IMMUNOLOGY, SEROLOGY AND and not to an antigen with dissimilar

determinants.
IMMUNOHEMATOLOGY
Immunoglobulins are glycoprotein substances secreted by
Immunology antigen-stimulated B cells. All classes of immunoglobulins
share the same basic structure: two heavy chains and two
•Study of host’s reaction when foreign light chains joined by varying numbers of disulfide bonds.
antigens are introduced to the body Heavy chains determine the isotype, or class, of
•Study body defenses, ag and abs, immunoglobulin. There are five immunoglobulin classes:
IgA, IgD, IgE, IgG, and IgM. Each molecule of
hypersensitivity immunoglobulin has either two kappa light chains or two
lambda light chains.
Antigen is a substance that stimulates antibody formation 1. IgA exists as a monomer in serum and as a dimer
and has the ability to bind to an antibody. in body secretions. It is the predominant
immunoglobulin in secretions such as tears,
Hapten is a low-molecular-weight, nonantigenic substance saliva, sweat, breast milk, and respiratory tract,
that, when combined with an antigen, changes the genital, and intestinal secretions. IgA binds
antigenic specificity of that antigen. antigens and prevents their adherence to
mucous membranes to keep them from invading
Antibody is a glycoprotein substance (immunoglobulin) the body. It also confers immunity from mother
that is produced by B lymphocytes in response to an to infant through breast milk. The normal range
antigen. for serum IgA is 77 to 400 mg/dL.
2. IgD exists as a monomer, and its function is
1. Antibodies may be monoclonal or polyclonal. unknown. Normal serum values of IgD are 3 to 5
Monoclonal antibodies are derived from a single mg/dL.
B-cell clone and are produced as a single class of 3. IgE exists in serum as a monomer. It binds to
immunoglobulin with specificity unique to the crystallizable fragment (Fc) receptors on mast
antigenic stimulus. cells and basophils and is elevated during
2. Polyclonal antibodies are produced as different parasitic infections and Type I allergic reactions.
classes of immunoglobulins by many B-cell Normal serum values for IgE are 17 to 450
clones in response to an antigen. mg/dL.
3. Antibodies produced in response to antigens 4. IgG is the predominant immunoglobulin in the
from another species are called adult. There are four subclasses of IgG: IgG1,
heteroantibodies or xenoantibodies. IgG2, IgG3, and IgG4. IgG binds complement, has
4. Alloantibodies are formed in response to roles in opsonization and antibody-dependent
antigens from individuals of the same species. cellular cytotoxicity (ADCC), and neutralizes
5. Autoantibodies are produced by the body’s toxins. It is also the only immunoglobulin that
immune system against “self” antigens. They crosses the placental barrier, thus transferring
function by facilitating phagocytosis and immunity from mother to infant. IgG precipitates
microbial killing and by neutralizing toxic and agglutinates in vitro. Normal serum values
substances. They also combine with antigens on for IgG are 591 to 1,965 mg/dL.
cell surfaces, which results in either intravascular 5. IgM is the largest of the immunoglobulins,
or extravascular destruction of the target cells. existing as a pentamer. It binds complement,
neutralizes toxins, and agglutinates antigens in
Antigen-antibody reactions vitro. IgM is the first immunoglobulin to be
1. An epitope is the part of an antigen that reacts produced after exposure to an antigen. Normal
specifically with an antibody or T-cell serum values are 50 to 311 mg/dL.
Receptor.
2. Agglutination is the clumping of particulate The complement system is a group of proteins
antigens by antibodies specific for the antigens. synthesized in mononuclear phagocytes, hepatocytes,
3. Affinity is the tendency that an epitope has for fibroblasts, and some endothelial cells.
combining with the antigen-binding site on an a. Complement proteins are involved in the
antibody molecule. disruption of microbial cell walls, inflammation
4. Avidity is the strength of the bond between the mediation, regulation of phagocytic activity, and
antigen and the antibody. the metabolism of immune complexes.
5. Sensitivity is the smallest amount of antigen or Complement can be activated through either the
antibody that can be detected. classic pathway, the alternate pathway, or the
6. Specificity is the ability of an antibody to bind to mannan-binding lectin (MBL) pathway.
an antigen with complementary determinants

