Lab Values

Topics: Immunodeficiency, Primary immunodeficiency, Quality control Pages: 9 (2445 words) Published: May 22, 2013
Standardization and Improvement of in-vitro Diagnosis and Monitoring of Treatment of Immunodeficiency Diseases in Developing Countries

Nabila El-Sheikh;
Molecular Immunology Unit, Al-Azhar University

Ladies and Gentlemen

The World Health Organization recognizes more than 200 primary immunodeficiency diseases (PIDD) - some are relatively common, others are quite rare; some affect a single cell within the immune system; others may affect one or more components of the system. An accurate medical history, family history and physical examination are critical in developing the best strategy for laboratory evaluation, and the orderly use of laboratory testing is strongly recommended. This typically begins with screening tests, followed by more sophisticated (and costly) tests that are chosen based on the initial test results.

In developing countries, it is unfortunate that opportunities for the diagnosis of PIDD, specific therapies, and general care are deficient. It is also unfortunate that the range of laboratory testing available to evaluate the immune system in these countries is very limited. This is driven in part by the under-recognition of the clinical syndromes associated with recurrent and or chronic infections.

We believe that it is the responsibility of EAI and all healthcare professionals to take measures that eventually lead to the establishment of a specialized hospital equipped for molecular diagnosis, management and research for patients with primary immunodeficiencies (PID). Direct link between the clinical findings and laboratory testing will extend our understanding of PIDD and help provide further answers to the underlying basis of the expanding range of PID.

Laboratory medicine

Laboratory medicine is the keystone on which the structure of scientific medicine is erected. A wide variety of laboratory-based disciplines (e.g., histology, hematology, clinical chemistry, Immunology and microbiology) contribute to nearly all of the elements necessary to effectively control infectious and noninfectious diseases. The clinical laboratory is no longer its own limited bionetwork, as it is increasingly integrated with patient care, assisting diagnosis, monitoring therapies and predicting clinical outcomes. A lack of reliable and efficient laboratory service can result in serious consequences for the patients as well as obscuring the true picture of the problem in an entire country.

Clinical laboratories have achieved significant improvements in the provision and quality of diagnostic tests. Automation, commercially produced reagents and computers are providing clinicians with an ever-increasing list of rapid and cost-effective tests. Advances in laboratory medicine have occurred in concert with analytical developments that measure many different molecules with specificity for pathological conditions, and with ever-increasing sensitivity. Such tests have revolutionized clinical diagnosis in ways that were unimaginable even a decade ago. As a consequence, laboratories and, at least in most developed countries, are expected to meet stringent technical, management and quality-assurance standards.

Laboratory Evaluation of the Immune System

Laboratory studies are essential to evaluate the immune system to determine the presence of primary immunodeficiency disease. The laboratory evaluation of a person’s immune system is usually prompted by an individual experiencing some clinical problems such as a recurrent and/or chronic infection. Information regarding the types of organisms, the sites of infection and the therapies required to effectively treat the individual’s infection often help focus the laboratory studies.

Normal versus Abnormal Laboratory Values

All results must be compared to appropriate reference ranges to avoid misinterpretation. An accurate medical history, family history and physical examination are critical in developing the best strategy for laboratory evaluation, and...
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