Here’s the must-have information you need to understand the essential principles of immunology and to master the serology techniques most commonly used in the laboratory. Easy-to-read, student-friendly coverage focuses on the direct application of theory to clinical laboratory practice, preparing you for the real world in which you will practice.

Table of Contents

• Preface
• Art Consultant
• Contributors
• Reviewers
• Acknowledgments
• SECTION I Nature of the Immune System
• 1 Introduction to Immunity and the Immune System - Christine Dorresteyn Stevens
• IMMUNITY AND IMMUNIZATION
• INNATE VERSUS ADAPTIVE IMMUNITY
• CELLS OF THE INNATE IMMUNE SYSTEM
• Leukocytes in Peripheral Blood
• Tissue Cells
• CELLS OF THE ADAPTIVE IMMUNE SYSTEM
• B Cells
• T Cells
• Natural Killer (NK) Cells
• ORGANS OF THE IMMUNE SYSTEM
• Primary Lymphoid Organs
• Secondary Lymphoid Organs
• SUMMARY
• CASE STUDIES
• REVIEW QUESTIONS
• 2 Nature of Antigens and the Major Histocompatibility Complex - Christine Dorresteyn Stevens
• FACTORS INFLUENCING THE IMMUNE RESPONSE
• TRAITS OF IMMUNOGENS
• EPITOPES
• HAPTENS
• ADJUVANTS
• RELATIONSHIP OF ANTIGENS TO THE HOST
• MAJOR HISTOCOMPATIBILITY COMPLEX
• Genes Coding for MHC Molecules (HLA Antigens)
• Structure of Class I and II MHC Molecules
• Role of Class I and II Molecules in the Immune Response
• Clinical Significance of MHC
• SUMMARY
• CASE STUDY
• REVIEW QUESTIONS
• 3 Innate Immunity - Christine Dorresteyn Stevens
• EXTERNAL DEFENSE SYSTEM
• INTERNAL DEFENSE SYSTEM
• Pathogen Recognition Receptors
• Acute-Phase Reactants
• Inflammation
• Phagocytosis
• Action of Natural Killer Cells
• SUMMARY
• CASE STUDIES
• REVIEW QUESTIONS
• 4 Adaptive Immunity - Christine Dorresteyn Stevens
• T-CELL DIFFERENTIATION
• Double-Negative Stage
• Double-Positive Stage
• Mature T Cells
• STAGES IN B-CELL DIFFERENTIATION
• Pro-B Cells
• Pre-B Cells
• Immature B Cells
• Mature B Cells
• Plasma Cells
• THE ROLE OF T CELLS IN THE ADAPTIVE IMMUNE RESPONSE
• Action of T Helper Cells
• Action of Cytotoxic T Cells
• THE ROLE OF B CELLS IN THE ADAPTIVE IMMUNE RESPONSE
• Response to T-Dependent Antigens
• Response to T-Independent Antigens
• LABORATORY IDENTIFICATION OF LYMPHOCYTES
• SUMMARY
• CASE STUDIES
• REVIEW QUESTIONS
• 5 Antibody Structure and Function - Christine Dorresteyn Stevens
• TETRAPEPTIDE STRUCTURE OF IMMUNOGLOBULINS
• THE NATURE OF LIGHT CHAINS
• HEAVY-CHAIN SEQUENCING
• HINGE REGION
• THREE-DIMENSIONAL STRUCTURE OF ANTIBODIES
• Immunoglobulin G (IgG)
• Immunoglobulin M (IgM)
• Immunoglobulin A (IgA)
• Immunoglobulin D (IgD)
• Immunoglobulin E (IgE)
• THEORIES TO EXPLAIN ANTIBODY DIVERSITY
• Ehrlich’s Side-Chain Theory
• Clonal Selection Hypothesis
• GENES CODING FOR IMMUNOGLOBULINS
• Rearrangement of Heavy-Chain Genes
• Light Chain Rearrangement
• MONOCLONAL ANTIBODY
• Hybridomas
• Clinical Applications
• SUMMARY
• CASE STUDIES
• REVIEW QUESTIONS
• 6 Cytokines - Rita M. Heuertz and Uthayashanker R. Ezekiel
• INTRODUCTION TO CYTOKINES
• CYTOKINES IN THE INNATE IMMUNE RESPONSE
• Interleukin-1 (IL-1)
• Tumor Necrosis Factors
• Interleukin-6
• Chemokines
• Transforming Growth Factor-β
• Interferon-α and Interferon-β