NEIL JOHN L. ORINEO, RMT

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 a. The classic pathway requires IgG or IgM for Resulting channels allow water to enter the cell
activation. Lysis occurs
b. The alternate pathway does not require specific
antibody for activation but is instead triggered CELLS AND TISSUES OF THE IMMUNE SYSTEM
by polysaccharides and lipopolysaccharides on
the surfaces of certain target cells. Many surface antigens or surface markers have been
c. The mannan-binding lectin (MBL) pathway is identified that help to characterize these cells according to
activated by binding of mannan binding lectin their function. These markers are referred to as clusters of
(MBL) to mannose-containing residues of differentiation (CD). An international nomenclature
glycoproteins on certain microorganisms. MBL- system has been developed to standardize the CD
associated serine protease (MASP) binds to MBL, numbers:
which leads to activation of components C2, C4, Clusters of Differentiation (CD)
and C3. This pathway is very similar to the CD Leukocytes
classical pathway except that it differs in the CD2 T lymphocytes
initial recognition and activation steps. CD4 T lymphocytes
d. Anaphylotoxins are the small fragments (C3a, CD8 T lymphocytes
C4a, C5a), which attract and activate different CD10 Pre-B lymphocytes, common ALL
types of leukocytes. Anaphylotoxins increase CD12 Monocytes, granulocytes, platelets
vascular permeability, can cause contraction of CD15 Granulocytes
smooth muscle, induce the release of histamine CD19 B lymphocytes
from basophils and mast cells, and draw in CD24 B lymphocytes, granulocytes
additional cells to the site of infection to help CD27 T lymphocytes, plasma cells
eliminate the microbes. C5a is the most potent, CD33 Myeloid leukemia
followed by C3a and C4a. CD34 Hematopoietic stem cells
b. Membrane attack complex. Although these two CD39 B lymphocytes, macrophages
pathways are separate and function CD41a Glycoprotein IIb/IIIa
independently, they converge at the C5 reaction, CD45 Leukocytes
and the reactions from C5 to C9 are common to CD47 Leukocytes, platelets
both pathways. These last components compose CD68 Macrophages
the common pathway and are also called the CD69 Activated Lymphocytes
membrane attack complex. The C567 complex CDw70 Reed-Sternberg cells
acts on C8 and C9. As C8 and C9 are inserted into CD77 Activated B cells
the cell membrane, the resulting lesions allow ALL = acute lymphocytic leukemia.
the rapid passage of ions, and the cell lyses from
osmotic pressure changes. T lymphocytes are derived from cells in the bone marrow.
This subset of lymphocytes migrates to the thymus, where
Classic Pathway of Complement Activation they mature and acquire and express certain surface
Activation of C1 antigens. T lymphocytes are responsible for cell-mediated
C1 is activated by IgG or IgM immune responses. They exist in several subpopulations
Activation of C4 with specific functions.
C4 is activated by C1s a. T helper cells (TH) are CD4 positive and produce
Activation of C2 the lymphokines interleukin-2 (IL-2), interleukin-
C1s interacts with C4 to cleave C2 3 (IL-3), granulocyte-monocyte colony-
C2 combines with C4 to form C42 complex (C3 stimulating factor (GM-CSF), and gamma
convertase) interferon (IFN-γ). They aid in B-cell
Activation of C3 differentiation, and they stimulate other T-cell
C3 is activated by C42, resulting in C3a and C3b populations.
C3b combines with C42 to form C423 (C5 b. T suppressor cells (Ts) are CD8 positive and
convertase) produce factors that inhibit the action of other T
cells.
Membrane attack complex c. Cytotoxic T cells (Tc) are CD8 positive. They
Activation of C5, C6, and C7 secrete lymphotoxins and release perforins,
C5 convertase splits C5 into C5a and C5b which destroy cells recognized as foreign.
C5b binds to C6 and C7, forming C567 complex d. Delayed-type hypersensitivity T cells (TDTH) are
on the cell membrane CD4 positive. They secrete macrophage
Activation of C8 and C9 chemotaxin and macrophage migration
C8 and C9 are acted on by C567 and insert inhibition factor (MIF).
themselves into the cell membrane

