Useful Starting Points for Immunology Requests

Disorder

Tests to request in primary screen

Notes

Arthralgia or arthritis

Rheumatoid factor, Antinuclear Antibody (ANA)

The laboratory will instigate more specific tests if indicated by the screen. A measure of the acute phase response may also be helpful.

Anti-phospholipid syndrome

Anti-cardiolipin (ACA)

If ACA negative and clinical suspicion high worth checking for lupus anticoagulant. If ACA positive result needs to be confirmed 12 weeks later.

Coeliac disease

Anti-tissue transglutaminase

The laboratory will confirm positive results by anti-endomysium and check for IgA deficiency as required.

Allergy

Allergen Specific IgE (formerly ‘RAST’)

History is paramount in making the diagnosis. The test helps only to confirm the diagnosis.

Autoimmune thyroid disease

TSH (to assess dysfunction)

Anti TPO helpful in the context of subclinical hypothyroidism i.e. when TSH 5-10mU/L.

Myeloma

Serum Electrophoresis, Urine for Bence Jones protein

Need to check both serum and urine.  Immunofixation will be performed if indicated by screen.

Possible immunodeficiency

Immunoglobulins, Immunophenotyping

History is paramount. Please discuss with laboratory to direct testing.

Persistent raised plasma viscosity

Immunoglobulins, autoimmune profile, liver function tests

Abnormal liver function/jaundice

Autoimmune liver screen (includes ANA, anti-smooth muscle, anti-mitochondria, anti-LKM)

Immunoglobulins may provide additional supporting information.