• CYTOKINES IN THE ADAPTIVE IMMUNE RESPONSE
• Th1 Cytokines
• Th2 Cytokines
• Cytokines Associated With T Regulatory Cells
• TH17 CYTOKINES IN INNATE AND ADAPTIVE IMMUNE RESPONSES
• HEMATOPOIETIC GROWTH FACTORS
• CYTOKINE AND ANTICYTOKINE THERAPIES
• CLINICAL ASSAYS FOR CYTOKINES
• SUMMARY
• CASE STUDY
• REVIEW QUESTIONS
• 7 Complement System - Ashley Frazer-Able and Christine Dorresteyn Stevens
• PATHWAYS OF THE COMPLEMENT SYSTEM
• The Classical Pathway
• The Lectin Pathway
• The Alternative Pathway
• SYSTEM CONTROLS
• Regulation of the Classical and Lectin Pathways
• Regulation of the Alternative Pathway
• Regulation of Terminal Components
• COMPLEMENT RECEPTORS AND THEIR BIOLOGICAL ROLES
• BIOLOGICAL MANIFESTATIONS OF COMPLEMENT ACTIVATION
• COMPLEMENT AND DISEASE STATES
• COMPLEMENT DEFICIENCIES
• Major Pathway Components
• Regulatory Factor Components
• LABORATORY DETECTION OF COMPLEMENT ABNORMALITIES
• Immunologic Assays of Individual Components
• Assays for the Classical Pathway
• Alternative Pathway Assays
• Interpretation of Laboratory Findings
• SUMMARY
• CASE STUDIES
• REVIEW QUESTIONS
• SECTION II Basic Immunologic Procedures
• 8 Safety and Quality Management - Marjorie Schaub Di Lorenzo
• LABORATORY HAZARDS
• Biological Hazards
• Sharps Hazards
• Chemical Hazards
• Radioactive Hazards
• Electrical Hazards
• Fire and Explosive Hazards
• Physical Hazards
• QUALITY MANAGEMENT
• Procedure Manual
• Preexamination Variables
• Examination Variables
• Postexamination Variables
• REGULATORY ISSUES
• Clinical Laboratory Improvement Amendments (CLIA)
• Clinical and Laboratory Standards Institute (CLSI)
• The Joint Commission (TJC)
• College of American Pathologists (CAP)
• QUALITY MANAGEMENT SYSTEMS
• Quality System Essentials
• The Lean System
• Six Sigma
• SUMMARY
• CASE STUDIES
• REVIEW QUESTIONS
• 9 Principles of Serological Testing - Christine Dorresteyn Stevens
• BLOOD SPECIMEN PREPARATION AND MEASURING
• DILUTIONS
• Simple Dilutions
• Compound Dilutions
• Test Parameters
• SUMMARY
• CASE STUDY
• REVIEW QUESTIONS
• 10 Precipitation and Agglutination Reactions - Christine Dorresteyn Stevens
• ANTIGEN-ANTIBODY BINDING
• Affinity
• Avidity
• Law of Mass Action
• PRECIPITATION CURVE
• Zone of Equivalence
• Prozone and Postzone
• MEASUREMENT OF PRECIPITATION BY LIGHT SCATTERING
• PASSIVE IMMUNODIFFUSION TECHNIQUES
• Radial Immunodiffusion
• Ouchterlony Double Diffusion
• ELECTROPHORETIC TECHNIQUES
• COMPARISON OF PRECIPITATION TECHNIQUES
• PRINCIPLES OF AGGLUTINATION REACTIONS
• TYPES OF AGGLUTINATION REACTIONS
• Direct Agglutination
• Passive Agglutination
• Reverse Passive Agglutination
• Agglutination Inhibition
• INSTRUMENTATION
• QUALITY CONTROL AND QUALITY ASSURANCE
• SUMMARY
• CASE STUDIES
• REVIEW QUESTIONS
• 11 Labeled Immunoassays - Christine Dorresteyn Stevens
• FORMATS FOR LABELED ASSAYS
• Competitive Immunoassays
• Noncompetitive Immunoassays
• HETEROGENEOUS VERSUS HOMOGENEOUS ASSAYS
• RADIOIMMUNOASSAY
• ENZYME IMMUNOASSAYS
• Heterogeneous Enzyme Immunoassays
• Homogeneous Enzyme Immunoassays
• Rapid Immunoassays
• FLUORESCENT IMMUNOASSAYS
• Direct Immunofluorescent Assays
• Indirect Immunofluorescent Assays
• Fluorescence Polarization immunoassays
