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Background
Lupus is a non-specific immune disorder. It is caused by antibodies of defense proteins which target the own tissues of body rather than foreign invaders. It can damage many tissues, joints, brain, kidneys, heart, lungs, and skin.
Lupus erythematosus (LE) cell was identified by Hargraves, Morton, and Richmond in 1948. These cells seen in bone marrow who are associated with lupus.
An LE cells are macrophage or neutrophil, which are ingested and phagocytized, which degrade in nuclear material from another cell. The strongly stained ingested nuclear material is referred to as the LE body. The LE cell response is positive in 50 % to 75 % of patients who have acute disseminated lupus. The positive reactions are observed in chronic hepatitis (lupoid), dermatomyositis, scleroderma, rheumatoid arthritis, acquired hemolytic anemia, polyarteritis nodosa, and Hodgkin disease. It is positive in patients who take hydralazine and phenylbutazone.
LE cell test was used to diagnose systemic lupus erythematosus (SLE). It is replaced by the ANA test, which is a more sensitive and specific test. ANA is used to detect lupus erythematosus. The optimal temperature for this test is 22°C, and incubation at 37°C may speed up the procedure.
Indications/Applications
The LE test is performed if you have symptoms like:
Rash: Butterfly shaped rash
Fatigue
Fever
Joint pain
Light sensitivity: Skin rashes by exposure to sunlight
Stiffness
Renal diseases: Symptoms like hematuria or proteinuria
Hematological diseases: leukopenia, hemolytic anemia, thrombocytopenia
lymphopenia
Neurological diseases: Seizures or psychosis
The LE test is used to identify autoimmune diseases. It is used for both women and men if symptoms like joint inflammation, extreme tiredness, pain in joint may indicate the positive SLE.
Reference Range
Negative test results indicate no presence of SLE. Positive test results indicate lupus.
A smear is regarded as positive if 10 or > 10 LE cells are observed with in 15 minutes. They are associated with amorphous, extracellular, and nuclear masses. The diagnosis of SLE indicated by the presence of lupus erythematosus cells in bone marrow.
Interpretation
When 2-30% LE cells are observed on slide in neutrophil count represents as a lupus erythematosus cell test positive. The reliability of this test is dependent on the technical and observational skills of the performer.
A positive test results may indicate other diseases like:
Acquired hemolytic anemia
Chronic hepatitis
Dermatomyositis
Polyarteritis nodosa
Scleroderma
Rheumatoid arthritis (RA)
Patients who take medications like hydralazine and phenylbutazone
Collection And Panels
LE test is performed by using any of the below samples:
Clotted venous blood
Defibrinated venous blood
Heparinized venous blood
Heparinized bone marrow
Oxalated venous blood
LE factor and donor cell
Collecting bone marrow is painful for patient. A Buffy coat from venous blood is used. If it is not available, an unprocessed venous blood sample is allowed to clot for 20 to 120 minutes, and plasma is removed. The leftover clot is centrifuged to collect buffy coat for 5 minutes. This is spread over the slides to see LE cells.
This test is also performed with plasma, serous effusions or serum of patients.
Panels:
Panels which are linked with LE cell test increase the effectiveness of diagnosis of SLE and other autoimmune diseases. LE cell test is not performed nowadays, but the below tests can be included in lupus diagnosis panels:
Antinuclear Antibody (ANA) test: This test identifies autoantibodies which target the cell nucleus.
Anti-dsDNA Antibody test: This test identifies particular double-stranded DNA which is specific for SLE.
Anti-Smith (anti-Sm) Antibody test: This test is a specific marker for SLE.
Complement Levels (C3, C4): Decreased levels of C3 and C4 seen in SLE.
C-Reactive Protein and Erythrocyte Sedimentation Rate (ESR): These tests detect inflammation in the body and increase in patients who have SLE.
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