Immunology Flashcards
what are the constitutive/ physical barriers to infection?
SKIN
tightly packed keritanised skin cells
low pH of skin
MUCOSA
secretory igA
lyzozyme
lactoferin- starves invading bacteria of iron
cilia
COMMENSAL BACTERIA
skin microflora
gut microflora
what are the specific names for macrophages in each of these organs:
liver
kidney
spleen
bone
lung
neural tissue
connective tissue
skin
liver- kupfer cells
kidney- mesangial cell
spleen- sinusoidal lining cells
bone- osteoclast
lung- alveolar macrophage
neural tissue- microglia
connective tissue- histocyte
skin- langerhans cells
briefly describe oxidative killing of microbia
NADPH oxidase complex converts oxygen to ROS (eg. superoxide, hydrogen peroxide)
myeloperoxidase catalyses production of hydroclorus acid which is antimicrobial
describe non oxidative killing of microbia
granular release of lyzozyme and lactoferrin into the phagolysosome
What happens during phagocytosis
phagocyte engulfs microbia via endocytosis. This process depleats phagocytes glycogen reserves leading to cell death
build up of dead neutrophils at site of infection –> abscess
what is migration of dendritic cells to lymph nodes mediated by?
CCR7 on DC recognise the chemokines CCL19 and CCL21
cell markers on T cells
all express CD3 (TCR)
CD8+ cells are cytotoxic T cells
CD4+ cells are T helper cells
Which HLA subtypes are there in class II and which cells express?
HLA-DR, HLA-DQ, HLA-DP
class II expressed by APCs
recognised by CD4+ cells
What are the different effector subtypes of CD4+ cells and what are their actions
Th1 cell-
polarised by IL12, IFNg
helps CD8+ and macrophages.
secretes IL2, IFNg, TNFa, IL10
Th2
polarised by IL4 and IL6
secretes IL4, IL5, IL13, IL10
helps humoral response
Th17
polarised by IL6, TGFb
helps neutrophil recruitment and generation of autoantibodies
secretes IL17, I21, IL22
Tfh
polarised by IL6, IL1b, TNFa
follicular helper T cells in B cell maturation
secretes IL2, IL10, IL21
Treg
polarised by TGFb
regulates T cell response expressing foxp3
Which HLA subtypes are there in class I and which cells express?
HLA A, B, C
expressed by ALL cells
recognised by CD8+ cells
How do CD8+ cells directly kill
secretes perforin and granzymes into cell –> apoptosis
which portion of Abs recognise antigens and which portion interacts with other components of the immune system?
Fab –> pathogen/antigen
Fc –> immune cells
briefly describe the different pathways of complement
classical:
Ab-Ag complex causes a conformational change of Ab, exposing binding site for C1 which activates cascade
mannose:
activated by direct binding of mannose binding lectin to mannose on bacteria cell surface carbohydrates . Directly stimulates activation of C4 and C2 (but not C1)
Alternate:
triggered by binding of C3 to bacterial cell wall eg. LPS or teichoic acid
Primary immune deficiencies:
feature of IgA deficiency
recurrent resp and GI infections
Primary immune deficiencies:
Kostmann syndrome
autosomal recessive severe congenital neutropenia
(eg <500/ul)
no pus formation
due to mutation oin HCLS1-associated protein X-1 (HAX1)
positive NBT test
Primary immune deficiencies:
Cyclic neutropenia
autosomal dominant
episodic neutropenia every 4-6 weeks and lasts ~6days
mutation in neutrophil elastase (ELA-2)
Primary immune deficiencies:
Reticular dysgenesis
failure of stem cells to differentiate along the myeloid or lympoid lineage
(failure of production of granulocytes, lymphocytes, monocytes and platelets)
fatal in very early life
autosomal recessive
mutation in mitochondrial energy metabolism enzyme AK2
Primary immune deficiencies:
Leukocyte adhesion deficiency
neutrophils lack CD18 (b2 integrin subunit) so cant adhere to endothelial cells and transmigrate
