Essential Clinical Immunology

by Chapel, Helen

• ISBN13: 9780632049721
• ISBN10: 0632049723
• Edition: 4th
• Format: Paperback
• Copyright: 1999-09-01
• Publisher: John Wiley & Sons Inc

Summary

The fourth edition of this highly popular book has been extensively revised. The first chapter, a revision of the immune system, has been updated to provide the 'nitty-gritty' a student or trainee needs to know in order to understand diseases that have an immunological basis. The rest of the book's focus is clinical but covers the underlying pathophysiology of disease so that the reader is left with a lasting grasp of the basis of symptoms, signs, special investigations and management of the patient. It will be of great value to medical students and postgraduate trainees who require a thorough knowledge of the rapidly expanding number of diseases that have an immunological basis.Other features of the book include:- Selected case-histories that cover key learning points- Questions (multiple choice) and answers to help test understanding- Updates on immune diseases, immunotherapy and transplantation- New sections on chemokines and their role in inflamation, viral infections and much, much more- A dedicated website that provides updates, further case-histories and references together with short commentary on evidence for new or controversial statements in the text. See www.immunologyclinic.com

Author Biography

Helen Chapel MA, MD, FRCP, FRCPath Consultant Immunologist, Senior Clinical Lecturer Department of Clinical Immunology and University of Oxford John Radcliff Hospital, Oxford Mansel Haeney MSc, MB ChB, FRCP, FRCPath Consultant Immunologist, Clinical Sciences Building Hope Hospital, Salford Siraj Misbah MSc, FRCP, MRCPath Consultant Clinical Immunologist, Honorary Senior Clinical Lecturer in Immunology Leeds General Infirmary, University of Leeds Leeds Neil Snowden MB, BChir, MRCP, MRCPath Consultant Rheumatologist and Clinical Immunologist North Manchester General Hospital, Delaunays Road Manchester

Table of Contents

Preface to the Fourth Edition	xiii
Preface to the First Edition	xiv
Acknowledgements to the First Edition	xv
User Guide	xvi
Basic Components: Structure and Function	1	(30)
Introduction	1	(1)
Key Molecules	2	(9)
Antigens	3	(1)
Antibody	3	(3)
T-cell receptors	6	(1)
Major histocompatibility complex antigens	7	(2)
Adhesion molecules and leucocyte--endothelial interaction	9	(1)
Cytokines	10	(1)
Functional Basis of the Immune Response	11	(7)
Antigen presentation	11	(2)
Antibody production	13	(4)
Cell-mediated responses	17	(1)
Non-Specific Effector Mechanisms	18	(4)
Complement	18	(3)
Macrophages	21	(1)
Neutrophil polymorphonuclear leucocytes	21	(1)
Antibody-dependent cell-mediated cytotoxicity	22	(1)
Natural killer cells	22	(1)
Outcome of Immune Responses	22	(2)
Direct functions of antibody	22	(1)
Indirect functions of antibody	23	(1)
Killing of target cells	23	(1)
Inflammation: a brief overview	23	(1)
Immune Regulation	24	(1)
Organization of the Immune System: an Overview	24	(2)
Tissue Damage Caused by the Immune system	26	(3)
Conclusions	29	(2)
Further Reading	29	(1)
Questions	29	(2)
Infection	31	(20)
Introduction	31	(1)
Normal Resistance to Infection	32	(2)
Non-specific resistance	32	(1)
Specific resistance	33	(1)
Viral Infection	34	(5)
Infectious mononucleosis	34	(1)
Epstein--Barr virus infection	34	(1)
