01/11 AIR note

PLT 下降：SLE、APS、vasculitis
PLT 上升：RA、AS (>400K)

MCV>100
hemolytic anemia：reticuocyte增加、coomb's test (+)、haptoglobulin減少 -- SLE、APS常見
MTX-induced anemia：MTX為folic acid antagonist，抑制DNA合成，所以服用時可合併葉酸使用

microcytic + macrocytic anemia可能會出現，MCV會是正常，可測RDW看RBC的range

LDH上升：hemolytic anemia、myopathy
CPK上升：myopathy

GOT上升>GPT上升：alcohol/herb-induced hepatitis、hemolysis、myopathy
GOT上升
24hrs urine protein留法：ex. 7AM~7AM 不留第一泡尿，留最後一泡尿

spot urine protein：算protein/Cr ratio

hematuria：RBC不變形->collecting system以下；RBC變形-> 腎絲球腎炎

ANA > 1:160為 (＋)
(++) high titer：SLE、MCTD
(＋) low titer：elderly、S.S、RA、SAE (spondyloarthropathy enthesopathy)、infection、malignancy、drug-induced

ANA在細胞核內
diffuse (chromatin) 均勻亮：a-dsDNA Ab、a-Histone Ab (drug-induced出現)
peripheral (chromatin) 核內外圈更亮：a-dsDNA Ab
coarse speckled (nucleolar不亮)：a-RNP Ab (MCTD)、a-Sm Ab (SLE)
fine speckled：SSA(Ro)、SSB(La)
nucleolar pattern (核仁更亮)：a-Scl70 Ab (DNA topoisomerase Ab)

ENA1+2：SSA、SSB、RNP、Sm

RF(+)：RA、S.S、bacteria endocarditis、Hepatitis C、TB、fungal infection、malignancy

S.S RF(+)的prevalence大於RA

C3、C4：點人頭
CH50：看能力 -> RBC hemolysis > 50%

補體由肝臟製造，所以肝功能下降，C3C4會下降

APS
1.Lupus anticoagulant (thromboembolism關連性高)
2.Anticardiolipin Ab -> pathogenic Ab、ACA-IgG IgA、ACA-IgM
3.Cofactor Ab -> AB2GPI Ab (thromboembolism關連性高)、APTS Ab (最sensitive)

periungal microcapillary exam：
密集網狀 -> SLE
loop dilatation, giant loop, hemorrhagic spot, avascular zone -> scleroderma or dermatomyositis
bushy form -> dermatomyositis