The 14-floor Queen Elizabeth University Hospital (QEUH) building is one of the largest acute hospitals in the UK and home to major specialist services including renal medicine, transplantation, neurology, spinal and vascular surgery, with state-of-the-art Critical Care, Theatre and Diagnostic Services. There is also a Teaching and Learning Centre for the University of Glasgow.
Current vacancies
The Queen Elizabeth University Hospital currently has a range of medical vacancies within its Emergency Department, including:
If you are interested in the above vacancies:
- Submit an online application on the NHS Scotland Recruitment website.
- Forward your CV to ggc.workforcesupply@ggc.scot.nhs.uk.
- Contact the NHS Greater Glasgow and Clyde Workforce Supply Team on 07977194920 (telephone, SMS, WhatsApp).
About us
NHS Greater Glasgow and Clyde
NHS Greater Glasgow and Clyde is the largest health board and provider of healthcare in Scotland and one of the largest in the UK. Responsible for the provision and management of the whole range of health services in this area including hospitals and General Practice, NHS Greater Glasgow and Clyde works alongside partnership organisations including local authorities and the voluntary sector.
It serves a population of 1.15 million covering 6 local authority areas which include the city of Glasgow as well as incorporating both urban and rural areas. With a total budget of £3.2 billion and a workforce of around 39,369 staff, NHS Greater Glasgow and Clyde delivers local, regional and national services including acute hospital, primary, mental health and community services.
Capital Building Modernisation Programme
A major capital building programme of over £1 billion to modernise Glasgow’s acute hospitals has already seen the delivery of the new West of Scotland Cancer Centre, two Ambulatory Care Hospitals at Stobhill and the Victoria as well as a new Laboratory Facility providing Biochemistry, Haematology, Pathology, Genetics and citywide mortuary services based on the South Glasgow Hospitals Campus which was opened in 2012.
NHS Greater Glasgow and Clyde, Acute Services Division
NHS Greater Glasgow and Clyde’s Acute Services are delivered currently from three Sectors covering North Glasgow, South Glasgow and Clyde and three Directorates with cross site responsibilities covering Women and Children’s Services, Regional Services and Diagnostics.
The dimensions of the Directorates/Sectors are around:
South Sector / Directorate
- Budget: £353 million
- Staff numbers: 5,116
Regional Sector / Directorate
- Budget: £273 million
- Staff numbers: 3,486
North Sector / Directorate
- Budget: £193 million
- Staff numbers: 3,397
Women and Childrens Sector / Directorate
- Budget: £193 million
- Staff numbers: 2,961
Diagnostics Sector / Directorate
- Budget: £187 million
- Staff numbers: 2,765
Clyde Sector / Directorate
- Budget: £177 million
- Staff numbers: 3,019
Acute Corporate Sector / Directorate
- Budget: £24 million
- Staff numbers: 49
Totals
- Budget: £1,400 million
- Staff numbers: 20,793
NHS Greater Glasgow and Clyde has the largest group of adult acute hospitals in Scotland offering many opportunities to ensure job satisfaction and career development. We provide a wide range of services from community-based care through to the full range of general and specialist hospital services. Close links are enjoyed with all universities in Glasgow and Clyde and our staff makes a significant contribution to both undergraduate and postgraduate teaching across the multidisciplinary spectrum.
In Glasgow north of the river Clyde, there are Glasgow Royal Infirmary, Stobhill Ambulatory Care Hospital, Gartnavel General Hospital (including the Beatson West of Scotland Cancer Centre) and Glasgow Dental Hospital & School. In Glasgow south of the river, there are the Queen Elizabeth University Hospital, the Royal Hospital for Children, the Victoria Ambulatory Care Hospital and West Glasgow Ambulatory Care Hospital. And within the Clyde area are the Royal Alexandra Hospital in Paisley, Inverclyde Royal Hospital in Greenock and the Vale of Leven District General Hospital in Alexandria.
Queen Elizabeth University Hospital
The 14-floor Queen Elizabeth University Hospital building is one of the largest acute hospitals in the UK and home to major specialist services including renal medicine, transplantation, neurology, spinal and vascular surgery, with state-of-the-art Critical Care, Theatre and Diagnostic Services. There is also a Teaching & Learning Centre for the University of Glasgow.
The adult hospital is integrated with the children’s hospital with separate functions and entrances.
There is a physical link for patients and staff from the hospitals into the Maternity and Neurosciences Institute buildings. The hospitals are also linked to the laboratory buildings via an underground tunnel and pneumatic tube.
The atrium of the hospital houses retail shops and a coffee shop. There is a large restaurant/coffee area on the first floor of the hospital with a balcony and views out onto the landscaped area in front of the hospital.
The Queen Elizabeth University Hospital is a large teaching hospital with an acute-operational bed complement of 1109 beds. The Hospital is situated in the south-west of Glasgow and provides a comprehensive range of acute and related clinical services.