Viruses and the immune response	35	(1)
Direct effects of viruses	36	(1)
Recurrent herpes zoster	37	(1)
Viral strategies to evade the immune response	37	(1)
Bystander damage caused by the immune response to viral infection	38	(1)
Chronic fatigue syndrome	39	(1)
Speculative effects of viral infection	39	(1)
Bacterial Infection	39	(3)
Acute bacterial tonsillities	39	(1)
Normal immune responses to bacterial infections	39	(1)
Streptococcal toxic shock syndrome	40	(1)
Bacteria as superantigens	40	(1)
Bacterial evasion of immune defences	41	(1)
Rheumatic heart disease	41	(1)
Bystander damage caused by the immune response to bacterial infection	41	(1)
Mycobacterial Infection	42	(3)
Tuberculosis	42	(1)
Mycobacterial infection	42	(1)
Mycobacteria and the normal immune response	43	(1)
Mycobacterial evasion of the immune response	44	(1)
Damage caused by the immune response to mycobacteria	44	(1)
Fungal Infection	45	(1)
Acute vulvo-vaginitis	45	(1)
Mechanisms of immunity to fungal infections	45	(1)
Bystander damage caused by immune reactions to fungi	45	(1)
Parasitic Infection	46	(5)
Cerebral malaria	46	(1)
Protozoal infection	46	(1)
Normal immune responses to protozoa	46	(1)
Protozoal evasion of immune responses	47	(1)
Schistosomiasis	48	(1)
Helminth infections	48	(1)
Normal immunity to helminth infection	48	(1)
Helminthic evasion of immune responses	48	(1)
Bystander damage caused by immune reactions to protozoa and helminths	49	(1)
Further Reading	49	(1)
Questions	49	(2)
Immunodeficiency	51	(26)
Introduction	51	(1)
Primary Antibody Deficiency	52	(8)
X-linked agammaglobulinaemia (Bruton's disease)	52	(1)
Diagnosis of primary antibody deficiencies	52	(2)
Major causes of primary antibody deficiency	54	(2)
Common variable immunodeficiency	56	(1)
IgA and IgG subclass deficiency	57	(1)
Differential diagnosis	58	(1)
Complications of antibody deficiency	58	(1)
Management of antibody deficiency	59	(1)
Combined Primary T- and B-cell Immunodeficiency	60	(3)
Types of defect	60	(1)
Severe combined immunodeficiency	60	(3)
Management of defects of cellular immunity	63	(1)
Primary Defects in Non-specific Immunity	63	(4)
Chronic granulomatous disease	64	(1)
Defects in neutrophil function	64	(2)
Isoloated deficiency of complement component	66	(1)
Complement deficiency	66	(1)
Secondary Immunodeficiency	67	(10)
Secondary causes of immunodeficiency	67	(1)
Acquired immune deficiency syndrome: Kaposi's sarcoma	68	(1)
Acquired immune deficiency syndrome	69	(1)
Transmission of human immunodeficiency virus infection	69	(1)
Acquired immune deficiency syndrome: persistent generalized lymphadenopathy	70	(1)
The clinical spectrum of human immunodeficiency virus infection	70	(2)
Immunopathogenesis of acquired immune deficiency syndrome	72	(1)
Therapeutic options in acquired immune deficiency syndrome	72	(1)
Listeria monocytogenes meningitis	73	(1)
Infections in the immunosuppressed host	74	(1)
Further Reading	75	(1)
Questions	75	(2)
Anaphylaxis and Allergy	77	(18)
Intrduction	77	(1)
Immediate (Type I) Hypersensitivity	78	(1)
Atopy	79	(1)
Anaphylaxis	79	(3)
Wasp venom anaphylaxis	79	(1)
Anaphylaxis	79	(1)
Latex-induced anaphylaxis	80	(1)
Drug-induced reaction	81	(1)
Anaphylactoid reactions	81	(1)
Allergic Conjunctivitis	82	(1)
Seasonal allergic conjunctivitis	82	(1)
Seasonal (hay fever) and perennial (vernal) allergic conjunctivitis	82	(1)
