From Big Medical Encyclopedia

PAULJA-BUNNJELLJA REACTION (J. R. Paul, amer. doctor, sort. in 1893; W. W. Bunnell, amer. doctor, sort. in 1902; synonym Hanganutsiu — Paul — Bunnellya reaction) — the nonspecific laboratory test of recognition of an infectious mononucleosis based on identification in blood serum of patients of the increased level of agglutinins to heterogeneous erythrocytes (heterohemagglutinins). At the beginning of the 30th Paul and Bunnell, studying the heterophyllous antibodies found at rheumatism — the test offered earlier Hanganutsiu (M. of Nap-ganutziu) — noticed that the caption of these nonspecific antibodies is highest at an infectious mononucleosis. Definition with the diagnostic purpose at an infectious mononucleosis of heterophyllous antibodies in blood serum received the name P. — B. of river. Deyvidson and Walker (I. David-sohn, P. H. Walker, 1935) suggested to apply the blood sera which are previously adsorbed by tissue of kidneys of a Guinea pig and erythrocytes of a bull to increase in specificity of reaction. In scientific literature of P. — B. the river which is carried out on glass with branded reagents is called the monotest for diagnosis of an infectious mononucleosis. In the USSR P. — B. the river is applied generally in research establishments of a clinical profile.

Heterohemagglutinins belong to system of heterophyllous antibodies as Forssman's antibodies and cold agglutinins (see. Antibodies ), constantly present (90 — 95% of cases) in low credits (1: 10, it is rare 1: 40) in blood sera of people. They belong to the class IgG and are adsorbed on suspension of tissue of kidneys of a Guinea pig. The antibodies accompanying an infectious mononucleosis belong to the class IgM (their caption 1: 80 and above — to 1: 1280) also are adsorbed only by erythrocytes of a bull that serves as the test for their differentiation. These antibodies appear in blood in the acute period of a disease, since first week i.e. when clinically it is not always possible to make the diagnosis in connection with existence of the symptoms which are often found and at other nosological forms (fever, a hyperadenosis, Qatar of upper respiratory tracts etc.). Heterophyllous antibodies are found in 50 — 80% of cases of an infectious mononucleosis therefore their absence does not exclude a wedge, the diagnosis of a disease. High credits of this sort of antibodies can be observed also at other diseases (a viral hepatitis, leukemia, scarlet fever, etc.). Especially high and resistant level them is noted at cirrhosis.

For statement of reaction use fresh erythrocytes of a ram in the form of 2% of a suspension in isotonic solution of sodium chloride and 10% suspension of tissue of kidneys of a Guinea pig. Storage of ready erythrocytes even within a day leads to decrease in their agglyutinabelnost.

Reaction can be put in two options: approximately and in detail. In the first case existence or lack of heterophyllous antibodies, in the second — their caption is defined. Both in that, and in other case ispytuyemy blood serum of the patient shall be heated-up before a research at t ° 56 ° within 30 min. or at t ° 63 ° within 3 min. and is exhausted adsorbed) by tissue of kidneys of a Guinea pig. Approximately reaction is put like reaction of definition of blood groups: on glass add 3 drops of the studied blood serum to one drop of suspension of erythrocytes of a ram and mix, shaking glass. Emergence of conglomerates of erythrocytes within a minute demonstrates existence of antibodies.

For definition of an antiserum capacity carry out the developed reaction. For this purpose prepare double serial dilutions of blood serum (since 1: 5 to 1: 1280) in isotonic solution of sodium chloride of 0,5 ml. Add to each test tube on 0,5 ml 2% of a suspension of erythrocytes of a ram, carefully stir up, place for 1 hour in the water bath at t ° 37 °, and then for the night at t ° 4 °. In a control test tube from 2% a suspension of erythrocytes instead of blood serum of the corresponding cultivation add 0,5 ml of isotonic solution of sodium chloride.

The accounting of reaction is carried out next day, i.e. after sedimentation of erythrocytes. If necessary more prompt reply of a test tube with a suspension of erythrocytes is centrifuged within 15 min., and then carefully stirred up. In a control test tube during the stirring the uniform suspension of erythrocytes, and in experienced — conglomerates of erythrocytes of various intensity is observed. An antiserum capacity consider the last cultivation of serum, at Krom conglomerates of erythrocytes are noted.

The heterophyllous antibodies defined in P. — B. rubles, reach the maximum level by the end of the 4th week and can is long to be found.

For diagnosis of an infectious mononucleosis in the nek-ry countries, in particular in the USA, the testing sets are issued, most of them includes the test of agglutination on glass which is usually carried out with one cultivation of serum and with for-malinizirovanny erythrocytes; also the erythrocytes processed by papain are applied.

Bibliography: Ananyev V. A., etc. Reaction of a geterogemmagglyutination at an infectious disease, in book: An infectious disease, under the editorship of E. M. Tareeva and A. K. Shubladze, page 221, M., 1956; The Guide to clinical laboratory trials, under the editorship of E. A. Kost and JI. G. Smirnova, page 876, M., 1964; Davidsohn I. Serologic diagnosis of infectious mononucleosis, J. Amer, med. Ass., v. 108, p. 289, 1937; Davi d-sohn I. Walker P. H. Nature of heterophilic antibodies in infectious mononucleosis, Amer. J. clin. Path., v. 5, p. 455, 1935; Paul J\R. B u n n e 1 1 W. W. The presence of heterophile antibodies in ihfectious mononucleosis, Amer. J. med. Sci., y. 183, p. 90, 1932.

V. A. Ananyev.