Immunity/Inflammation/Hematology Flashcards
Immunity
protection from illness or disease that is maintained by the body’s physiologic defense mechanisms.
What are inflammation and immunity critical to?
maintaining health and preventing disease.
What is considered a non-self cell or protein?
infected body cells, cancer cells, cells from other people, and invading organisms
What is self-tolerance and what is it’s purpose?
The body’s ability to recognize self vs non-self cells/proteins - this prevents immunity from harming healthy body cells.
HLA
Human Leukocyte Antigens - Unique surface proteins that are specific to each person; they are the “universal product code” for that person.
How is one person’s HLA’s recognized by another person?
as foreign or non-self
Antigens
proteins capable of stimulating an immunity response.
Where are HLA’s located?
on the surfaces of most body cells (not only leukocytes)
What is assessed by the immune system cell in order to determine if body cells are self cells or invaders?
As the immune system comes into contact with other cells it compares the surface protein HLAs to determine if the cell belongs to the body.
What happens if the immune system cell does not recognize a cell’s HLAs?
The immune system cell then takes action to neutralize, destroy, or eliminate the foreign invader.
Where do most immune system cells come from and is the source of all blood cells?
the bone marrow
pluripotent
having more than one potential outcome
What are immature, undifferentiated cells called that are produced in the bone marrow?
stem cells
What is the growth factor for a stem cell to become a red blood cell (erythrocyte)?
Erythropoietin - when immature stem cells are exposed to erythropoietin they commit to the erythrocyte pathway.
Red blood cells are also called what?
erythrocytes
white blood cells are also called what?
leukocytes
What defensive actions do leukocytes take to provide protection? (5)
- recognition of self vs non-self
- destruction of foreign invaders, cellular debris, and unhealthy or abnormal self cells
- production of antibodies directed against invaders
- complement activation
- production of cytokines that stimulate increased formation of leukocytes in bone marrow and increase specific leukocyte activity
What are the three processes needed for human protection through immunity?
- inflammation
- antibody-mediated immunity
- cell-mediated immunity
What does immunocompetence require?
Full immunity requires the function and interaction of all three immunity processes
(inflammation, antibody-mediated immunity, cell-mediated immunity)
What leukocytes are involved in inflammation?
Neturophil macrophage monocyte eosinophil basophil
What leukocytes are involved in antibody mediated immunity?
B-lymphocyte
plasma cell
Memory cell
What leukocytes are involved in cell-mediated immunity?
helper/inducer t-cel
cytotoxic/cytolytic T-cell
Natural killer cell
What is the function of a neutrophil?
Provides non-specific protection after microorganisms and foreign proteins, especially bacteria, enter the body; destroys by phagocytosis and enzymatic digestion.
What does ANC stand for and what does it measure?
absolute neutrophil count - used to measure a patient’s risk for infection (the higher the numbers, the greater the resistance to infection)
What does the differential of a normal WBC cell count show?
the number and percent of the different types of circulating leukocytes.
What are most circulating neutrophils?
segmented neutrophils (mature cells)
What is bandemia (left shift)?
When the there’s a shift in circulating neutrophils causing them to be mostly immature forms rather than mature - caused by problems such as sepsis
What does bandemia (left shift) indicate?
that the patient’s bone marrow cannot produce enough mature neutrophils to keep pace with the continuing infections and is releasing immature neutrophils into the blood.
What is the function of a macrophage?
nonspecific recognition of microorganisms and foreign proteins; ingestion and phagocytosis; helps stimulate response of antibody-mediated and cell-mediated immunity.
what is the function of a monocyte?
destruction of bacteria and cellular debris (matures into macrophage)
What is the function of an eosinophil?
releases vasoactive amines during allergic reactions to regulate reaction; usually associated with parasitic infections
What is the function of a basophil?
“signs and symptoms” - releases histamine and heparin in areas of tissue damage
what do tissue mast cells do?
maintain and prolong inflammation and allergic reactions.
phagocytosis
the engulfing and destruction of invading microorganisms and foreign proteins; rids the body of debris after tissue injury.
Which cells are most efficient in phagocytosis?
neutrophils and macrophages
What are the 7 steps of phagocytosis?
