Clinical Laboratory Immunology: An Indispensable Player
Clinical Laboratory Immunology: An Indispensable Player
The scope of clinical laboratory immunology is quite broad, with major implications for infectious disease, pediatrics, rheumatology, allergy and asthma, transplantation, nephrology, pulmonology, gastroenterology, neurology, cardiology, hematology, and oncology. Specific knowledge of the multitudinous components of the immune system, cellular interactions, and the function and physiology of the immune response are central to the practice of clinical laboratory immunology Table 1. In addition, understanding the regulation of the immune response by other host systems such as those under neuroendocrine and metabolic control is essential to formulating new approaches to the diagnosis and management of immunologic diseases. Such knowledge is not typically presented in standard pathology residency training programs. Training in clinical laboratory immunology requires dedicated programs with specified durations for individuals with the appropriate foundational background in immunology to gain the additional skills required to translate basic knowledge into clinical laboratory practice. Such dedicated programs fulfill the stringent regulatory requirements associated with laboratory medicine and provide the necessary expertise to engage with clinicians in diagnostic consultations and guidance.
Laboratory evaluations using established and emerging techniques as well as concepts of immunology are essential for the diagnosis and management of immune-mediated disorders. Because of the inter-relationship between immunology and other laboratory disciplines such as chemistry, microbiology, and hematology, there exists some overlap in methodologic techniques and tests.Table 2 presents specific immunologic analyses and technique(s) central to the clinical immunology laboratory. In some medical centers and reference hospitals/laboratories, serologic determination of antibodies to self-antigens and allergens is performed in clinical chemistry, immunophenotyping in hematopathology, and immunohistochemistry in anatomic pathology. Equipped with the foundational knowledge of normal and aberrant immune response, individuals trained in clinical laboratory immunology can effectively synthesize data obtained from these various laboratories into the appropriate clinical contexts. This is particularly important in the diagnosis and management of rare or complex diseases, such as primary immunodeficiencies, certain autoimmune disorders, and transplantation (organ or hematopoietic) cases where laboratory assays are required to assess immunophenotype, function, and response to treatment. Training also encompasses experience with specialized genetic tests that evaluate monogenic and polygenic immune disorders, flow cytometry, and other cellular techniques used to assess immune phenotype and function.
Assessment of biomarkers such as antibodies, cytokines, chemokines, and antigen-specific cells representing the diverse components of the immune system is a growing aspect of clinical laboratory immunology. Moreover, the introduction of biologic therapies such as chimeric, humanized and human monoclonal antibodies, fusion proteins, and the assessment of immune response to these drugs presents the clinical immunology laboratory with novel opportunities for immune monitoring. Likewise, assessment of cell-mediated immune responses complements traditional in vivo delayed type hypersensitivity skin testing. Assays such as interferon gamma response assays are now commonly used for tuberculosis screening and posttransplant monitoring of immune responsiveness. With the potential development of vaccines to treat chronic infections by engaging T-cell responses, monitoring antigen-specific T-cell function will likely become an integral component of tests offered in clinical immunology laboratories.
Knowledge and Techniques in Clinical Laboratory Immunology
The scope of clinical laboratory immunology is quite broad, with major implications for infectious disease, pediatrics, rheumatology, allergy and asthma, transplantation, nephrology, pulmonology, gastroenterology, neurology, cardiology, hematology, and oncology. Specific knowledge of the multitudinous components of the immune system, cellular interactions, and the function and physiology of the immune response are central to the practice of clinical laboratory immunology Table 1. In addition, understanding the regulation of the immune response by other host systems such as those under neuroendocrine and metabolic control is essential to formulating new approaches to the diagnosis and management of immunologic diseases. Such knowledge is not typically presented in standard pathology residency training programs. Training in clinical laboratory immunology requires dedicated programs with specified durations for individuals with the appropriate foundational background in immunology to gain the additional skills required to translate basic knowledge into clinical laboratory practice. Such dedicated programs fulfill the stringent regulatory requirements associated with laboratory medicine and provide the necessary expertise to engage with clinicians in diagnostic consultations and guidance.
Laboratory evaluations using established and emerging techniques as well as concepts of immunology are essential for the diagnosis and management of immune-mediated disorders. Because of the inter-relationship between immunology and other laboratory disciplines such as chemistry, microbiology, and hematology, there exists some overlap in methodologic techniques and tests.Table 2 presents specific immunologic analyses and technique(s) central to the clinical immunology laboratory. In some medical centers and reference hospitals/laboratories, serologic determination of antibodies to self-antigens and allergens is performed in clinical chemistry, immunophenotyping in hematopathology, and immunohistochemistry in anatomic pathology. Equipped with the foundational knowledge of normal and aberrant immune response, individuals trained in clinical laboratory immunology can effectively synthesize data obtained from these various laboratories into the appropriate clinical contexts. This is particularly important in the diagnosis and management of rare or complex diseases, such as primary immunodeficiencies, certain autoimmune disorders, and transplantation (organ or hematopoietic) cases where laboratory assays are required to assess immunophenotype, function, and response to treatment. Training also encompasses experience with specialized genetic tests that evaluate monogenic and polygenic immune disorders, flow cytometry, and other cellular techniques used to assess immune phenotype and function.
Assessment of biomarkers such as antibodies, cytokines, chemokines, and antigen-specific cells representing the diverse components of the immune system is a growing aspect of clinical laboratory immunology. Moreover, the introduction of biologic therapies such as chimeric, humanized and human monoclonal antibodies, fusion proteins, and the assessment of immune response to these drugs presents the clinical immunology laboratory with novel opportunities for immune monitoring. Likewise, assessment of cell-mediated immune responses complements traditional in vivo delayed type hypersensitivity skin testing. Assays such as interferon gamma response assays are now commonly used for tuberculosis screening and posttransplant monitoring of immune responsiveness. With the potential development of vaccines to treat chronic infections by engaging T-cell responses, monitoring antigen-specific T-cell function will likely become an integral component of tests offered in clinical immunology laboratories.
