The 12th Invest in ME Research Conference June, 2017, Part 2
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Question about immune system testing

Discussion in 'Immunological' started by Azrael, Nov 25, 2014.

  1. Azrael

    Azrael

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    Hi

    If you come to a doctor specialized in the immune system what sort of tests will he make to rule out there's any problems with the immune system?

    The only 3 i know about is the Iga Igg Igm, which I took several years ago and was according to him (not specalist) normal. IF you know any refence values please add that as well.

    Thanks
     
  2. Jonathan Edwards

    Jonathan Edwards Senior Member

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    The answer to the question could be as long as you like, and the tests done would depend on the health problem but some basics would be as below. Standard ranges vary from lab to lab so you need to compare results against the standard range on the form.

    Immunoglobulins: IgG, IgA and IgM. The most important for immune protection is IgG. IgG can be tested for subclasses but this will probably only be done if the total is abnormal. In addition a protein electrophoresis can be done to look for any single dominant antibody species or 'monolconal' bands, which indicate an abnormal explansion of one B cell clone. IgE levels may also be measurable but I have not ever used them myself.

    Complement components and activity can be measured (C3, C4, CH50, C1q), as can the genes. Complement deficiencies are associated with lupus and allergic syndromes.

    The circulating lymphocyte count is easily measured with the usual blood count. More detailed analysis of lymphocytes involves a FACS analysis (fluorescent cell sorting) and indicates T cell and B cell subsets. There are at least fifty subsets that can be potentially identified using about twenty different test reagents. The standard options include CD3, CD4, CD8 (T cell subsets), CD19 (B cell), CD56 and or 57 for NK like cells.

    In some circumstances it might be appropriate to do scans of lymphoid organs like spleen and nodes, at least an abdominal ultrasound for spleen.

    There are then a whole range of autoantibodies that could be tested for, but which ones will depend on the relevance to the problem.

    There are also a number of tests which are not purely immunological but are needed to screen for immune disease, like C reactive protein, straightforward haemoglobin, white count and platelets, lactate dehydrogenase, liver enzymes and renal function. Urine can be checked for protein including Bence Jones protein.

    That's probably most of what gets done in screening but I have probably forgotten one or two things.
     
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  3. Azrael

    Azrael

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    Hi Jonathan

    I appreciate you taking the time explaining this to me. It's good to have some basic knowledge when you first see your doctor.

    I dont think I have any questions at this point but I might come back :)

    Thanks again
     
  4. NilaJones

    NilaJones Senior Member

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    When i went to an immunoligist, he ran dozens of tests. In addition to stuff from Jonathan's excellent list, he also asked me which immunizations I had had, and tested for antibodies to those pathogens, in order to find out if my immune system was reacting properly to the immunizations. Oh, and he ran a panel for pneumonia antibodies -- apparently there are a zillion kinds and I have antibodies to most of them.
     
  5. JT1024

    JT1024 Senior Member

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    Massachusetts
    There is substantially more testing that CAN be done. However, few physicians have access to this type of testing unless they are affiliated with a research/teaching hospital. Numerous researchers are evaluating cytokines, genetic expression/epigenetics etc.

    Immune profiles involving cytokines is available from Mayo Medical Labs/ARUP labs:

    Cytokine Panel 12
    • Tumor Necrosis Factor – alpha
    • Interleukin 2
    • Interleukin 2 Receptor CD25 Soluble
    • Interleukin 12
    • Interferon gamma
    • Interleukin 4
    • Interleukin 5
    • Interleukin 10
    • Interleukin 13
    • Interleukin 1 beta
    • Interleukin 6
    • Interleukin 8
     
  6. Jonathan Edwards

    Jonathan Edwards Senior Member

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    Yes, if there were any query about adequacy of Immunoglobulin levels a screen of standard protective antibodies like tetanus and pneumococcus would be standard.
     
  7. Jonathan Edwards

    Jonathan Edwards Senior Member

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    Yes, but these are in general research tools because, as far as I know, apart perhaps from IL-2, nobody really knows if they are relevant to clinical care. Most cytokine assess are so unpredictable in results that they add nothing to clinical care in my experience. We measure these things but have no idea what to do with the results.
     
