Quality and Managerial Issues

Introduction Structure of the NHS and the NHS plan Clinical Pathology Accreditation (CPA) Medicines and Healthcare Products Regulatory Authority (MHRA) Quality management system (QMS) Concepts of quality assurance in the laboratory Quality control (internal) Quality control (external) 1: EQA schemes Quality control (external) 2: benchmarking and CE marking...

Cellular investigations

Introduction Flow cytometry Tissue culture Proliferation assays Immunohistology Cytokine, chemokine, soluble protein assays Apoptosis assays Adhesion markers Bronchoalveolar lavage (BAL) studies CD40 ligand expression Complement membrane regulatory factors Cytokine and cytokine receptor measurement Cytotoxic T cells FOXP3 (regulatory T cells—IPEX syndrome) Genetic and protein studies...

Autoantibodies

Introduction Techniques: overview Particle agglutination assays Immunoprecipitation assays Indirect immunofluorescence Direct immunofluorescence Radio-immunoassay (RIA) Enzyme-linked (EIA) and fluorescent immunoassays (FIA) Immunoblotting Acetylcholine-receptor antibodies (AChRAb) Actin antibodies Adrenal cortex autoantibodies Amphiphysin antibodies Anti-nuclear antibodies (ANA) and ANCA Aquaporin antibodies Auerbach’s plexus antibodies β‎2-GPI antibodies C1q antibodies...

Autoimmunity associated with cardiac, respiratory, and renal disease

Cardiac disease 1: myocarditis and cardiomyopathy Cardiac disease 2: eosinophilic syndromes Cardiac disease 3: recurrent pericarditis and Dressler’s syndrome Cardiac disease 4: rheumatic fever Respiratory disease 1: idiopathic pulmonary fibrosis (cryptogenic fibrosing alveolitis) Respiratory disease 2: pulmonary alveolar proteinosis (PAP) Respiratory disease 3: lymphoid interstitial pneumonitis and sarcoidosis...

Allergy tests

Introduction Allergen-specific IgE Allergen-specific IgG antibodies Basophil activation test CD23, soluble (Fcε‎ receptor) C3a, C4a, and C5a (anaphylotoxins) Challenge tests Drug allergy testing Eosinophil cationic protein (ECP) Eosinophil count Flow-CAST® and CAST-ELISA® Histamine-release assays Immunoglobulin E (total IgE) IgE autoantibodies/IgE receptor antibodies...

Autoimmunity and the endocrine system

Classification of autoimmune thyroid disease Graves’ disease Hashimoto’s thyroiditis Subacute thyroiditis syndromes Primary hypothyroidism and sporadic goitre Thyroid disease and other symptoms Classification of diabetes mellitus Type I diabetes (insulin-dependent) Immunological complications of insulin therapy Crow–Fukase syndrome (POEMS syndrome; Takatsuki syndrome) Classification of adrenal insufficiency...

Transplantation

Stem cell transplantation (HSCT) 1: clinical indications and types of HSCT HSCT 2: conditioning and matching HSCT 3: post-transplant monitoring HSCT 4: immunological reconstitution HSCT 5: immunization post-transplant and results Gene therapy Graft-versus-host disease (GvHD) Acute GvHD (aGvHD) Chronic GvHD (cGvHD) Graft-versus-tumour (GvT) effect Graft failure...

Connective tissue disease

Rheumatoid arthritis: aetiology, clinical features, and immunopathology Rheumatoid arthritis: immunological tests, treatment, and childhood RhA Juvenile chronic arthritis (JCA) and Still’s disease Adult Still’s disease Ankylosing spondylitis (AS) and related spondyloarthropathies SAPHO syndrome Psoriatic arthritis Reactive arthritis (including Reiter’s syndrome) Systemic lupus erythematosus (SLE) and variants...

Autoimmunity in gastrointestinal disease

Autoimmune enteropathy Achalasia Eosinophilic gastroenteritis (including oesophagitis) Crohn’s disease Ulcerative colitis (UC) Whipple’s disease Coeliac disease Sclerosing mesenteritis Autoimmune pancreatitis Irritable bowel syndrome (IBS) Autoantibodies against gut enterocytes have been associated with: • Coeliac-like enteropathy (DQ2 positive), unresponsive to gluten-free diet, with villous atrophy. •...

Autoimmunity of the nervous system

Myasthenia gravis (MG) Lambert–Eaton myasthenic syndrome (LEMS) Acquired neuromyotonia (Isaac’s disease) and stiff person syndrome (SPS) Morvan’s syndrome Rasmussen encephalitis PANDAS Paraneoplastic autoimmune neurological syndromes Demyelinating diseases 1: multiple sclerosis (MS) Demyelinating diseases 2: Guillain–Barré syndrome (GBS) and variants Demyelinating diseases 3: chronic inflammatory demyelinating polyneuropathy (CIDP), related conditions, and Devic’s syndrome (neuromyelitis optica)...