feature:
- very high neutrophil count in blood
- absence of pus formation
- delayed umbilical chord separation
Primary immune deficiencies:
chronic granulomatous disease
X-linked
deficient in NADPH so fails to make ROS
impaired killing on pathogens
–> excessive inflammation and neutrophil/macrophage accumulation
non caseating granuloma formation, hepatosplenomegaly, lyphadenopathy
susceptable to PLACESS microbes (pseudomonas, listeria, aspergillus, candida, E.coli, staph aureus, serratia)
Ix:
negative Nitro-blue tetrazolium test (pos: yellow-> blue when incontact with hydrogen peroxide)
normal neutrophil count
Mx:
IFNg
Primary immune deficiencies:
deficiency of IL-12 and IFNg
susceptibility to mycobacteria, BCG and salmonella
Primary immune deficiencies:
complement deficiencies
deficiency in C1, C2 or C4 (C2 most common)
almost all with C2 deficiency have SLE
increased susceptibility to encapsulated bacteria:
-Haemophilus influenzae type B (Hib)
-Streptococcus pneumoniae (pneumococcus)
-Neisseria meningitides (meningococcus)
-Group B streptococcus (GBS)
-Salmonella typhi.
Primary immune deficiencies:
severe combined immunodeficiency (SCID)
unwell by 3 months of age
before protected by maternal IgG
- infections of all types
- failure to thrive
- persistent diarrhoea
FHx of early infant death
diminished T cells and non-functional B cells
hypoplasia and atrophy of the thymus
mucosal associated lymphoid tissue (MALT)
X-linked SCID
45% of SCID
- X-linked recessive
mutation of gamma chain of IL2 receptor on chromosome Xq13.1
inability to respond to cytokines causes arrest of T cell and NK cell development and production of immature B cells
Di George syndrome
22q11.2 deletion
developmental defect of pharyngeal pouch (embryological abnormality in 3rd and 4th brachial arches)
CATCH-22
Cardiac abnormalities
Atresia (oesphageal)
[Abnormal face (high forehead, low set ears)]
Thymic aplasia
Clef palate
Hypocalcaemia/hypoparathyroidism
22- chromosome
Investigtions for phagocytic immune deficiencies
Nitro blue tetrazolium test:
yellow - blue in the presence of hydrogen peroxide ROS
DRH flow cytometry reaction
DRH- rhodamine in the presence of hydrogen peroxide which is very fluorescent
investigations for complement deficiencies
CH50 and AP50 tests
investigations for lymphocyte deficiencies
WCC, lymphocyte subsets, serum Ig, protein electrophoresis
autoimmune polyendocrine syndrome type 1(APS1)
monogenetic autoimmune disease
autosomal recessive
abnormality in tolerance
defect in AIRE so failure of central tolerance –> autoreactive T and B cells
Features:
multiple autoimmune diseases
hypothyroidism, addisons, hypopaarathyroidism, T1DM, vitiligo, enteropathy
Immune dysregulation, polyendocrinopathy, enteropathy (IPEX)
X linked
abnormality of Tregs
mutation in FOXP3
features:
T1DM, hypothyroidism, enteropathy
diabetes, diarrhoea and dermatitis
autoimmune lymphoproliferative syndrome (ALPS)
abnormality of lymphocyte apoptosis
autosomal dominant
mutation in Fas pathyway
features:
autoimmune cytopenias
lymphoma
‘APOPtosis to the ALPS would be FASt’
HLA associations with Ankylosing spondylitis
HLA B27
HLA associations with goodpastures syndrome
HLA DR15/DR2
‘Dr Too Good’
HLA associations with Graves disease
HLA DR3
HLA associations with SLE
HLA DR3
‘SLE and DR3’
HLA associations with T1DM
HLA DR3/DR4
HLA associations with RA
HLA DR4
‘RA-dR4’
autoantibodies and associated condition:
anti-Smooth muscle
autoimmune hepatitis or primary sclerosing cholangitis
autoantibodies and associated condition
p-ANCA
eosinophilic granulomatosis with polyangiitis
(aka: Churg strauss syndrome)
blood vessels of lungs, GIT and peripheral nerves most commonly affected
