The clinical Immunology service comprises of two elements: A) the laboratory service and B) the clinical primary immune deficiency service. Both services are based at the Royal Infirmary of Edinburgh.
A) Clinical Immunology Laboratory Services:
The Clinical Immunology laboratory processes blood testing for the investigation of patients suspected of autoimmunity, immune deficiency and some forms of allergy.
The service is provided to General Practitioners, clinics and hospitals in Edinburgh, Lothians and the Borders. Approximately 40,000 samples are received per annum and approximately 100,000 tests are carried out. There are 3 distinct areas within the laboratory;
Autoimmune Serology Service: Measurement of a number of autoantibodies found in a range of connective tissue diseases, endocrine disorders, primary vasculitides and other autoimmune disorders. These autoantibodies are measured by enzyme-linked immunosorbent assay (ELISA), indirect immunofluoresence (IIF) and fluorescence enzyme immunoassay (FEIA).
Further details on the individual tests are available in the test directory on the Edinburgh laboratory medicine website: http://www.edinburghlabmed.co.uk/TestDirectory/Pages/default.aspx
Autoantibodies testing is rarely ‘diagnostic’ for a particular condition, and therefore the testing is best clinically utilised when there is the presence of clinical symptoms/ signs to raise clinical concern of a particular autoimmune condition. In general, most autoimmune serological tests are not useful ‘screening tests’ as often false positive / equivocal results may be seen, highlighting that the presence of autoantibodies does not necessarily equate to the diagnosis / presence of autoimmune disease. Furthermore, in some patients with certain autoimmune conditions (e.g Rheumatoid Arthritis), there may be ‘seronegative’ disease, where rheumatoid factor and/or CCP antibodies are not detected, although these patients do have the disease. Please see specific RefHelp guidelines on these tests/ conditions for further information.
B) Clinical Immunology Primary Immune Deficiency (PID) Service
This Clinical Immunology PID service involves the investigation, clinical assessment, treatment and holistic management of patients with suspected and established primary immunodeficiencies [PID] requiring life-long treatment. It is responsible for all clinical referrals, for the Lothians, Fife, the Scottish Borders and some patients from Forth Valley.
Our overall catchment for primary and some secondary antibody deficient patients is of approximately ~1.5 million population. The department looks after patients with a range of PID disorders (currently a total of ~110 patients), including primary antibody deficiency (including Common Variable Immune Deficiency (CVID)), X-linked Agammaglobulinaemia (XLA), Combined Immune Deficiency, other complex PID syndromes, C1 inhibitor deficiency (including Hereditary Angioedema (HAE)), and some patients with secondary antibody deficiency who are on immunoglobulin replacement home therapy.
Adults with suspected immune deficiencies are seen within the Clinical Immunology clinics. There are also joint transition clinics held at the RIE or the Royal Hospital for Sick Children (RHSC), where adolescent / young patients are seen by both the Paediatric and Adult Immunology teams, as the initial steps for transitional care are made. There are no admitting facilities for Immunology.
Patients with primary immune deficiency commonly present with a clinical history of infections (usually bacterial) which are:
Severe
Persistent
Unusual
Recurrent
If clinical concern about primary immune deficiency, total immunoglobulins (IgG, IgA and IgM and electrophoresis) should be measured as first line tests and discussion with the clinical Consultant Immunologist is advised.
There is currently no clinical allergy service provided within the Clinical Immunology service in Edinburgh.