Services include Emergency Medicine, Dermatology, ENT, General Medicine (including sub-specialties), General Surgery (including sub-specialties), Medicine for the Elderly (including Assessment, Rehabilitation and Day Services), Gynaecology, Neonatal Paediatrics, Obstetrics, Ophthalmology, Orthopaedic Surgery, Urology, Physically Disabled Rehabilitation and Continuing Care. The Obstetrics, Gynaecology, Urology and Ophthalmology Departments provide the single in-patient location for the whole population of South Glasgow. In-patient Maxillofacial (trauma and elective surgery and specialist provision for head and neck cancer), Dermatology and the Assessment and Rehabilitation service for the Physically Disabled are also provided for the whole city from the Queen Elizabeth University Hospital.
The Institute of Neurological Sciences is based on the Queen Elizabeth campus and provides Neurosurgical, Neurological, Clinical Neurophysiology, Neuroradiological and Neuropathology facilities for the West of Scotland. The Queen Elizabeth National Spinal Unit for Scotland provides a spinal injuries service to the whole of Scotland. This is housed in a purpose-built facility.
There is also a wide range of therapeutic services including Audiology, Clinical Psychology, Dietetics, Occupational Therapy, ECG, Physiotherapy, Radiology (including MRI and CT provision for the general hospital service) and Speech Therapy.
Emergency Department
The Emergency Department of the Queen Elizabeth University Hospital is expected to see circa 110 000 new patient attendances per annum. An active shop floor consultant presence is maintained as is the importance of high quality training in Emergency medicine.
The Emergency Department provides a full 24-hour a day 7 day a week service for all 999 ambulance patients and patients who self-present. This provides the medical staff with a very broad range of clinical practice which includes acute general medicine, cardiology, surgical emergencies, major trauma, orthopaedic surgery, ophthalmology, ENT, paediatric medicine and surgery, psychiatric care and a small percentage of primary care patients.
In addition to the Emergency Department patients, GP referrals to orthopaedics are reviewed by the respective receiving teams in the Emergency Department. When these patients require resuscitation or immediate attention, the Emergency Department medical staff initiate initial treatment.
The Emergency Department consultant rota has been extensively revised to comply with the new consultant contract, extend consultant shop floor presence and foster closer working within the team. Emergency Medicine Services are delivered from minor injury units and one large Emergency Department on the Queen Elizabeth University Hospital site. The MIU’s and the Emergency Departments have a number of Emergency Nurse Practitioners who provide Minor Injury Services. In addition consultants employed within the Emergency department of the Queen Elizabeth University Hospital participate in the EMRS retrieval service.
Publications and resources
NHSGGC publications
Annual Report and Accounts
NHSGGC Clinical Strategies
NHSGGC Workforce Strategies
Health and Social Care Partnerships
Health and Social Care Partnerships (HSCPs), are organisations formed to integrate health and social care services provided by NHSGGC and six local authorities in the Greater Glasgow and Clyde region. Each partnership is jointly run by NHSGGC and the local authority.
Living and working in Greater Glasgow and Clyde
Living in Glasgow
We understand that choosing the right place to live is just as important as choosing the right job. Many people who have moved from abroad to Scotland have been attracted by the opportunity to enhance their quality of life.
We are aware you will ask yourself many questions and do a lot of research before making your final decision to move to Scotland.
Scotland’s people are well known for being warm, welcome and friendly. Scotland is a home to over five million people, and it is estimated that for every person living in Scotland, another five people living across the world have Scottish ancestry. With such wide connections spreading to every corner of the globe, it is no wonder that overseas visitors are made to feel like they are returning home!
As a place to live, the Greater Glasgow and Clyde area has many attractions. The West of Scotland combines cosmopolitan charm, lush countryside and soothing seaside. Culturally diverse, architecturally stunning and historically rich, this vibrant region is home to innovation, celebration and the largest city in Scotland – Glasgow.
As Scotland’s most populous region, the West of Scotland is home to approximately two million people. In addition to the city of Glasgow, East and West Dunbartonshire, Inverclyde, Ayrshire, North and South Lanarkshire, Renfrewshire and East Renfrewshire make up this captivating and eclectic part of the country.
This is a region of striking contrast. Larger areas like Glasgow are within easy reach of picturesque towns, villages and some of Scotland’s most scenic beaches, captivating wildlife and tranquil countryside.
Glasgow
- One of the highest ranking cities in the UK for quality of life (Mercer, 2012)
- Top 5 best cities in the world (Time Out, 2022)
- The world’s friendliest city (Time Out Index, 2022)
Glasgow is multicultural, magnificent and brimming with personality. Scotland’s largest city is home to nearly 600,000 people. Discover rich history, stunning architecture and the best shopping in the UK outside London.
