CLASS 12 - IMMUNE DISORDERS + RELATED THERAPIES Flashcards
What is immunity? What are the 2 types?
The body’s ability to resist disease.
The 2 types are innate and acquired / adaptive.
Describe innate immunity.
Which cells are involved?
Is this response antigen-specific?
The innate immune response is the body’s “first line of defense”.
Involves neutrophils + monocytes.
This response is not antigen-specific, therefore it can respond w/in minutes to an invading microorganism w/o prior exposure to it.
Describe Acquired/Adaptive Specific Immunity. What are the 2 types?
Development of immunity either actively or passively.
2 types are active + passive.
Describe Active Acquired Immunity
Does this immunity develop quickly or slowly? Is it short or long lasting?
- Active: results from the invasion of the body by foreign substances which leads to the development of antibodies and synthesized lymphocytes.
- W/ each reinvasion of the microorganisms, the body responds more rapidly and vigorously to fight it off.
- This can result naturally from a disease or artifically through vaccines.
- This immunity takes time time to develop but is long lasting
Describe Passive Acquired Immunity
Does this immunity develop quickly or slowly? Is it short or long lasting?
The host receives antibodies rather than synthesizing them.
Can happen through injection of immunoglobulin (antibodies) or transfer of antibodies across the placental membrane.
Immediate response but short-lived bc no antibodies are synthesized.
What are mononuclear phagocytes?
What is the role of mononuclear phagocytes in the immune reponse?
Includes monocytes in the blood and macrophages throughout the body.
Mononuclear phagocytes capture (via phagocytosis), process, and present antigens to the T or B lymphocytes which stimulate an immune response.
Where are B Lymphocytes located?
What is the role of B Lymphocytes in the immune response?
Produced in the bone marrow
B Lymphocytes convert to plasma cells when activated and produce antibodies
Where are T Lymphocytes located?
What is the role of T Lymphocytes in the immune response?
T Lymphocytes are produced in the bone marrow and mature in the thymus.
They play a role in long-term immunity
Responsible for immunity to intracellular viruses, tumour cells, and fungi
Where are Cytotoxic T (CD8) cells located?
What role do they play in the immune response?
Are these cells antigen-specific?
Cytotoxic T cells are produced in the bone marrow and mature in the thymus.
They attack antigens on the cell membrane of foreign pathogens and release cytolytic substances to destroy them.
These cells are antigen-specific and are sensitized by exposure to the antigen.
Where are T Helper (CD4) cells located?
What is the role of T Helper Cells in the immune response?
Produced in the bone marrow and mature in the thymus.
- Play a role in the regulation of cell-mediated immunity and the humoral response.
- produce cytokines
- stimulate phagocyte-mediated ingestion + killing of microbes
- stimulate eosinophil-mediated immunity
Where are natural killer cells located?
Are these cells antigen-specific?
NK cells are located in the cytoplasm.
Prior sensitization is not required. These cells play a role in the recognition and killing of virus-infeced cells, tumor cells, and transplanted graphs. They “survey” for malignant cell changes.
Where are dendritic cells located in the body?
What role do they play in the immune response?
Dendritic cells are located in the skin, nose, lungs, stomach, and intestines. When immature, they are located in the blood.
Dendritic cells capture antigens at sites of contact w the external environment such as the skin + mucous membranes and transport them to T cells w specificity for those antigens.
Play a role in activating the immune response
What are cytokines? What is their function?
messengers between the cell types; instruct other cells to alter their proliferation, differentiation, secretion, or activity.
What are the 4 types of cytokines?
- interleukins
- interferons
- tumor necrosis factor
- colony stimulating factors
describe the function and effect of interleukins.
function - enhances immune response effect - promotes B + T cell proliferation
describe the function and effect of interferons
anti-viral (inhibits viral replication)
describe the function and effect of tumor necrosis factor (TNF)
enhance inflammation and immune response
kill tumor cells
describe the function of Colony stimulating factors
give 2 examples of CSFs.
stimulate proliferation and differentiation of cells
ex - erythropoietin, neupogen
Compare the humoral immune response and cell-mediated immune response. What cells are involved? What does each response protect us against?
homoral response: antibody-mediated, involves B lymphocytes.
Protects us from bacteria, extracellular viruses, and respiratory + GI pathogens.
cell-mediated response: antigen mediated, involves T lymphocytes. Protects us from intracellular viruses, chronic infectious agents, and tumour cells.
Describe the process of the humoral immune response
- The B cells convert to plasma cells when activated and produce antibodies IgM and IgG
- antibodies attach to their antigens and either interfere w their function or mark them for phagycytosis
- Results in the production of memory B cells for quicker rxn w second exposure
In the humoral response:
- which antibodies are primarily produced in the primary immune response (first exposure to antigen)?
- which antibodies are primarily produced upon the secondary immune response
Primary immune response: primarily IgM
Secondary immune response: primarily IgG
Identify the 4 classes of antibodies
- IgM
- IgG
- IgA
- IgE
Identify the locations of the following immunoglobulins in the body:
- IgM
- IgG
- IgA
- IgE
- IgM (plasma)
- IgG (plasma, ISF)
- IgA (body secretions such as tears, saliva, breast milk)
- IgE (plasma, ISF)
Describe the function of IgM.
- Responsible for primary + early immune response
- forms antibodies to ABO blood antigens
Describe the function of IgG.
- responsible for secondary immune response; predominant in late immune response
- only immunoglobulin that crosses the placenta
Describe the function of IgA.
lines mucous membranes + protects body surfaces
useful in defending the airways
Describe the function of IgE.
causes symptoms of allergic rxns by releasing histamine
fixes to mat cells and basophils
assists in defense against parasitic infections
Describe the process of the Cell-Mediated Immune Response. What cells are involved?
