Several different serum tests are used to detect autoimmunity. These are conditions where the immune system acts directly against the bodys own tissues. One test, the ANA, or anti-nuclear antibody test, detects antibodies that are directed against various components of the nucleus of the cell. These include antibodies that have been formed against double-stranded or single-stranded DNA (two ways in which the cells DNA can be found in the serum after being released from old and dying cells). Other components of the nucleus such as histones are also released from old cells and can also become targets of the immune response. When they appear they may be markers for excess or inappropriate immune responses directed against ones own tissues. Physicians in our group test for various autoantibodies in order to characterize patients as those who might have a tendency for autoimmune responses. Those who test positive have been found to have a higher risk for recurrent pregnancy loss and are more likely to benefit from therapeutic interventions (see diagram).
-Antinuclear Antibody (ANA) positive, speckled pattern.
-Autoantibody to DNA leads to inflammation in the placenta.
-Autoimmune disease screening in the woman is negative (No evidence of lupus or rheumatoid arthritis).
A blood test determines the presence of antibodies to polynucleotides, histones and DNA. This process involves running 27 different tests on a sample of blood.
The presence of antibodies is also tested for by doing the ANA test. This is a less sensitive test but one that many doctors have already done on their patients before we ever see them.
The test is reported as a titer and a pattern. Any titer above 1:40 is significant. The titers can get into the thousands such as 1:2,500. This simply means that the test is positive when the blood serum is diluted many times.
The pattern is reported as homogeneous, nucleolar or speckled:
-Homogeneous: the antibody is to the ss DNA or ds DNA.
-Nucleolar: the antibody is directed to the polynucleotides.
-Speckled: the antibody is directed against the histones.
Some women demonstrate a mixed pattern of speckled/homogeneous. These same antibodies appear positive in women with lupus, rheumatoid arthritis, Crohn's disease and other autoimmune diseases. They are usually in high titers. Pregnancy losses, infertility and IVF failures cause the titers to be much lower and a low positive titer does not mean that you have or are getting an autoimmune disease; however, this is ruled out during the testing.
In women with autoimmune diseases these antibodies cause inflammation in joints and organs. In women with no autoimmune diseases but a positive antibody, the antibody causes inflammation around the embryo at the time of implantation or in the placenta after implantation. This inflammation is exactly the same as occurs if you get a splinter under your fingernail. The tissue around the splinter gets hot, red and swollen and it happens quickly.