This aptly-named ‘Dear Green Place’ blends the best of urban-living with the splendour of lush gardens and parks. Impressively, the city boasts more green space per square mile than any other UK city.
With some of the biggest and brightest businesses Scotland has to offer, in addition to enjoying the scenery, you can explore the many great career opportunities the city offers.
Offering the best of both worlds, Glasgow is close to breath taking countryside offering up nearby hill walking, sailing, and cycling. Some of the world’s greatest golf courses are all within an hour’s drive of the city. And this bustling city’s arts and culture, nightlife and food are hard to surpass.
Education
Home to over 133,000 students from around the world, Greater Glasgow and Clyde has world-renowned universities and award-winning colleges.
Universities
At this level, students undertake degree-level education that usually requires four years to complete. Students only gain qualification at the end of this period.
Degree courses at Scottish universities cover academic subjects, while some can be vocational. Universities in Scotland encourage a greater level of independence, with the student primarily responsible for their own learning.
Today, Scottish universities are leading the way in innovations in areas such as life sciences, medical research, biotechnology, and environmental sciences. Glasgow is home to six world-renowned universities:
Colleges
College courses are considered to be more vocational, with studies predominantly leading straight into employment within a specific industry. There are a number of course levels such as a Higher National Certificate (one year to complete) or a Higher National Diploma (two years to complete).
Each level offers a certified qualification. This means college students have something to show for each year of work.
Colleges work in partnership with local authorities and employers to deliver high quality Modern Apprenticeship (MA) programmes – over 10,000 college students are currently in MA programmes.
Not only do colleges work in partnership with employers to prepare students for work, some also have arrangements with universities to allow fast track degree entry. Glasgow is home to five exceptional colleges:
Getting around
The region’s excellent transport links mean you’re connected to the rest of the UK – and the world.
The M8 motorway connects the West with the rest of Scotland, taking just under an hour to drive between the country’s major cities Glasgow and Edinburgh, a well-used commuter’s route.
The bus is an effortless way to get around because it’s inexpensive and widely available across the region – even in remote locations. Glasgow has the UK’s largest suburban rail network outside London.
An abundance of stations and travel times makes exploring the region by train an easy option. The rail network links both rural areas and cities with the rest of Scotland and the wider UK.
From Ardrossan, Gourock, Wemyss Bay and Oban you can also travel by ferry to many of Scotland’s western isles.
Glasgow has access to two international airports (Glasgow and Prestwick Airports) which connect the region with the rest of the UK and beyond. There are approximately 200 flights per day (pre-pandemic levels) from Glasgow international airport alone, ready to fly to over 90 destinations like London, Dubai and New York.
The best of the city-living, magnificent countryside and an opportunity to work in some of Scotland’s most exciting industries means this region is a hugely popular place to live and work.
Housing
Whether you are renting or buying, Greater Glasgow and Clyde offers a superb selection of housing. Here you’ll have your choice of apartments on the River Clyde, spacious Victorian flats in the West End and family homes in leafy suburbs conveniently located near to schools.
Renting a property
If you don’t want to buy a property straight away, renting in Glasgow is relatively straightforward and cost-effective. Glasgow offers excellent tenancy rights to make sure that you’re safe, your deposit is treated fairly and the property is looked after.
You can rent a property through a housing association, a private landlord or a letting agency and there are usually lots of flat shares available in Glasgow.
Buying a property
If you’re interested in buying a property in Glasgow then the great news is that house prices here are, on average, lower than anywhere else in the UK!
In recent times house prices in Glasgow have also dropped, making it a buyer’s market. In Glasgow, most properties are sold through estate agents or solicitors (lawyers). However, you can also buy privately through the owner of the property, though you will still need a solicitor to handle the legal work.
Weather
Scotland’s reputation when it comes to the weather is well-known, and slightly unfair. The weather in Scotland actually tends to be quite moderate and changeable, but is rarely extreme. You might experience ‘four seasons in one day’, but travel 20-30 minutes in any direction and the weather is generally completely different! There’s no bad time of year to live in Scotland, with plenty to see and do regardless of the elements. After all, as the old saying goes, ‘there is no such thing as bad weather, only the wrong clothes’!
Spring (March, April, May)
- Average temperature – 4°C-12°C
- Average hours of daylight – 13 hours
- Average rainfall – 48mm
- One word forecast – ‘Mochie’: warm, moist weather (‘it’s a wee bit mochie ootside’)
Summer (June, July, August)
- Average temperature – 11°C-18°C
- Average hours of daylight – 17 hours
- Average rainfall – 72mm
- One word forecast – ‘Stoater’: fantastic (‘it’s a stoater of a day th’day’)
Autumn (September, October, November)
- Average temperature – 7°C-13°C
- Average hours of daylight – 11 hours
- Average rainfall – 52mm
- One word forecast – ‘Oorlich’: damp and chilly (‘it’s gey oorlich oot there’)
Winter (December, January, February)
- Average temperature – 2°C-7°C
- Average hours of daylight – 8 hours
- Average rainfall – 57mm
- One word forecast – ‘Jeelit’ – freezing (‘it’s fair jeelit outside’)
For further information, please contact the NHS Greater Glasgow and Clyde Workforce Supply Team:
Recruitment Agency disclaimer: We do not accept CVs or applications from recruitment agencies where terms of business have not been signed and we will not consider or agree to payment of any recruiter fees under these circumstances.
