LQCL2506 - CMLE - Clinical Utility of Reporting Cytoplasmic HEp-2 IFA Patterns-LQCL2506

LQCL2506 - Educational Activity

Pdf Summary

The document is a comprehensive clinical immunology guide about the interpretation and significance of HEp-2 Indirect Immunofluorescence Assay (IFA) results, authored by Dharmendra Jain, PhD, and Lisa K. Peterson, PhD. Key learning objectives include understanding nomenclature differences in HEp-2 IFA antibody results, identifying knowledge gaps in cytoplasmic HEp-2 IFA staining patterns, and discussing their role in diagnosing Systemic Lupus Erythematosus (SLE).<br /><br />A case history of a 39-year-old male with neuropsychiatric symptoms suggestive of SLE is presented. Despite negative MRI and standard laboratory tests, further analysis revealed cytoplasmic staining patterns on HEp-2 cells and positive Ribosome P Antibody, indicating SLE. This underscores the complication of classifying SLE when antibodies target cytoplasmic rather than nuclear antigens.<br /><br />The document elaborates on the clinical utility and complexities in interpreting HEp-2 IFA patterns. Although ANA testing is common, the presence of autoantibodies against nuclear and cytoplasmic antigens requires careful evaluation. The International Consensus on ANA Patterns (ICAP) proposes using the term "anticellular antibodies (ACA)" to encompass both cytoplasmic and nuclear patterns. The use of ACA is suggested to minimize confusion, as traditional terms like ANA may not accurately reflect all relevant autoantibodies.<br /><br />The importance of cytoplasmic HEp-2 IFA patterns in SLE and other autoimmune diseases is highlighted. Despite their clinical relevance, cytoplasmic patterns like speckled patterns (associated with autoantibodies against ribosomal P protein) are less frequently reported and understood. The document emphasizes the need for better awareness and education on the clinical significance of these patterns.<br /><br />In conclusion, the case emphasizes the necessity of recognizing cytoplasmic patterns for accurate diagnosis and treatment of SLE. A collaborative approach between clinicians and laboratorians is essential for effective assay utilization and interpretation.

Keywords

HEp-2 IFA

cytoplasmic staining

Systemic Lupus Erythematosus

Ribosome P Antibody

anticellular antibodies

ANA testing

autoimmune diseases

cytoplasmic patterns

clinical immunology

Dharmendra Jain