autoantibodies and associated condition
anti-Jo1
dermomyositis with interstitial pulmonary involvement
–> autoimmune inflammation of muscle fibre in skin
and polymyositis
autoantibodies and associated condition
anti-cyclic citrullinated protein
RA
autoantibodies and associated condition
anti-centromere
CREST syndrome
(limited cutaneous form of systemic sclerosis)
autoantibodies and associated condition
anti-double stranded DNA
SLE
autoantibodies and associated condition
anti-parietal cell
pernicious anaemia
autoantibodies and associated condition
anti-TSH
graves
autoantibodies and associated condition
anti-topoisomerase
diffuse systemic scleroderma
autoantibodies and associated condition
anti-mitochondrial
Primary billiary cirrhosis
autoantibodies and associated condition
c-ANCA
Granulomatosis with polyangiitis
(aka wengers granulomatosis)
autoantibodies and associated condition
anti-cardiolipin
antiphospholipid syndrome
SLE
syphilis?
autoantibodies and associated condition
anti-ribonucleoprotein and anti-U1RNP ab
mixed connective tissue disease
autoantibodies and associated condition
anti-glutamic acid decarboxylase
T1DM
autoantibodies and associated condition
anti-Ro and anti-La
Sjogrens and SLE
autoantibodies and associated condition
anti-intrinsic factor
pernicious anaemia
autoantibodies and associated condition
anti-endomysial
Coeliac and dermatitis herpatiformia
Primary immune deficiencies:
Bruton’s agammaglobulinaemia
X linked disease
mutation of BTK gene which expresses tyrosine kinase
‘BruTonsX(K)’
mutation inhibits B cell maturation and therefore low Ig levels
bloods:
notmal T cell
low B cell, absent plasma cells
low IgA, IgM and IgG
immune deficiencies:
hyper IgM syndrome
mutation in CD40 ligand on T cells required in the germinal centre development of B cells
- unable to class switch and thereofre leads to high IgM
- deficient IgA, IgG and IgE
Wiskott Aldrich syndrome
X-linked
mutation in WASp gene
WAS protein expressed in developing haematopoetic stem cells
mutation is linked to development of lymphomas, thrombocytopenias and eczema
Sx: easy bruising, nose bleeds, GI bleeds, petechiea,
recurrent bacterial infections caused by haemophilus influenzae and strep pneumoniea
what are you at risk of of with hyposplenism
risk of infections by encapsulated bacteria, for example strep pneumoniea
(spleen has lots of lymoid tissue)
- vaccinations and prophylactic Abx
clinical features of dermatomyositis
heliotrope rash around eyes
gottrons papules on dorsum of finger
proximal limb weakness
features of CREST syndrome
Calcinosis
Raynauds
Esphageal dysmotilisty
Sclerodactyly
Telangectasia
hypergammaglobulinaemia
anaemia
raised ESR
Features of Sjogrens syndrome
Dry eyes (confirmed by schirmers test)
dty mouth
parotid swelling
fatigue
arthralgia
myalgia
autoimmune destruction of exocrine glands
salivary gland biopsy reveals infiltrate of T and B
features of granulomatosis with polyangiitis
saddle nose deformity (due to perforated septum)
pulmonary haemorrhage (haemoptysis)
glomerulonephritis (haematuria)
examples of type I hypersensitivity reaction
Anaphylaxis
food allergy
oral allergy syndrome
allergic rhinitis
atopic dermatitis
acute urticaria
examples of type II hypersensitivity reaction
ANY DISEASE WITH AUTOANTIBODIES TO ANTIGEN ATTACHED TO TISUE
autoimmune haemolytic anaemia
AITP
Goodpastures syndrome
Graves
myesthenia gravis
pernicious anaemia
examples of type III hypersensitivity reaction
SLE
Mixed essential cryoglobulinaemia
serum sickness
polyarteritis nodosa
examples of type IV hypersensitivity reaction
T1DM
multiple sclerosis
RA
contact dermatitis
Mantoux test
Chrons disease
what is a type I hypersensitivity reaction?