• CHEMILUMINESCENT IMMUNOASSAYS
• SUMMARY
• CASE STUDY
• REVIEW QUESTIONS
• 12 Molecular Diagnostic Techniques - Lela Buckingham
• CHARACTERISTICS OF DEOXYRIBONUCLEIC ACID AND RIBONUCLEIC ACID
• Nucleotides
• The Nucleic Acid Polymer
• DNA Replication
• RNA Synthesis
• Protein Synthesis
• Mutations
• Polymorphisms
• MOLECULAR ANALYSIS
• Strand Cleavage Methods
• Hybridization Methods
• Amplification Methods
• DNA SEQUENCING
• Sanger (Chain Termination) Seguencing
• Pyroseguencing
• Next Generation Seguencing (NGS)
• SUMMARY
• CASE STUDIES
• REVIEW QUESTIONS
• 13 Flow Cytometry and Laboratory Automation - Candace Golightly and Jeannie Guglielmo
• CELL FLOW CYTOMETRY
• Instrumentation
• Data Acquisition and Analysis
• Sample Preparation
• Clinical Applications
• IMMUNOASSAY AUTOMATION
• Validation
• SUMMARY
• CASE STUDIES
• REVIEW QUESTIONS
• SECTION III Immune Disorders
• 14 Hypersensitivity - Linda E. Miller
• TYPE I HYPERSENSITIVITY
• Immunologic Mechanism
• Genetic and Environmental Influences on Type I Hypersensitivity
• Clinical Manifestations of Type I Hypersensitivity
• Treatment of Type I Hypersensitivity
• Testing for Type I Hypersensitivity
• TYPE II HYPERSENSITIVITY
• Clinical Examples of Type II Hypersensitivity
• Testing for Type II Hypersensitivity
• TYPE III HYPERSENSITIVITY
• Arthus Reaction
• Serum Sickness
• Autoimmune Diseases and Other Causes of Type III Hypersensitivity
• Testing for Type III Hypersensitivity
• TYPE IV HYPERSENSITIVITY
• Contact Dermatitis
• Hypersensitivity Pneumonitis
• Skin Testing for Delayed Hypersensitivity
• SUMMARY
• CASE STUDIES
• REVIEW QUESTIONS
• 15 Autoimmunity - Linda E. Miller
• ETIOLOGY OF AUTOIMMUNE DISEASE
• Self-Tolerance
• Genetics
• Other Endogenous and Environmental Factors
• SYSTEMIC AUTOIMMUNE DISEASES
• Systemic Lupus Erythematosus (SLE)
• Antinuclear Antibodies (ANAs)
• Antiphospholipid Antibodies
• Rheumatoid Arthritis (RA)
• Granulomatosis With Polyangiitis (Wegener’s Granulomatosis)
• Antineutrophil Cytoplasmic Antibodies (ANCAs)
• ORGAN-SPECIFIC AUTOIMMUNE DISEASES
• Autoimmune Thyroid Diseases (AITDs)
• Type 1 Diabetes Mellitus (T1D)
• Celiac Disease
• Autoimmune Liver Diseases
• Multiple Sclerosis (MS)
• Myasthenia Gravis (MG)
• Goodpasture’s Syndrome
• SUMMARY
• CASE STUDIES
• REVIEW QUESTIONS
• 16 Transplantation Immunology - John L. Schmitz
• HISTOCOMPATIBILITY SYSTEMS
• Major Histocompatibility Complex (MHC) Antigens
• Minor Histocompatibility Antigens (mHAs)
• MHC Class I-Related Chain A (MICA) Antigens
• ABO Blood Group Antigens
• Killer Immunoglobulin-Like Receptors (KIRs)
• Self-Antigens
• ALLORECOGNITION
• TRANSPLANT REJECTION
• Hyperacute Rejection
• Acute Rejection
• Chronic Rejection
• GRAFT-VERSUS-HOST DISEASE (GVHD)
• IMMUNOSUPPRESSIVE AGENTS
• CLINICAL HISTOCOMPATIBILITY TESTING
• HLA Typing
• HLA Phenotyping
• HLA Genotyping
• HLA Antibody Screening, Identification, and Crossmatching
• SUMMARY
• CASE STUDIES
• REVIEW QUESTIONS
• 17 Tumor Immunology - Linda E. Miller
• INTRODUCTION TO TUMOR BIOLOGY
• TUMOR ANTIGENS
• Tumor-Specific Antigens (TSAs)
• Tumor-Associated Antigens (TAAs)
• CLINICALLY RELEVANT TUMOR MARKERS
• Clinical Uses of Tumor Markers: Benefits and Limitations
