LAB EVALUATION OF

THE IMMUNE SYSTEM

Krithika Valli.R
WHEN IS IT INDICATED?

• Infection
• Inflammation
• Immunodeficiency
• Autoimmune diseases
• Malignancies- leukemia, lymphoma
BASELINE INVESTIGATION

• Complete blood count, ( also cell counts in CSF, urine etc)

1. Total count
2. Differential counts
• Peripheral smear
• In inflammation- Erythrocyte sedimentation rate, c reactive protein
• In infection- specific antigen, antibody assays
• In allergy- IgE, skin prick tests
IN IMMUNODEFICIENCY

• Serum immunoglobulin study-

IgG, IgM, IgE, IgA
• Subtype cell counts-
. T cell, b cell counts by flow cytometry
. Cd4, Cd8 counts
. HIV testing
• Specific antibody responses/titres
• Electrophoresis- plasma, urine
IN AUTOIMMUNE DISEASE

• Autoantibodies:
1. Rheumatoid factor
2. Anti citrullinated peptide antibodies
3. Antinuclear antibodies
4. Antiphospholipid, antiNeutrophil cytoplasmic antibodies
• Complement levels- c3,c4
IN MALIGNANCIES

• Complete blood counts

• Peripheral smear
• Bone marrow examination
• Immunophenotyping, immunohistochemistry
• Flow cytometry for specific subtypes of cells, antibodies.
NORMAL VALUES

• Total counts- 4000- 11000 cells/mL

• Erythrocyte sedimentation rate- males 0-10mm/Hr, females 3-15mm/Hr

• C Reactive protein- <3mg/l
TOTAL COUNT

LEUCOCYTOSIS( >12000 CELLS/ML) LEUCOPENIA (<4000 CELLS/ML)

• Infection • Reduction in all cells- pancytopenia, bone
marrow infiltration
• Inflammation
• Reduction in particular cell lines-
• Stress/trauma
infections
• Malignancies
NEUTROPHILS

NEUTROPHILIA (>75%) NEUTROPENIA

• Physiological- exercise, stress, pregnancy
• Acute infections- mostly bacterial
• Trauma, burns, surgery
• Tissue necrosis- MI, Pulmonary embolism,
malignancy, infarct
• Inflammation- RA, gout, Crohn’s, ulcerative colitis
• Drugs- steroids,
• Infection- Typhoid, paratyphoid, viral influenza
• HIV/AIDS
• Bone marrow depression- drugs, chemicals,
Radiation
• Autoimmune connective tissue disorders
• Bone marrow infiltration- leukaemia,
myelodysplasia
LYMPHOCYTES

LYMPHOCYTOSIS LYMPHOCYTOPENIA
• Infants and young children- relative • Steroids
lymphocytosis • HIV
• Viral infections- pertussis,chicken pox • Autoimmune disease
• Chronic infections- tuberculosis, • Bone marrow suppression
hepatitis
• Leukemia(CLL), lymphoma
 BASOPHILIA

• Viral infections

• Inflammation- acute
hypersensitivity, ulcerative colitis,
crohn’s • EOSINOPHILIA
• polycythemia, CML
• Allergy- bronchial asthma, urticaria
• Iron deficiency
• Parasitic infections
MONOCYTOSIS • Vasculitis
• Infection- Tuberculosis, Infectious • AML, myeloproliferative disorders
mononucleosis, malaria, Kala azar

• Inflammation- ulcerative colitis,

Crohn’s disease

• Malignancy- solid tumours, CML

PERIPHERAL SMEAR APPEARANCE
ESR
• Indirect measure of inflammation
• Elevation caused by raised plasma
proteins-immunoglobulins, acute phase
reactants
• Raised in infections( tuberculosis,
abscesses, endocarditis) autoimmune
disease( SLE, Sjogren's) multiple myeloma
CRP
• Acute phase reactant synthesized by
liver
• Raised within 6 hours of inflammatory
stimulus, short half life
• In acute bacterial, fungal infections,
necrotising bacterial infections.
IMMUNOGLOBULINS
MONOCLONAL INCREASE
• Multiple myeloma
• CLL, Lymphoma
• POLYCLONAL INCREASE
• Amyloidosis
• Acute, chronic infections
• Monoclonal gammapathy of
unknown significance • Neonatal infections- syphilis, toxoplasmosis, rubella
• Autoimmune diseases- rheumatoid arthritis, SLE,
DECREASE
scleroderma
• Drugs, Diabetes, Chronic renal
failure • Hepatitis, cirrhosis
• Nephrotic syndrome, protein • Chronic inflammation
losing enteropathy, burns

• Inherited immune deficiencies

THANK
YOU