immediate IgE mediated reaction provoked by are-exposure to an allergen
mast cell release of histamines
what is a type II hypersensitivity reaction?
IgG or IgM autoantibody reacting to self tissue or matrix
what is a type III hypersensitivity reaction?
IgG or IgM immune complexes reacting to a soluble antigen causing tissue damage
what is a type IV hypersensitivity reaction?
delayed type hypersensitivity which is T cell mediated
autoantibodies in hashimotos thyroiditis
anti-TPO and anti-thyroglobulin
autoantibodies in hashimotos thyroiditis
anti-TPO and anti-thyroglobulin
autoantibodies in T1DM
anti-glutamate decarboxylase and anti- pancreatic B cells
autoantibodies in ITP/AITP
anti-glycoprotein IIb-IIa or Ib-IX Ab
autoantibodies in goodpastures syndrome and features
anti-glomerular basement membrane Abs
glomerulonephritis and pulmonary haemorrhage
What antibody tests are there for coeliac?
anti-endomysial Ab (95% specific, 85% sensitive)
anti-transglutaminase Ab (95% sensitive, 95% specific)
anti-gliadin antibody (30-50% specific, 60% sensitive)
Associations with coeliac
Trisomy 21
Dermatitis herpatiformis
DQ2 or DQ8 (2 8 or not to eat)
What primary immune deficiency is associated with delayed umbilical chord detachment
leukocyte adhesion deficiency type 1
Conditions that may lead to impaired primary barrier function
Coeliac –> impaired mucociliary clearance
Keratoconjunctivitiis sicca–> dry eyes (lysozyme in tears)
What measures total complement activity?
CH50 (measures all components of classical and final pathways (C1-9)
AH50 measures components of alternative pathway
what is reduced C3 and C4 associated with?
SLE
What is reduced C3 but normal C4 associated with?
membranoproliferative glomerulonephritis
What is the role of IgD?
found on cell surface of immature B cells and plays a role in lymphocyte activation
HLA associations with coeliac
HLA DQ2
‘DQ2 i need a poo’
Features of APECED
mild immune deficiency
dysfunctional parathyroid
dysfunctional adrenal
hypothyroidism
gonadal failure
alopecia
vitiligo
Mutation of AIRE gene
what are some mechanisms of autoimmunity?
molecular mimicry and cross reactivity
defect in central tolerance (AIRE gene mutation)
defect in peripheral tolerance immune regulation (FOXP3 defect)
IL2 therapy associated with autoimmune thyroid disease
Release of ‘hidden’ atigens after damage eg. Dresslers syndrome where MI causes release of proteins and generation of auto-Abs –> pericarditis
What is Von Gierke’s disease
Glycogen storage disease casued by a deficiency in G6PD
present with severe hypoglycaemia and neutropenia
What is a positive Nikolsky’s sign indicative of?
Pemphigus vulgaris
how long after transplantation would an acute cellular reaction occur?
