Exam 5 Flashcards by Tia Guidry

An exaggerated immune response to
a typically harmless antigen

Hypersensitivity

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Develop minutes to hours after antigen exposure
* Mediated by antibodies
* Type I, type II, type III

Immediate reactions

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Clinical manifestations don’t develop until 24 to 48 hours
after antigen exposure
* Mediated by sensitized T cells
* Type IV

delayed reactions

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Also known as ANAPHYLACTIC or immediate
hypersensitivity

Type 1 hypersensitivity

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typically thought of as “ALLERGIES”

type 1 hypersensitivity

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Commonly occur within seconds to hours after
exposure to an allergen

type 1 2 and 3 hypersensitivities

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antibody released in hypersensitivity 1

IgE antibody

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other cells released during type 1 hypersensitivity are

mast cells, eosinophils, basophils

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what is type 1 hypersensitivity 3 phases

sensitization, activation, effector

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what phase: IgE binds to Fc receptors on mast cells and basophils.

Sensitization phase

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Histamine and heparin are released and bind to target organs. what phase?

activation phase

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Allergy symptoms are produced: Asthma, Eczema, Hay fever, Hives, Anaphylaxis etc. what phase?

effector phase

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Clinical Manifestations of Type I
Hypersensitivity

Rhinitis “hay fever”
Allergic asthma
hives, anaphylaxis

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Treatments for Type I Hypersensitivity

antihistamines; monoclonal anti- IgE antibody; allergy shots

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Known as antibody-mediated cytotoxic hypersensitivity

Type II Hypersensitivity

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Immediate hypersensitivity
▪ IgG and IgM antibodies directed against a cell surface antigen

Type II Hypersensitivity

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IgG and IgM bind to cell surface antigen which activates complement. which type?

type 2 hypersensitivity

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transfusion reactions, hemolytic disease of the newborn, autoimmune hemolytic anemia. these are examples of which type of hypersensitivity?

type 2

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Tests for Type II Hypersensitivity

DAT( direct antiglobulin test)
IAT (indirect antiglobulin test-coombs test)

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TESTING FOR TYPE 2

DAT AND IAT

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TESTING FOR TYPE 1

RAST TESTS

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examples of type 1 hypersensitivity (AAA)

allergies, asthma, anaphylaxis

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example of type 2 hypersensitivity

transfusion reaction, hemolytic disease of the newborn (HDN), autoimmune hemolytic anemia

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example of type 3 hypersensitivity

autoimmune diseases such as SLE and RA

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Sequelae to infections

type 3 hypersensitivity

treatments for type 1 hypersensitivity

allergy shots, antihistamines, epi pens

testing for type 1

RAST or RIST testing

common allergies of type 1:

food, dust mites, pollen

Small antigen–antibody complexes precipitate out and deposit in tissues.

type 3

Complex-mediated hypersensitivity

type 3

causes CELL DESTRUCTION due to complement

type 2

Complexes bind with complement; vasodilation and Vaso permeability increase. Process results in TISSUE DAMAGE

type 3

conditions associated with type 3

RA, SLE, post strep GN

testing for type 3

ANA, RF, and Complement

Cell-mediated hypersensitivity; Also known as type 4Delayed hypersensitivity

type 4

Hypersensitivity peaks 48 to 72 hours after antigen exposure

type 4

clinical examples of type 4 are

intracellular pathogens and contact dermatitis

Antigen applied to skin surface. Test for contact dermatitis

patch test

Antigen injected intradermally; used for PPD

Mantoux testing method

Test for tuberculosis exposure

PPD (Protein purified derivative)

Disorders in which immune responses are targeted toward self-antigens and result in damage to organs and tissues in the body

autoimmune disease

Antibody produced against an antigen found in an individual’s own cells, tissues, or organs

autoantibody

what are ANA'S

anti nuclear antibodies used for screening autoimmune diseases

Directed against antigens in cell nuclei

ANA'S

uniform staining of entire nucleus; due to antibodies to dsDNA, anti-histones, or DNP and seen in SLE, drug-induced lupus, and many other rheumatic autoimmune diseases

Homogeneous (Diffuse)

(Native DNA) staining of the outer edges of nucleus; antibody to dsDNA seen in SLE

Peripheral (rim)

discrete fluorescent specks throughout the nuclei; due to anti-ENA and seen in patients with SLE, scleroderma, and other rheumatic autoimmune diseases

Speckled

a few large areas of fluorescence representing the nucleoli within the nuclei; due to antibodies to RNA and RNP and seen mainly in patients with systemic sclerosis; Anti-RNA

Nucleolar

numerous discrete speckles (about 46) in the nuclei of each cell; due to antibodies to proteins in the centromeres of the chromosomes and seen mainly in patients with the CREST syndrome

Centromere

homogenous ANA pattern indicative of what

SLE usually

a peripheral rim pattern is usually indicative of what?