• Serum Tumor Markers
• LABORATORY DETECTION OF TUMORS
• Tumor Morphology
• Immunohistochemistry
• Immunoassays for Circulating Tumor Markers
• Molecular Methods in Cancer Diagnosis
• INTERACTIONS BETWEEN THE IMMUNE SYSTEM AND TUMORS
• Immune Defenses Against Tumor Cells
• Innate Immune Responses
• Adaptive Immune Responses
• IMMUNOEDITING AND TUMOR ESCAPE
• Elimination
• Equilibrium
• Escape
• IMMUNOTHERAPY
• Active Immunotherapy and Cancer Vaccines
• Passive Immunotherapy
• Adoptive Immunotherapy
• SUMMARY
• CASE STUDIES
• REVIEW QUESTIONS
• 18 Immunoproliferative Diseases - Donald C. Lehman
• MALIGNANT TRANSFORMATION OF HEMATOLOGIC CELLS
• Cell Properties
• Genetic Changes
• CLASSIFICATION OF HEMATOLOGIC MALIGNANCIES
• LEUKEMIAS
• Acute Lymphocytic Leukemia (ALL)
• Chronic Lymphocytic Leukemia or Lymphoma
• Hairy Cell Leukemia
• LYMPHOMAS
• Hodgkin Lymphoma (HL)
• Non-Hodgkin Lymphoma (NHL)
• PLASMA CELL DYSCRASIAS
• Monoclonal Gammopathy of Undetermined Significance (MGUS)
• Multiple Myeloma
• Waldenström Macroglobulinemia
• Heavy-Chain Diseases
• ROLE OF THE LABORATORY IN EVALUATING IMMUNOPROLIFERATIVE DISEASES
• Immunophenotyping by Flow Cytometry
• Evaluation of Immunoglobulins
• Serum Protein Electrophoresis (SPE)
• Immunofixation Electrophoresis (IFE)
• Serum Free Light Chain Analysis (sFLC)
• Evaluation of Genetic and Chromosomal Abnormalities
• SUMMARY
• CASE STUDIES
• REVIEW QUESTIONS
• 19 Immunodeficiency Diseases - Thomas S. Alexander
• CLINICAL EFFECTS OF PRIMARY IMMUNODEFICIENCIES
• THE NINE CATEGORIES OF PRIMARY IMMUNODEFICIENCIES
• Category 3: Predominantly Antibody Deficiencies
• Category 1: Combined Immunodeficiencies
• Category 2: Combined Immunodeficiencies With Associated or Syndromic Features
• Category 4: Diseases of Immune Dysregulation
• Category 5: Congenital Defects of Phagocyte Number, Function, or Both
• Category 6: Defects in Innate Immunity
• Category 7: Autoinflammatory Disorders
• Category 8: Complement Deficiencies
• Category 9: Phenocopies of Primary Immunodeficiencies
• LABORATORY EVALUATION OF IMMUNE DYSFUNCTION
• Screening Tests
• Confirmatory Tests
• Newborn Screening for Immunodeficiencies
• Evaluation of Immunoglobulins
• Bone Marrow Biopsy
• Family History
• SUMMARY
• CASE STUDIES
• REVIEW QUESTIONS
• SECTION IV Serological and Molecular Diagnosis of Infectious Disease
• 20 Serological and Molecular Detection of Bacterial Infections - James L. Vossler
• HUMAN-MICROBE RELATIONSHIPS
• BACTERIAL VIRULENCE FACTORS
• Structural Virulence Features
• Extracellular Virulence Factors
• Endotoxin and Exotoxins
• IMMUNE DEFENSES AGAINST BACTERIAL INFECTIONS AND MECHANISMS OF EVASION
• Immune Defense Mechanisms
• Bacterial Evasion Mechanisms
• LABORATORY DETECTION AND DIAGNOSIS OF BACTERIAL INFECTIONS
• Bacterial Culture
• Microscopic Visualization
• Antigen Detection
• Molecular Detection
• Serological Diagnosis
• GROUP A STREPTOCOCCI (STREPTOCOCCUS PYOGENES)
• Classification and Structure
• Virulence Factors
• Clinical Manifestations of Group A Streptococcal Infection
• Group A Streptococcal Sequelae
• Laboratory Diagnosis
• HELICOBACTER PYLORI
• Helicobacter H pylori Virulence Factors
