Turbidimetric Immunoassay for Determination of Rheumatoid Factors Quantia Rf® (Courtesy: Tulip Group of Companies)

 

Autoimmune diseases, immune complex diseases, mixed

cryoglobulinemia, serum sickness, chronic renal failure,

thrombotic thrombocytopenic purpura, neonatal respiratory

distress syndrome, genetic deficiency

Complement C4 APR, RA, SLE, rheumatic fever, ankylosing

spondylitis, temporal arteritis, acute viral hepatitis,

MI, DM, malignancies, thyroiditis, irritable bowel

syndrome, pneumonia, pregnancy

Acquired deficiencies resulting from:

Hypercatabolism: Disease in which circulating immunecomplexes

are likely to lead to acquired hypocomplementemia, subacute

bacterial endocarditis, mixed cryoglobulinemia, hereditary

angioneurotic edema, progressive glomerulonephritis

Hyposynthesis: Protein calorie malnutrition, liver disease,

Sjögren’s syndrome

Congenital deficiencies: Associated with increased frequency of

scleroderma, chronic hepatitis, autoimmune hepatitis, HenochSchönlein purpura

Lipoproteins

Apolipoprotein

A-1

Familial hyperalphalipoproteinemia, modest

alcohol intake, estrogen use, exercise, thyroid

hormones androgen use

Chronic renal failure, tangier disease, diabetes,

hypertriglyceridemia, liver diseases, familial and non-familial

hypoalphalipoproteinemia, certain drugs,

Apolipoprotein B Premature atherosclerosis, familial defective

Apo B, hyperapobetalipoproteinemia, tendon

xanthomata, hepatosplenomegaly, diabetes

mellitus, chronic renal disease, tangier disease,

hypothyroidism, nephrotic syndrome, familial

hypercholesterolemia

Familial hypobetalipoproteinemia, abetalipoproteinemia,

neuromuscular degeneration, chronic anemia, exercise, liver

disease, acute inflammation, certain drugs, neurologic disease

Lipoprotein (a) Coronary artery disease, cerebrovascular disease,

peripheral vascular disease, nephrotic syndrome,

DM (variable), cancer, gout, APR, familial

hypercholesterolemia

Cirrhosis (particularly primary biliary cirrhosis), certain drugs

(nicotinic acid, neomycin, oral estrogen), some steroids such as

stanozolol

Immunoglobulins

IgA class Polyclonal: Chronic liver disease, alcoholic and

non-alcoholic cirrhosis, chronic respiratory

infections, Gl diseases, some immunodeficiency

states, RA, ankylosing spondylitis, nephropathy

Oligoclonal: May be observed in electrophoresis

of IgA myeloma

Monoclonal: Multiple myeloma (IgA type)

Infancy and early childhood, selective IgA deficiency, proteinlosing syndromes, congenital rubella, macroglobulinemia or nonlgA multiple myeloma

IgG class Polyclonal: Autoimmune diseases, chronic

liver disease, chronic or recurrent infections,

sarcoidosis, some parasitic infections, intrauterine

contraceptive devices

Oligoclonal: Lymphoid or non-lymphoid

malignancies, various autoimmune disorders,

infections

Monoclonal: IgG myeloma, lymphoma,

Monogammopathies of unknown significance

Agammaglobulinemia, hypogammaglobulinemia, omenn’s

syndrome, X-linked hyper-IgM syndrome, nephrotic syndrome,

non-IgG myelomas, infancy, pregnancy

Contd...

Diagnostic Immunology 717

Protein Increased in Decreased in

IgM class Polyclonal: Viral infections (hepatitis

A, CMV), parasitic infections (filariasis,

malaria), chronic liver disease, hyper-IgM

dysgammaglobulinemia, collagen vascular

disease, primary biliary cirrhosis, primary

sclerosing cholangitis

Monoclonal: Waldenström’s

macroglobulinemia, malignant lymphoma,

reticulosis, cold agglutinin/hemolysin disease

Immunodeficiency states (Wiskott-Aldrich syndrome), non-IgM or

IgM myeloma, infancy and early childhood, lymphoma

IgD class IgD myeloma, chronic infections

(pyelonephritis), connective tissue disease,

Hodgkin’s disease, some forms of liver disease

Various hereditary and acquired deficiency syndromes

IgE class IgE myeloma, allergic rhinitis, atopic

dermatitis, bronchial asthma, hay fever, thymic

dysplasia, selective IgA immnodeficiency,

eosinophilic gastroenteritis, Wiskott-Aldrich

syndrome, Loeffer’s syndrome, hyper-IgE

syndrome, active SLE nephritis, certain drugs

(particularly gold compounds)

Some progressive neoplastic diseases, ataxia-telangiectasia,

hypogammaglobulinemia, hypersensitivity

CRP APR, bacterial infections, viral infections,

rheumatic fever, active RA, vascular disorders,

MI, Crohn’s disease, ulcerative colitis, renal

transplant failure, early pregnancy, intrauterine

devices, malignancies with widespread

metastases

None described

Fibrinogen APR, nephrotic syndrome, hemodialysis

patients, pregnancy, estrogen therapy,

contraceptives, acromegaly

Consumption coagulopathies, recurrent pulmonary embolism, recurrent

stroke, DIC, incompatible blood transfusion reactions, obstetrical

complications, inherited deficiency, prostatic carcinoma, liver disease,

certain drugs (e.g. tamoxifen, anabolic steroids, nicotinic acid)

Haptoglobin (Hp) APR, RA, biliary obstruction, nephritis,

ulcerative colitis, aplastic anemia.

Major depression, corticosteroid therapy,

androgen use

Ineffective erythropoiesis (sickle cell anemia, folic acid deficiency),

intravascular hemolysis, progressive tumors of liver and marrow,

severe liver disease, pregnancy, estrogen therapy, newborns

Proteinase Inhibitor

AT III APR, vitamin K deficiency Inherited deficiency, acute thrombosis, DIC, consumptive

coagulopathies, certain chemotherapeutic drugs, severe liver disease,

estrogen therapy, nephrotic syndrome, heparin therapy, some

contraceptive medications

Other Markers

Serum β2-

microglobulin

Decreased glomerular filtration,

lymphoproliferative disorders, myeloma, RA,

viral infections, anticancer drugs, newborns,

ESRD, Crohn’s disease, Sjögren’s syndrome,

dialysis related amyloidosis, certain antiinflammatory drugs

None reported

APR = acute phase reactant, RA = rheumatoid arthritis, SLE = systemic lupus erythematosus, MI = myocardial infarction, DM = diabetes

mellitus, ESRD = end-stage renal disease

Contd...

718 Concise Book of Medical Laboratory Technology: Methods and Interpretations AN EXAMPLE OF TURBIDIMETRIC IMMUNOASSAY

Turbidimetric Immunoassay for Determination of

Rheumatoid Factors Quantia Rf®

(Courtesy: Tulip Group of Companies)

Summary

In rheumatoid arthritis (RA), diagnostically useful

autoantibodies termed as rheumatoid factors (RF) can be

detected which are immunoglobulins of the class IgG, IgM,

IgA and IgE. IgM class IgA with specificity to human IgG Fc

is the most useful prognostic marker for RA.

RF play a role in perpetuating the rheumatoid inflammatory process, the severity of joint damage could be predicted

according to the strength of RF reactivity. A significant decline

of RF with the remission of disease activity has also been

demonstrated. Therefore, quantified serial determinations

of RF are more meaningful for the diagnosis, prognosis, and

assessment of therapeutic efficacy of rheumatoid arthritis.