- exposure and invasion
- attraction
- adherence
- recognition
- cellular ingestion
- phagosome formation
- degradation
What are the five cardinal symptoms of inflammation?
warmth, redness, swelling, pain, and decreased function
What are the three stages of inflammatory response?
Stage 1: (vascular) - change in blood vessels
constriction and hyperemia and edema
Stage 2: (cellular exudate) - neutrophilic, pus
Stage 3: (tissue repair and replacement)
WBCs trigger new blood vessel and growth (angiogenesis) and scar tissue formation.
What is specific immunity?
an adaptive protection that results in long-term resistance to the effects of invading microorganisms.
Why is specific immunity known as acquired immunity?
because the body has to learn to generate specific immune responses when it is infected by or exposed to specific organisms
antibody-mediated immunity
“humoral immunity” - immunity that uses antigen-antibody interactions to neutralize, eliminate, or destroy foreign proteins.
What cell are antibodies produced by?
sensitized B-lymphocytes (B-cells)
What is the function of B-lymphocytes
become sensitized to a specific foreign protein (antigen) and produce antibodies directed specifically against that protein.
What are the seven steps for specific antibody production against a specific antigen?
- Exposure or invasion
- Antigen recognition
- Sensitization
- antibody production
- antibody-antigen binding
- antibody-binding actions
- Sustained immunity (memory)
What are antibody-binding actions?
Agglutination Lysis Complement activation and fixation Precipitation Inactivation (neutralization)
What is the function of plasma cells?
secretes immunoglobulins in response to the presence of a specific antigen
What is the function of a memory cell?
remains sensitized to a specific antigen and can secrete increased amounts of immunoglobulins specific to the antigen on re-exposure
What is the function of a helper/inducer T-cell?
enhances immune activity of all parts of general and specific immunity through secretion of various factors, cytokines, and lymphokines
What is the function of a cytotoxic/cytolytic T-cell?
selectively attacks and destroys non-self cells, including virally infected cells, grafts and transplanted organs
What is the function of natural killer cells?
nonselectively attacks non-self cells, especially body cells that have undergone mutation and become malignant; also attacks grafts and transplanted organs.
Where are a large number of macrophages found?
liver, spleen and intestinal tract
Which cells act on blood vessels?
basophils
Which cells are very active against infestations of parasitic large and also limits inflammatory reactions?
eosinophils
why is antibody-mediated immunity also known as humoral immunity?
because antibody molecules from plasma cells are released into the blood and body fluids (body “humors”) as free antibodies that are separate from the b-cells.
Antibodies are also called what?
immunoglobulins or gamma globulins
On first exposure to an antigen, what type of antibody does the newly sensitized B-cell produce?
IgM - special type of antibody that forms itself into a five-member group with ten antigen binding sites. slow production but very efficient so initial illness lasts only 5-10 days.
On re-exposure to an antigen, what type of antibody is produced?
IgG - fast production so efficient at clearing the antigen and protecting the patient from becoming ill with the disease again.
adaptive immunity
a person’s body learns to make as an adaptive response to invasion by organisms or foreign proteins.
active immunity
occurs when antigens enter a person’s body and it responds by making specific antibodies against the antigen
natural active immunity
occurs when an antigen enters the body naturally without human assistance - most effective and longest lasting
artificial active immunity
protection developed by vaccination or immunization
passive immunity
occurs when the antibodies against an antigen are transferred to a person’s body after first being made in the body of another person or animal (short-term protection against a specific antigen - flu shot)
Natural passive immunity
occurs when antibodies are passed from the mother to the fetus via the placenta or to the infant through colostrum and breast milk.
Cell-Mediated immunity
a type of immunity that involves many white blood cell actions and interactions; provided by lymphocyte stem cells of the thymus and pericortical areas of lumps nodes.
What is RA?