Respiratory Allergy	82	(4)
Perennial allergic rhinitis	82	(1)
Allergic rhinitis	83	(1)
Allergic asthma	84	(1)
Asthma	84	(2)
Food Allergy and Intolerance	86	(4)
Cow's milk allergy	87	(1)
Nut allergy	87	(1)
Food allergy and intolerance	88	(1)
Is this food allergy?	89	(1)
Diagnosis of food allergy and intolerance	89	(1)
Skin Disease and Allergy	90	(5)
Chronic urticaria and angioedema	90	(1)
Urticaria and angioedema	90	(1)
Atopic eczema	91	(1)
Atopic eczema	91	(1)
Atopic keratoconjunctivitis	92	(1)
Atopic keratoconjunctivitis	93	(1)
Contact dermatitis	93	(1)
Further Reading	93	(1)
Questions	93	(2)
Autoimmunity	95	(16)
Definition of Autoimmunity and Autoimmune Disease	95	(1)
Is this rheumatoid arthritis?	95	(1)
Patterns of Autoimmune Disease	96	(1)
Organ-specific autoimmune disease	96	(1)
Non-organ-specific autoimmune disease	96	(1)
Myasthenia gravis	97	(1)
Who Gets Autoimmune Disease?	97	(1)
Primary autoimmune hypothyroidism	98	(1)
What Prevents Autoimmunity?	98	(4)
Autoimmunity and self-tolerance	98	(1)
Thymic tolerance	98	(1)
Peripheral tolerance	99	(3)
B-cell tolerance	102	(1)
How Does Tolerance Break Down?	102	(3)
IL-2 treatment and rheumatoid arthritis	103	(1)
Guillain--Barre syndrome	104	(1)
What Triggers Autoimmunity?	105	(3)
Genetic factors	105	(1)
Environmental factors	106	(1)
Minocycline-induced systemic lupus erythematosus	107	(1)
Mechanisms of Tissue Damage	108	(1)
Treatment of Autoimmune Disease	108	(3)
Further Reading	109	(1)
Questions	109	(2)
Lymphoproliferative Disorders	111	(17)
Introduction	111	(1)
Biology of Malignant Transformation	112	(1)
Leukaemia	113	(6)
Acute leukaemia (common type)	113	(1)
Acute leukaemia	113	(3)
Chronic lymphocytic leukaemia	116	(1)
Chronic lymphocytic leukaemia	116	(2)
Sezary syndrome	118	(1)
T-cell lymphomas and leukaemias	118	(1)
Hairy cell leukaemia	118	(1)
Hairy cell leukaemia	118	(1)
Hodgkin's Disease	119	(1)
Hodgkin's disease	119	(1)
Hodgkin's disease	119	(1)
Non-Hodgkin's Lymphomas	119	(3)
Non-Hodgkin's lymphoma	119	(1)
Non-Hodgkin's lymphoma	119	(2)
Multiple myelomas	121	(1)
Plasma Cell Dyscrasias	122	(6)
Multiple myeloma	122	(1)
Benign paraproteinaemia	123	(1)
Benign paraproteinaemia (monoclonal gammopathy of unknown significance)	124	(1)
Waldenstrom's macroglobulinaemia	124	(1)
Waldenstrom's macroglobulinaemia	124	(1)
Other plasma cell dyscrasias	125	(1)
Further Reading	125	(1)
Questions	126	(2)
Immune Manipulation	128	(18)
Introduction	128	(1)
Immunosuppression	129	(6)
Drugs	129	(2)
Epstein--Barr virus-induced lymphoma in a transplant recipient	131	(1)
Pneumocystis pneumonia complicating immunosuppressive therapy	132	(1)
Antibodies as immunosuppressive agents	132	(1)
Severe rheumatoid arthritis treated with anti-tumour necrosis factor α antibodies	133	(1)
Plasmapheresis and plasma exchange	133	(1)
Total lymphoid irradiation	133	(1)
Ultraviolet light	133	(2)
Immune Potentiation	135	(2)
Hormones	135	(1)
Cytokine therapy	135	(2)
Gene therapy	137	(1)
Immunomodulation by Intravenous Immunoglobulin	137	(1)
Kawasaki's disease treated with intravenous immunoglobulin	137	(1)
Other Uses of Monoclonal Antibodies	138	(1)
Psychological Factors	139	(1)
Immunization Against Infection	139	(5)
Theoretical basis of immunization	139	(1)
Adjuvants	140	(1)
Routine immunization	141	(1)
Fatal pneumococcal sepsis eight years following splenectomy	141	(1)
Immunication for travellers	142	(1)