~1 week
MOA of cyclosporine
inhibits protein phosphate calcineurin which reduces IL2 secretion from T cells and T cell proliferation
MOA of azathioprine
metabolised to 6-mercaptopurine which acts as a purine analogue and prevents DNA synthesis mostly affecting lymphocytes
MOA of methotrexate
anti-metabolite and anti-folate drug
inhibits dihydrofolate reductase used in the synthesis of nucleoside thymidine, essential for DNA synthesis
MOA of corticosteroids
inhibits phospholipid A2 preventing prostaglandin production and other inflammatory
–> Blocks arachidonic acid and prostaglandin formation and so reduces inflammation
Also decreases traffic of phagocytes to site of infection by interfering with adhesion molecules
–> high neutrophils
sequestration of lymphocytes to tissue
–> low lymphocyte count
blocks cytokine gene expression
decreased Ab production
function of IL2R mAb and example
eg. daclizumab
targets CD25 of IL2 receptors expressed on activated T cells
esp used in kidney transplant
MOA of rituximab
targets CD20 on B cells
used in lymphomas
development of lymphomas, thrombocytopenia and eczema
Wiscott-Aldrich syndrome
mutation in MHC III
common variable immunodeficiency
mechanism of action of mycophenolate mofetil
and indicaiton
anti-metabolite which prevents guanine synthesis
blovks de novo nucleotide synthesis preventing DNA replication
targets T cells more then B cells
used in transplantation, autoimmune diseases and vasculitis
what is progressive multifocal leukoencephalopathy a complication of
from the JC virus in immunosupressed pts ge. after mycophenolate mofetil therapy
mechanism of action of tacrolimus
inhibirts calcineurin preventing T cell proliferation/ function via reduced IL2 expression
side effects of cyclosporin
gingival (gum) hypertrophy
nephrotoxicity
HPTN
neurotoxic
mechanism of action of infliximab
anti-TNFa
what is the receptor binding and membrane binding glycoprotein on influenza
haemagglutanin
what does influenza bind to on human cells?
sailic acid on RBCs
examples of toxoid vaccines
diphtheria
tetanus
what are adjuvents, examples and how do they work
ALUM- most common. antigens absorbed into alum so are released at a slower steady rate in the body which improves B cell priming
stimulatory ajuvants mimic the action of PAMPs on TLRs to boost immune response eg:
CpG- activates TLRs on APCs
Freunds ajuvent- water in oil emulsion containing mycobacterial cell wall components. not clinically used
what are mRNA vaccines complexed with in vaccine
lipids
how do adenovirus vector vaccines work?
DNA of virus (eg. Sars-CoV-2) into viral vector (adenovirus)
Infect cells in vivo
Transcription/translation to produce protein
Stimulates immune
response including T cells and B cells with production of antibodies
How do dendritic cell vaccines work
take out DCs and pump them with tumour specific antigens
- incubate with recombinant protein
- conjugated with GMCSF
-APC back into patient which can stimulate immune response against tumour
Examples of cytokine therapy and what is it used for
IL-2 therapy for renal cell cancer
IFNgamma used in chronic granulomatous disease to boost oxidative phosphorylation
Examples of therapies that replace missing parts of immune response
Haematopoetic SCT
Ab replacement (IVIg)
Indications for Ab replacement
Brutons
X linked hyper IgM
common variable immuno def
Haem malignancy
post exposure prophylaxis
Examples of ID with post exposure prophylaxis Abs given
VZV in non immune preganat women
Hep B
Rabies
Tetanus
example of virus specific T cell therapy
EBV related B lymphoproliferative disease
Cancers where tumour infiltrating lymphocyte T cell therapy is uesd
head and neck
melanoma
lung
gynae
Uses for CAR-T cell therapy
ALL
Non-Hodgkins lymphome
examples of immune checkpoint blcockade
anti-PD1- Abs- prevents PD1 from binding to PD!L and therefore prevent programmed cell death of T cells
anti-CTLA4- CD80/86 on APC bind to CT4A4 which blocks nagative regulation of T cells
exaples of PD1 checkpoint blockade and what is it used for
Pembrolizumab and Nivolumab
used in melanoma
example of CTLA4 checkpoint blockade and what is it used for
Ipilimumab
melanoma
function of CTLA4
inhibitory checkpoint on t cells. completes with CD28 to bind to CD80/86 on APCs
which vaccine should NOT be given to an immunosuppresed person