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Several mitogenic substances have been found to 1. Primary granules contain
stimulate T cells and, thus, can be used in laboratory myeloperoxidase (MPO) and
evaluation of T-cell function, including: lysozyme, which are important
a. Concanavalin A (ConA) bactericidal agents.
b. Phytohemagglutinin A (PHA) 2. Secondary granules also contain
c. Pokeweed mitogen (PWM) lysozyme. Neutrophils have
chemotactic receptors, which allow
B lymphocytes secretes immunoglobulin. These cells them to respond to chemotaxins
develop in the bone marrow in adults and are later produced at sites of inflammation.
localized also in the spleen and lymph nodes. There are a. Chemotaxins commonly involved in
several identifiable stages of B-cell maturation. this process include the C5a
a. Both T and B stem cells have terminal component of complement, formyl
deoxynucleotidyl transferase (TdT). Stem B cells peptides found in bacteria, and
also have immune response (Ir) gene products, arachidonic acid metabolites released
which are major histocompatibility complex from damaged cell membranes.
(MHC) proteins. b. The ingestion of bacteria and other
b. The pre-B cell is characterized by foreign particles by these cells is
immunoglobulin gene rearrangement and the enhanced if the particles are coated
appearance of heavy chains in the cell’s with immunoglobulin or the C3b
cytoplasm. component of complement
c. In the immature B cell, light chain genes are (opsonization).
rearranged, and the light chains appear in the
cell’s cytoplasm. Coupled with the heavy chains, As circulating monocytes respond to chemotaxins, they
the light chains form IgM, which is confined to leave the circulation and enter the tissues, where they are
the cell surface (sIgM). converted to macrophages. These cells are important in
antigen processing and antigen presentation.
B cells also respond to a variety of other mitogens a. Surface receptors. Macrophages have several
including: different surface receptors, including the
a. Lipopolysaccharides found on the cell surface of integrin Mac 1-CR3, which binds the C3b
gram-negative bacteria component of complement; Fc receptors, which
b. Protein A found on the surface of Staphylococcus bind immunoglobulin; CR1, which binds C3b and
aureus C4b; and Class II MHC receptors.
c. PHA b. Secreted products. Macrophages secrete
d. PWM products that assist in the immune response.
e. Phorbol myristate 1. Interleukin 1 (IL-1) stimulates T-cell
f. Anti-IgM antibody growth.
2. Interleukin 6 (IL-6) stimulates B cells.
Non-T, non-B lymphocytes have neither T-cell nor B cell 3. Tumor necrosis factor (TNFα) has
markers and have been classified as killer cells (K), natural antitumor and antibacterial activity
killer cells (NK), and lymphokine-activated killer cells and stimulates production of IL-1 and
(LAK). It is unclear as to whether they represent separate interferon.
populations or are the same cells with different functions. 4. Endothelial leukocyte adhesion
1. K cells express surface immunoglobulin molecule (ELAM-1) plays a role in
receptors and lyse target cells by ADCC. diapedesis (migration of cells into
2. NK cells play a role in tumor host defense tissues from the circulation).
because they have the ability to recognize and
destroy tumor cells. E. Other cells involved in antigen presentation are:
3. LAK cells use IL-2 to help lyse tumor cells. 1. Dendritic cells
2. Langerhans cells
Phagocytes play a major role in the immune system. 3. B lymphocytes
Polymorphonuclear leukocytes (PMNs) include F. Lymphoid tissues are found throughout the entire
eosinophils, basophils, and neutrophils. body.
a. Eosinophil granules contain antimicrobial agents. 1. Distribution
b. Basophil granules contain histamine and a. Spleen
heparin, which play a role in anaphylactic b. Thymus
reactions. c. Thoracic duct
c. The two major populations of neutrophil d. Lymph nodes
granules are primary and secondary granules. e. Bone marrow

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 f. Peyer’s patches made later, the majority of immunoglobulin
g. Tonsils produced during a primary response is IgM.
h. Appendix 3. The secondary response. A second or any
2. Concentration. Although both T and B subsequent exposure to the same antigen elicits
lymphocytes can be found in all lymphoid a secondary response. This time, there is a rapid
tissues, the highest concentration of T cells is antibody response, usually within 2 to 4 days
found in the thymus. The highest concentration after antigen exposure. IgG is the predominant
of B cells is found in the bone marrow. immunoglobulin. The circulating antibody titer is
much higher and lasts longer than that seen in
IMMUNITY the primary response.