If speculative CVs are submitted by recruitment agencies, NHS Greater Glasgow and Clyde reserves the right to contact these candidates directly and consider them for current/future roles without any financial obligation to the recruitment agency in question. This will also apply to any CVs sent directly to line managers.
Striving for excellence in education and training as individuals, teams and as an organisation.
About Medical Education
Cover the full of NHSGGC health board and will provide help and support to both Undergraduate medical students and Post Graduate Medical trainees, from Foundation Year 1 (FY1) to Specialty Training (ST8).
We are involved in many workstreams from Weekly FY1 teaching to Quality Improvement Visits.
We are based within the main acute site:
- Queen Elizabeth University Hospital
- Glasgow Royal Infirmary
- Royal Alexandra Hospital
- Inverclyde Royal Hospital
Please direct your queries via a relevant email below, and a member of team will be in touch to assist you.
Medical Education Complaints Procedure / Raising Concerns
NHS Greater Glasgow and Clyde Medical Education is committed to ensuring high quality education, access to education and staff wellbeing. This allows excellent service to all who use NHSGGC services. We understand, however, that sometimes things go wrong.
If something goes wrong or if you are dissatisfied with something we have done, or have not done, please tell us and we will do our best to put things right. If we cannot resolve matters in the way you want, we will explain why it is not possible to do as you suggest.
If you are experience behaviours which you find unacceptable, speak to someone. Your first point of contact is your educational or clinical supervisor, or someone within your clinical unit, e.g Clinical Director.
You will also have a chief resident within your department/speciality. Chief residents are senior trainees and will support you.
If, for any reason, these routes are not possible or appropriate, please contact our Director of Medical Education, Dr Colin Perry.
ggc.directorofmedicaleducation@ggc.scot.nhs.uk
The laboratory is open from 9.00am to 5.00pm, Monday to Friday (except Bank Holidays).
There is a limited ‘on-call’ service on weekend mornings to support the cardiac transplant service.
For all non-urgent Immunology & Neuroimmunology laboratory enquiries, please email Immunology.Labs@ggc.scot.nhs.uk
Please phone the laboratory to discuss all urgent requests.
Postal Address
Department of Immunology and Neuroimmunology
Level 1B, Laboratory Medicine & Facilities Management Building
Queen Elizabeth University Hospital
1345 Govan Road
Glasgow
G51 4TF
How reliable is my patient’s result?
Measurement of uncertainty refers to the extent of variation of results at a given value within our assays. This can be affected by a multitude of factors. We generate data over an extended period of time for each of our quantitative assays in order to provide a measure of the expected range in results.
This aids the clinician to determine the significance of any change in concentration of a given analyte – particularly relevant for those tests used in monitoring.
Summary tables below contain uncertainty of measurement values for our assays.
- Automated serology – includes total IgE, allergen specific IgE, IgA & IgG TTG (coeliac serology), CCP antibodies, MPO/PR3 antibodies, GBM antibodies, dsDNA antibodies, ENA antibodies (screen & identities), IgG Aspergillus antibodies, tryptase.
- Specialist techniques – includes acetylcholine receptor antibodies, GAD antibodies (for Diabetes and Stiff Person Syndrome), intrinsic factor antibodies and functional antibodies.
- Immunochemistry (Optilite) – includes serum free light chains and C1 inhibitor (quantitative assay).
- Complement function – includes C1 inhibitor function, classical complement function, alternative complement function.
- Flow cytometry – including lymphocyte subsets analysis for CD3+ CD4+/CD8+ T cells, CD19+ B cells and CD16/56+ NK cells (percentages and absolute counts)
Please contact the laboratory to discuss if required.
NHSGGC Online Organisational/Corporate Induction/LearnPro
Please complete NHSGGC Online Organisational, Corporate Induction and LearnPro Modules inline with information held on main induction page.
If you have any issues, please contact your the medical education team by emailing GGC.MedicalEducationInduction@ggc.scot.nhs.uk
IMG Induction day
Medical Education held a face to face induction day for Simulation and Clinical Skills. this course was designed to welcome International Medical Graduates who are coming to join us in NHSGGC. This complimented other induction activities offered by NES and your place of work.
Some of the work practices and educational processes here in Scotland may be different to the countries you have previously trained and worked in. This course will give you the chance to explore some of these differences in a safe and welcoming environment. There is a course outline attached to this email.