(inc pts with RA, IBD on immunosupressive drugs)
BCG
Yellow fever
side effects of steroids
diabetes, central obesitiy, chushingoid, adrenal supression
cataracts, glaucoma, peptic ulcer, pancreatitis, avascular necrosis
psychosis
infection
examples of drugs that inhibit DNA synthesis (anti proliferative agents) affecting lymphocytes prodominently
cyclophosphamide (most toxic)
mycophenolate mofetil
azathioprine
side effects of anti proliferative agents
Bone marrow suppression
Infection
- Malignancy
- Teratogenic
complications of cyclophosphamide
Toxic to proliferating cells:
Bone marrow depression
Hair loss
Sterility (male»female)
Haemorrhagic cystitis
–>Toxic metabolite acrolein excreted via urine
Malignancy:
Bladder cancer
Haematological malignancies
Non-melanoma skin cancer
Infection
–>Pneumocystis jiroveci
side effects of azathioprine
Bone marrow suppression
Some people have a thiopurine methyltransferase polymorphism which means they can’t metabolise azathioprineso are very susceptible
Hepatotoxicity
risks of mycophenolate therapy
infection:
- herpes virus reactivation
- Progressive multifocal leukoencephalopathy (JC virus)
mechanism of plasmaphoresis and diseases its used in
remove pathogenic Ab and replaced with albumin.
type 2 hypersensitivity reactions (eg. MG, goodpastures)
role of calcineurin
involved in expression of IL2
stimulates NFATc which upregulates IL2 expression
examples of drugs that inhibit calcineurin
Tacrolimus
cyclosporin
examples of mTOR inhibitors and how do they work
sirolimus
rapamycin
mTOR involved in IL2 pathway
mechanism of tofacitinib (jakinibs)
inhibits JAK-STAT pathway so blocks cytokine production
mechanism of anti-thymocyte globulin
lymphocyte depletion
modulation of T cell activation and migration
Drugs that target CD25 and whats the pathway that is affected
Basiliximab and daclizumab
blocks IL2 induced T cell proliferation
how does anti-CTLA4-Ig fusion protein work
eg. abatacept
blocks the interaction between CD28 and CD80/86 so prevents
????
mechanism of rituximab
anti-CD20 expressed on mature B cells
- depletes B cells but not plasma cells
mechanism of TNFa blockers and indications for use
TNFa pivitol in inflammation affecting many cell types
inhibition leads to a broad effect on immune response
used in: RA, IBD, psoriasis, ank spond, familial Mediterranean fever
side effects og TNFa blcockers
TNFa is important in protection against TB
other infections HBV/HCV
lupus like conditions
demyelination
function of IL1
secretion dirven by procaspase within the inflammasome
used in familial mediterranean fever, gout, adult onset stills disease
function of IL6 and indication for blockade
affects T and B cells
affects synoviocytes
affects osteoclast activation
IL6 receptor blocker used in RA
IL pathwyas key in eosinophilic pathway and eczema, asthma
IL4/5/13
mechanism of blockade used in osteoporosis
anti-RANK-ligand which blocks osteoclast stimulation and reduces bone resorption
risks of immunosupressive therapy
INFECTION:
TB risk - epdemiology, IGRA/manteaux test
–> prophylactic TB treatment
HBV/HCV
JCV activation
HIV
MALIGNANCY:
lymphoma (EBV associated)
non melanoma skin cancer
dysregulation of immune response leading to autoimmune conditions
- lupus like disease, antiphospholipid, vasculitis, demyelination
describe john cunningham virus disease
Common polyomavirus that can reactivate
- Infects and destroys oligodendrocytes
-Progressive multifocal leukoencephalopathy
-Associated with use of multiple immunosuppressive agents
- AIDS defining disease
what do mast cells release when activated by allergen in allergy
histamine
tryptase
proteoglycans
cytokines
mechanism of symptoms of allergic reactions
skin: urticaria, angiooedema
degranulation causes vasodilation to skin or mucosa- more blood flow = red and leakage
Itching due to nerve stimulation
respiratory: bronchoconstriction, nasal discharge, sneezing
GI:
oedema of intestine= gut discomfort
CVS: vasodilation
management of anaphylaxis
- remove trigger
- lie pt flat and lift legs (fluid bolus)
- IM adrenaline
- A-E
- IV fluids
- repeat adrenaline if no change after 5 mins
mechanism of adrenaline in anaphylaxis
vasoconstriction (a1)
bronchodilation (b2)
acts on B2 receptor on immune cells preventing degranulation
why not to give anti-histamines in anaphylaxis?