Rheumatoid Arthritis - common connective tissue disease that presents as chronic, progressive, systemic inflammatory autoimmune disease that primarily affects synovial joints
What happens in RA?
transformed autoantibodies (rheumatoid factors) form and attack healthy tissue, causing inflammation
Who is most commonly effected by RA?
white women (typical onset between ages 35-45)
ankylosis
immobility of a joing
What are the early symptoms of RA?
joint stiffness, swelling, pain, fatigue, generalized weakness
What are the late symptoms of RA?
joints become progressively inflamed and painful
What is the RA disease pattern?
bilateral and symmetric affecting multiple joints; upper extremities first;
can be acute and sever or slow and progressive;
vague symptoms can last for months
What are the systemic symptoms of RA?
persistent low grade fever fatigue generalized weakness anorexia (2-3 lbs) paresthesias (burning and tingling sensations)
hyper acute rejection
begins immediately on transplantation and is an antibody-mediated response
acute rejection
occurs within 1 week to 3 most after transplantation and may occur sporadically after that
chronic rejection
similar to chronic inflammation and scarring - donated organ tissues are replaced with fibrotic, scar like tissue
what does hyperacute rejection occur mostly with?
transplanted kidneys
who is at greater risk for hyperacute rejections?
- those who have received donated organs of an ABO blood type different from their own.
- those who have received multiple blood transfusions at any time in life before transplantation.
- those with a history of multiple pregnancies
- those who have received a previous transplant
maintenance therapy
continuous immunosuppression used after a solid organ transplant
rescue therapy
used to treat acute rejection episodes
perfusion
total arterial blood flow through the tissues (peripheral perfusion) and blood that is pumped by the heart (central perfusion)
clotting
complex, multi-step process by which blood forms a protein-based structure (clot)
What are the accessory organs of blood formation?
spleen and liver
intrinsic factors
conditions, such as circulating debris or venous stasis, within the blood itself that can activate platelets and trigger the blood clotting cascade
extrinsic factors
condition outside the blood such as trauma that activates platelets.
What are the three sequential processes in blood clotting?
- platelet aggregation w/platelet plug formation
- blood clotting cascade
- formation of a complete fibrin clot
What happens to the blood as we age?
- decrease in blood volume with lower levels of plasma proteins
- bone marrow produces fewer blood cells
- RBC, WBC counts lower
- Lymphocytes les reaction to antigens, lose immune function
- hemoglobin levels fall after middle-age
What is one of the most important plasma proteins involved in coagulation cascade?
prothrombin - Factor II (2)
Which clotting factor activates prothrombin to thrombin?
Factor X (10) - the stuart-prower factor
What is the most important ion involved in all coagulation pathways?
Calcium - Factor IV (4)
Which clotting factors are involved in the intrinsic pathway?
Factors: VIII, IX, XI, XII (8, 9, 11, 12)
Which clotting factor is involved in the extrinsic pathway?
Factor VII (7)
Which clotting pathway is fast initiation and which is slow?
extrinsic is fast
intrinsic is slow
Which clotting factors are dependent on the synthesis of vitamin K?
prothrombin (Factor II) (2) Factor VII (7) Factor IX (9) Factor X (10)
Which anticoagulant is a Vitamin K antagonist?
Warfarin (Coumadin)
What are the 4 stages of infection?
- Incubation period: interval between entrance of pathogen into body and appearance of first symptoms.
- Prodromal Stage: interval from onset of nonspecific signs and symptoms to more specific symptoms
- Illness Stage: interval when patient manifest signs and symptoms specific to type of infection.
- Convalescence: interval when acute symptoms of infection disappear.
What are the natural defense mechanisms of the skin?
- intact multilayered surface (first line of defense)
- Shedding of outer layer of skin cells
- Sebum
What are the natural defense mechanisms of the mouth?
- intact multilayered mucosa
- saliva
What are the natural defense mechanisms of the eye?
- tearing and blinking
What are the natural defense mechanisms of the respiratory tract?
- Cilia lining upper airway, coated by mucus
- macrophages
What are the natural defense mechanisms of the urinary tract?
- flushing action of urine flow
- intact multilayered epithelium
What are the natural defense mechanisms of the Gastrointestinal tract?
- Acidity of gastric secretions
- Rapid peristalsis in small intestine
What are the natural defense mechanisms of the vagina?
- at puberty normal flora causing vaginal secretions to achieve low pH
Serous exudate
clear, like plasma
Sanguineous exudate
containing red blood cells
Purulent exudate
containing WBCs and bacteria
