Immunity Flashcards by Kevin Dale

key characteristic about immune system:

The ability to distinguish between self and nonself

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What are the 2 subcategories of the immune system?

Innate (natural) immunity
Adaptive (acquired) immunity

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What is innate (natural) immunity

-First line of defense
-Activated when a pathogen is first encountered
-Initial response: Sneezing, tearing, coughing, sweating

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What is adaptive (acquired) immunity

Produces antibodies with specificity for different pathogens

Becomes prominent as it develops antigen specific antibodies in response to activation by the innate system

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Immune response of innate and adaptive immunity:

Humoral response
Cell mediated response

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Humoral response:

Mediated by B lymphocyte antibodies circulating in the lymph or blood

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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

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Innate immune system

-Inherited
-First line of defense

-Rapid response but lacks immunological memory

-Does not require prior pathogen exposure for activation

-Response is always the same regardless of prior exposure to the same pathogen

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Major cellular components of the innate immune system

Granulocytes

Agranulocytes

Dendritic cells (DCs)

Cytokines

Complement system

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What cells are granulocytes?

Neutrophils
Eosinophils
Basophils

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what cells are Agranulocytes?

Monocytes
Macrophages

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What is phagocytosis?

The process of ingesting pathogens (bacteria, viruses, fungi, parasites, tumor cells, and apoptotic cells)
Exposes the pathogen to intracellular chemical pathways that destroy it

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What cells are phagocytes?

Neutrophil

Eosinophils
Monocytes
Macrophages

Dendritic cells

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Opsonization:

Antibodies and complements (opsonins) bind to the pathogen and mark it for destruction by the phagocytes

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Mononuclear Phagocyte System (MPS):

-Formerly called the reticuloendothelial system
-Includes phagocytes located in reticular connective tissues (including in the lymph nodes, spleen, lungs, and liver)
-Activated when the MPS encounters a pathogen
-The MPS phagocytes secrete cytokines that promote migration of neutrophils, monocytes, eosinophils, and basophils to the infection site
-Also secrete colony-stimulating factors that stimulate production and release of additional phagocytes from the bone marrow

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PAMPs:

PRRs can recognize specific pathogen-associated molecular patterns (PAMPs) found exclusively on bacteria, fungi, parasites, and viruses

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DAMPs:

PRRs also recognize danger-associated molecular patterns (DAMPs) on stressed host cells in response to infection, trauma, ischemia, and tissue damage
Also called alarmins

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NEUTROPHILS:

Most numerous white blood cells (WBCs)***

-Sensitive to the acidic environment of infected tissues

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What are neutrophils responsible for?

-Responsible for elevated WBCs that occur with infection

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What is the half-life of neutrophils?

-The half-life of 6 hours

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What do dying neutrophils turn in to?

-Dying neutrophils become part of the purulent exudate at the site of infection

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Where are Langerhans cells found?

in epidermis

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Where are kupffer cells found?

liver
alveolar cells in the lungs microglia cells in the CNS

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Basophils:

Least common blood granulocyte

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Mast Cells:

Reside in peripheral tissues, especially connective tissue close to blood vessels

What do basophils and mast cells do?

Key initiators of immediate hypersensitivity reactions through the release of histamine, leukotrienes, cytokines, and prostaglandins Play a major role in atopic allergies (hay fever, asthma, eczema) Respond directly to bacterial pathogens

where are Eosinophils concentrated?

GI mucosa respiratory tract urinary tract

What do eosinophils primarily defend against?

parasites

what do eosinophils release to kill microbes

cytokines

what do eosinophils play a role in?

allergic reactions and asthma

Where are dendritic cells found?

concentrated in: secondary lymphoid tissue --spleen -lymph nodes -mucosa-associated lymphoid tissues -skin -mucous membranes

What are the Most potent antigen-presenting cells (APCs)

Dendritic cells

What other cells cytokines include?

Interleukins Interferons (IFNs) Tumor necrosis factor (TNF) Chemokines

Tumor necrosis factor (TNF)

TNF-α: Primary role is regulation of proinflammatory effects, including induction of fever

Complement system: what does it complement?

the innate and adaptive immune systems

Main function of the complement system

Main function: Mark pathogens for permanent destruction and recruit other immune cells to destroy the pathogens

What are the 2 pathways of the complement system?