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  8. NilaJones

    NilaJones Senior Member

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    It was very reassuring to me to get good results from those. Yay, I won't get tetanus! And, as the doc said, 'So, your immune system is not completely broken.'

    But then I had an adverse reaction to a drug he prescribed, and that made him decide I was mental. So, no more immunology work.
     
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  9. melamine

    melamine Senior Member

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    I have had mildly abnormal tests for several years in association with many symptoms, including a progressing neuropathy. Many, though not all of the symptoms began or worsened at the time of, or following acute infections, which, however, were not documented properly, when at all.

    These are my Immunoglobulin and IgG subclass panels from the past couple years. There was another subclass test done in 2011 or 2012 that I could not find but in which IgG1 was mildly below normal. *

    8/13 3/14 11/14

    IgG - 813 792 751 (N = 700 - 1600)
    IgA - 117 139 123 (N = 70 - 400)
    IgM - 391 407 433 (N = 40 - 230)

    IgG Subclass 11/13

    IgG1 - 332 (N = 341 - 894)
    IgG2 - 432 (N = 171 - 632)
    IgG3 - 24.1 (N = 18.4 - 106)
    IgG4 - 37.3 (N = 2.4 - 121)

    My C3 has been below normal, but I don't remember Cq1 being tested. A test in 2007 showed IgG2 elevated by 55 points and other subclasses within range, with subtle indication of IgM gammopathy. I had not recovered from 2 misdiagnosed infection in the year prior to that, one viral and the other bacterial, which may have accounted for the IgG2. I have elevated titers of EBV (rising), all coxsacki b's and Adenovirus but stopped telling most doctors about them because the ones who ordered them said they were meaningless.

    My primary doctor referred me to an immunologist earlier this year expecting him to address these labs in light of my symptoms and infections, but he went strictly by the book - if total IgG is normal, will not diagnose immune deficiency as long as patient has functioning heart, lungs, and brain, more or less.

    I had a bone marrow biopsy earlier this year to confirm a clonal monogammopathy and repeat blood work showed IgG and IgM continuing to move in opposing directions.

    * Note: my test tables altered when I posted and there is no way for me to edit the spacing for clarity, as it reverts back to as is. Sorry.
     
    Last edited: Dec 19, 2014
  10. Azrael

    Azrael

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    Hi

    So I was away and did some testings related with the immunesystem, this was purely basic so they wont do another testing schedule as everything showed normal. Some of these are for inflammation as well.

    Adding the tests here:

    IgG, IgA and IgM
    albumin
    Orosomucoid
    Haptoglobin
    CRP
    Alpha 1-antitrypsin

    After those they did a few -cyte checkups:

    eosinophils
    basophils
    lymphocytes
    monocytes
    neutrophils
    leukocytes
    erythrocytes
    thrombocytes

    All of these were normal except eosinophils that after looking at the lab values came out slightly high.

    Doctor told me everything was good, I usually order the lab values to myself for the personal archive.

    I have so many symptoms belonging to inflammation and immunesystem so im shocked nothing shows up.

    The doctors are long gone looking at me with suspicion and judging me, now im more or less a clown.

    Comments anyone ?
     
  11. melamine

    melamine Senior Member

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    Upstate NY
    @Azrael - Doctors of the kind you describe routinely pronounce abnormal results to be normal or occasionally "trivial" once they've decided there is "nothing wrong with the patient." It looks like you have not yet received copies of the labs themselves? That is the first thing you need to do - Do not trust, but verify.

    I am not familiar with a few of your tests but I see your total immunoglobulins are supposedly normal. If you take a look at mine above, you will see that my total IgG is normal, but the sub-class IgG 1 is not. There is a possibility that you could have abnormal sub-classes or complement, either of which could affect your immune competence.

    Vaccine-challenge is another test that immunologists will order if there is indication for it. Mine was normal the only time it was done, in 2007, even though I was very sick at the time. Immunologists are generally not very helpful unless you have radically abnormal labs or HIV.

    If your immune function tests were in fact all normal, I would wonder about a suppressed immune system artificially lowering inflammation or other signs. Perhaps someone on here with more knowledge of this can respond.

    Usually there is some clue in the labs, no matter how small, so grab it and research the possibilities of how it might correspond with your symptoms. One of my early signs was kidney dysfunction, something I would never have thought to ask for, but my doctor did. It never really connected strongly with anything but allowed me to see a nephrologist who was helpful in other ways.