SLE(highly suggestive)

a speckled Ana pattern is usually indicative of what?

SLE diagnosis

a nucleolar ana pattern is indicative of what?

scleroderma, sjogren's syndrome

a centromere ana pattern is indicative of what?

CREST

testing using Hep-2 cells plus fluorescent anti-human IgG cells

Indirect Immunofluorescent Test

A chronic systemic inflammatory disease that affects multiple organ systems

SLE

Involves the Joints, Kidneys and Neurologic symptoms; butterfly rash

SLE

key antibodies in SLE

anti-ds DNA, anti- sm

ana patterns for SLE?

Homogeneous, Peripheral & Course Speckled

Chronic arthritis of the peripheral joints that can progress to joint deformity and disability

Rheumatoid Arthritis

IgM Autoantibody directed against the Fc portion of IgG ✓ capillary swelling, inflammation, deposits of immune complexes; initiates complement cascade

Used to confirm positive RF tests ✓ Allows earlier diagnosis an earlier treatment which may reduce joint erosion and deformity.

anti-CCP antibody

found in patients with other connective tissue diseases like SLE

anti-RNA antibodies directed against tear / salivary ducts

Sjogren’s Syndrome

Anti-RNA antibodies; Anti-SS-A & Anti SS-B are key antibodies in what?

Sjogren’s Syndrome

Antibodies against the proteins in the centromere of chromosomes; includes CREST syndrome

Systemic sclerosis, SSc (Scleroderma)

what does CREST stand for?

Calcinosis , Raynauds, Esophagus dysfunction, Sclerodactyly, Telangiectasia

what does ACID stand for?

Allergies, Cytotoxic mediated, Immune complex, Delayed response

autoantibody directed against receptor for TSH

Grave's disease

autoantibody directed against Basement membrane (kidney, lungs)

Goodpasture's Disease

autoantibody directed against thyroglobulin

Hashimoto's Thyroiditis

autoantibody directed against Myelin Sheath of Nerves or Myelin Basic Protein

Multiple Sclerosis

autoantibody directed against Acetylcholine Receptors at Neuromuscular Junctions

Myasthenia Gravis

autoantibody directed against RF (IgM) directed against IgG (Fc)

Rheumatoid Arthritis

autoantibody directed against Salivary duct/tear duct

Sjogren's Syndrome

Normal TSH; ↓ FT4, Considered Chronic Lymphocytic thyroiditis ▪ Results in Hypothyroidism.

Hashimoto’s Thyroiditis

Hyperthyroid; weight loss and exophthalmos (bulging eyes); Goiter firm; Decreased TSH & Inc FT4; Trab (antibodies to TSH receptors)

Graves Disease

Hyperglycemia; Antibodies against Islet cells of pancreas;fatigue, thirst, frequent urination; Lab results: high blood glucose, high Hgb-A1C

Type I Diabetes (Juvenile Diabetes)

Affects small intestines; triggered by dietary gluten; antibodies against gliadin

Celiac Disease

antibodies against the myelin basic protein; destruction of CNS; lab test: looking for oligoclonal bands in protein electrophoresis of CSF

Multiple Sclerosis

affects neuromuscular system; antibodies against acetylcholine receptors.

Myasthenia Gravis

antibodies to basement membranes lining the renal glomeruli and lung alveoli.

Anti-Glomerular Basement Membrane Disease (Goodpasture’s syndrome)

monoclonal gammopathies: characterized by a clone of identical plasma cells and overproduction of an immunoglobulin component called Myeloma Protein (M protein).

Plasma Cell Dyscrasias

malignancy of mature plasma cells, excess Plasma cells in BM

Multiple Myeloma

CD markers of Multiple Myeloma

CD38, CD56, CD138

The monoclonal immunoglobulin mostly seen in patients serum with M.M?

IgG

what is found in patients urine that has M.M?

Bence Jones protein

renal failure and bone pain is seen in what proliferative disorder?

Multiple Myeloma

what does the acronym CRAB stand for?

hyperCalcemia, Renal failure, Anemia, Bone lesions

kappa lambs light chains in urine is also called what?

bence jones protein

malignant proliferation of WBCs in bone marrow

Waldenstrom Macroglobulinemia

CD markers for Waldenstrom Macroglobulinemia

CD19 and CD22

symptom of hyper-viscosity serum is caused from what?

Waldenstrom Macroglobulinemia

monoclonal immunoglobulin mostly seen is IgM. which disease?

Waldenstrom Macroglobulinemia

Proliferation of Monoclonal IgM in serum

Waldenstrom Macroglobulinemia