Passive immunization	142	(1)
New approaches to immunization	142	(2)
Immunization Against Autoimmune Disease I: T-cell Vaccines	144	(1)
Immunization Against Autoimmune Disease II: Oral Tolerance	144	(2)
Further Reading	144	(1)
Questions	145	(1)
Transplantation	146	(15)
Introduction	146	(1)
Histocompatibility Genetics in Humans	146	(1)
Renal Transplantation	147	(6)
Selection of recipient and donor	147	(2)
Acute rejection	149	(1)
Post-transplantation period	149	(1)
Clinical rejection	150	(1)
Immunopathology of rejection (the allograft response)	150	(1)
Graft survival	151	(1)
Primary cytomegalovirus infection in renal transplant recipient	151	(1)
Complications	152	(1)
Other Types of Transplantation	153	(2)
Liver transplantation	153	(1)
Heart transplantation	154	(1)
Lung transplantation	154	(1)
Pancreatic transplantation	154	(1)
Skin grafting	154	(1)
Corneal grafting	155	(1)
Bone Marrow Transplantation	155	(4)
Indications and selection of patients	155	(1)
Bone marrow transplantation for acute myeloid leukaemia	155	(1)
Management of the patient	155	(1)
Graft-versus-host disease in an infant with severe combined immune deficiency	156	(1)
Complications and their prevention: graft versus host disease and infection	157	(1)
Results	158	(1)
Peripheral blood stem cell transplantation	158	(1)
Stem cell transplantation for autoimmune disease	158	(1)
Xenotransplantation	159	(2)
Further Reading	159	(1)
Questions	159	(2)
Kidney Diseases	161	(22)
Introduction	161	(1)
Clinical Syndromes	162	(1)
Normal Glomerular Structure	162	(1)
Histological Classification of Glomerulonephritis	163	(1)
Glomerulonephritis	163	(2)
Acute immune-complex nephritis	164	(1)
Poststreptococcal glomerulonephritis	164	(1)
Acute post infectious glomerulonephritis	164	(1)
Chronic Glomerulonephritis	165	(10)
Membranous glomerulonephritis	166	(1)
Membranous glomerulonephritis	167	(1)
Membranoproliferative glomerulonephritis type II	168	(1)
Membranoproliferative glomerulonephritis (mesangiocapillary glomerulonephritis)	169	(1)
Systemic lupus erythematosus	170	(1)
Rapidly progressive glomerulonephritis	170	(1)
Anti-glomerular basement membrane glomerulonephritis	171	(1)
Anti-glomerular basement membrane disease	171	(1)
Antineutrophil cytoplasmic antibody-associated necrotizing crescentic glomerulonephritis	172	(1)
Antineutrophil cytoplasmic antibody-associated glomerulonephritis	173	(1)
Other forms of glomerulonephritis	173	(1)
IgA nephropathy	173	(1)
IgA nephropathy	173	(1)
Henoch-Schonlein nephritis	174	(1)
Henoch-Schonlein nephritis	174	(1)
Nephrotic Syndrome	175	(3)
Minimal-change nephropathy	175	(1)
Minimal-change nephropathy	175	(1)
Focal glomerulosclerosis	176	(1)
Idiopathic amyloid	176	(1)
Amyloid disease	177	(1)
Other causes of the nephrotic syndrome	178	(1)
Tubulointerstitial Nephropathy	178	(2)
Acute tubulointerstitial nephritis	178	(1)
Acute drug-induced tubulointerstitial nephritis	178	(1)
Myeloma kidney	179	(1)
Multiple myeloma and myeloma kidney	179	(1)
Other immunologically mediated tubulointerstitial nephritides	179	(1)
Chronic Renal Failure	180	(1)
Recurrent Glomerulonephritis in Transplanted Kidneys	180	(3)
Further Reading	180	(1)
Questions	181	(2)
Joints and Muscles	183	(23)
Introduction	183	(1)
Patterns of Joint Disease	184	(1)
Arthritis and Infection	184	(2)
Septic arthritis	185	(1)
Septic arthritis	185	(1)
Rheumatoid Arthritis	186	(4)
