LECTURE 3 - finished Flashcards
(38 cards)
What are some differences between ESR and CRP?
- Serum CRP levels are more sensitive for the evaluation and monitoring of inflammation than ESR
- CRP is independent of factors that affect ESR
- CRP correlates better with disease activity
- CRP level rise 4 to 6 hours after tissue injury (i.e. much earlier than other acute-phase reactants)
What are ANA’s?
ANAs are autoantibodies that target specific protein antigens present in the body’s cell nuclei
What is Rheumatoid Factor? What are the most common?
- RF is a group of autoantibodies that are directed against the Fc portion of the host’s own IgG antibodies
- Most RF is IgM, hence the most commonly measured RF is IgM
- The other RFs include IgG, IgE, and IgAs
What % of RA patients are seronegative?
20%
In which people can ANA’s be detected in the serum?
Normal people
- 25-30% have a +ve test with a titre of 1:40
People with rheumatic conditions
People with auto-immune conditions
How does immunofluorescence microscopy work?
They use reagent cell nucleus and apply the patients serum sample containing ANA’s. The ANA’s bind to the antigens on the cell surface. The problem is that we cant see the ANA’s or the antigens, so they created an ANA antibody which is tagged with a fluorescent molecule attached. This then attaches to the ANA’s which are attached to the antigens. We can then view these fluorescent antibodies under the microscope.
What can large amounts of circulating cryoglobulins cause?
Bruising Rashes Joint pain Weakness Raynauds phenomenon
What does CRP test/detect?
• C-reactive protein is a test that detects the presence of inflammation due to:
– Tissue injury
– Autoimmune disease
– Infection etc
What is ESR increased in?
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- conditions causing increased serum Fibrinogen e.g. pregnancy, malignancy etc
- Inflammatory conditions e.g. tb, pneumonia, ra
- conditions with increased Plasma protein levels e.g. multiple myeloma (increased globulins)
- Age
- extensive tissue Necrosis e.g. ami, trauma
What are some non-rheumatic conditions RF is positive in?
Bacterial endocarditis Infections - Hepatitis - TB Malignancy Pulmonary disease - Sarcoidosis
In what conditions is CRP and ESR both elevated?
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- Neoplasms
- Infection
- Infarction
- Inflammatory arthritis
- Trauma
What titer of ANA’s indicates an autoimmune condition?
> 1 : 640
What is complement testing used for?
- Diagnose and monitor the activity and treatment of autoimmune diseases such as SLE and RA
- Diagnose the cause of recurrent microbial infections
- Monitor immune complex-related conditions such as glomerulonephritis, vasculitis etc
What conditions are cryoglobulins present in?
Crying is present in VAG Infections
Vasculitic conditions
Autoimmune conditions (e.g. SLE, RA)
Glomerulonephritis
Infections (e.g. cirrhosis, endocarditis)
Where is CRP synthesised? What is it released in response to?
The liver
It is released in response to cytokines such as interleukins IL-1 and IL-6.
What are the 3 main consequences of complement activation?
- opsonisation of pathogens
- recruitment of inflammatory cells
- direct killing of pathogens
What are the most widely measured acute phase reactants?
CRP and ESR
What can precipitated cryoglobulins lead to?
Thrombosis: Increased blood viscosity slows blood flow
Ischaemic necrosis: Due to small blood vessel blockage (e.g. skin ulcers, gangrene)
Vasculitis: Cryoglobulins activate the immune system leading to immune complex formation and deposition in tissues, causing inflammation, bleeding the thrombosis.
What are nuclear antigens?
Nuclear antigens (NA) are antigens that are found in the nuclei of cells
What can cause a false positive in ESR?
E can give you false positive News About HPV
- Nephrotic syndrome (loss of plasma albumin)
- Anemia (affects RBC shape, size & number)
- Hypergammaglobulinemia
- increased Plasma protein levels
- increased plasma Viscosity
What is complement?
An immunte system consisting of plasma and membrane proteins that provide innate defense against microbial pathogens
Describe what ESR is and basically how it is performed
When anticoagulated whole blood is allowed to stand, RBCs settle down under the influence of gravity
The ESR is a measure of the height that erythrocytes fall through plasma in a Wintrobe tube over a period of 1 hour (i.e. mm/h)
The ESR is rough measure of the abnormal concentrations of acute phase proteins and immunoglobulins in the serum
Who has APLA’s?
• Normal people may have transiently raised APLAs following acute medical illness and infections
• People with:
– SLE
– Antiphospholipid antibody syndrome: (A syndrome is characterised by venous thromboembolism, arterial thrombosis, or pregnancy morbidity (individually or in combination), together with antiphospholipid antibodies and lupus anticoagulant)
When is ANA testing indicated?
Ana indicates PMSSS
The ANA test is ordered when someone shows ssx consistent with a systemic autoimmune disorder such as:
- Polymyositis
- MCTD
- Scleroderma
- SLE
- Sjögren syndrome
