Paul Bunnell reaction

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The Paul-Bunnell reaction is a classic diagnostic test method in medicine, with which heterophile antibodies against red blood cells of mutton ( mutton thyrocytes) are detected. The test is used to detect an acute infection with the Epstein-Barr virus (EBV).

The Paul Bunnell reaction was named after the American doctors John Rodman Paul and Walls Willard Bunnell , who first described it in 1932. The principle is based on the fact that the red blood cells of the mutton clump together in the presence of heterophilic antibodies ( agglutination ). This phenomenon is visible to the naked eye when the blood serum of a corresponding patient is mixed with the suspension of mutton erythrocytes.

The Paul-Bunnell reaction is rarely used today; its significance is predominantly historical. The test procedure was further developed by Israel Davidsohn between 1938 and 1968 by studying the reaction with red blood cells from different animal species in parallel. It was found that mutton erythrocytes have only a rather low sensitivity for the detection of infectious mononucleosis , whereas horse erythrocytes are more suitable. Davidsohn also experimented with upstream absorption steps (with guinea pig kidneys and bovine erythrocytes). This further development has led to the name Paul-Bunnell-Davidsohn test , under which the procedure was known for decades.

There are modifications of the Paul-Bunnell reaction that deliver a much faster result, use latex particles instead of hammer celerythrocytes, can be processed on microscope slides instead of in test tubes and are still in use. In the Anglo-American language area, these tests are known as monospot . Such modified tests for heterophile antibodies (so-called EBV rapid tests) achieve a sensitivity and specificity of over 90% in each case for the detection of an acute infection with the Epstein-Barr virus . It should be noted, however, that these tests are more often false-negative in children (lower sensitivity).

However, these tests for heterophile antibodies are used less and less for the laboratory diagnosis of EBV infection, as more modern test methods ( ELISA ) enable a more reliable diagnosis.

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  1. ↑ John Rodman Paul and Willard Walls Bunnell: The presence of heterophilic antibodies in infectious mononucleosis . In: Am J Med Sci . Vol. 183, 1932, pp 91-104, ISSN  0002-9629
  2. ↑ CL Lee et al .: Horse agglutinins in infectious mononucleosis. III. Criterion for differential diagnosis . In: J Clin Path . Vol. 21, No. 5, 1968, pp. 631–634, ISSN  0021-9746 , PMC 473877 (free full text)
  3. ↑ Anne-Lise Bruu et al .: Evaluation of 12 Commercial Tests for Detection of Epstein-Barr Virus-Specific Antibodies and Heterophilic . In: Clin Diagn Lab Immunol . Vol. 7, No. 3, 2000, pp. 451–456, ISSN  1071-412X , PMC 95893 (free full text)