Rheumatoid arthritis	186	(1)
Diagnosis	186	(1)
Serology	187	(1)
Pathology	187	(1)
Immunopathogenesis	187	(1)
Aetiology	188	(1)
Fibrosing alveolitis in rheumatoid arthritis	189	(1)
Complications	189	(1)
Management	189	(1)
Seronegative Spondyloarthritis	190	(3)
Ankylosing spondylitis	190	(1)
Ankylosing spondylitis	191	(1)
Reiter's disease	191	(1)
Other seronegative spondyloarthritides	191	(1)
Other seronegative arthritides	192	(1)
Behcet's syndrome	192	(1)
Chronic Arthritis in Children	193	(1)
Juvenile chronic arthritis	194	(1)
Systemic Lupus Erythematosus	194	(5)
Clinical features	194	(1)
Systemic lupus erythematosus	195	(1)
Laboratory findings	196	(1)
Differential diagnosis	196	(1)
Mild systemic lupus erythematosus	196	(1)
Drug--induced systemic lupus erythematosus	196	(1)
Management	197	(1)
Prognosis	197	(1)
Aetiology and pathogenesis	198	(1)
Other Connective Tissue Diseases	199	(2)
Mixed connective tissue disease	199	(1)
Mixed connective tissue disease	200	(1)
Sjogren's syndrome	200	(1)
Sjogren's syndrome	200	(1)
Scleroderma	201	(1)
Systemic Vasculitis	201	(3)
Polyarteritis nodosa	201	(1)
Polyarteritis nodosa	202	(1)
Polymyalgia rheumatica	203	(1)
Polymyalgia rheumatica and temporal (giant cell) arteritis	203	(1)
Other vasculitides	203	(1)
Inflammatory Muscle Disease or Myositis	204	(2)
Polymyositis	204	(1)
Further Reading	204	(1)
Questions	205	(1)
Skin Diseases	206	(16)
Introduction	206	(1)
Infections and the Skin	207	(1)
Recurrent cold sores	207	(1)
Atopic Eczema	208	(1)
Atopic eczema	208	(1)
Contact Dermatitis	209	(1)
Nickel dermatitis	209	(1)
Contact dermatitis	209	(1)
Bullous Skin Diseases	210	(3)
Pemphigus vulgaris	211	(1)
Pemphigus vulgaris	211	(1)
Bullous pemphigoid	212	(1)
Pemphigoid gestationis	212	(1)
Epidermolysis bullosa acquisita	212	(1)
Dermatitis herpetiformis	212	(1)
Systemic Diseases with Skin Involvement	213	(9)
Hereditary angioedema	213	(1)
C1 inhibitor deficiency	213	(1)
Urticarial vasculitis	214	(1)
Vasculitis	214	(1)
Mixed cryoglobulinaemia	215	(1)
Cryoglobulinaemia	216	(1)
Discoid lupus erythematosus	216	(1)
Lupus erythematosus	216	(1)
Systemic sclerosis	217	(1)
Systemic sclerosis	217	(2)
Psoriasis	219	(1)
Vitiligo	220	(1)
Alopecia areata	220	(1)
Further Reading	220	(1)
Questions	220	(2)
Eye Diseases	222	(8)
Introduction	222	(1)
Conjunctivitis	223	(3)
Conjunctival infection	224	(1)
Conjunctival infection	224	(1)
Allergic conjunctivitis	225	(1)
Allergic conjunctivitis	225	(1)
Autoimmune conjunctivitis	225	(1)
Stevens--Johnson syndrome	225	(1)
Stevens--Johnson syndrome	225	(1)
Other causes of conjunctivitis	225	(1)
Keratitis	226	(1)
Scleritis	226	(1)
Uveitis	226	(4)
Reiter's disease	226	(1)
Anterior uveitis	226	(1)
Posterior uveitis	227	(1)
Lens-induced uveitis	228	(1)
Lens-induced uveitis	228	(1)
Further Reading	228	(1)
Questions	228	(2)
Chest Diseases	230	(16)
Introduction	230	(1)
Respiratory Infections	231	(2)
Infections in the immunocompetent host	231	(1)
Pneumonia and chronic lymphatic leukaemia	232	(1)
Infection in the immunocompromised host	232	(1)
Granulomatous Diseases	233	(3)
Formation of a granuloma	233	(1)
Tuberculosis	234	(1)
Pulmonary tuberculosis	234	(1)
Sarcoidosis	235	(1)
Sarcoidosis	235	(1)
Interstitial Lung Disease	236	(4)
Allergic bronchopulmonary aspergillosis	237	(1)
Pulmonary eosinophilia	237	(1)
Extrinsic allergic alveolitis: farmers' lung	238	(1)
Extrinsic allergic alveolitis: bird fanciers' lung	238	(1)
