Pemphigus vulgaris
      - HLA-DRA5
        
        Hashimoto**
- - - - Suppressor
        Supress formation of IgE of course
        
        TH1
        
        produces
        
        INF Y
      - INITIATOR
        reason of the formation of IgE
        
        TH2
        
        produces
        
        INTERLEUKINS 3,4,5,9,13
        
        4, 13
        
        For final differentiation in B cell = makes IgE
        
        4, 9
        
        for development of Mast cells
        
        5,9
        
        developement of Eosinophils
        
        4,9,13
        
        For overproduction of MUCUS
        
        most common sa allergic reactions
- - - - The mediators:
        histamine, heparin
        eosinophil chemotactic factor of anaphylaxis (ECF-A)
        neutrophil chemotactic factor
        & proteases
        
        HISTAMINES
        
        major component of mast cell granules
        
        low-molecular-weight vasoactive amine
        
        effect takes 30 to 60 seconds afte release
        
        Dependent
        on activation of four different types of receptors
        
        H2
        
        increases gastric acid secretion, mucus production and capillary permeability
        
        H3
        
        found on central and peripheral neural tissue.
        
        H1
        
        contraction of smooth muscles
        
        increased mucus production, capillary permeability
        
        intestines, vessels, bronchioles
        
        H4
        
        immune regulation
        
        chemotaxis: Mast cells
        
        recruitment: Eo,Baso,Neutro...cytokine production
        
        Responsible for flare formation
        
        Contraction of bronchiole (smooth muscle)
        = airflow obstruction
        
        Increase vascular permeability
        = shock/hypotension
        
        Eosinophil chemotactic factor of anaphylaxis (ECF-A)
        
        attracts eosinophils sa area
        
        induces expression ka eosinophils receptors for C3b
        
        its granules has products that are toxic to helminths and bronchial epi cells
        
        enzyme released = tryptase Ano pulos ka tryptase?
- - - - Nuclear RNP
        
        Scl-70
        
        Sjorgen syndrome A
        SSA Ro
        
        Sjorgen syndrome B
        SSB LA
        
        Sm
        
        Diagnostic for SLE (high specificity)
        
        Sjorgen, SLE
        
        Sjorgen, SLE
        
        Scleroderma (systemic sclerosis)
        
        SLE, mixed connective tissue dse
      - Drug-induced SLE
- - - - Anti-acetylcholine receptor
        
        Anti-mitochondrial
        
        Anti-parietal cell
        
        Anti-GAD
        (glutamic acid decarboxylase)
        
        Anti-smooth muscle cell
        
        Anti-glomerular basement membrane
        
        2 more items...
        
        Chronic active hepatitis
        
        Type 1 DM
        
        Pernicous anemia
        
        Primary Billiary Cirrhosis
        
        Myasthenia gravis
      - CREST
- - - - C4
        
        C5-C8
        
        C9
        
        CD 56
        
        CD 59
        
        FI/H
        
        2 more items...
        
        PNH (MIKI: Membrane of Inhibitor of Reactive Lysis)
        
        PNH (DAF: Decay Accelerating Factor)
        
        No disease assoc
        
        Neisseria infection
        
        Lupus-like
      - Most severe
        Glomerulonephritis
- - - - Macropahges, Neutrophils, Eosinophils may FC receptor para sa FC region ka Ab na nakatapik sa cell, thus enhancing PHAGOCYTOSIS
      - NK cell may FC receptor man for cytotoxicity
      - Relate c3b