- Believed that apoptosis of self reacting of t and b cells is incomplete - Also thought once a cell becomes destroyed and DNA gets released that DNA is not completely cleared from body and immune system and recognizes it as foreign -- makes antibodies against it

- Rule in and rule some diseases out - Rarely definitive just by testing alone: good place to start

hep 2 cells - Part of continuous cell line, we use these to look at mitotic cells

autoimmunity Flashcards by Jess Fazekas

autoimmunity

multifaceted: many characteristics that go along with the disease; affects many parts of the body

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autoimmunity is a quantitative disorders and you must continuously

checked for level of antibody or t cell involvement

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environmental factors that play a role

Exposure to certain medications, chemicals, UV light, certain poisons can trigger it

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what gender is more prone to autoimmune disorders

women

-around age 40

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antigenic mimicry

Introduction of exogenous antigen but looks similar to endogenous antigen and thought once immune system gets turned on to fight exogenous antigen doesn’t get turned off because finding endogenous antigens

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what sites in immune system are more prone to autoimmunity

privileged sites
- avascular site that is not normally seen by the immune system

-happens when injury to these areas now immune system reacts to it

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theory of autoimmunity

Some of reacting t and b cells toward self antigens never get destroyed

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autoimmunity classified as either

multiple organ (systemic) or organ specific

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SLE stands for

Systemic Lupus Erythematosus

-multi system
-chronic infections

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what ethnicity is SLE highest

african and asian

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lupus patients have presence of

HLA A1, B8, or DR3

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what heightens lupus

○ Sunlight- photosensitivity
○ Medications
○ Stress
○ Certain hormones

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in lupus antibodies get formed to

nuclear antigens – then get antigen antibody complex of intermediate size (hardest size for immune system to completely clear)

-trapped in many organs and fall on glomerular basement membrane

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what is lupus often misdiagnosed as

-cross react for some testing procedures

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classic symptoms of RA

butterfly rash across the face or wolf like rash

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first symptoms of lupus

stiffness of small joints

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when there is kidney dysfunction in lupus what is seen on fluorescence

bumpy pattern

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examples of autoantibodies that can be seen in lupus

double stranded DNA
histone complex
lymphs
RBCs
platelets
phospholipids
lupus anticoagulant

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theories of lupus

Believed that apoptosis of self reacting of t and b cells is incomplete
Also thought once a cell becomes destroyed and DNA gets released that DNA is not completely cleared from body and immune system and recognizes it as foreign – makes antibodies against it

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diagnosis of lupus

presence of LE cell
CRP levels - increased
complement levels - decreased

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what is LE cell

neutrophil that has engulfed the antibody coded nucleus of another neutrophil

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purpose of ANA test

Rule in and rule some diseases out
- Rarely definitive just by testing alone: good place to start

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cells used in ANA

hep 2 cells

Part of continuous cell line, we use these to look at mitotic cells

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gold standard for lupus

Fluorescent

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homogenous

even pattern of staining -need to see mitotic cells -means antibodies to double stranded DNA or histone complex

high titers in homogenous =

lupus

low titers in homogenous

RA or drug induced lupus

what does homogenous pattern need to be followed up with

DNA test

what stains the brightest

peripheral -mitotic cells must also stain

what does peripheral stain mean

producing antibodies to double stranded DNA or histone complex

what does peripheral stain follow up with

DNA test

in speckled pattern

mitotic cells do not stain

speckled pattern should be followed up with

ENA- extrable nuclear Ag

speckled patterns are

non specific ex can be smith SS-A SS-B Scl-70

smith Ag

only antigen that is associated with lupus that causes speckled pattern

SS-A also called

SS-B also called

SS-A and SS-B indicate

Sjogren's syndrome

scl-70 associated with

scleroderma

in nucleolar only

nuclei stain -NO mitotic cells stain

nucleolar is antibodies against

own RNA -seen in scleroderma or mixed connective tissue disease

centromere also called

starry night patten =46 speckles

in centromere antibodies against

centromeres

in centromere do mitotic cells stain

centromere associated with

CREST- form of scleroderma -this pattern is definitive

classic test for DNA testing

Crithida lucilae organism : parasite to blowfish

what do we want stained in Crithida lucilae

kinetoplast -very rich in double stranded DNA

decrease in titer in DNA testing shows

medication is working

in drug induced lupus DNA test is

negative

steroid drugs that cause drug induced lupus

Isoniazid Procainamide

titer in what stain is seen for drug induced lupus

low homogenous titer

automated ANA

not as sensitive and specific as indirect fl. -Can tell specific pattern have to titer it out-- more distinguished

multiplex testing

- Detect multiple nuclear antigens using same specimen

antiphospholipid antibodies

- Antibodies against phospholipids : often seen in DVT and major source of miscarriages (later in pregnancy)