Extrinsic allergic alveolitis	238	(1)
Cryptogenic fibrosing alveolitis	239	(1)
Fibrosing alveolitis	239	(1)
Pulmonary Vasculitis	240	(1)
Wegener's granulomatosis	241	(1)
Pulmonary Fibrosis	241	(1)
Cardiac Disease	242	(1)
Pericarditis	242	(1)
Myocarditis	242	(1)
Endocarditis	243	(1)
Coronary Artery Disease	243	(1)
Kawasaki's disease	243	(1)
Diseases of the Great Vessels	244	(2)
Takayasu's arteritis	244	(1)
Further Reading	244	(1)
Questions	245	(1)
Gastrointestinal and Liver Diseases	246	(23)
Introduction	246	(3)
Normal immune mechanisms	246	(2)
Spectrum of the intestinal immune response	248	(1)
Human Immunodeficiency Virus	249	(1)
Acquired immune deficiency syndrome presenting as Salmonella enteritis	249	(1)
Human immunodeficiency virus and the gut	249	(1)
Gastritis	250	(2)
Pernicious anaemia	250	(1)
Atrophic gastric and pernicious anaemia	250	(2)
Food-Induced Gastrointestinal Disease	252	(3)
Food allergy	252	(1)
Coeliac disease	253	(1)
Coeliac disease	253	(2)
Autoimmune Enteropathy	255	(1)
Inflammatory Bowel Disease	256	(1)
Crohn's disease	256	(1)
Crohn's disease and ulcerative colitis	256	(1)
Viral Hepatitis	257	(5)
Hepatitis A	257	(1)
Hepatitis A	257	(1)
Hepatitis B	258	(2)
Hepatitis C-induced liver disease	260	(1)
Hepatitis C	261	(1)
Other hepatitis viruses	262	(1)
Autoimmune Liver Diseases	262	(7)
Autoimmune hepatitis	262	(1)
Chronic active hepatitis	262	(2)
Primary biliary cirrhosis	264	(1)
Primary biliary cirrhosis	264	(1)
Associated syndromes	265	(1)
Alcohol-induced liver disease	266	(1)
Drug-induced liver disease	266	(1)
Further Reading	267	(1)
Questions	267	(2)
Endocrinology and Diabetes	269	(13)
Introduction	269	(1)
Mechanisms of Endocrine Autoimmunity	269	(1)
Thyroid Disease	270	(5)
Graves' disease	271	(1)
Thyrotoxicosis	271	(2)
Hashimoto's thyroiditis	273	(1)
Hashimoto's thyroiditis	273	(1)
Primary myxoedema	274	(1)
Idiopathic thyroid atrophy (myxoedema)	274	(1)
Diabetes Mellitus	275	(2)
Classification of diabetes mellitus	275	(1)
Immunopathogenesis of diabetes mellitus	275	(2)
Complication of diabetes mellitus	277	(1)
Diabetes mellitus	277	(1)
Are immunological tests useful?	277	(1)
Adrenal Disease	277	(1)
Addision's disease	278	(1)
Autoimmune adrenal disease	278	(1)
Parathyroid Disease	278	(1)
Gonadal Disease	278	(1)
Oophoritis	278	(1)
Infertility	279	(1)
Autoimmune male infertility	279	(1)
Immunology of infertility	279	(1)
Pituitary Disease	279	(1)
Autoimmune Polyendocrine Disease	279	(3)
Further Reading	280	(1)
Questions	280	(2)
Haematological Diseases	282	(13)
Introduction	282	(1)
Mechanisms of destruction	282	(1)
Autoimmune Haemolytic Anaemias	283	(4)
Primary autoimmune haemolytic anaemia	284	(1)
Warm antibody haemolytic anaemias	284	(1)
Cold haemagglutinin disease	285	(1)
Cold antibody haemolytic anaemias	286	(1)
Cephalosporin-induced haemolytic anaemia	286	(1)
Drug-induced autoimmune haemolytic anaemias	287	(1)
Paroxysmal nocturnal haemoglobinuria	287	(1)
Alloantibodies causing anaemia	287	(1)
Immune Thrombocytopenia	287	(3)
Immune thrombocytopenia	288	(1)
Immune thrombocytopenia	288	(1)
Drug-induced thrombocytopenia	289	(1)
Neonatal alloimmune diseases	289	(1)
Neonatal thrombocytopenia	290	(1)
Neutropenia	290	(1)
Haemopoietic Progenitor Cells	290	(1)
Immune Disorders of Coagulation	291	(1)
Primary antiphospholipid antibody syndrome	291	(1)