If you are an International Medical Graduate who already works in NHSGGC we would be delighted if you would consider attending a course to meet and support your new colleagues please contact your local Medical Education team / or by emailing medicaleducation@ggc.scot.nhs.uk
Resources
Scottish IMG Doctor Support Network Facebook Group
If you feel we should include anything please let us know by emailing medicaleducation@ggc.scot.nhs.uk
Welcome
On behalf of NHS Greater Glasgow and Clyde, We would like to extend a very warm welcome to you in your role as a NHSGGC employee.
Throughout your induction and ahead of starting any post within our NHSGGC, Medical Staff are required to complete various induction material, be this online modules and appropriate learning and education items to enable appropriate access to the systems you require . We hope your induction will be enjoyable.
You will be informed of the specific details and date(s) to submit your induction information at the end of this welcome letter and on our NHSGGC Medical Education website about how to access both of these, and provide evidence of completion.
Within NHSGGC we strive for excellence in medical education and therefore would love to hear your feedback. We are genuinely interested in your constructive feedback about your induction, as this helps us improve year upon year.
At any time in your training – if there is something going wrong or you see something which you think is incorrect or unsafe please tell someone. You will meet your educational supervisor early on in your rotation and they will often be your first point of contact. Please remember that your peers, colleagues, nursing staff and medical managers are there to support you in your post and help you deliver excellent patient care.
We hope you enjoy your induction and look forward to working with you as you start your career within medicine.
Common Abbreviations (A-Z)
ARCP (Annual Review of Competence Progression) – The ARCP is a formal process for reviewing foundation doctors’ progress which uses the evidence gathered by them and supplied by their supervisors. A board will review the evidence displayed on TURAS and will decide the outcome.
CBD (Case based discussion) – A presentation made to a senior doctor discussing a particular case you were involved in during your placement and what you learnt.
DOPS (Direct Observed Procedures) – Any practical procedure performed under supervision that is outside of the 15 core procedures required to be completed by ARCP.
Eportfolio/TURAS – TURAS is the online portfolio system for junior doctors working in GG&C. Here you can upload evidence of case based discussion, mini-cex and TABs. This will also be the platform for writing reflections, uploading certificates and at the end of the year the evidence uploaded to your eportfolio will be appraised for your ARCP.
EWTD (European Working Time Directive) – A directive from the Council of the European Union to protect the health and safety of workers in the European Union. It lays down minimum requirements in relation to working hours, rest periods, annual leave and working arrangements for night workers.
H@N (Hospital at Night) – This varies between hospitals but refers to the team of nurses/HCAs/doctors working the night shift. You can handover jobs to H@N such as bloods tests or chasing scan results.
HEPMA (Hospital Electronic Prescribing and Medicines Administration) – digital prescribing system replacing paper drug chart (kardex) for inpatient areas across NHSGGC.
IDL (Immediate Discharge Letter) – a summary of a patients’ care while in hospital. This letter will also go to their GP and sometimes may need to be sent to another specialty for outpatient follow up.
LearnPro – Online learning platform hosting elearning statutory and mandatory training topics for all staff working in health and social care settings.
MDT (Multidisciplinary Teams) – A meeting comprising of specialist doctors and nurses who meet regularly to establish diagnosis and treatment plans based on radiology results, blood and tissue samples. The MDT serves as a means to enable practitioners and other professionals in health and social care to collaborate successfully.
Meds rec (Medicines Reconciliation) – Patients admitted to hospital will need their regular medicines transcribed onto the kardex/HEPMA. The medicines reconciliation will involve finding out what medications the patient is taking in the community through various sources such as portal, dosette boxes/blister packs and from the history. A precise and thorough meds rec minimises the chance for drug errors and ensures optimal care for patients.
Mini-Cex (Mini clinical evaluation exercise) – This will include a formal history, examination of a patient. An subsequent presentation to a senior. Evidence for this can be uploaded to your eportfolio.
PDP (personal Development plan) – This plan will consist of a particular experience you want to gain or skill you wish to build upon during your current placement. A PDP will be agreed upon with your supervisor in your initial meeting.
Portal – An additional electronic patient record system widely accessed from various NHS clinical systems. It will contain a more extensive database of patient records e.g previous clinic letters, hospital admissions as well as blood results and scan reports. Portal is also used to complete IDL’s and Meds recs when organising a patients discharge.
SLE (supervised learning event) – Mini-Cex/CBD/DOPS are the SLEs you will be required to complete and upload to your eportfolio over the next year. There will be a minimum number of SLEs you are required to complete for each block.
SOP (Standard Operating Procedure) – A written means to instruct staff on how a particular procedure should be carried out and lays out boundaries of responsibility.
TAB (Team Assessment of Behaviour) – TABs are feedback forms concentrating on your behaviour in the workplace rather than your clinical knowledge. There will a minimum number of TABs that have to be completed before you can view the content of the feedback forms. Once completed the feedback will be uploaded to TURAS and can be viewed by yourself and
supervisor.
