Evaluating the Immune Deficient Patient Flashcards
10 warning signs of pimary immunodeficinecy (not caused by drugs or nutrition or infection)
Yes she could
- shows signs of chronic infection (pseudomonas, MAC, warts)
autimmune cytenias, lyphoreticular maligancies (lymphoma, EBC), splenomegaly and adenopathy and poor wound healing also indicate a sign of immunodeficiency.
Fill out the infectious disease susceptibility chart for T, B, NK, PMN, MN and complement cells.
important aspects of history while assessing for immune deficiency
- exposures (day care, occupation, travel, chemical, toxin, drugs, sick contacts)
- autoimmune/allergy history (AI illnesses (ex/ rheumatoid arthritis can cause neutropenias and other cytopenias like anemia (ACD)). Eczema, lupus, joint pain, allergies
- Wound healing capabilities
- previous infections: and with what? an infection with a variety of bacterial, viral, parasitic and fungal infections would indicate a T cell deficiency.
- vaccine titres
- growth and development, nutrition.
- congenital issues and syndromes (down syndrome predisposes to certain diseases like heart issues and AML)
- consanguinity, family history of early childhood death, malignany and autoimmune disease.
what to do before diagnosing with primary immunodeficiency
rule out common causes of acquired immune deficiency
- autoimmune disease (diabetes, arthritis, aplastic anemia)
- HIV/viral/EBV/CMV/Hep etc causing neutropenia and cytopenias
- r/o drug use and medications/immunosuppressive drugs like methotrexate.
- r/o severe trauma like severe burns, infection/sepsis
fill in this table for C’, phagocytes, humoral, cellular, and combined types of immunity.
a complelement ddeficiency would be characterized by recurrent ___ or ____
pyogenic or neisseria infections. complement systems result in more BACTERIAL INFECTIONS.
PMN deficiency would be characterized by recurrent ___ and ___ infections
bacteria and funus infections (like CGD– cannot undergo oxidative burst)
specific bacterias that infect PMN deficient hosts
catalase positive organisms. make sure to test using oxiative burst or NBT test for CGD. Leukocyte adhesion deficiencies could also cause recurrent bacterial and fungal infections seen in PMN deficiency.
(staph A, klebsiella, candida, aspergillus, nocarrdia, pseudomonas, E.coli)–> common infections in neutropenic or PMN deficient host
a person with a humoral (b cell deficiency) would show recurrent ___ and ___ infections
bacterial and viral infections.
how to diagnose a B cell deficiency(humoral deficiency)
could be due to many causes (including malignancy– too many immature B cells in non-hodgkins lymphoma, DLBCL, or in CLL/ALL could cause immunodeficiency)
- need flow cytometry to measure the number ot T, b and Nk cells and to determine clonality.
- B cell markers: CD5, CD19, CD23+
testing functionality of B cells
- ex/ flow cytometry would display presence of B cells, but vaccine titers, isohemagglutinin titers, igGAME levels would indicate if the B cells present are actually functioning.
what kind of infections do patients with T cell defects get?
all: bacterial, viral, parasitic, fungal, mycobacteria
that’s why when there is a T cell deficiency (ex/ HIV, T cell non-hodgkins causing most of the T cells to just be immature and useless etc), there is a high high high risk of death due to infection.
tests that would test T cell function
mitogen.
patient lymphocytes are stimulated with mitogens, or chemicals that are strong activators of T cells.
flow cytometry would test for presence (ex/ if tehre are CD3+ CD4+/ CD8+ cells, you;d know that there are most likely T cell present)– they may not necessarily be functional.
if you are suspecting a T cell immune deficiency, what should you rule out?
HIV (CD4+ decreaser) and non hodgkins lymphoma T cell.
Before you go diagnosing a primary immunodeficiency like CVID
