Does IgA deficiency involve special considerations in histological diagnosis?

[Dimitri001]

I was reading a paper entitled Pathogenesis and treatment of gastrointestinal disease in antibody deficiency syndromes, and there's a passage in it that reads:

Quote

In contrast, the specific IgA-class antibodies against gliadin, endomysium, and tissue transglutaminase are not produced in IgA-deficient patients, and IgA-secreting plasma cells are absent in intestinal biopsy specimens, 14,17,80–82 making detection of disease and monitoring of therapy challenging.

Does the bolded part mean there is some specific way in which a pathologist must asses a sample from an IgA deficient person that is different from a regular sample? I checked the references, but couldn't find any mention of this point about IgA-secreting plasma cells or the answer to my question.

I'm being treated in a national health system that is highly unpersonalized and the pathologist who'll be receiving my samples won't know I have IgA deficiency, so I'm a bit concerned about this.

[Dimitri001]

To clarify, the quote is speaking specifically about specimens taking for celiac diagnosis.

[trents]

I do not think it means there is no damage being done to the small bowel villi which is what they are looking for in a biopsy. It's saying that the cells that normally secrete the IGA antibody markers of inflammation are missing or at least abnormally low and this can skew serum IGA antibody tests toward the negative end. I think it's simply saying that when total IGA is low, the IGA antibody testing may not be reliable.

[RMJ]

1 hour ago, Dimitri001 said:

I was reading a paper entitled Pathogenesis and treatment of gastrointestinal disease in antibody deficiency syndromes, and there's a passage in it that reads:

Does the bolded part mean there is some specific way in which a pathologist must asses a sample from an IgA deficient person that is different from a regular sample? I checked the references, but couldn't find any mention of this point about IgA-secreting plasma cells or the answer to my question.

I'm being treated in a national health system that is highly unpersonalized and the pathologist who'll be receiving my samples won't know I have IgA deficiency, so I'm a bit concerned about this.

I’m not sure I’d agree with this phrase from the paper (in the section on intestinal autoantibodies):

Quote

Staining of IgA deposits, which are small-bowel mucosal TG2-targeted autoantibodies, has extensively been used in the diagnostic workups of celiac disease. 

IF biopsy specimens were only processed to look at IgA deposits, it could be a problem, but I don’t think that is routine.  Most celiac biopsy specimens are stained with dyes (for example H&E - hematoxylin and eosin - which are what give specimens the pretty blue/purple and pink colors). These dyes do not stain IgA. The three features that are diagnostic of celiac disease, shortened/absent villi, crypt hyperplasia and excess intraepithelial lymphocytes, can be seen with H&E staining.

The Marsh classification for histologic findings in celiac disease does not require staining of IgA deposits. 

It could be a problem for the EMA blood test, because that test usually looks for IgA antibodies. 

 

[Scott Adams]

This article has a detailed description of the blood test procedure: