immunology Qs from case study Flashcards
What is a type 2 hypersensitivity reaction?
the result of antibody dependent cytotoxicity
3 important ddx of haemoptysis?
- Chest infection e.g. pneumonia, tuberculosis, bronchiectasis
- Pulmonary embolism
- Lung carcinoma
Pulmonary oedema is another possible cause of alveolar haemorrhage.
what tests would you do if someone presents with haemoptysis?
- Full blood count (FBC)
- Urea and electrolytes (U&E)
- Liver function tests (LFTs)
- Inflammatory markers e.g. CRP, ESR
- Coagulation screen (PT, APTT, fibrinogen) given his haemoptysis
- Group and save given his haemoptysis
other tests to consider if has pyrexia and haemoptysis
- Septic screen (including blood cultures, serum lactate)
* Arterial blood gas (to investigate for respiratory failure and acid-balance)
what are the 3 classifications of causes of AKI?
Pre-renal
renal
post-renal
cause of pre-renal AKI?
inadequate blood supply!!!
sooo…..
Dehydration
Hypotension (shock)
Heart failure
renal causes of AKI?
Intrinsic disease!!!
soooo…..
Glomerulonephritis
Interstitial nephritis
Acute tubular necrosis
post-renal causes of AKI?
obstruction to the outflow!!!!
soooooo…….
Kidney stones
Masses such as cancer in the abdomen or pelvis
Ureter or uretral strictures
Enlarged prostate or prostate cancer
SHOUT acronym for causes of AKI
Sepsis Hypovaolaemia Obstruction Urine analysis Toxins
what is pulmonary renal syndrome?
respiratory and renal failure caused by rapidly progressive glomerulonephritis and diffuse alveolar haemorrhage
immune aetiology of pulmonary, renal disorder?
ANCA associated vascultitis (70%)
Anti GBM disease (15-20%) (Goodpasture’s disease)
Systemic lupus erythematosus
infectious causes of pulmonary-renal disorder?
Post streptococal glomerulonephritis
causes of alveolar haemorrhage that can cause AKI?
Severe lung infection with sepsis
Pulmonary oedema with circulatory collapse
what investigations should you do if think pulmonary-renal disease and want to check immunological causes?
A. Serum anti-nuclear antibodies (ANA)
B. Cytoplasmic anti-nuclear cytoplasmic antibody (C-ANCA)
C. Peri-nuclear anti-nuclear cytoplasmic antibody (P-ANCA)
D. Anti-glomerular basement membrane antibodies (anti-GBM)
antigen and antibody behind SLE?
ds DNA
Anti-ds DNA
antigen and antibody behind Granulomatous with polyangiitis (GPA)
small vessel vasculitis
antigen Proteinase 3 (PR3)
antibody- C-ANCA
what is pleuritic chest pain?
Chest pain which is exacerbated by breathing and cough
infers the underlying pathology namely inflammation of the parietal pleura which can be due to a number of causes.
3 causes of pleuritic chest pain
- Pulmonary embolism
- Pneumothorax
- Pneumonia
patient has low eGFR tests u should do?
- Urinalysis for presence of haematuria, proteinuria or signs of infection (leukocytosis, nitrates). If proteinuria present, quantify this with a urinary protein : creatinine ratio.
- Urine culture to exclude a urinary tract infection
patient has low Hb count- and normocytic anaemia
- Haematinics
• Serum folate
• Serum vitamin B12
• Serum ferritin - Blood film to assess cell morphology
- Reticulocyte count ?red cell haemolysis or bleeding
what is high serum ferritin indicitive of?
elevated in inflammation
what does Rouleaux formation of blood film indicate?
suggesting on ongoing inflammation
what are Haemolytic anaemia blood test and blood film results?
normochromic, normocytic anemia, but with a raised reticulocyte count, and often supportive rbc changes on the blood film.
iron def anaemia blood test and blood film findings?
hypochromic, microcytic anaemia picture, characteristic rbc findings on blood film, and the diagnosis is usually supported by a low serum ferritin (sometimes falsely high if concurrent infection or inflammation).
megablastic anaemia blood test and blood film findings?
macrocytic anaemia, and can be caused by low serum folate and/or B12.
what type of hypersensitivity reaction is lupus?
Type 3
what is the pathophysiology of a type 3 hypersensivity reaction?
Immune complex deposition
main subclass of autoantibodies in type 3 hypersensitivity reaction?
ANA
do you get mast cell degranulation in lupus?
yes.
type 3 stimulates a systemic inflammatory reaction by activating complement, recruiting inflammatory cells and leading to mast cell degranulation. This explains the clinical features seen in SLE.
