Immunology Test Profiles for Common Clinical Problems

Written by Craig Webster Created on Updated on .

The basic approach to clinical problems is suggested.

The medical staff of the department are happy to advise with the investigation of any problems.

 

CLINICAL PROBLEM INITIAL TESTS SUBSEQUENT TESTS
(if initial tests abnormal or clinical condition persists)

Immunodeficiency

  • (a) Recurrent upper and/or lower respiratory infections.
Serum Igs (G,A,M.) Functional antibody levels. (Tetanus, Hib, Pneumococcus).  Discuss with Immunologist.
  • (b) Failure to thrive - < 6 months 
Serum Igs (G,A,M.), lymphocyte count. Lymphocyte subsets and function tests (discuss with laboratory).
  • on weaning, with family history of atopy.
Serum Igs, IgE, Specific IgE to foods.
  • ? Coeliac disease
Transglutaminase  antibodies.


All suspected pediatric immunodeficiency should be discussed with an Immunologist.

 

1) If risk factors present, HIV antibody

2) If risk factors absent or HIV ab negative

  • (c) Opportunistic infections, whether or not known to be immunocompromised

Lymphocyte subsets (CD3, CD4, CD8)

Lymphocyte subsets and function (discuss with laboratory).

  • (d) Recurrent or persistent staphylococcal infections or abscesses.
Serum Igs (G,A,M.), neutrophil count. Neutrophil function tests (discuss with laboratory).
  • (e) Recurrent meningitis or other Neisserial infection
C3, C4, CH50/AP50 Discuss with immunologist.

Connective Tissue Diseases

  • Acute or chronic polyarthropathy
Rheumatoid Factor (RF), ANA C3, C4, ENA, DNA etc.
  • Multiple system clinical picture
RF, ANA, ANCA, Igs DNA, ENA, Ro/La, Scl70, Jo-1, C3, C4.
  • Recurrent thromboses, recurrent abortions, thrombocytopaemia. 
ANA, cardiolipin antibodies. Ro antibodies, DNA antibodies.

G. I. Tract Disorders

  • Jaundice - obstructive or recurrent hepatocellular
Igs (G.A.M.), ANA, Smooth Muscle, Mitochondrial, LKM antibodies  
  • Malabsorption, weight loss, failure to thrive (children)
Transglutaminase antibodies. (TTG)  

Renal Disease

  • Haematuria, acute nephritic syndrome.
C3, C4, ANA, ANCA, GBM Abs. DNA, PR-3, MPO Abs, C3 nephritic factor if low C3
  • Acute renal failure
C3, C4, GBM antibodies, ANA, ANCA DNA antibodies
  • Nephrotic syndrome
C3, C4. C3 nephritic factor if low C3

Bullous skin eruptions

Skin biopsy (uninvolved perilesional)
Transglutaminase abs
Epidermal antibodies (basement membrane or intercellular substance) to monitor treatment if biopsy positive.

Suspected myeloma

  • (anaemia, renal failure, spontaneous fractures, etc.)
Igs (G.A.M.)
Urine for Bence-Jones Protein
Beta-2 microglobulin.

Allergy

  • indicate clinical features and putative allergens
Total IgE
Specific IgE (RAST)
Discuss with Immunologist.

Anaphylaxis 

Tryptase
(1 - 3 hours and >24 hours after the event)
Allergy clinic referral for assessment.
Angioedema only Thyroid Abs
C3, C4, C1 inhibitor
 

Urticaria/Angioedema

 

Acute

Total IgE, C3, C4 Specific IgE if allergen implicated

Chronic

Thyroid Abs, C3, C4 Thyroid function.

 

Tags: clinical advice immunology