doesnt do anything to vasculature or bronch but does improve urticaria so may be decieving that the pt is improving when they are still in anaphylaxis
what are released from mast cells minutes to hours after (late phase reaction)
leukotriene
prostaglandins
prostacyclins
thromboxane A2
what inherited immunodeficiency is particularly associated with recurrent meningococcal disease
complement deficincies (encapsualted bacteria)
important condition to screen for in SLE pts. and how is it done
anti-phosopholipid syndrome
anti-cardiolipin Ab
anti-b2glycoprotein 1 ab
lupus anticoagulant test
tests for complement
C3, C4 levels
CH50
AP50
features of antiphospholipisd syndorme
thrombocytopenia
livedo reticularis (mottled rash)
libmann sacks endocarditis
pathophysiology of SLE
abnormality in clearance of apoptotic cells
abnormalities in cellular
drugs used in SLE
prednisolone
anifrolumab
azathioprine
hydroxychloroquine
Rituximab
Belimumab
Mycophenolate Mofetil (more than aza and cyclo as steroid sparing)
Cyclophosphamide
what is Rheumatoid factor
antibody against Fc portion of IgG
moderate sensitivity and specificity to RA
Sjorgrens may have positive RF
what increases your risk of RA and why
smoking
PADI polymorphism
gingivitis
–> leads to increased citrullination of proteins which can form Abs to
first line tx of RA
DMARDS
- methotrexate
- sulhasalazine
- hydroxychloroquine
-IL6 receptor blockers
- TNFa blockers
- anti CD20
- CTLA4 fusion protein
what to screen for when starting on immunosupressants
TB, HBV, HCV exposure
prior Hx of septic arthritis that may not have fully cleared
inc risk of melanoma so skin protection
what is ESR and why is it raised in myeloma
measures rate of fall of erythrocytes in plasma in a centrifuge
clumping of RBC in myeloma causes them to fall more rapidly
what inherited immunodeficiencies leads to increased risk of viral infections eg. recurrent otitis media and URTI
immunoglobulin deficiencies
eg. Brutons X linked agammaglobulinaemia
Pathogenic antibody in bullous pemphigoid
anti-hemidesmosome (adhesion molecules of BM)
pathogenic antibody in pemphigus vulgaris
anti-desmoglein 1&3
What viral enzyme is predominantly responsible for the high mutation rate of HIV and other RNA viruses?
reverse transcriptase
what is the defective protein in XSCID
common gamma chain
mechanism of the CH50 test
looks at complement activity
tests the ability for the patient serum to lyse sheep RBCs coated in rabbit anti sheep antibodies
what mAb is used in osteoporosis and what is the target?
denosumab
targets RANKL
what is measured in anyphylaxis to monitor response to treatment
mast cell tryptase
what is the specific target of p-ANCA Abs
myeloperoxidase
what is the specific target of c-ANCA Abs
proteinase 3
gold standard test for diagnosing food allergy
double blind oral food challenge
most common inherited primary immunodeficiency
selective IgA deficiency
