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POD Exam 3 > Hypersensitivity II > Flashcards

Hypersensitivity II Flashcards

1
Q

What two Abs does Type II hypersensitivity involve?

A

IgG

IgM

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2
Q

Where is the Ag located?

A

surface of cell in circulation (soluble phase)

in a tissue

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3
Q

what two main things are involved in Type II

A

circulating Ab

its target Ag

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4
Q

What is often the result of type II

A

Cytotoxicity

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5
Q

Mechanisms of Type II

A

complement- and Fc receptor- mediated inflammation

opsonization and phagocytosis

ADCC, macs, NK cells

Abnormal physiologic responses without cell/tissue injury

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6
Q

ADCC: which Ab serve as bridges

A

IgG

links target cells to effector cells

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7
Q

what are the effector cells in ADCC

A

Macs
NK
Neutrophils
Eosinophils

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8
Q

What are two examples of abnormal physiologic responses without cell/tissue injury seen in Type II

A
  • Ab stimulates TSH receptor w/o hormone (Graves)

- Ab inhibits binding of ACh to ACh receptor (Myasthenia Gravis)

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9
Q

What are some diseases associated with Type II?

A
  • Transfusion reaction
  • Hemolytic disease of the new born
  • Autoimmune hemolytic anemia
  • goodpasture’s disease
  • pemphigus vulgaris
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10
Q

Important tests used in Type II diseases

A
  • Coombs test

direct vs indirect

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11
Q

What does Coomb test detect?

A

Anti-RBC antibodies

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12
Q

Direct Coombs test

A

picks up Ab DIRECTLY on the surface of RBC

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13
Q

What is the resulting effect of coombs test

A

agglutination of RBC

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14
Q

What does direct coombs test help detect?

A
  • Hemolytic disease of the the newborn
  • Autoimmune hemolytic anemia
  • transfusion reaction
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15
Q

Indirect coombs

A

two step

Measures Anti-RBC Abs in the SERUM

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16
Q

Basically what is happening with the coombs test?

A

Antibody on RBC (direct or indirect) – then add Anti Ig —> agglutination of RBC

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17
Q

when is indirect coombs used?

A

blood banking:

  • cross-matching
  • blood typing
  • Ab detection
  • Ab identification
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18
Q

What type of reaction does transfusion reaction cause?

A

Type II

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19
Q

Blood group AB has what Ags? what are the Abs in serum?

A

Ag: AB
Ab: none

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20
Q

Blood group O has what Ags? what are the Abs in serum?

A

Ag: H
Ab: anti-A, Anti-B

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21
Q

What is the Ig antibodies found in blood?

A

IgM antibodies

22
Q

If the potential donor is O type, do you have to worry about a transfusion reaction?

A

No

23
Q

Why do you not have a transfusion reaction against any donors with AB type recipient?

A

Recepient has no Abs against A or B

24
Q

What are the clinical symptoms of transfusion reaction?

A

Fever
Low BP
Nausea, vomiting
Back/chest pain

25
Q

Hemolytic disease of the newborn

A

Type II

Erthoblastosis fetalis
Ag on RBC - RhD

26
Q

When does Hemolytic disease of the newborn occur?

A

second pregnancy of women who is RhD NEG and has RhD POS baby. The anti-Rh affects the RhD+ fetus – lysis occurs

27
Q

In HDN, mother is RhD ___?

Baby?

A

Negative mom

positive baby

28
Q

What do you see in HDN?

A

elevated Bilirubin

Large liver/spleen

Petechiae

Positive Direct coombs test

29
Q

What test is used for HDN?

A

direct coombs test

30
Q

When does sensitization occur in HDN?

A

Postpartum - Ab formed against the RhD+ RBC from the baby in the FIRST pregnancy

31
Q

What can be given to destroy the fetal blood cells that leaked into maternal circulation?

A

Anti-D(Rh) injections: Rhogam

32
Q

What is the Anti-D treatment?

A

Passive immunization: inject Rh- mothers with preformed Anti-RhD — so that - No sensitization occurs

destorys RhD+ in MATERNAL circulation

repeat each pregnancy and after procedures

33
Q

Autoimmune Hemolytic Anemia

A

Anti-RBC antibodies produced
hemolysis of RBC
Pos. direct coombs

34
Q

Drug induced hemolytic rxn

A

DRUG binds surface protein on RBC (seen with penicillin)

IgG sp to drug prodcued

– binding of the IgG:
Complement mediated lysis
Opsonization/phagocytosis (C3b/IgG via Macs)

35
Q

Pemphigus vulgaris

A

Ag is FIXED tissue Ag (autoabs against inTERcellular subs)

Autoimmune blistering disease
IgG Ab

affects skin/mucus membranes
separation of epidermal layers/epithelial cells

36
Q

Immunofluorescence of Pemphigus vulgaris/Goodpasture’s syndrome?

A

Type II so linear staining pattern

AB to FIXED AG ***

37
Q

Goodpasture’s syndrome

A

Ag in kidney/lung - basement membrane (BM)
- Circulating Ab to glomerular BM (Anti-GBM abs) cross reacts with alveolar BM – leads to pulm hemorrhage

Autoimmune
IgG abs

Anti-tissue Ab – > activate complement and recruit inflammatory cells

38
Q

What are two main clinical presentations for Goodpasture’s

A

Acute Glomerulonephritis
Pulmonary hemorrhage

Males

39
Q

Treatment of Goodpasture’s

A

remove anti-GMB ab by PLASMAPHERESIS

Immunosuppressant drugs

40
Q

Example of cross-reactivity with Ag from infectious agent

A

ARF

41
Q

ARF

A

GAS Ag (throat infection) –> cross react with myocardial Ag

  • cardiac manifestations
  • migratory arthiritis
42
Q

Ab interference with cell function

A

Perinicious anemia : intrinsic factor of gastric parietal cells gets neutralized –> dec Vit B12 absorption

Autoimmune

43
Q

What is the result of lack of intrinsic factor?

A

dec Vit B12 absorption

Abnormal erythropoiesis and anemia

44
Q

Two diseases with Anti-receptor Abs?

A
  • Myasthenia gravis (inhibition)

- Grave’s Disease (stimulation)

45
Q

Clinical presentation of myasthenia gravis

A

Ptosis
muscular weakness
respiratory problems

(receptor # dec or destoryed in addition inhibition of NT binding)

46
Q

who is more affected by Grave’s?

A

20-30 yo women

47
Q

Clinical presentation of Grave’s disease?

A

Hyperthyroidism
Exophthalmos
Myxedema

heat intolerance, anxiety

48
Q

What occurs in Grave’s disease?

A

Anti-TSH receptor Antibody —> stimulates receptor and mimics action of TSH

Continuous release of T3 and T4

(normally, T3 and T4 signals pituitary to stop releasing TSH)

49
Q

Treatment of type II hypersensitivity

A

Plasmapheresis

Immunosuppression

50
Q

What does plasmapheresis do?

A

Gets rid of Abs by removing affected plasma and replacing with good plasma

51
Q

what is immumosuppression used for?

A

for reactions against self Ag

POD Exam 3 (6 decks)

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