Immune System

Question 1

CBC differential: normal range - WBC

Answer 1

5 - 10 K

Question 2

CBC differential: normal range - Hgb and Hct

Answer 2

1 to 3 ratio

Hgb: 12 -15
Hct: 36 - 45

Question 3

CBC differential: normal range - platelets

Answer 3

150K - 450K

Question 4

leukocytosis

Answer 4

increased WBC (>10K)
indication of infection

Question 5

leukocytopenia

Answer 5

• decreased WBC (< 5K)
• indication of: chemo drugs
• risk of infection

Question 6

polycythemia vera (PV)

Answer 6

• increased Hgb (> 15)

- risk of stroke, MI

Question 7

anemia

Answer 7

• decreased Hgb (< 12)
• S/Sx: fatigue, SOB
• indications: bleeding, chemo,
• Tx: transfusion of packed red blood cells (PRBC) for <8 or Hct < 24

Question 8

thrombocytopenia

Answer 8

• decreased platelets (<150K)

- risk for bleeding

Question 9

thrombocytosis

Answer 9

• increased platelets (> 450K)
• too many immature platelet cells
• at risk of bleeding

Question 10

WBC involved in non-specific (innate) immunity

Answer 10

neutrophils

monocytes

Question 11

first line of innate immunity

Answer 11

skin, physical barrier, mucous membrane

Question 12

specific immunity: adaptive immunity

cell-mediated immunity

Answer 12

T-lymphocytes

Question 13

specific immunity: adaptive immunity

humoral immunity

Answer 13

B lymphocytes

Question 14

monoclonal antibody

Answer 14

antibody for one antigen

Question 15

Immune system

Answer 15

1. antigens
2. dendritic cells - antigen presenting cells
3. cytokines - activate immune cells
4. CD4 T cells (Helper T cells) - Master switch
5. CD8 T cells (cytotoxic T cells)
6. B cells

Question 16

CD4 T lymphocytes

Answer 16

• Master Switch for immune system
• Helper T Cells
• Secrete cytokines that activate most other types of immune cells

Question 17

CD8 T lymphocytes

Answer 17

• cytotoxic - activated by helper CD4 T cells –> destroy target cells
• “cell-mediated immunity”
  => rejection of foreign tissue cells
  => kill other cells that are virus/bacteria infected
  => delayed hypersensitivity reaction

Question 18

humoral immunity

Answer 18

• Activated B cells => plasma cells + produce millions of antibodies (each is antigen specific)
• Some B cells survive as memory B cells

1st response - slow (7-10 days)
2nd response - much quicker

Question 19

monoclonal antibodies

Answer 19

• immunoglobulins (Igs)
• play key role in:
  = recognition of foreign antigens
  = stimulation of immune response to them

Question 20

Host versus graft disease (HVGD

Answer 20

host’s body rejects graft

Question 21

Graft versus host disease (GVHD)

Answer 21

graft rejects host’s body
- T lymphocytes of the transplanted tissue attack host tissue

Ex. - bone marrow transplant

Question 22

4 types of hypersensitivity disorders

Answer 22

Type 1: immediate, IgE mediated (asthma, peanut butter)

Type II: antibodies-mediated cell damage (bad blood transfusion - ATN (acute tubular necrosis)

Type III: immune complex disorders

Type IV: cell-mediated, delayed 24-72 hrs or even years (TB skin test, transplant rejection, contact dermatitis from poison ivy)

Latex allergy

Question 23

Epoitin Alfa (Epogen, Procrit)

Answer 23

immunostimulant - increases RBC
- by recombinant DNA

Indications:

• anemia of CKD, ESRD
• medication induced anemia = Zidovudine (AZT), cytotoxic drugs, chemo

Route: SQ 1/week
Toxicity: incr risk of stroke, MI
NI: monitor CBC, H and H levels
Drug abuse by professional athletes

Question 24

Filgrastim (Neupogen)

Answer 24

increases WBC
Indications: 
- chemo pt to reduce risk of infection
- pt getting bone marrow transplant
- severe chronic neutropenia

SE: bone pain
CBC - monitor WBC

NI: hand washing

• no plants or fresh flowers
• steril technique

Question 25

Oprelvekin (Neumega)

Answer 25

increase platelet production

Indications:
- pts getting chemo/HIV drugs to minimize bleeding

SE:
- fluid retention (expansion of plasma volume)
- peripheral edema
= caution in pts w/HG
- cardiac dysrhythmias (tachycardia, Afib)

Question 26

leukocytosis w/shift left

Answer 26

too many immature WBC, so aren’t as effective