Specialty Content

Immunology specialty

Clinical Immunology covers autoantibodies, complement, immunodeficiency screening, transplant immunology, and allergy.

Where the content lives

• The Immunology Laboratory — /immunology-lims — the full laboratory simulation: Worklist, Bench, Interpret, Learn. Autoverification and what a laboratory may release, the autoantibody and flow benches, what a positive actually licenses, and the pathways from coeliac and allergy to immunodeficiency and vasculitis
• Specialty page — /immunology-interviews — guides, simulators and case studies, with the link into the Interview Explorer question bank (Bands 2 to 8)
• Result Interpretation (immunology) — open /result-interpretation and click the Immunology card — autoimmune serology, complement, flow cytometry patterns
• Specialist Portfolio (Immunology) — /portfolio → choose the Immunology discipline card, then select Specialist Diploma in the AI Assistant tab
• Cross-references — flow cytometry overlaps with Haematology; HLA matching overlaps with Transplant

Key competencies covered

• Autoantibody testing — ANA (HEp-2), ENA panel, ANCA, anti-dsDNA, anti-CCP, rheumatoid factor
• Immunofluorescence — IIF pattern interpretation
• Complement — C3, C4, total complement (CH50), complement deficiency screening
• Immunoglobulins — IgG/IgA/IgM, paraprotein detection (electrophoresis + immunofixation, free light chains)
• Allergy testing — specific IgE, total IgE, food/environmental panels
• Cellular immunology — lymphocyte subsets (CD4, CD8, CD19, NK)
• Immunodeficiency screening — primary and secondary
• Transplant immunology — HLA typing, antibody screening (often a separate H&I lab)
• Flow cytometry — gating strategies, panel design

Bands progression

• Band 5 (£32,073-£39,043) — qualified BMS performing routine autoantibody, complement, immunoglobulin assays
• Band 6 (£39,959-£48,117) — specialist interpretation of complex patterns, validation, training; usually requires Specialist Portfolio in Immunology
• Band 7 (£49,387-£56,515) — section lead, clinical interpretation sign-off, advanced flow panels, MDT contribution

Standards alignment

• ICAP anti-cell nomenclature — the classification tree for HEp-2 immunofluorescence patterns, AC-0 to AC-31 plus AC-XX for an unclassified pattern. AC-30, AC-31 and AC-XX were added in September 2024 following the 7th ICAP Workshop; a pattern set stopping at AC-29 is the edition before that
• EULAR/ACR 2019 classification criteria for systemic lupus erythematosus — an ANA of 1:80 or above on HEp-2 is the entry criterion, meaning the point at which the criteria may be applied, not evidence that they are met
• NICE NG20, coeliac disease — tissue transglutaminase IgA first line with a total IgA alongside it. Recommendation 1.3.1 refers young people and adults with positive serology for endoscopic biopsy; 1.3.2 refers children for further investigation. The no-biopsy threshold of ten times the upper limit of normal is ESPGHAN's, not NICE's
• IMWG 2014 diagnostic criteria — including an involved-to-uninvolved free light chain ratio of 100 or more as a myeloma-defining event in its own right
• CLSI H62, Validation of Assays Performed by Flow Cytometry — first edition, published October 2021
• NICE NG35 myeloma, NG33 tuberculosis and the interferon-gamma release assays, CG134 anaphylaxis and the timed tryptase samples, CG116 food allergy in under 19s
• British Society for Immunology, Royal College of Pathologists and EFI for transplant immunology and H&I
• UK NEQAS Immunology, UK NEQAS for H&I
• ISO 15189:2022 — the quality framework, which since this edition also covers point-of-care testing
• MHRA for clinical immunology devices

Common interview question themes (Band 5-7)

• "Walk me through your ANA-positive workflow — what would you do next?"
• "How do you interpret a high IgG with low IgA — what investigations follow?"
• "What does a 'rim' pattern on IIF suggest, and what confirmatory tests would you do?"
• "How would you set up a flow cytometry panel for primary immunodeficiency?"
• "Describe how you would investigate a discrepant complement result"

A good preparation stack: Result Interpretation → Practice Tests filtered to Immunology + your Band → AI Interview Coach. The flow-cytometry gating component benefits from time on the Virtual Lab if available.