APA 2 - Immune System Flashcards
Immune system begins at approximately _____
6 weeks of age
Functions of immune system
support, protect, vitalize functions, maintain homeostasis
The non-specific or _______ system provides defense against a very large number of ______
innate / pathogens
foreign substances
antigens
_____ _______ immunity involves immune cells directed at elimination or destruction of pathogen cells.
cell-mediated
_____ ______ comprises different antibodies and proteins, such as complement, that can directly or in concert with cellular immunity orchestrate cell injury and destruction.
humoral immunity
Primary defenses against bacterial invasion
integument, phagocytosis, killer T c ells, respsonses (sneezing, tearing, coughing, sweating, body temp, normal flora)
Passive immunity includes antibodies (activated T cells) given to provide protection and this usally happens by ______ and can last ___ to ____
transfusion / hours to weeks
Acquired or _______ immunity is accomplished by destruction of organisms and toxins by ______ and specific lymphocytes
adaptive / antibodies
No innate immunity exists with ______ immunity
acquired
With acquired immunity, resistance is developed after entrance to _________. At that point, antigens interact with lymphocytes to form ________. These are prodcued by __ lymphocytes and called _________ which has MEMORY
body / antibodies / B / immunoglobulins (IG)
Humoral branch consists of B-lymphocytes which originate in ____ ___ and _____ _____
bone marrow and plasma cells
Cell-mediated branch has T-lymphocytes which originate in ____ ___ and mature in the _______
bone marrow / thymus
Vaccinations are used to produce ______ ______
acquired immunity
______ _______ is immunity from serum antibodies produced by plasma cells. More specifically, someone who has never been exposed to a specific diesease can gain humoral immunity through administration of __________ from someone who has been exposed, and survived the same disease.
humoral immunity / antibodies
Humoral refers to the bodily fluids where these free-floating serum antibodies bind to antigens and assit with _______
elimination
Cell-mediated immunity can be acquired thorugh __ _______ from someone who is immune to the target disease or infection. Cell-mediated refers to the fact that the response is carried out by _______ cells
T-cells / cytotoxic
Review Slides 9 and 10
Now
______ immunity is where a pathogen is deliberately administered to an individual for the sole purpose of stimulating the immune system. After repeat exposure, _____ immune system is able to provide a quicker and more efficient response. Example vaccines
active / adaptive
_______ __________ is where a person receives another person’s _______ to help fight or prevent certain infectious diseases. Protection is immediate but short _______.
passive immunity / antibodies / lived
Fetus during pregnancy from mother via IgG
passive immunity
IgA via breast milk
passive immunity
Rh immune golbulin (RhoGAM) to Rh-negative mothers to prevent their immune system from developing antibodies to a fetal Rh antigen
passive immunity
Components of the Nonspecific Human Immune system
mononuclear cells, polymorphonuclear cells, eosinophils, neutrophils, basophils, mast cells, natural killer cells, platelets, B-lymphocytes, T-lymphocytes, plasma cells
Review slide 13
cells
Granulocytes
neutrophils, basophils, eosinophils
Granulocyte order of number
neutrophils > eosinophils > basophils
Most numerous WBC’s, 6 hour half life, fight bacteria and fungal infection
neutrophils
least common granulocyte, involved in hypersensitivity reactions, release histamine, leukotrienes, cytokines and prostaglandinds, and stimulate smooth muscle contraction (bronchospasm)
basophils
Heavy in GI (parasites), respiratory , and urinary mucosa
eosinophils
Agranulocytes
monocytes and lymphocytes
phagocytosis, release cytokines, present pieces of pathogens to T-lymphocytes
Monocytes
B-lymphocytes
humoral immunity and produce antibodies
T-Lymphocytes
cell-mediated immunity (DOES NOT produce antibodies)
A pathogen is deliberately administered to an individual for the sole purpose of stimulating the immune system. Repeat exposure, the adaptive immune system is able to provide a quicker and more efficient response (vaccines)
Active Immunity
Inflammation in both innate and acquired immunity
localized vasodilation, increased blood flow, increased capillary permeability, extravasation of plasma proteins (complement and coagulation factors), c hemotaxic movement of leukocytes to site of injury
Clinical manifestations of inflammation
erythema, localized edema, pain
Antibodies are gamma globulins called _______. Each antibody is specific for a particular _______; this characteristic is caused by its unique structural organization of amino acids in the variable portions of both the light and heavy chains.