A. Natural immunity is present at birth and provides B. Cell-mediated immunity is especially important in viral
protection against disease and aids in recovery from and fungal infections and in infections caused by acid-fast
disease. However, it also provides the basis for organ bacilli (e.g., tuberculosis, Hansen’s disease).
rejection after transplantation. Factors involved in natural 1. Macrophages, Tc, and NK cells play a role in cell-
immunity include: mediated immunity
1. Physical barriers, such as skin and mucous 2. ADCC. Cells with cytolytic activity and Fc
membranes receptors, especially NK cells, are able to directly
2. Genetically controlled susceptibility and lyse antibody-coated (usually IgG) target cells.
nonsusceptibility to certain diseases 3. Cytokines are protein messengers produced by
3. Inflammation, which involves a vascular cells. Many play a role in cell-mediated
response and a cellular response by phagocytic immunity.
cells a. Lymphokines are produced primarily by activated T
4. Acute-phase plasma proteins, such as C-reactive lymphocytes and include:
protein, haptoglobin, and fibrinogen, which are 1. IL-2
produced in response to injury and aid in wound 2. IL-3
healing 3. IL-4
B. Acquired or specific immunity results when 4. GM-CSF
immunologic memory and antibody specific to a foreign 5. B-cell growth factor 2
antigen develop in response to the antigen. Acquired 6. Macrophage activating factor
immunity may be active (through immunization or disease) 7. MIF
or passive (through transplacental transfer). This type of 8. IFN-γ
immunity involves both cell-mediated and humoral b. Monokines are produced by monocytes and include:
immune responses. 1. IL-1
2. TNFα
IMMUNE RESPONSE. The Immune Response may be
roughly divided into two components, cell-mediated and MAJOR HISTOCOMPATIBILITY COMPLEX
humoral. Although most immune response contain
elements of both, certain antigens elicit a strong humoral A. In transplantation studies, MHC gene products were
response with little cell-mediated involvement, and other identified as responsible for graft rejection. Likewise,
antigens elicit primarily a cell-mediated response. studies on responses to antigens, demonstrated that MHC
gene products were found to control immune responses. It
A. Humoral immunity involves immunoglobulin (antibody) was determined that antigen-specific T cells recognize
production by B lymphocytes. Complement can also be portions of protein antigens that are bound noncovalently
considered a humoral component because it can be to MHC gene products.
activated by immunoglobulin. The humoral response B. The Major histocompatibility complex is found on
occurs in three phases: human chromosome 6.
1. Antigen elimination. This phase is accomplished 1. Have a role in intercellular recognition and
by phagocytosis. Most injected antigen is discrimination of self/nonself.
removed within minutes, but complete removal 2. Have a role in development of humoral and cell-
may take months or years. mediated immune responses.
2. The primary response. After exposure to an 3. One’s set of MHC genes influences the
antigen, there is a latent period of approximately repertoire of antigens to which that person’s TH
5 to 15 days before antibody appears in the and TC cells can respond, therefore, one’s MHC
serum. The antibody titer increases, plateaus, plays a role in susceptibility to disease and
then decreases. IgM is the first immunoglobulin autoimmunity.
to appear. Although a small amount of IgG is C. Organization of MHC

