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
- — refers to when the immune system fails to protect adequately against infection and these defects mat be — or relatively —
- Pattern of infection points to part of immune system which is —
- Immunodeficiency can be
- Primary : — or —
- Secondary: —- or—
immunodeficiency
generalised or specific
impaired
genetic or idiopathic
infection or medication
-allergy care starts from — > — > — >
- the gp role in allergy care:
- Differentiating — from — – eg Chronic Spontaneous Urticaria +/- angioedema
- Managing uncomplicated rhinitis
- Managing uncomplicated asthma
- Managing uncomplicated eczema
- initial assessment of – allergy, & referral if required
- Assessment of – allergy & documentation – referral only needed if complex
- Ongoing — for patients & continuing –
- UK – important role for GPs special interest in allergy
- while specialist allergy care:
- — allergy – some aspects
- — allergy – complex investigation, challenges,
desensitisation if appropriate - — allergy – often multiple allergic conditions
- Differentiating — from allergy –
- allergen — to identify/ — allergens
- —- – biologics / desensitisation
self care gp then specialist care
allergy from allergy mimics
food
drug
support
manegemtn
food
drug
complex
allergy from allergy mimics
difficult
cross reactive
new treatment
All centres
* Laboratory diagnostics & associated advice
* Organ specific autoimmune disease managed by organ
based specialists
* Non- organ specific autoimmunity – consult/tertiary
service
* Intolerance / complex issues with immunosuppression
Some centres
* Vasculitis care
* Shared Rheumatology clinic
are all —
autoimmunity - immunology role
immunology role in transplantation :
1- Haemopoietic stem cell transplantation aka — :
* – resolution typing of donor and recipient
* Searches of – databases
2- Solid Organ Transplantation aka –:
* — typing donor & — ( —/— resolution)
* Screening for —
* —
* — assess Donor-Recipient pair
* Advice on Immunosuppression if increased –
haematology
high
donor
immunology
HLA
recipient
low-medium resolution
anti HLA antibodies
cross matching
risk
increased risk
key lab tests in immodiagnostics:
* No test is perfect
* Important that testing is guided by the — and —
* Essential to understand the —
* Patient — and — of testing
* Inappropriate testing can harm patients can lead to disease
delay correct diagnosis inappropriate treatment.
history and differential diagnosis
limitation
preparation n timing
key tests:
– is a systemic response to inflammation
- Increased production of —
- Decreased production of — eg —
1- Most useful —- Protein:
Begins to rise within – of onset.
Falls — with treatment
— to measure
2- —- rate
— to rise (days) and — to respond
Multiple — . Cumbersome.
acute phase response
protective proteins
transport proteins as albumin
CRP aka c reactive protein
6 hours
falls rapidly
easy
ESR – Erythrocyte sedimentation rate
slow
slow
mulible interference
Measuring Proteins
Immunoglobulins
Serum Protein Electrophoresis
Antibodies post vaccination – tetanus; diphtheria
Vaccine response – Post Pneumovax II antibodies
Complement proteins C3 & C4
CH100 (Complement Haemolytic 100)
AP100 (Alternative Pathway 100)
are all under
key immunology test - immunodeficiency
in key immunology test - immunodeficiency :
Measuring — aka — as
— Susets:
* Total — - CD3+ cells
* —- : – CD4+ cells
* —- : – CD8+ cells
* — – CD20+ cells
Measuring cell— as
* Lymphocyte —
* — function
* Protein —
* — production
cells
FBC
lymphocyte
total T cells
helper T cells
cytotoxic T cells
b cells
cell fucntions
proliferation
neruophil
protein expression
cytokine
keys test - organ specific - autoimmunity:
1- — disease – anti-thyroperoxidase
2- — disease – anti-nuclear antibody
anti-smooth muscle antibodies
anti-mitochondrial antibodies
anti-liver kidney microsomal antibodies
3- — disease – anti- GBM antibodies (glomerular basement membrane)
4- — – anti-gastric parietal cell antibodies
anti-intrinsic antibodies
thyroid
liver
kidney
Pernicious anaemia
key test - NON organ specific autoimmunity as:
1- — Diseases
* Anti-nuclear antibodies / connective tissue screen
* Anti-double stranded DNA
* Antibodies to extractable nuclear antigens
* Evidence of complement consumption (lowC3 & C4)
2- —-
* Rheumatoid Factor
* Anti-CCP (cyclic citrullinated peptides)
3- —
* ANCA (anti-neutrophil cytoplasm antibody)
* Anti-MPO (myeloperoxidase)
* Anti-PR3 (Proteinase 3)
connective tissue disease
rheumatoid factor
vasculitis
-Allergy is a clinical diagnosis, based on —
- Diagnosis is supported by demonstration of allergic — , by either
* — tests
* Specific — ( —test)
- Measuring total IgE of very — value.
- Can have positive tests to foods etc which are eaten uneventfully – sensitisation NOT allergy
history
allergic sensitisation
skin prick
IgE
blood test
limited
writing a good immunology consult includes:
- Demographics / communication information
- What problem are you requesting help with?
- Detailed history – always important, but particularly for
allergy. - What treatment has been tried /given and response to
treatment - Other medical problems – past medical history
- Medications
- Known drug allergies
- Who else in involved in patient management
- What has the patient been told/ understanding
summary :
- Clinical Immunology is an integrated — and — Specialty
- Key area of expertise is detailed knowledge of the immune
system, and ability to apply this to multiple, diverse, clinical problems
-Clinical Immunology plays key role in management of patients with allergy, immunodeficiency, and autoimmunity.
Also play key role in transplant services
clinical n laboratory