TrakCare – The electronic patient management system where all patient episodes (outpatient, inpatient and emergency) are recorded. The systems incorporates electronic requesting (Order Comms) for labs, radiology and cardiology and contains the list of patients on the wards, the results of their scans, blood tests and other investigations.
This list is by no means exhaustive but includes some common abbreviations used across NHSGGC.
If you feel we have missed one, or many, please email ggc.medicaleducationinductions@ggc.scot.nhs.uk.
Immunology
Neuroimmunology
The Glasgow Neuroimmunology Diagnostic Laboratory offers a range of standard and specialist antibody assays.
A wide variety of autoimmune diseases affecting the nervous system are associated with measurable abnormalities in either the serum or the cerebrospinal fluid. These tests can aid in accurate clinical classification and guide decisions about treatment for neurologists and physicians involved in the management of patients with autoimmune neurological diseases.
The laboratory has a special interest and expertise in the measurement of anti-glycolipid antibodies found in the serum of patients with a wide variety of auto-immune neuropathies.
The service is available to clinicians throughout the UK and overseas. A small charge is levied to cover costs. Contact the laboratory for current prices.
For our laboratory handbook, routine request form, accreditation and quality information, please see the Immunology and Neuroimmunology page.
In House Testing
Ganglioside (Anti-Glycolipid Antibodies)
Anti-glycolipid antibodies are found in a significant proportion of patients with a variety of autoimmune peripheral neuropathies. They are measured in the serum by enzyme-linked immunosorbent assay (ELISA). A wide variety of anti-glycolipid antibodies are present under different clinical circumstances and the laboratory offers a range of diagnostic tests using a panel of up to 12 glycolipid antigens. Such investigations can be useful to classify acute and chronic motor or sensory neuropathies and thus aide diagnosis and clinical management.
Anti-glycolipid antibodies are associated with several distinct peripheral nerves syndromes: Multifocal motor neuropathy is associated with anti-GM1, -GA1 and -GD1b IgM antibodies. Chronic ataxic neuropathy with ophthalmoplegia M-protein, cold agglutination, and disialosyl antibodies (acronym: CANOMAD) is associated with anti-GD1b and related IgM antibodies. Miller Fisher syndrome is associated with anti-GQ1b and -GT1a IgG antibodies. Acute motor axonal neuropathy (AMAN) is associated with anti-GM1 and -GD1a IgG antibodies.
A clinically important form of IgM paraproteinaemic neuropathy is associated with antibodies to myelin-associated glycoprotein (MAG) and a closely related glycolipid termed sulphated glucuronyl paragloboside. These antibodies are detected by a commercial ELISA assay kit using MAG as the antigen. The neuropathy has a characteristic clinic pattern and in the vast majority of cases is associated with an IgM gammopathy. Around 50% of patients with neuropathy-associated IgM gammopathy have anti-MAG antibodies.
ELISAs depend on the fact that antibodies or antigen can be linked to an enzyme, with the complex retaining both immunological and enzymatic activity. In these assays the antigen (ganglioside) is attached to a solid phase support (ELISA plate) to allow for easy separation of bound and free antibody (patient serum). Detection is by a horseradish peroxidase labelled anti-human serum which can be visualized by a colour reagent and read spectrophotometrically. 1ml of serum is required for these investigations.
The assay is conducted two tothree times per week and results are reported the following day.
Acetylcholine Receptor Antibodies
Antibodies to the acetylcholine receptor (anti-AChR) are present in a very high proportion of patients with the neuromuscular transmission disorder, myasthenia gravis (MG). Myasthenia gravis is clinically characterized by generalised muscle weakness with fatiguability (generalised MG). This condition also frequently involves and is isolated to the extraocular muscles, leading to the symptom of double vision (ocular MG). Anti-AChR autoantibodies interfere with normal neuromuscular function by binding to the post-synaptic acetylcholine receptor.
The disease has a prevalence of approximately 5 per 100,000 individuals and can occur at any age. In women, the disease usually presents between the ages of 20 and 40 years, while disease onset in men typically occurs later in life. There is also a peak of incidence in old and very old age; thus neither age nor sex are precluding factors for anti-AChR screening. MG also has a strong association with tumours of the thymus (thymoma).
Approximately 90% of patients with generalised MG have these antibodies detectable in their serum. In patients with purely ocular MG the proportion of positive patients is lower at approximately 70%. A positive result is up to 99% specific for MG. Antibody titres tend to be higher in females and a correlation between antibody titre and the degree of muscle weakness has been observed in longitudinal studies in individual patients; however titre cannot be used to compare severity between individuals. In individual patients with established myasthenia gravis, anti-AChR antibody titres tend to rise several weeks before exacerbations. Remission after thymectomy is associated with a progressive decline in antibody titres. Consequently, serial measurements of acetylcholine receptor antibodies can be useful in monitoring disease progression, as well as the effects of treatment.