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 1. Class I MHC are glycoproteins found on most a. Complement components C2, C4a, C4b, and
nucleated cells. Class I molecules present factor B
antigenic peptides to the TC. b. Steroid enzymes 21-hydroxylase enzyme A
2. Class II MHC are glycoproteins found on antigen and 21-hydroxylase enzyme B
presenting cells (APC). c. Inflammatory proteins TNF-α and TNF-β.
3. Class III MHC consists of secreted proteins with d. Heat shock proteins such as HSP70.
immune function. e. These are not related structurally to the
4. Inheritance MHC-I and MHC-II molecules.
a. MHC alleles are inherited as two sets. f. They have no role in antigen presentation.
One set from each parent. g. They do play a role in the immune
b. One set is the haplotype. response.
c. A heterozygous human inherits one
paternal and one maternal haplotype, E. Diversity of the human MHC locus
each containing three Class-I (B, C and 1. Class I MHC–known alleles; 60A × 110B × 40C =
A) and three Class II (DP, DQ and DR) 2.6 × 105
loci 2. Class II MHC–known alleles; 4DP × 6DQ × 488 DR
d. A heterozygous individual will inherit a = 1.2 × 104
maximum of six Class I specificities. 3. Total possible combination; (2.6 × 105)(1.2 ×
e. Similarly, the individual will also inherit 104) = 3.12 × 109
DP and DQ genes and express both
parental antigens. F. Clinical significance of HLA
D. Function and characteristics of MHC 1. Organ transplant & bone marrow transplant will
1. Class I MHC: have an increased survival rate of the patient
a. Class I molecules are found on virtually all and a decreased risk of graft vs. host disease if
body tissue cells. HLA and MHC matching between donor and
b. Platelets express primarily Class I HLA-A and recipient is done.
HLA-B antigens. 2. Platelet transfusion matching between donor
c. Specific for antigens of 8 to 10 amino acid and recipient is useful to patients who are
peptide length retractile to random donor platelets
d. Peptide Interactions: 3. HLA compatibility exerts the strongest influence
1. Presentation of peptides to CD8+ T on long-term kidney survival after a transplant.
cells 4. HLA identical donors for bone marrow
2. Endogenous intracellular proteins transplantation to reduce the frequency of graft
digested to peptides in cytosol of cell vs. host disease.
3. Transported to endoplasmic reticulum 5. Paternity testing for exclusion or nonexclusion.
where peptides are associated with 6. Disease association
Class I MHC a. Association between HLA phenotype and
4. Peptides of suitable length (∼8–18 some diseases
amino acids) are specifically b. HLA-B27 is found in >90% of patients with
transported across the ER membrane. ankylosing spondylitis, but in only ∼10%
2. Class II MHC: normal individuals.
a. Class II molecules are found on B G. HLA Testing
lymphocytes, activated T lymphocytes, 1. A heterozygous human inherits one paternal
monocytes, macrophages, dendritic cells, and one maternal haplotype, each containing
early hematopoietic cells, and some tumor three Class I (B, C and A) and three Class II (DP,
cells. DQ and DR) loci.
b. Peptide interactions: 2. A heterozygous individual will inherit a
1. Class II molecules present maximum of six Class I specificities.
peptides to CD4+ T cells. 3. Similarly, the individual will also inherit DP and
2. Peptides are exogenous in origin DQ genes and express both parental antigens.
and processed through the 4. The Class II MHC molecule consists of two chains
endocytic pathway. (α and β), with some antigenic determinants
3. Peptide interactions are (specificities) on each chain.
membrane bound proteins. a. DR α- and β-chains can associate in
4. Specific for antigens of 13 to 18 ether cis (both from the same parent)
amino acid peptide length or trans (one from each parent)
3. Class III MHC molecules consist of secreted combinations, an individual can have
proteins with immune function. additional DR specificities.

NEIL JOHN L. ORINEO, RMT

2
 b. Also, there is more than one functional 3. Immune thrombocytopenia
DR β-chain gene. Hence, many DR 4. Certain drug allergies
specificities can be found in any one C. Type III reactions are immune complex
individual. reactions. IgG and IgM antibodies form soluble
5. Amicrocytotoxicity test demonstrates that if the immune complexes with antigens. These
antigen is present on the lymphocytes, addition complexes may be deposited in extravascular
of complement will cause them to become tissues, which results in infiltration by
porous and unable to exclude the added dye. neutrophils and local tissue damage.
6. Mixed-lymphocyte reaction (MLR) can be used Complement is also activated and contributes
to quantify the degree of class II MHC to the inflammatory response. Examples
compatibility between potential donors and a include:
recipient. 1. Immune glomerulonephritis
2. Serum sickness
HYPERSENSITIVITY is an enhanced immune reaction to an 3. Arthus reaction
antigen. These immune reactions are classified into four
different types, depending on their pathophysiology. Types D. Type IV reactions are delayed-type
I, II, and III are humoral (i.e., antibody mediated), and type hypersensitivity reactions. CD4-positive T
IV hypersensitivity reactions are cell-mediated. lymphocytes react with the foreign antigen
and release lymphokines, some of which are
Type Mechanism Example chemo attractants that attract PMNs,
I Immediate-type Urticaria monocytes, and macrophages. These cells
Hay fever release substances such as proteases,
Bronchial asthma collagenases, cathepsins, and TNF, which
II Cytotoxic HTR mediate inflammation. Examples include:
HDN 1. Tuberculin skin test
ITP 2. Contact dermatitis
Some drug allergies
III Immune complex Immune glomerulonephritis AUTOIMMUNITY
Serum sickness
Arthus reaction AUTOIMMUNITY is an expression of the immune response
IV Delayed-type Tuberculin skin test that occurs when the body’s self-tolerance system fails.
Contact dermatitis The body’s immune cells are no longer able to recognize
ITP = immune thrombocytopenic purpura; HDN = “self” and thus mount an immune response against its
hemolytic disease of the newborn; HTP = hemolytic own antigens. This can result in a variety of apparently
transfusion reactions. unrelated diseases known as autoimmune diseases.
However, all autoimmune diseases involve immune
A. Type I reactions are immediate-type complexes. The autoimmune response is strongly
hypersensitivities that can range from mild influenced by MHC antigens and can involve either Class I
food allergies to anaphylactic shock. Antigens or Class II MHC proteins. Many autoimmune diseases are
complex with IgE and attach to basophils or associated with specific Class II human leukocyte antigens
tissue mast cells, which results in the release of (HLA) and determining an individual’s HLA type can help
histamines and the synthesis of leukotrienes predict the risk of certain diseases.
C4, D4, and E4. Although Type I reactions can A. Mechanisms. Autoantibodies form in response to many
be systemic, most are localized. Examples different immunogenic stimuli. The autoimmune response
include: may be triggered by:
1. Urticaria (hives) 1. Sequestered antigens, which do not normally
2. Hay fever circulate in the blood and, as a result, fail to
3. Bronchial asthma establish immunogenic tolerance
4. Food allergies 2. Foreign antigens, which may cross-react with
B. Type II reactions are cytotoxic responses. In self-antigens
these reactions, complement-fixing IgG or IgM 3. Altered antigens, which become denatured or
antibodies are directed against cellular or mutated because of physical, chemical, or
tissue antigens such as those found on the biologic changes
surface of white blood cells (WBCs) and 4. Mutation of immunocompetent cells, which
platelets. Examples include: may become responsive to self-antigens
1. Hemolytic transfusion reactions (HTR) 5. Dysfunction of T cells, which may lose their
2. Hemolytic disease of the newborn ability to regulate the immune response
(HDN)

