Apex- WBCs and hypersensitivty reactions Flashcards
Anaphylaxis causes degranulation of: (Select 2):
-neutrophils
-monocytes
-basophils
-mast cells
mast cells and basophils
what does it mean when a cell degranulates?
it releases cytotoxic contents from it’s storage vesicles
Match:
Neutrophils, Basophils, Eosinophils
Immune defense agaisnt parasites, allergic reactions, immune defense
Neutrophils = immune defense
Basophils = allergic response
Eosinophils = immune defense agaisnt parasites
Which one provides humoral immunity vs cellular immunity- T lymphocytes bs B
what’s the differene?
B = humoral
T= cellular
B-lymphocytes: Humoral immunity > produces antibodies (B : B cells, antiBodies)
T-lymphocytes: cell-mediated immunity > does NOT produce antibodies
What is the most abundant type of WBCs
what are they responsible for?
Neutrophils (keepin everything neutral)
immune defense - fight bacterial and fungal infections
What specific receptor does epi act on to help in treating anaphylaxis?
Binds to BETA-2 receptor on the cell membranes of basophils and mast cells and prevents their degranulation (releasing of their contents into circulation)
Why might someone with a bad viral ilness not have elevated WBC count?
what could you specifically look at on CBC with diff
Bc neutrophils make up 60% of WBCs and they fight bacterial and fungal infections
monocytes are the ones that fight viral infections
monocytes
What do natrual killer cells do
limit the spread of tumor and microbial cells
Why might someone say to avoid opioids in somone with cancer?
bc opioids reduce the function of natural killer cells which help limit the spread of tumor and microbial cells (concern for cancer recurrance or spread)
Match Each type of hypersensitivity reaction with its BEST example: Tyypes 1-4:
Serum sickness after snake bite
ABO incompatability
Anaphylaxis
Graft-vs-host reaction
1- Anaphlyaxis (1st is the worst)
2- ABO incompatability (2 bloods mixing)
3- Serum sickness after snake bite
4- Graft vs host reaction
- Immediate hypersensitivity
- antibody mediated
- immune complex mediated
- delayed
Match each type of hypersensitivity reaction : types 1-4
-immune complex mediated
-antibody mediated
-delayed
-immediate hypersensitivty
- immediate hypersensitivity
- antibody mediated
- immune complex mediated
- delayed
- anaphylaxis and extrinsic asthma
- ABO incompatability and HIT
- snake venom reaction
- contant dermatitis, graft-vs-host
What type of hypersensitivty reaction:
anaphylaxis
1
immediate hyperesensitivty
What type of hypersensitivty reaction:
Extrinsic asthma
1
immediate hypersensitivty
What type of hypersensitivty reaction:
HIT
2
antibody mediated
What type of hypersensitivty reaction:
ABO-incompatability
2
antibody mediated
What type of hypersensitivty reaction:
snake-venom reaction
3
immune complex mediated
What type of hypersensitivty reaction:
contact dermatitis/steven johnson
4
delayed
What type of hypersensitivty reaction:
graft-vs-host disease
4
delayed hypersensitivity
3 ways epi works to treat anaphylaxis
1- prevents degranulation of mast cells and basophils
2- provides CV support
3- dilates the airways
1- beta 2 receptors on basophils and mast cells
2- beta 1 receptors
3- beta 2 receptors
What are the 3 most common culprits for periop allergic reactions
- NMBs - SUX*
- Latex
- Antibotics (beta-lactams most common)
beta lactams = PCN, ampicilin, and cephalosporins
Differene between Anaphlyactic and anaphylactoid reactions
why doesnt it really matter
anaphylaxis- requires prior sensitization or cross reactivity
anaphylactoid - no prior exposure is needed
bc they both degrade mast cells and basophils and tx is the same
What 3 things are released when mast cells and basophils degranulate?
- Histamine & Arachidonic acid metabolites:
- leukotrienes
- prostaglandins
3 effects of histamine 1 receptor
2 effects on histamine 2 receptor
H1 = vasodilation, increased vascular permeability, smooth muscle contraction ( not VSM)
H2 = cardiac stimulation (tachycardia) and gastric acid secretion
pt bronchospasms- what 2 things would you notice first
- drop off in ETCO2
- high PIPS
followed by your sat plummeting
What type of hypersensitivity is IgE mediated
Type 1- Immediate hypersensitivty
Angigen + antibody interaction in a pt previously sensitized to the antigen
anaphylaxis + extrinsic asthma
What type of hypersensivity reaction is IgG mediated
Type 2- antibody mediated
IgG and IgM antibodies bind to the cell surfaces or extracellular regions and activate the complemnt cascase
ABO-incompatabilty, HIT
What type of hypersensivitity reaction is IgM mediated?
Type 2- Antibody mediated reaction
IgG and IgM antibodies bind to the cell surfaces or extracellular regions and activate the complemnt cascase
ABO- incompatability and HIT
What type of hypersensivity reaction is tissue rejection?
Type 4- delayed
Type 4 hypersenisitivity reactions are delayed for at least how long following exposure?
12 hours
contact dermatitis, graft-host, tissue rejection
Epi dosing for anaphylaxis:
-what to start with for hypotension vs CV collapse
5-10mcg for hypotension
0.1-1mg for CV collapse
take 0.1mg epi (100mcg/ml)
-dilute in 20ccs 5mcg/ml
if you only have 1mg vials:
-take 0.5cc (500mcg/ml)
-dilute it in 20mls = 25mcg/ml (25 x 2 = 50 [add the zero in from the 20] = 500mcg)
-take 2ccs (50mcg) and dilute it in 5mls
How much hydrocortisone are you going to give in anaphylaxis and why
250mg to prevent the delayed release of inflammatory compounds
no immediate effect
Anaphylactic steps
*discontinue offending agent
1. 100%fio2
2. epi (start with 5-10mcg) - dilute 0.1mg in 20ccs for 5mcg/ml
3. open fluids
4. H1 and H2 blockers (block the effects of histamine)
5. albuterol for bronchospasm
6. vasopressin for refractory hypotension (1-2unit bolus, gtt is 0.01unit/min start)
7. hydrocortisone 250mg to prevent delayed rlease of inflammatory substances
H1- vvasodilation, vascular permeability, smooth musccle relaxation
H2- cardiac stimulation (tachycardia) and gastric acid secretion
Groups of people at high risk for latex allergy (4)
- spinabifida/myelomeningocele
- atopy (allergic to everything)
- heatlhcare workers
- allergy to fruits: banana, kiwi, mango, papaya, pinepple …… & tomato lol
