23 y/o M p/w cough and constitutional symptoms found to have ANCA (MPO) vasculitis and eosinophils
Dr. Kathy Nickerson | Morning Report | 04/12/2017 | video
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Eosinophilic Granulomatosis with Polyangiitis (EGPA)
- Previously Churg-Strauss
- Characterized by chronic rhinosinusitis, asthma and peripheral blood eosinophiliaalong with vasculitis of small/medium vessels
- Asthma precedes vasculitis phase by 8-10 years
- Renal involvement in ~20-25% of patients
- ACR Criteria for Diagnosis (need 4)
- Asthma (a history of wheezing or the finding of diffuse high pitched wheezes on expiration)
- Greater than 10 percent eosinophils on the differential leukocyte count
- Mononeuropathy(including multiplex) or polyneuropathy
- Migratory or transient pulmonary opacities detected radiographically
- Paranasal sinus abnormality
- Biopsy containing a blood vessel showing the accumulation of eosinophils in extravascular areas
Posted 04/12/17 09:07:30 AM by Ying Liu
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ANCA (Antineutrophil Cytoplasmic Autoantibodies)
Two assays- Indirect Immunofluorescence (IF) --> Have fluorescing antibodies that bind patient antibodies. Patient serum is incubated with ethanol fixed neutrophils, resulting in distinct staining patterns
- C-ANCA: staining is diffuse throughout the cytoplasm (usually corresponds to antibodies to PR3)
- P-ANCA: staining pattern around the nucleus (usually corresponds to antibodies MPO)
- Enzyme-linked immunosorbent assay (ELISA)
- ELISA antibodies to antibodies that bind PR3 (proteinase 3) antibodies and MPO (Myeloperoxidase), which are antigens present in cytoplasm of neutrophils. Upon binding, there will be a signal released to identify presence of these antibodies
Posted 04/12/17 09:08:29 AM by Ying Liu
- Indirect Immunofluorescence (IF) --> Have fluorescing antibodies that bind patient antibodies. Patient serum is incubated with ethanol fixed neutrophils, resulting in distinct staining patterns
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For further reading...
Posted 04/12/17 09:09:39 AM by Ying Liu
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