Classic pathway Alternative pathway

Classic pathway:

Alternative pathway:

C3 (C3a, c3b, c4a, c5a, c5b, c6-9

is the innate or adaptive immune system response faster?

innate

What does the adaptive immune system do?

Produces antibodies with specificity for different pathogens

What does the adaptive immune system do?

Produces antibodies with specificity for different pathogens

does the innate or adaptive have a more aggressive response?

adaptive

Types of mature lymphocytes (4)

B lymphocytes (B cells) T lymphocytes (T cells) Natural killer cells (NK) Natural killer T cells (NKT)

B cells function:

production of antibodies N terminal and C terminal

Five classes of immunoglobulin (Ig):

IgG IgM IgA IgE IgD

IgG

– gamma chains

IgM

– mu chains

IgA

– alpha chains

IgE

– epsilon chains

IgD

– delta chains

Where do T cells originate?

bone marrow mature and differentiate in the thymus before migrating to secondary lymphoid organs

Two types of T cells produced in the thymus:

T helper (Th) cells T killer or cytotoxic (Tc) cells

Two types of T cells produced in the thymus:

T helper (Th) cells T killer or cytotoxic (Tc) cells

Natural killer cells (NK)- do they directly attack pathogens?

Do NOT directly attack pathogens

Histamine is the most important mediator of:

Type I hypersensitivity reactions

Immediate Hypersensitivity occurs within:

15-30 minutes of exposure to the antigen

Binding of histamine to H1 receptors triggers:

bronchoconstriction increased vascular permeability vasodilation urticaria pruritus increased gut permeability increased mucus production

Binding of histamine to H2 receptors triggers:

increased gastric acid secretion decreases histamine release from mast cells and basophils

Anaphylaxis symptoms:

angioedema systemic vasodilation hypotension extravasation of protein and fluid bronchospasm dysrhythmias

Treatment of Type I Hypersensitivity reaction:

-Antihistamines – to prevent systemic effects of histamine -Cromolyn sodium – to prevent mast cell degranulation -Bronchodilators – to treat bronchospasm

Cause of intraoperative anaphylaxis: ****

1. Neuromuscular blockade drugs 2.Antibiotics 3.Latex

Symptoms of anaphylaxis in the anesthetized patient:

Hypotension tachycardia bronchospasm…. followed quickly by: hypovolemia shock hypoxemia

If anaphylaxis is left untreated it will result in:

rapid progression to pulseless electrical activity (PEA) and cardiac arrest

Front-line tx for intraop anaphylaxis

Epinephrine (*definitive treatment) Rapid administration of IV fluids Arginine vasopressin Methylene blue Glucagon

2nd line treatment for anaphylaxis:

Antihistamines H₁ antagonists H₂ antagonists Bronchodilators β₂ agonists Albuterol Terbutaline Ipatropium bromide (Atrovent) Corticosteroids – for airway edema

examples of type 2 reactions

-Type I diabetes mellitus -Myasthenia gravis -Drug-induced hemolytic anemia -Granulocytopenia -Thrombocytopenia -Transfusion reactions -Anemia -Goodpasture’s nephritis

Examples of type 3:

systemic lupus erythematosus (SLE), serum sickness rheumatoid arthritis (RA)

example of type 5:

Graves’ disease

Examples of type 4

Contact hypersensitivity (poison ivy) Granulomatous sensitivity (tuberculosis and leprosy)

6 most common autoimmune diseases

Graves’ disease Hashimoto thyroiditis Multiple sclerosis (MS) Rheumatoid arthritis (RA) Systemic lupus erythematosus (SLE) Type 1 diabetes mellitus

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 drug causes the greatest depression of the immune system?

Morphine

Regional Anesthesia:

Attenuates the surgical stress response and supports the preservation of normal immune function

weaker immune modulation drugs

Hydromorphone oxycodone tramadol hydrocodone

strong immune modulation drugs

Codeine methadone remifentanil fentanyl

ASA:

reduces cancer metastasis

chronic inflammation is a sign of:

autoimmune disease