Involves antigen recognition by T cells. T Lymphocytes attack infected cells.
Includes T-Lymphocytes (Cytotoxic and T Helper Cells), macrophages, and NK cells.
Cytotoxic T cells attach antigens on the cell membrane of foreign pathogens and release cytolytic substaces that destroy the pathogen. They then produce Memory Cytotoxic T Cells.
T Helper cells stimulate pahocyte-mediated ingestion + killing of microbes,regulate cytotoxic T cell and B cell responses, produce cytokine messengers, and produce Memory T Helper Cells.
Identify which of the following would result in a humoral response. Which would result in a cell-mediated response? - Anaphylactic shock - atopic diseases - transfusion rxns - bacterial infections - tuberculosis - fungal infections - contact dermatitis - graft rejection - destruction of cancer cells
- Anaphylactic shock (HUMORAL)
- atopic diseases (HUMORAL)
- transfusion rxns (HUMORAL)
- bacterial infections (HUMORAL)
- tuberculosis (CELL-MEDIATED)
- fungal infections (CELL-MEDIATED)
- contact dermatitis (CELL-MEDIATED)
- graft rejection (CELL-MEDIATED)
- destruction of cancer cells (CELL-MEDIATED)
Describe the normal immune response (7 steps)
- Virus invades the body through a break in the skin or another portal of entry.
- Macrophage recognizes the antigens on the surface of the virus. The macrophage then digests the virus and displays pieces of it (= antigens) on its surface.
- T-Helper Cells recognize the antigen displayed on the macrophages which stimulates the production of cytokines: IL1 and IL2, TNF, and interferon.
- IL2 instructs other T Helper cells and Cytotoxic T cells to multiply. T Helper cells release cytokines causing B cells to multiply and produce antibodies.
- The antibodies bind to the virus and mark it for macrophage destriction.
- Cytotoxic T Cells and NK cells destroy the infected body cells.
- Once the virus is gone, activated T and B cells are turned off by suppressor T cells. Memory B and T cells remain behind and respond quickly if the same virus attacks again.
Identify the 3 types of altered immune responses.
- immunodeficiencies / immuno-incompetencies (severe infections, cancers, immune deficiency diseases)
- hypersensitivity (allergies, autoimmune disorders)
- active acquired immune responses
A 40 y/o woman who completed first round of chemotherapy for breast cancer. She reports feeling malaise + chills 2 wks after her first treatment. She has been gardening and cut herself on rose bushes.
She has an oral temp of 38, a WBC count of 2.0 x 109 / L, and an ANC of 1.3 x 109 / L.
What is the appropriate term for this patient’s WBC?
What does this mean for the patient clinically?
What should be included in the assessment of this patient?
- leukopenia w mild neutropenia
- patient is very susceptible to infection
- a temp of 38 on someone who is neutropenic is probably equal to a temp of 39 on a normal patient
assesment should include wound assesment on hand, look for infection (oral, respiratory, GI, GU) culture + sensitivity of wound + blood, swab oral cavity, urine sample, bone marrow biopsy if neutropenia is unexplained.
What is neutropenia? What is severe neutropenia?
neutropenia = ANC less than 1.5
severe neutropenia = ANC less than 0.5
What are the clinical implications of severe neutropenia? What steps should the nurse take?
Patient is at high risk for sepsis due to limited ability to fight infection and shows diminished signs of inflammation.
Administer broad spectrum antibiotics.
What is the normal range for WBC count?
5-10 x 109 / L
What are the possible causes of a higher WBC count?
What are the possible causes of a lower WBC count?
WBC count could be raised due to inflammatory + infectious processes or leukemia
WBC count could be lowered due to aplastic anemia, autoimmune diseases, overwhelming infection, side effects of chemotherapy and irradiation.
What is the normal range of band neutrophils?
What are the possible causes of an increased band neutrophil count?
0-1 x 109 / L (0%-9%)
Acute infections
What is the normal range of eosiniphils?
What are the possible causes of an increased eosiniphil count?
What are the possible causes of a decreased eusinophil count?
0.00-0.5 x 109 / L (1%-4%)
Causes of an increased eosinophil count:
- Allergic rxns
- Eosinophilic and chronic granulocytic leukemia
- Hodgkin’s disease
- Parasitic disorders
Causes of a decreased eosinophil count:
- Corticosteroid therapy
What is the normal range of lymphocytes?
What are the possible causes of an increased lymphocyte count?
What are the possible causes of a decreased lymphocyte count?
1.0-4.0 x 109 / L (20%-40%)
Causes of an increased lymphocyte count: • Chronic infections • Lymphocytic leukemia • mononucleosis • Viral infections
Causes of a decreased lymphocyte count:
• Corticosteroid therapy
• Whole body irradiation
What is the normal range of monocytes?
What are the possible causes of an increased monocyte count?
0.1-0.7 x 109 / L
causes of increased monocyte count: • Acute infections • Chronic inflammatory • Hodgkin’s disease • Malaria • Monocytic leukemia
What is the normal range of segmented neutrophils?
What are the possible causes of an increased segmented neutrophil count?
2.5-7.5 x 109 / L (62%-68%)
increased count:
• Bacterial infections
• Collagen diseases
• Hodgkin’s disease
decreased count:
• Aplastic anemia
• Viral infections
What is hypersensitivity?
What is an autoimmune disease?
Hypersensitivity occurs when the immune response is overreactive against foreign tisse or reacts aginst its own tissue, resulting in tissue damage.
An autoimmune disease is a type of hypersensitivity response in which the body fails to recognize self-proteins and reacts against self-antigens.