NEIL JOHN L. ORINEO, RMT

2
B. Autoimmune diseases may be organ-specific or (b) Symptoms. More than half of SLE patients develop a
systemic characteristics rash
Organ-specific autoimmune diseases. Virtually any organ or other skin abnormalities during the course of the
system can be affected by autoimmune diseases. Examples disease. Other common
include: symptoms include myocarditis, lymphadenopathy,
a. Hematologic disorders glomerulonephritis,
1. Paroxysmal cold hemoglobinuria and serositis.
2. Warm autoimmune hemolytic anemias (c) Causes. SLE may be idiopathic or drug induced. Drugs,
(AIHAs) such as procainamide,
3. Immune thrombocytopenia purpura phenytoin, methyldopa, penicillin, and sulfonamides,
(ITP) may
b. Endocrine disorders cause a lupus-like syndrome. ANA are present and may
1. Graves’ diseases persist for months
2. Hashimoto’s thyroiditis after the drug has been discontinued.
3. Insulin-dependent diabetes mellitus (2) Pathophysiology. Antibodies to native or altered self-
c. Neuromuscular disorders antigens are produced
1. Myasthenia gravis and form circulating immune complexes with the antigens.
2. Multiple sclerosis Typically, the antigens
d. Renal disorders involved are nuclear antigens, especially deoxyribonucleic
1. Goodpasture’s syndrome acid (DNA).
2. Tubulo-interstitial nephritis These complexes are deposited in various organs and
e. Gastrointestinal disorders cause inflammation,
1. Pernicious anemia which eventually results in tissue injury.
2. Primary biliary cirrhosis (3) ANA are autoantibodies that react with the body’s
Systemic diseases are characterized by widespread nuclear proteins, DNA, or
involvement. Autoantibodies are not confined to any one histones. In general, they are neither organ-specific nor
specific organ. Examples include: species-specific, and

Rheumatoid arthritis (RA)

1. General considerations. RA is characterized by
the presence of abnormal circulating IgM
autoantibodies known collectively as rheumatoid
factor (RF). These antibodies react specifically
with the Fc portion of IgG molecules. RF may
also be seen in patients with chronic hepatitis,
systemic lupus erythematosus (SLE), syphilis,
hypogammaglobulinemia, or
hypergammaglobulinemia.
2. Testing. There are a variety of tests for RF,
including:
a. Latex fixation
b. Latex agglutination (commonly used
test; considered positive for RF if the
titer is at least 20)
c. Sheep red cell agglutination
d. Quantitation of IgM RF
Polymyositis
(1)Polymyositis is characterized by inflammation and
degeneration of skeletal muscle.
(2) Autoantibodies. Antinuclear antibodies (ANA), RF, and
anti-Jo-1 antibodies are present.
c. SLE
(1) Description. SLE is a systemic rheumatic disorder that
is characterized by the presence of circulating immune
complexes.
(a) Epidemiology. It is most commonly seen in women and
persons of African
descent.

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