Focused on consolidating and integrating the

The engine of this evolutionary period is the improvement in AIDs diagnostics, which has allowed an increasing number of recognized cases of individuals (3–8 % of the population; 80 % women) suffering from one or more AIDs [].

The main recent cornerstones in this field have been: (a) The discovery of new autoantibody-autoantigen systems (both systemic and organ-specific); (b) Recognition that autoantibodies may have predictive, pathogenic, or protective roles; (c) The availability of new diagnostic technologies (monoplex and multiplex immunoassays-IMA), and (d) Changes in organizational processes (integration and automation) [].

This, in turn, will enable the start of immunosuppressive or other specific therapies as soon as possible.

This is the case, for example, for ANCA-associated small-vessel vasculitides or Goodpasture’ syndrome [].

To meet both clinical need and growing demand for autoantibody testing, automation of autoimmune diagnostics has invaded the laboratory as an extension of the general technological improvement already achieved in almost all other diagnostic areas of the clinical laboratory [].

Currently, all stages of the analytical procedure for detection and quantification of autoantibodies are automated.

It is now customary to manage the flow of highly demanded autoantibody tests (thyroperoxidase, thyroglobulin, tissue transglutaminase, citrullinated peptide autoantibodies) in ‘human-less’ robotic platforms, characterized by total laboratory automation (TLA) which includes pre-analytical, analytical, and post-analytical operations [].Most, if not all, the obstacles to automation as defined by Tomar as much as 15 years ago [] are now completely removed.In the next sections of this article, we present some models related to the introduction of automation in the autoimmunology laboratory: a.automated multiplex IMAs and autoantibody profiling. Recently, indirect immunofluorescence (IIF) automation for reading and interpretation of ANA and other autoantibodies was developed, supported by the American College of Rheumatology recommendation that IIF is the reference method for anti-nuclear-cytoplasmic antibodies (NCA or ANA) [).These systems allow for automated classification of samples, with a high efficiency in discriminating between positive and negative ANA and an acceptable correlation with manual microscope reading [These features allow a different approach to the diagnostic strategy for the detection of NCA-ANA, ANCA, and DNAAb, based on a two-step algorithm: the first stage, the screening of positive/negative and positive samples selection; the second stage, identification of specific antibodies for confirmation of screening results and classification of autoimmune diseases [This flow of information in autoimmune diagnostics has long been conducted with the strategy of reflective testing.

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That is, the morphologist identifies positive samples using the IIF method and, on the basis of the fluorescence pattern, decides which autoantibodies are to be detected by IMA methods.

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