Immunity Flashcards
What are the two subcategories of the immune system?
Innate (natural) immunity:
First line of defense
Activated when a pathogen is first encountered
Initial response: Sneezing, tearing, coughing, sweating
Adaptive (acquired) immunity:
Becomes prominent as it develops antigen-specific antibodies in response to activation by the innate system
What is the key characteristic of the immune system?
The ability to distinguish between self and nonself
What is the Humoral response mediated by?
B lymphocyte antibodies circulating in the lymph or blood
Cell Mediated Response
Produced by phagocytes, T lymphocytes, and cytokines
Directed primarily at microbes that survive in host cells
Plays a major role in transplanted organ rejection
Does the innate immune response require prior pathogen exposure for activation?
nope!
Response is always the same regardless of prior exposure to the same pathogen
What is the most numerous of all the white blood cells?
Neutrophils
Responsible for elevated WBCs that occur with infection
Half-life 6 hours
Basophil and Mast Cells:
Express cell surface high affinity receptors for immunoglobulin E (IgE)
Key initiators of immediate hypersensitivity reactions through the release of histamine, leukotrienes, cytokines, and prostaglandins
Stimulate smooth muscle contraction
Play a major role in atopic allergies (hay fever, asthma, eczema)
Respond directly to bacterial pathogens
What acts as messengers in the immune system and modulate the response to pathogenic microbes, tumor cells, and apoptotic cells?
cytokines
What are the most potent antigen-presenting cells (APCs)
Dendritic Cells (DCs)
What “Complements” the innate and adaptive immune systems?
Compliment system
Main function: Mark pathogens for permanent destruction and recruit other immune cells to destroy the pathogens
Key points about the adaptive immune system
Produces antibodies with specificity for different pathogens
Slower response than the innate system but develops immunological memory that allows for a more aggressive response with repeated exposure to a pathogen
Adaptive immune system cells develop from hematopoietic stem cells that differentiate into a common lymphoid progenitor
The common lymphoid progenitor further differentiates into four types of mature lymphocytes:
B lymphocytes (B cells)
T lymphocytes (T cells)
Natural killer cells (NK)
Natural killer T cells (NKT)
What cells produce antibodies?
B Cells
What cells originate in bone marrow, mature and differentiate in the thymus before migrating to secondary lymphoid organs?
T Cells
Some T cells become memory T cells – quicker response with repeat exposure to an antigen
Do Natural Killer Cells (NK) directly attack pathogens?
nope!
What is active immunity?
Active immunity is achieved when a pathogen is administered for the purpose of stimulating the immune system to produce antibodies specific for the antigen
With repeat exposure to the antigen, the adaptive immune system provides a quicker and more efficient response
Vaccines:
Live, attenuated vaccines:
Long lasting protection immunity, but concerns regarding mutation and reversion to the live pathogen that will cause disease
Inactivated bacterial toxins: Used for bacterial diseases that are caused by a toxin produced by the bacterium (not the bacterium itself)
Example: tetanus vaccine
Shorter length of protection than live vaccines and require boosters for long term immunity
What is passive immunity?
Passive Immunity:
Occurs when an individual receives another person’s antibodies to help prevent or fight infectious diseases
Protection is immediate but short-lived (lasting only a few weeks or months)
Vaccine type
What are Monoclonal Antibodies (MABs)?
Lab engineered molecules that mimic natural antibodies
Attach to abnormal cells and mark them for identification and destruction by the immune system (immunotherapy)
Surrounding healthy cells are not affected by MABs
What is the most important mediator of Type I hypersensitivity reactions?
Histamine
Treatment of Type I Hypersensitivity reaction?
Antihistamines – to prevent systemic effects of histamine
Cromolyn sodium – to prevent mast cell degranulation
Bronchodilators – to treat bronchospasm
What are the causes of Cause of intraoperative anaphylaxis?
- Neuromuscular blockade drugs
- Antibiotics
- Latex
What are the symptoms of anaphylaxis in the anesthetized patient?
Hypotension, tachycardia and bronchospasm…. followed quickly by hypovolemia, shock, and hypoxemia
Left untreated, rapid progression to pulseless electrical activity (PEA) and cardiac arrest
How do you treat intraoperative anaphylaxis?
Front-line Treatments:
Epinephrine (*definitive treatment)
Rapid administration of IV fluids
Necessary to counteract the loss of intravascular volume into the extravascular space
Arginine vasopressin
Indicated for hypotension unresponsive to epinephrine
Methylene blue
A selective inhibitor of guanylate cyclase, prevents nitric oxide (NO) mediated vascular smooth muscle relaxation
Glucagon
Directly activates adenyl cyclase and is indicated for continuing hypotension and bronchospasm in patients on β blockers
What are the second line treatments for anaphylaxis?
Antihistamines
H₁ antagonists
H₂ antagonists
Bronchodilators
β₂ agonists
Albuterol
Terbutaline
Ipatropium bromide (Atrovent)
Corticosteroids – for airway edema
What is Type II Hypersensitivity?
Cytotoxic Hypersensitivity
Type I diabetes mellitus
Myasthenia gravis
Drug-induced hemolytic anemia
Granulocytopenia
Thrombocytopenia
Transfusion reactions
Anemia
Goodpasture’s nephritis
What are type III reactions?
Immune Complex Hypersensitivity
Examples: systemic lupus erythematosus (SLE), serum sickness, and rheumatoid arthritis (RA)
Type V Hypersensitivity
graves
What is Alloimmunity/Isoimmunity?
transplact, transfusion reactions, neonatal allimmune thrombocytopenia
What is the is the classic sign of autoimmune disease?
Chronic inflammation
What are the six most common autoimmune diseases?
Graves’ disease
Hashimoto thyroiditis
Multiple sclerosis (MS)
Rheumatoid arthritis (RA)
Systemic lupus erythematosus (SLE)
Type 1 diabetes mellitus
What is the most common cause of hyperthyroidism?
Graves’ Disease
Thyroid enlargement (goiter)
Weight Loss
Exopthalmus
What is the most common thyroid disorder in the United States?
Hashimoto Thyroiditis
What is the most prevalent demyelinating disorder of the CNS?
Multiple Sclerosis
Females effected 2X more than males
An inflammatory autoimmune disease characterized by synovial inflammation and hyperplasia, cartilage and bone destruction, and systemic features, including cardiovascular, pulmonary, *****psychological, and skeletal disorders
Rheumatoid Arthritis
What is the most common primary immunodeficiency disorder?
Selective IgA Deficiency
The CDC defines a surgical site infection as:
one that occurs at or near the surgical incision within 30 days of the procedure or within 1 year of the implantation of a prosthetic device
What is the most vulnerable time for metastasis of tumor cells?
The postoperative period
This can be attributed to the surgical suppression of cell-mediated immunity
True/false: Blood transfusion is: associated with immune system depression, increased incidence of surgical site infection, and earlier recurrence of cancer
True
Perioperative Hypothermia facts
Defined as a core body temperature below 36° C
Suppresses innate and adaptive immunity
Associated with:
Increased incidence of surgical site infections
Increased blood loss
Impaired wound healing
Decreased immune function
What opioid is associated with the greatest depression of the immune system?
Morphine
Least common WBC?
Basophils