immunoglobulins / antigen
Antibodies act mainly in two ways to protect the body against invading agents:
- by direct attack on the invader 2. by activation of the “complement system” that then has multiple means of tis own for destroying the invader
There ____ general classes of antibodies
five (IgG, IgM, IgA, IgE, IgD)
With allergies, antibodies attach to ____ ____ and _____
mast cells and basophils
With Allergies, antibodies attaching to mast cells and basophils initiate change which:
release histamines and other substances, lead to abnormal response, vary in presentation and magnitude, urticaria, hay fever-like symptoms, asthma, anaphylaxis
H3 receptors occur at _________ sites and inhibit the release of a variety of _______
presynaptic / neurotransmitters
Type I hypersensitivity
anaphylaxis
Type II hypersensitivity
antibodies specific to antigens attach to cell surface. Example is cytotoxic (autoimmune hemolytic anemia)
Type III hypersensitivity
Immune complex disease. Antibodies bind antigens and release enzymes that cause tissue damage (SLE, rheumatoid, glomerulonephritis)
Type IV hypersensitivity
Delayed sensitivity (contact dermatitis, graft rejection) CELL MEDIATED
Type I immune reactant
IgE
Type II immune reactant
IgG
Type III immune reactant
IgG
Type IV immune reactant
TH1, TH2 cells, CTL
Type I initiation time
2-30 min
Type II initiation time
5-8 hr
Type III initiation time
2-8 hr
Type IV initiation time
24-72 hr
Anaphylaxis is ____ mediated and releases potent meidators like mast cells and basophils
IgE
With anaphylaxis, hypotension is secondary to _____ ____ ______
increased capillary permeability (50% fluid shift)
Anaphylaxis requires ______ _______
prior exposure
Anaphylactoid is caused by mediator release from mast cells and basophils and is not ______ mediated
IgE
Anaphylactoid can happen with ____ exposure
first
rocuronium is indicated in ____ % of anaphylactic reactions related to periop
60%
other reasons for anaphylaxis
latex 15%, ABX 5-10%, opiods <5%
read slide
29 now
Standard non-life threatning treatment epii
epinephrine 100-500 mcg subq or IM repeat 15 min (adult) children epi is 10mcg/kg-500mcg max q15 min x2, then q4hrs
standard treatment with benadryl
1-2 mg/kg or 25-50 mg IV
Treatment of anaphylaxis
airway maintenance, 100% 02, Epi 50-100 mcg IV or more, fluids and glucagon if on beta-blocker, CPR, pressors, fluids, bronchodilators, H1 and H2 antagonists, corticosteroids
Mild transfusion reaction
hives and pruritis
Fetal hemolytic reaction
usually from ABO incompatibility where antibodies destroy donor cells and bad things happen (DIC, renal failure, death). This is masked with anesthesia and will have cardiovascular instability, hypotension, fever, hemoglobinuria, bleedeing diathesis **TREAT IMMEDIATELY
Latex allergy high risk factors
Health care workers, neural tube defects, multiple surgeries, spina bifida, genitourinary tract defects and allergies to bananas, kiwi, mangos
What type of reaction is a latex allergy usually manifested as?
Type IV: Dermatitis AND Type I: Anaphylaxis
Latex reactions in the AWAKE patient
itchy eyes, generalized pruritis, SOB, faintness, feeling of impending doom, nausea, vomiting, abdominal cramping, diarrhea, wheezing
Latex reactions in the ANESTHETIZED patient
taachycardia, HTN, Wheezing, Bronchospasm, Cardiopulmonary arrest, flusing, facial edema, laryngeal edema, urticaria
Insufficient or limited response to antigens superseded by a self-reactive state that is inadequate and dysfunctional. Alterations in response to insult cause body to attack itself. May proliferate (anemias, arthritis, adreanl dysfunction, thyroid dysfunction, platelet aberrations)
Autoimmude disease
With ______, the immune system plays important role to reject and resist. It is variable with cell type and immune resposne.