lupus patients produce what 2 antibodies

anticardiolipin lupus anti-coagulant

anti-cardiolipin

cause false + in RPR

lupus anti-coag

prolonged APTT and PT -not correct with mixing normal serum

lupus anti-coag in vivo

bind to clotting inhibitors

lupus anti-coag in vitro

bind to clotting factors

#1 cause of death od lupus patients

kidney failure

what is scleroderma

overproduction of collagen in tissue -hardening of the skin

symptoms of scleroderma

○ Raynaud's syndrome- antigen antibody complex on small blood vessel underneath the skin

another form of scleroderma

CREST -systemic sclerosis -milder form

sjogren's syndrome

dry eye and mouth syndrome

if sjogren gets systemic can involve

GI and pancreas function due to antibodies

what enhances severity and onset of RA

cigarette smoking

how to specify RA

can be organ specific or systemic

symptoms of RA

-morning stiffness - need movement -small joint to large joint swelling

presence of what interferons cause destruction in RA

IL-6 IL-17

RA is considered what kind of hypersensitivity

type 3

antibodies in RA

Anticyclic citrullinated peptide Ab (anti-CCP Rheumatoid factor

Anticyclic citrullinated peptide Ab (anti-CCP

-almost always found in RA -most specific for RA

what is rheumatoid factor

Typically IgM produce against altered Fc portion of an IgG particle -first antibody discovered

what antigen is found in RA

NHC-DRB1

what non specific test can be done for RA

cryoglobulins -IgM precipitate in the cold -put in fridge and look at bottom

False + on cryptococcus Ag test from

rheumatoid factor

treatment for RA

* Reduce inflammation --steroids * Methotrexate * Cytokine blocking drugs

age onset for multiple sclerosis

20-50 chronic women

is there 1 test to diagnosis MS

no must do lots of testing

what can enhance MS

environmental factors such as stress -some viruses may induce antibody inflammation

how does MS occur

Destruction of myelin sheath - antibody and cytokine mediated -increased IL-1 and tumor necrosis factor

increased production of what Ig in MS

IgG in csf >0.70= MS know formula

what antibody found only in CSF in MS

myelin basic protein

what band found in gamma region in MS

oligoclonal banding

Myasthenia Gravis affects

neuromuscular junction -can be seen with other autoimmune disease -increased risk of developing RA or lupus

2 onsets of Myasthenia Gravis

○ Early - develop symptoms in teens ○ Late - develop symptoms after 40

symptoms of Myasthenia Gravis

* Start in face and head; eye and mouth drooping on 1 side of the face * Affects vision, speech * Gets worse as more tired (end of the day)-- more severe * Gait * After menstrual cycle, cause infertility * Numbness in legs Weakness in upper limbs

antibody in Myasthenia Gravis

acetylcholine receptors

celiac disease affects

small intestine- essential for absorption -leads to malnutrition

culprit of celiac disease

gluten

what is used as confirmatory test for celiac test

HLA-DQ2 and HLA-DQ8

predisposing factors in celiac disease

european relatives with this IgA def type 1 diabetes

symptoms of celiac disease

* GI symptoms * Dermatitis herpetiformis - blistering skin condition

what is found in gluten

gliadin -gluten acted on by tissue transglutaminase no villi= no absoprtion

to truly diagnose celiac disease need

biopsy of small intestine

#1 test that used to be for celiac disease

Abs gliaden

tests now for celiac disease

Tissue transglutaminase Abs endomysial Abs

Tissue transglutaminase Abs

-most specific test -first IgA, if negative but sus do IgG

Endomysial Abs

Highly specific for celiac disease

autoimmune hepatitis

attacks liver have to rule out all other liver diseases

testing for autoimmune hepatitis what do u look for

ASMA-anti smooth muscle antibody ANA liver enzymes- increase ALT and AST

most common test done for autoimmune hep

ASMA -antibodies against microsome of liver and eventually kidney

ANA for autoimmune hep

looks homogenous but mitotic cells negative

most common autoimmune liver disease

Primary Biliary Cholangitis (Cirrhosis)

Primary Biliary Cholangitis (Cirrhosis) is antibodies against

bile duct inflammation of duct and blockages -conjugated bili does not get as high

symptoms of Primary Biliary Cholangitis (Cirrhosis)

dry eyes and mouth itching around the liver

antibody seen in Primary Biliary Cholangitis (Cirrhosis)

AMA- antimitochondrial antibodies

Granulomatosis with Polyangiitis/ Wegener's Granulomatous Disease

Form of vasculitis -- inflammation in small arteries and veins

main race that Granulomatosis with Polyangiitis affects

caucasian men and women equal

antibody in Granulomatosis with Polyangiiti

ANCA- anti-neutrophilic cytoplasmic Abs -against azurophilic granules

symptoms of anti-neutrophilic cytoplasmic Abs

* Start in respiratory tract, runny nose, sore throat, but can't understand * Can have bloody sputum * If not treated can lead to lose of vision, hearing, lots of tissues

antibodies in Granulomatosis with Polyangiitis

cytoplasmic antibodies perinuclear antibodies

Cytoplasmic antibodies connected to

PR3 antigen

Perinuclear antibodies connected to

myeloperoxidase antigen (MPO)

autoimmunity Flashcards

(114 cards)