• Pathology and Pathogenesis
• Diagnosis of H pylori Infection
• MYCOPLASMA PNEUMONIAE
• Mycoplasma Pneumoniae Pathogenesis
• Dermatological Manifestations
• Immunology of Mycoplasma Pneumoniae Infection
• Laboratory Diagnosis of Mycoplasma Pneumoniae Infection
• RICKETTSIAL INFECTIONS
• Agents of Rickettsia-Related Disease
• Rocky Mountain Spotted Fever
• SUMMARY
• CASE STUDIES
• REVIEW QUESTIONS
• 21 Spirochete Diseases - Marc Golightly, Candace Golightly, and Christine Dorresteyn Stevens
• SYPHILIS
• Characteristics of the Organism
• Mode of Transmission
• Stages of the Disease
• Congenital Syphilis
• Nature of the Immune Response
• Laboratory Diagnosis
• LYME DISEASE
• Characteristics of the Organism
• Stages of the Disease
• Nature of the Immune Response
• Laboratory Diagnosis
• Treatment
• RELAPSING FEVER GROUP—BORRELIA MIYAMOTOI
• Characteristics of the Organism
• Stages of the Disease
• Laboratory Diagnosis
• SUMMARY
• CASE STUDIES
• REVIEW QUESTIONS
• 22 Serological and Molecular Diagnosis of Parasitic and Fungal Infections - James L. Vossler
• PARASITIC IMMUNOLOGY
• Immune Responses to Parasites
• Parasite Survival Strategies
• Serodiagnosis of Parasitic Diseases
• Molecular-Based Diagnosis of Parasitic Disease
• FUNGAL IMMUNOLOGY
• Characteristics of Fungi
• Classification of Mycotic Infections (Mycoses)
• Immune Responses to Fungi
• Laboratory Diagnosis of Fungal Infections
• Fungal Pathogens
• SUMMARY
• CASE STUDIES
• REVIEW QUESTIONS
• 23 Serology and Molecular Detection of Viral Infections - Linda E. Miller
• IMMUNE DEFENSES AGAINST VIRAL INFECTIONS
• VIRAL ESCAPE MECHANISMS
• LABORATORY TESTING FOR VIRAL INFECTIONS
• HEPATITIS VIRUSES
• Hepatitis A
• Hepatitis E
• Hepatitis B
• Hepatitis D
• Hepatitis C
• HERPES VIRUS INFECTIONS
• Epstein-Barr Virus
• Cytomegalovirus
• Varicella-Zoster Virus
• OTHER VIRAL INFECTIONS
• Rubella
• Rubeola
• Mumps
• Human T-Cell Lymphotropic Viruses
• SUMMARY
• CASE STUDIES
• REVIEW QUESTIONS
• 24 Laboratory Diagnosis of HIV Infection - Linda E. Miller
• HIV TRANSMISSION
• CHARACTERISTICS OF HIV
• Composition of the Virus
• Structural Genes
• Viral Replication
• IMMUNOLOGIC MANIFESTATIONS
• Immune Responses to HIV
• Effects of HIV Infection on the Immune System
• CLINICAL SYMPTOMS OF HIV INFECTION
• TREATMENT AND PREVENTION
• LABORATORY TESTING FOR HIV INFECTION
• SCREENING AND DIAGNOSIS
• Testing Algorithms
• Serological Test Principles
• Qualitative Nucleic Acid Tests (NATs)
• DISEASE MONITORING
• CD4T-Cell Enumeration
• Quantitative Viral Load Assays
• Drug Resistance Testing
• TESTING OF INFANTS YOUNGER THAN 18 MONTHS
• SUMMARY
• CASE STUDIES
• REVIEW QUESTIONS
• 25 Immunization and Vaccines - Linda E. Miller
• VACCINES
• Historical Evolution of Vaccines
• Conventional Vaccines
• Factors Influencing Immunogenicity
• Next Generation Vaccines
• Benefits and Adverse Effects of Vaccines
• PASSIVE IMMUNIZATION
• Passive Immunization as Therapy for Infectious Diseases
• Advantages and Limitations of Passive Immunization
• Immunosuppressive Effects of Passive Immunization
• Monoclonal Antibodies
• ADOPTIVE IMMUNOTHERAPY
• SUMMARY
• CASE STUDIES
• REVIEW QUESTIONS
• Glossary
• References
• Answer Key