Anti-AChR antibodies can also very rarely be positive in uncomplicated thymoma, primary lung cancer, and in patients with autoimmune liver disease. A negative anti-AChR antibody test does not preclude the diagnosis of MG. Anti-AChR seronegative cases exist, and a proportion of these have antibodies to a neuromuscular protein termed MuSK (muscle specific kinase). In a clinically related condition, the Lambert-Eaton myasthenic syndrome (LEMS), antibodies to a presynaptic protein (the voltage gated calcium channel, VGCC) are present.
The anti-AChR test is conducted by a radioimmunoprecipitation assay using radio-iodinated bungarotoxin bound to acetylcholine receptors that have been extracted from an acetylcholine receptor expressing cell line. 125I-AChR is incubated with test sera and any resulting complex of labelled receptor and receptor antibody is then immunoprecipitated with anti-human IgG. After a centrifugation and wash step the precipitate is counted, and the result is reported as nmol/litre of anti-AChR antibody.
The assay is conducted once per week and results are despatched the following day. 1ml of serum is required for this investigation.
Oligoclonal Bands
The clinical diagnosis of multiple sclerosis can be supported by analysis of cerebrospinal fluid (CSF). In a very high proportion of patients with multiple sclerosis (>90%) the CSF contains oligoclonal bands that are not present in the serum.
Oligoclonal bands are IgG immunoglobulins secreted by plasma cells that are resident within the CNS in multiple sclerosis. They are secreted into the CSF and can be detected using isoelectric focusing (IEF) in combination with Western blotting. Serum immunoglobulins are also present in low concentration in the CSF and in order to reliably discriminate between locally (CNS) synthesised and systemically synthesised immunoglobulins it is necessary to analyse both serum and CSF collected from a patient at the same time.
The oligoclonal bands resolved by IEF are visualized by IgG-specific antibody staining. The detection of CSF oligoclonal bands by isoelectric focusing is not absolutely specific for multiple sclerosis. It reaches its maximal value in the differential diagnosis only when other rare causes of CNS inflammation have been excluded. Isoelectric focusing (IEF) of CSF in agarose gels is followed by passive blotting onto nitrocellulose membrane, followed by immunostaining of IgG by double antibody, using horseradish peroxidase as a visualizing agent.
Isoelectric focusing is a method of electrophoresis in a pH gradient established between two electrodes and stabilized by carrier ampholytes. In this technique proteins migrate until they align themselves at their isolelectric point (pI), the point at which a protein possesses no net overall charge and will therefore cease migrating.. It is the electrophoretic technique of choice for detecting CSF immunoglobulin diversity with the highest resolution, in which component that differ by 0.001 of a pH unit can be resolved.
For this assay 1ml of CSF and 1ml of serum are required. Smaller volumes can be analysed upon request. The assay is conducted twice a week and results are reported the following day.
Anti-Neuronal Antibodies
Anti-neuronal antibodies are present in the serum of patients with paraneoplastic disorders affecting the nervous system. These disorders have a very wide range of clinical presentations and often enter the differential diagnosis of complex neurological problems. Sensitivity and specificity of the tests available are difficult to state and vary according to clinical circumstances.
Negative results do not preclude the possibility of an underlying paraneoplastic disorders. Strongly positive results in appropriate clinical circumstances should lead to a thorough search for an appropriate underlying neoplasm, although this search may ultimately be negative. In many human sera from individuals unaffected by paraneoplastic syndromes, low levels of antibody to paraneoplastic antigens may be detected using the sensitive assays performed; these results must be carefully considered along with the clinical findings in individual patients in order to assess their significance. The laboratory reports the results of the assays without reference to the patient demographics or clinical circumstances. Individual cases in which uncertainty in interpretation exists should be discussed with the laboratory director.
Paraneoplastic antigen-antibody pairs include anti-Yo (PCCA), anti-Hu (ANNA-1) and anti-Ri (ANNA-2) antibodies. They are screened in the first instance by immunofluorescent staining of sections from primate cerebellum.
Primate cerebellum can be used to detect the following antibodies:- GAD, PCA (Yo), ANNA1 (Hu), ANNA2 (Ri), Ma2Ta, Amphiphysin, CV2/CRMP5, SOX1, and Tr.
Positive or borderline samples are then screened for anti-Hu, -Yo, -Ri, -CV2, -Ma2/Ta, Titin, Recoverin, SOX1 and Amphiphysin activity by Immuno blot analysis using recombinant antigen kits. The recombinant antigen kits are highly sensitive and thus frequently detect low levels of antibody that are unlikely to be of clinical significance
(currently the Euroimmun Neuronal Antigens Profile PLUS RST Kit).