Primary antiphospholipid antibody syndrome	291	(1)
Other antibodies to coagulation factors	291	(1)
Blood Transfusion	292	(3)
Principles of blood transfusion	292	(1)
Transmission of hepatitis C by a blood product	292	(1)
Risks of blood transfusion	292	(1)
Further Reading	293	(1)
Questions	294	(1)
Neuroimmunology	295	(9)
Introduction	295	(1)
Haemophilus influenza type by meningitis	296	(1)
Infections	296	(1)
Demyelinating Diseases of the Central Nervous System	297	(2)
Multiple sclerosis	297	(1)
Multiple sclerosis	297	(2)
Other demyelinating diseases	299	(1)
Autoimmune Diseases of the Neuromuscular Junction	299	(2)
Myasthenia gravis	299	(1)
Myasthenia gravis	299	(1)
Lambert-Eaton myaesthenic syndrome	300	(1)
Immune-Mediated Neuropathies	301	(1)
Guillain--Barre syndrome	301	(1)
Acute idiopathic polyneuritis (Guillain--Barre syndrome)	301	(1)
Chronic inflammatory peripheral neuropathy	301	(1)
Chronic inflammatory peripheral neuropathies	302	(1)
Monoclonal gammopathies	302	(1)
Cerebral Systemic Lupus Erythematosus	302	(2)
Systemic lupus erythematosus	302	(1)
Cerebral systemic lupus erythematosus	302	(1)
Further Reading	303	(1)
Questions	303	(1)
Pregnancy	304	(10)
Introduction	304	(1)
Immunological Mechanisms in Implantation and Pregnancy	304	(2)
The role of the uterus	304	(1)
The role of the placenta	305	(1)
Maternal mechanisms	306	(1)
Pregnancy and Maternal Infection	306	(1)
A mother infected with Listeria	306	(1)
Protection of the Fetus and Neonate Against Infection	307	(2)
Cellular development of the fetus	307	(1)
Placental transfer of IgG	307	(1)
Hypogammaglobulinaemia of prematurity	308	(1)
Immunological value of breast-feeding	308	(1)
Disorders of Pregnancy	309	(5)
Recurrent spontaneous abortion	309	(1)
Recurrent abortion	309	(1)
Systemic lupus erythematosus	309	(1)
Outcome of pregnancy in systemic lupus erythematosus	310	(1)
Other rheumatic diseases in pregnancy	310	(1)
Pre-eclampsia	310	(1)
Haemolytic diseases of the newborn	311	(1)
Alloimmunization	311	(1)
Transient neonatal Graves' disease	312	(1)
Organ-specific autoimmune diseases in pregnancy	312	(1)
Further Reading	312	(1)
Questions	313	(1)
Techniques in Clinical Immunology	314	(21)
Introduction	314	(1)
Production of Antisera Used in Clinical Immunology Laboratories	315	(1)
Measurement of Immunoglobulins and Other Specific Proteins	316	(1)
Qualitative Investigation of Immunoglobulins	317	(2)
Serum	317	(1)
Urine	318	(1)
Cerebrospinal fluid	318	(1)
Investigation of Complement and Immune Complex Disorders	319	(2)
Assays for individual components	319	(1)
Detection of complement breakdown products	320	(1)
C3 nephritic factor	320	(1)
Functional assays	320	(1)
Assays for immune complexes	321	(1)
Antibodies to Microbial Antigens	321	(1)
Detection of Autoantibodies	321	(4)
In serum	321	(4)
Biopsy material	325	(1)
Tests for Allergy and Hypersensitivity	325	(2)
Antigen-specific IgE antibodies	325	(1)
Total serum IgE	326	(1)
Precipitating antibodies	326	(1)
Assessment of Lymphocytes	327	(2)
Quantitation of lymphocytes	327	(1)
Functional tests	327	(2)
Assessment of Neutrophils and Monocytes	329	(1)
Neutrophil and monocyte quantitation	329	(1)
Functional tests	329	(1)
Recombinant DNA Technology in Clinical Immunology	330	(2)
DNA analysis	330	(2)
Diagnosis implications	332	(1)
Histocompatibility Testing	332	(3)
Further Reading	333	(1)
Questions	333	(2)
Appendix	335	(2)
Answers	337	(2)
Index	339