intro to immunology Flashcards
— an integrated clinical and laboratory specialty, in which specialists apply a detailed understanding of the immune
system to a wide variety of clinical problems.
—- assess and manage patients, run general & specialized immunology laboratories.
clinical immunology
clinical immunologist
-immunology laboratory service for hospital and community services by which these test involves diagnosis/assessment/management of :
– Allergy
– Autoimmune disease
– Infections & Immunodeficiency
– Some aspects of lymphoproliferative disease
- Lead clinician for patients with — + —
- Some centres provide service for— diseaseas lead clinician
- Multiple referrals for —- illness. See many rare diseases
- Rare diseases are
– individually rare (<1:1,000 population), collectively common – 8% of population has a rare disease
allergy n immunodeficiency
autoimmune disease
undiagnosed
clinical immunology - care delivery ;
* —-: – see and assess new & follow-up patients
* —-: – infusions of immunoglobulin / biologics allergy day ward – complex investigations
* —-: – immunoglobulin replacement programme
* —-: – ED and in-patients; telephone advice
* —-: – either own beds or shared care
out patient
day care
home therapy
consults
in patient care
- Overall responsibility for the service
- Quality Management and External Quality Assurance
- Strategic planning
- Agree service and quality objectives with scientists
- Direct reporting of complex tests
- Clinical Liaison – advising lab users about complex tests
giving clinical advice on what tests to do
giving clinical advice on what tests mean, in context of individual patient. - Advise Lab users at level of protocol / guidelines
- MDT participation
- Teaching & Education – Undergrad & Postgrad
- Training – Immunologists & related specialties
- Research – clinical and laboratory, +/- basic science
- Audit – measuring service delivered against standards
- Quality Improvement
- Horizon scanning & service development
- Laboratory Management
are all roles of;
medical immunologist
when using any lab you need:
* — about the tests you are requesting
– Lab users handbook – specimen requirements etc
– THINK – about patient factors
– ASK ADVICE – from the lab; your team; lab medics
* Provide the – requested
* Provide — when asked
* If you don’t understand a result – GET –
* Important to understand the — of all tests
* Remember no test is —
learn
info
clinical info
advice
limitations
perfect
factors specific to immunology test:
* —- is important in interpretation – if you don’t give details it limits the advice we can give.
* Some —- interfere with antibody based tests – for example, IV immunoglobulin interferes with serology for weeks for several weeks
* Some — can interfere with tests – false negative serology results in patients with low IgG
* Many tests affected by —- , — – weak false pos autoantibodies
clinical codex
treatment
conditions
acute ilnesss or acute phase response
true or false regarding results:
* You are responsible for following up results you of tests you order
* Need to ensure that test results are checked, andappropriate action taken.
* Need to ensure safe hand-over if you are away /
changing post etc.
* Area of risk for patient safety
true
diagnostic process is :
1- —
2- —
3- formulate —
4- — test to rule in or rule our differentials
5- more — test to confirm diagnosis and exclude differentials
6- — diagnosis by — where possible
clinical history
patient examination
differential diagnosis
basic test
specific test
confirm
gold standard
-lab tests often play a role in ongoing assessment of:
- Important to learn the appropriate interval to repeat tests as Eg Half life of IgG is 3 weeks – rarely repeat antibody tests <1 month
– Disease activity
– Response to treatment
– Toxicity of treatment
– Co-morbidities
ideal vs real immune systems
1- ideal:
* — response to – infection
* Doesn’t react to —
* Ignores – stimuli
* Recognises and destroys —
* Tolerant of —
2- immunopathy:
* —
* —-
* —
* fails to recognise and
destroy many —
* — of organs
adequate
all
self
innocuous ( aka not harmful )
tumours
transplants
immunodeficny
autoimmunity
allergy
tumours
rejection
infections n immunity challenges to overcome:
1. Bugs come in all — and
2. Bugs vary —
3. Immune system must be capable of – billions of pathogens
4. Immune system must avoid – by distinguishing self from non-self
5. Successful immunity requires the – type of immunity
6. Illness determined by – but also by – factors
shapes n sizes
rapidly
recognising
friendly fire
right
pathogens
host
defence against infection could be
1- — defense
2- — reponse
3- — response
- Non-specific defenses
- Innate immune response
- Adaptive immune response
clinical course of infection is determined by — including — of the pathogen and — which includes:
– — immunity
– Immune — , including —
- — types as homozygosity
– — immunogenetics
– Ability to mount — immune response
pathogen n dose
host
pre existing
deficiency as mild defects
HLA
non HLA
optimal
identifying immune deficits from those w severe infection
- In 2020, lack of certainty about why some people with no
apparent risk factors had severe/died from Covid - Comparison of immune related genes in those with
severe & mild disease identified defects in
INTERFERON as a risk factor for severe disease - Further work identified autoantibodies against
INTERFERONs associated with severe disease - Identified key risk for severe COVID-19