1ml of serum is required for these investigations.
The assay is conducted once a week and results reported that day.
Please use this link to view a table describing the most widely recognised associations between antibody, tumour type and clinical presentation:
NMDA (Anti-Glutamate Receptor (Type NMDA) Antibodies)
Anti-NMDA receptor encephalitis manifests along a spectrum of psychosis, altered behaviour, movement disorder, seizures, autonomic dysfunction and decreased consciousness. In younger patients, particularly female, it is associated with an underlying teratoma. Early identification and treatment with immunotherapy leads to better outcomes (Pubmed ID 23290630). It is less common in older patients (over 45 years old) and they display a less severe phenotype and have poorer outcomes (Pubmed ID23946310).
Antibodies against the NR1 subunit of the NMDA receptor are identified in our laboratory via indirect immunofluorescence of cell lines transfected with cDNA coding this protein. This test has very high positive and negative predictive values. Testing is carried out on serum or CSF. CSF is preferred for testing since there are fewer false positives or false negatives compared with serum.
LGI1 & CASPR2 (Anti Voltage Gated Potassium Channel Associate Proteins)
Antibodies against the VGKC associated proteins LGI1 and Caspr2 are associated with a number of neurological syndromes.
Anti-LGI1 antibody encephalitis usually manifests in a number of ways. It can cause faciobrachial dystonic seizures (FBDS), other focal seizures – often with prominent autonomic features – a more pronounced limbic encephalitis with amnesia, cognitive decline and seizures, or it can cause a rapidly progressive encephalopathy (Pubmed ID 27590293).
Anti-Caspr2 antibody mediated syndromes include peripheral nerve hyperexcitability, Morvan syndrome and a more protracted, subacute limbic encephalitis with encephalopathy, seizures, cerebellar dysfunction, autonomic disturbance, neuropathic pain, insomnia and weight loss (Pubmed ID 27371488).
Antibodies against Caspr2 or LGI1 are identified in our laboratory via indirect immunofluroscence of cell lines transfected with cDNA coding the protein of interest. This is a very specific and sensitive test for antibodies against these antigens and an alternative to the anti-voltage-gated potassium channel complex antibody (VGKCC) radioimmunoassay.
Anti-GAD65 Antibodies associated with Stiff Person Syndrome
Antibodies against the enzyme glutamic acid decarboxylase (GAD) are associated with a number of neurological syndromes. Stiff-person syndrome (SPS) is the most common and clearly associated condition. It is likely that the circulating antibodies are pathogenic in this condition.
The vast majority of patients with SPS have very high serum titres of anti-GAD antibodies. A small number are negative for anti-GAD but have anti-amphiphysin antibodies. In the anti-amphiphysin positive cases there is often a paraneoplastic cause, most commonly breast cancer in women.
Stiff-limb syndrome (SLS) is similar to SPS but the clinical pattern of stiffness and other clinical features differ and the immunological profile also differs, with more patients with SLS being anti-GAD antibody negative.
Progressive encephalomyelitis with rigidity and myoclonus (PERM) is a more severe, rapidly progressive and fulminant form of SPS that often includes brainstem dysfunction. Some patients are anti-GAD antibody positive but many are not. Other antibodies are also associated with PERM including anti-amphiphysin, anti-glycine and others.
Anti-GAD antibodies have been reported in association with a number of other neurological syndromes including treatment-resistant focal epilepsy, ataxia and others. The relationship between the antibodies and neurological symptoms in these patients is less clear than for SPS.
Lower titres of anti-GAD antibodies are seen in patients with autoimmune diabetes. These recognise an epitope distinct from that recognised by anti-GAD antibodies found in patients with SPS, they are generally not seen in CSF and do not stain cerebellar tissue sections.
Anti-Aquaporin 4 and Anti-MOG Antibodies
Antibodies against the aquaporin 4 (AQP4) channel are the commonest detected autoantibody in neuromyelitis optica spectrum disorder (NMOSD). Up to 80% of NMOSD patients have these antibodies. They are also found in up to 50% of patients with longitudinally extensive transverse myelitis (LETM) who do not otherwise meet the NMOSD criteria. We test for these antibodies in serum using a commercial cell-based assay. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5013123/
Antibodies against myelin oligodendrocyte glycoprotein (MOG) are seen in a large proportion of patients with NMOSD who do not have detectable anti-AQP4 antibodies. The clinical phenotype in anti-MOG antibody-associated disease is a wide spectrum that includes classic NMO, isolated optic neuritis, transverse myelitis, focal cortical encephalitis and acute disseminated encephalomyelitis (ADEM). We test for these antibodies in serum using a commercial cell-based assay.
Both these antibodies are tested for in parallel in our cell-based assay and so a request for either antibody will generate a report for both. We perform the test on serum. We have not validated the assay on CSF.
Specialist Testing
Scottish Autoimmune Encephalitis Register