Cancer
________ decrease ciliary action and cause increased risk for infection
hypnotics
Anesthesia agents can ______ the immune system as it relates to nonspecific host resistance mechanisms
depress
Inhalation agents, opiods, and regional anesthesia have _______ or controversial effects on immune system
negligible
_________ can have transient alteration of lymphocyte and killer T cell activity
epidurals
Surigical site infection occurs at or near a surgical incision within _____ days of the procedure or ___ year(s) from the implant
30 days / 1 year
The _______ immune system Is activated during surgery. Tissue damage and blood loss leads to a sterile systemic ______ ______. The DAMPs released promote neutrophil and macrophage migration to site.
innate / inflammatory response
As it relates to surgical site infection, T cell levels _______ which correlates with procedure duration and blood loss. ___________ surgery is associated with decreased immune suppression. ________ ________ is associated with depression of the immune system and increased risk of SSI. Hyperglycemia and _____ also contribute.
decrease / laparoscopic / blood transfusion / hypothermia
Retrovirus invades cell-mediated branch of immune system. Transmission through blood and certain body fluids. Usually on many drugs and little evidence to support different anesthetics.
HIV/ AIDS
NNRTIs __________ CYP450 system
induce
Cardiovascular abnormalities with HIV
abnormal EKG (50%) and pericardial effusion (25%)
Common comorbidities with HIV
wasting syndrome, peripheral neuropathies, platelet instability (splenectomy), non-hodkins lymphoma and kaposi’s
Two major concerns with HIV
infectioin of patient and infection of YOU
Most common opportunistic infection with HIV/AIDs
pneumocystic carinii
Chronic inflammatory disease with production of ANA
SLE
Presentation of SLE
polyarthritis and dermatits, malar rash in 1/3 of patients, renal dz in >50% of patients which is most common cause of death and 10-20% of them will require dialysis
Treatment of SLE
corticosteriods, antimalarial, immunosuppressants
Having a dx of SLE carries a higher risk of
seizures, stroke, dementia, neuropathy, psychosis, pericardial effusion (tamponade rare)
What exacerbates SLE
infection, pregnancy, surgical stress, drugs
Drugs that exacerbate SLE (if patient over 80)
procanimide, hydralazine, captopril, enalapril, isoniazid, methyldopa, d-penicillamine
Anesthesia implications for someone with SLE
Prone to PE, pneumonitis, alveolar hemorrhage, pulmonary HTN, restrictive disease
With SLE, 1/3 of patients exhibit what?
cricoarytenoid arthritis and RLN palsy
Someone with SLE may require_________
corticosteroids
With SLE, Cyclophosphamide which is used to treat lupus nephritis, it may cause problems ______ LA and succinylcholine because it inhibits ______ ______
ester / plasma cholinesterase
Collagen vascular disease that is characterized by inflammation, vascular sclerosis, fibrosis of skin and organs
scleroderma
Sleroderma progression
injury to the vascular endothelium, vascular obliteration and leakage of proteins into the interstitial space, tissue edema and lymphatic obstruction due to the protein leakage, tissue fibrosis
Review slide 57
Scleroderma
Anesthetic implications of scleroderma
may require fiberoptic intubation, bleeding with airway manipulation, chronic HTN (contracted vascular volume), GERD (hypotonis of LES), corneal abrasion (prone to dry eyes), pulmonary HTN (avoid acidosis and hypoxemia)
Advantages of regional anesthesia with Scleroderma
peripheral vasodilation and post op pain control
Characterized by cellular hyperplasia in synovium, infiltration by lymphocytes, plasma cells and fibroblasts AND articular cartilagtge eventually completely destroyed
RA
Treatment for RA
corticosteroids, methotrexate, immunosuppressants, NSAIDS
Anesthetic considerations with RA
steroid supplement, cyclophsphamide inhibits plasma cholinesterase and NSAIDS interfere with platelet function
Airway considerations with RA
neck extension restricted, antlantoaxial subluxation, TMJ, Laryngeal joints with edema and laryngeal swelling, consider glidescopoe or fiberoptic