    Your doctors are no doubt sharing the cartoon they've made of you among themselves by way of immortalizing their characterization of you in their notes and in prejudicial bad faith referrals.
     
    Last edited: Dec 19, 2014
  12. Azrael

    Azrael

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    Thanks for adding your opinion.

    You're right, I always get copies to verify things myself. Cant trust that others will do their job.

    Lab copies is something you need to ask for here, you will never get any without asking

    I got the copies at home actually got the papers today, I can add all the values but not today im tired and fed up on how things are moving. But soon.

    When you're at a doctor in the U.S. do they ask you things like you have a girlfriend/married and type that down in the journal ?

    I know they are all doing it here and more...so every time I see a new doctor they start asking about personal things.

    One even had the nerves of asking of my financial situation. A bunch of nonsense.

    I tell them none of your business. At that stage when you stand up for yourself they already start judging you. They might even think no one else have made such a clear statement as to say that it's not of their business to ask such personal questions. Maybe 1 of 10 patients stands up and say that such personal questions is not okay

    Then they start adding more text to the journals.

    Patient mental state: Questions authorites, bad emotional contact etc

    Why dont they just castrate me so we can move on...

    I have no reason to like doctors, I have had bad experiences in 9 out of 10 visits.

    But the best thing you can be over here is a lemming, dont question anything and be quite.

    But I usually start with being nice, but that is usually changed during the meeting as I see they are all alike.

    From the lab reports I do see IgM almost at the top of the reference value, might be something but I dont know. Plus leukocytes is also at the top of the reference value but none of them are above.

    IgM 2.07 g/L - reference value 0.27-2.10
    Leukocytes 8.6 10^9/L - reference value 3.5-8.8

    Was reading on wikipedia about Leukocytes -
    Will add the rest another day.
     
  13. Azrael

    Azrael

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    Oh and I can add a few other interesting things.

    I got psoriasis last year on top of everything else and 3 years ago I had iritis (eyes) both of which are auto immune reactions.

    I told the doctors about this as well.
     
  14. melamine

    melamine Senior Member

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    Upstate NY
    Yes! The bad ones anyway - mostly primary care do that, but I've run into it occasionally with specialists who have read notes from the referring doctor ahead of my appointment and take them seriously. It rarely happens to me now that I have more tests but was quite a problem for awhile. Allopathic doctors can be emotionally costly, but it's the price to pay for getting certain necessary tests at reduced cost or free, depending on ones insurance, and occasionally connecting with doctors who are capable of understanding complex illnesses and are willing to help to the extent they can.

    Your high-normal range IgM and leukocytes can indicate recent acute infection, I believe. High leukocytes are sometimes seen in certain autoimmune conditions but I don't believe the combination of both of those things would indicate that so much. You could have both conditions of course, since you have indications of autoimmunity. I am not an expert in reading labs and would defer to others for anything more than broad indications.

    Normally, those two labs would not be a reason to order more tests or refer you to specialists, but "normally" means when they are seen in a healthy person who has gotten briefly ill and is recovering normally. If you were healthy and feeling well, you would not be running to the doctor. The nature of your symptoms and the length of time you have been experiencing them, as well as your medical history - the real one that you have explained to them, not their reinterpreted version of it - is something they are required to consider when interpreting labs if they have any intention of not misdiagnosing you. They are already doing that.
     
    Last edited: Dec 20, 2014
  15. AS_Suferrer

    AS_Suferrer

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    Hi Jonathan,

    Is there a way I can email you? I have a few things I want to know about regarding these tests. Its been 2 years since you made this statement. Has anything changed in two years? Are these tests more reliable now? Can they help in determining if there are high TNF in my body?
    http://ltd.aruplab.com/tests/pub/0051394

    Thanks in advance for your response.
     
  16. Jonathan Edwards

    Jonathan Edwards Senior Member

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    I don't think things will have changed much. Cytokines mostly work at short range so blood levels probably tell us rather little. If TNF is signalling more than normal in a relevant way then the most sensitive test is probably a c-reactive protein assay. In a sense that is the body's own 'functional bioassay'. In general CRP is not raised in ME/CFS as far as I know.
     
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