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Assessing disease activity in systemic lupus erythematosus (SLE)
Investigating an undetectable total complement (CH50) level
The complement system is an integral part of the immune defenses. The primary complement pathway consists of recognition (Clq, Clr, Cls), activation (C4, C2, C3), and attack (C5, C6, C7, C8, C9) mechanisms with respect to their role in antibody-mediated cytolysis.
The complement system can be activated via immune complexes, and the alternative pathway (properdin pathway), which is activated primarily by foreign bodies such as microorganisms.
C3 activation involves cleavage by C3 convertase into C3a and C3b. When immune complexes are not involved, the alternate method of complement activation initiates the reactant sequence at C3, bypassing C1, C4, and C2.
Severe recurrent bacterial infections occur in patients with homozygous C3 deficiency and in those patients with low levels of C3 secondary to the absence of C3b activator.
Decreased C3 may be associated with acute glomerulonephritis, membranoproliferative glomerulonephritis, immune complex disease, active systemic lupus erythematosus, septic shock, and end-stage liver disease.
A decrease in C3 levels to the abnormal range is consistent with disease activation in systemic lupus erythematosus (SLE).
The results are dependent on appropriate specimen transport and storage.
1. Ross SC, Densen P: Complement deficiency states and infection: epidemiology, pathogenesis, and consequences of neisserial and other infections in an immune deficiency. Medicine 1984;63:243-273
2. Frank MM: Complement in the pathophysiology of human disease. N Engl J Med 1987;316:1525-1530