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Immunology

Interpret antibody, antigen, and cell-based results in infection, autoimmunity, allergy, immune deficiency, and transplantation in light of the method used.

Steps

  1. Innate and adaptive immunity15 min
    4 skills
    • Tell innate from adaptive immune cells by their receptors and memory
    • Name where lymphocytes develop and where they first meet antigen
    • Match MHC class I and class II presentation to the CD8 or CD4 T cell they activate
    • Explain how a secondary antibody response differs from a primary response
  2. Antibody structure and classes13 min
    3 skills
    • Match Fab and Fc fragments to antigen binding and effector function
    • Match an immunoglobulin class to its distribution and immune function
    • Distinguish single-site affinity from total binding avidity
  3. Lattices, prozone and agglutination16 min
    3 skills
    • Recognize antibody excess as a cause of weak agglutination
    • Recognize antigen excess as a cause of a falsely low immunoassay result
    • Read direct and inhibition agglutination using the assay's controls

    At the bench Review immunoassay controls and recognize an unreliable run

  4. Complement16 min
    4 skills
    • Distinguish classical, lectin, and alternative complement initiation
    • Match a complement fragment to its principal immune effect
    • Interpret paired CH50 and AH50 results to locate a complement defect
    • Check that a CH50 or AH50 specimen was separated and frozen promptly before accepting it

    At the bench Check specimen identity and suitability before analysis

  5. Labeled immunoassays and immunofluorescence15 min
    3 skills
    • Predict labeled-assay signal direction from the binding format
    • Distinguish direct from indirect immunofluorescence by the labeled reagent
    • Distinguish cytokine concentration from counts of cytokine-secreting cells

    At the bench Review immunoassay controls and recognize an unreliable run

  6. Tolerance, ANA and systemic autoimmunity16 min
    3 skills
    • Distinguish central from peripheral mechanisms of self-tolerance
    • Interpret an ANA pattern and titer without assigning an unmeasured specificity
    • Match systemic autoantibodies such as ANA, anti-dsDNA, and anti-Sm to their diseases

    At the bench Interpret an autoantibody pattern with its confirmation results

  7. Thyroid, rheumatoid and organ-specific autoantibodies15 min
    3 skills
    • Choose the antibody tests that fit a suspected organ-specific disease
    • Tell thyroid antibody results from thyroid function, and TRAb binding from stimulation
    • Tell a nonspecific rheumatoid factor result from a more specific anti-CCP result

    At the bench Interpret an autoantibody pattern with its confirmation results

  8. Hypersensitivity and allergy testing15 min
    3 skills
    • Classify a hypersensitivity reaction by its main effector mechanism
    • Distinguish allergen sensitization from clinical allergy
    • Compare an acute tryptase with the patient's own baseline
  9. Plasma cell disorders, cryoglobulins and tumor immunity16 min
    3 skills
    • Tell MGUS from myeloma by M protein, marrow plasma cells, and myeloma-defining events
    • Reject a cryoglobulin specimen that was not kept warm until separation
    • Predict how tumor-antigen or HLA class I loss changes T-cell and NK-cell attack

    At the bench Check specimen identity and suitability before analysis

  10. Immunodeficiency16 min
    3 skills
    • Choose first tests for a suspected antibody, T-cell, or phagocyte deficiency
    • Recognize when low immunoglobulins or lymphocytes need tests for an inherited deficiency
    • Send a low TREC newborn screen for lymphocyte subsets and confirmatory testing
  11. HLA typing and crossmatching17 min
    4 skills
    • Calculate sibling HLA-haplotype sharing probabilities
    • Distinguish recipient attack on a graft from graft-versus-host injury
    • Report HLA typing only to the allele resolution the typing method reached
    • Tell single-antigen bead HLA antibody results from a donor-cell crossmatch
  12. Hepatitis B, C and D serology16 min
    4 skills
    • Read HBsAg, anti-HBs, and anti-HBc together to classify hepatitis B status
    • Choose RNA follow-up to determine current hepatitis C infection
    • Distinguish HDV exposure from current infection in a person with HBV
    • Apply each infection's own IgM and paired-titer timing rules to a serology result

    At the bench Relate viral serology findings to the stage of infection

  13. EBV, CMV and varicella serology15 min
    3 skills
    • Call EBV infection recent or past from VCA IgM, VCA IgG, and EBNA antibody
    • Choose the CMV test for past exposure, current replication, or congenital infection
    • Choose lesion PCR or VZV IgG to tell current infection from past immunity

    At the bench Relate viral serology findings to the stage of infection

  14. The HIV testing algorithm16 min
    3 skills
    • Choose the next laboratory test in the HIV diagnostic algorithm
    • Recognize when recent exposure or antiretroviral use limits HIV detection
    • Choose virologic testing for an infant with possible perinatal HIV exposure

    At the bench Relate viral serology findings to the stage of infection

  15. Viral load and CD4 counts14 min
    2 skills
    • Distinguish what an HIV viral load measures from what a CD4 count measures
    • Calculate a CD4-to-CD8 ratio from comparable absolute counts
  16. Syphilis testing16 min
    3 skills
    • Choose the next test for a reactive treponemal screen with a nonreactive RPR
    • Call a fourfold RPR or VDRL titer change only between results from one method
    • Report a negative CSF VDRL without excluding neurosyphilis

    At the bench Follow the laboratory algorithm for discordant syphilis results

  17. Lyme and tuberculosis testing15 min
    2 skills
    • Read Lyme two-tier results, counting an IgM blot only in the first 30 days of illness
    • Interpret an IGRA with its controls and limits for active tuberculosis