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Immunology > lab assessment > Flashcards

lab assessment Flashcards

1
Q

What are the three major proteins of natural immunity?

A

Interferon, Lysozome, Complement

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2
Q

What is the main fxn of the complement system?

A

Integral part of both the inflammatory process and host defenses against infection

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3
Q

What are the three ways complement can be activated?

A

classical, lectin, alternative

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4
Q

What is the key enzyme of complement activation where all three pathways converge?

A

C3 convertase

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5
Q

What are the results of the activation of complement?

A

opsonization, inflammation, cytolysis

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6
Q

Describe classical pathway of complement activation

A

Activated when IgM or IgG antibodies bind to antigens (viral, bacterial or autoantigens)
C1: C1r and C1s.

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7
Q

Describe lectin pathway of complement activation

A

Similar to classical except that antibody is replaced by a lectin such as MBP. Activate C4 and C2

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8
Q

Describe the alternative pathway of complement activation

A

Does not require the presence of antibodies or lectins. Continuously activated at a low level
C3 binds to target

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9
Q

What does the C3b fragment do to the target?

A

Deposition of C3b marks the target for immune adherence and then elimination by phagocytic cells.

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10
Q

What does C3a, C4a, and C5a do to the target?

A

they’re anaphylatoxins so they assemble the membrane attack complex

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11
Q

What happens as a result of the actions of complement?

A

Chemotaxis. Release of mediators.
Activation of macrophages, epithelial cells and most types of immunocompetent cells. Contraction of smooth muscles. Dilation of blood vessels. Exudation of plasma

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12
Q

When should you measure complement?

A

In cases of recurrent infection w/ normal WBCs and no immunosuppression. Diagnose Auto-antibody-mediated immune syndromes. Diagnose immune complex-mediated syndromes

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13
Q

What is an example of an auto-antibody mediated immune syndromes?

A

autoimmune hemolytic anemia

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14
Q

What some examples of immune complex-mediated syndromes?

A

lupus, Sjogren’s glomerulonephritis

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15
Q

What is a CH50 test used for?

A

screening test to detect deficiencies in classical pathway. (lupus, RA)

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16
Q

What is the AH50 test used for?

A

screening test to detect deficiencies in alternative pathway

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17
Q

What are individual complement assays of C3 and C4 used for?

A

to determine whether deficiencies or abnormalities in the complement system are causing, or contributing to, a patient’s disease or condition.

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18
Q

What are some diseases where you would see decreased complement levels?

A

Recurrent microbial infections, Autoimmune diseases, angioedema, Various types of kidney disease, Malnutrition, Septicemia, Serum sickness

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19
Q

What are commonly used tests for immunodeficiency?

A

CBC and differential. Antibody detection methods (IgM, IgG, IgA)‏. Quantification and separation of Ig levels. Testing for cell mediated immunity

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20
Q

What does a CBC establish?

A

the presence or absence of lymphopenia, and any associated gross hematologic abnormalities

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21
Q

Describe a WBC and differential

A

Sensitive, but non-specific test that rises with bacterial, viral and some rheumatologic diseases

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22
Q

What are bands?

A

Less mature neutrophils that have recently been released from the bone marrow into the bloodstream. Nucleus is not segmented, but has a band or rod-like shape

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23
Q

When do you expect to see neutrophils and bands?

A

An increased need for neutrophils, as with an acute bacterial infection, will cause an increase in both the total number of mature neutrophils and the less mature bands.

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24
Q

What does the term shift to the left mean?

A

that the bands have increased, indicating an infection in progress

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25
Q

What is neutropenia?

A

a decrease in neutrophils

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26
Q

With what kind of infections would you expect to see a decreased neutrophil count?

A

viral diseases (hepatitis, flu, rubella, rubeola, mumps)

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27
Q

What are some types of medications that can reduce the neutrophil count?

A

antibiotics, lithium, phenothiazines, TCAs

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28
Q

When are decreases with eosinophil counts observed?

A

when a patient is receiving corticosteroid drugs.

29
Q

What do basophils contain?

A

heparin, histamines, serotonin

30
Q

What can cause an increase in basophil counts?

A

leukemia or Hodgkins

31
Q

What can cause a decrease in basophil counts?

A

Corticosteroid drugs, allergic reactions, and acute infections

32
Q

What substance do phagocytic monocytes produce?

A

interferon

33
Q

What diseases cause monocytosis?

A

tuberculosis, malaria, Rocky Mountain spotted fever, monocytic leukemia, chronic ulcerative colitis and regional enteritis

34
Q

What counts are done to test for AIDS?

A

T lymph counts

35
Q

What is the expected difference btw neutrophil and lymphocyte counts in adults and children?

A

In adults, lymphocytes are the second most common WBC type after neutrophils. In young children under age 8, lymphocytes are more common than neutrophils.

36
Q

What can cause an increase in lymphocytes?

A

many viral infections and with tuberculosis.

37
Q

What can cause a decrease in lymphocytes?

A

Corticosteroids and other immunosuppressive drugs

38
Q

What count of lymphocytes places a patient at very high risk for infection?

A

less than 500

39
Q

What is the normal WBC count for adult?

A

4,500-11,000 cells/cm2

40
Q

What is the normal WBC differential for adults?

A

PMN—45-75% (about 70% normal)‏
lymphocytes—20-45% (about 30% normal)‏
The others all make up small percentages

41
Q

What is neutropenia quantified as?

A

<1800 in adults

42
Q

What are some etiologies of neutropenia?

A

overwhelming bacterial infections, viral, rickettsial and others like malaria. Drugs and chemicals (sulphas, antibiotics, analgesics)‏. Ionizing radiation. Hematopoietic disorders. Hypersplenism

43
Q

What is the ANC equal to?

A

the product of the white blood cell count (WBC) and the fraction of polymorphonuclear cells (PMNs) and band forms noted on the differential analysis.

44
Q

What is lymphocytopenia quantified as?

A

ALC < 1500 in adults

45
Q

What is the polyclonal response?

A

multiple plasma cells derived from different B cells produce heterogeneous antibodies (Ig)‏

46
Q

What is the monoclonal response?

A

plasma cells derived from single antigen stimulated B cell, produce homogenous antibodies (Ig)‏

47
Q

Describe IgG

A

largest concentration of all immunoglobulins in the plasma. provides long-term immunity. Activates complement if conditions are optimal. Especially effective against encapsulated pathogens

48
Q

Describe IgM

A

is found in relatively small amounts. First antibody to appear in response to antigen
very good complement activator

49
Q

Describe IgA

A

first line of defense on mucosal surfaces. found in secretions. Protects against infections in urinary, GI, and respiratory tracts

50
Q

Describe IgE

A

Mediates allergic and hypersensitivity reactions

51
Q

Describe IgD

A

Activation of some lymphocytes not much known about it. Surface receptor of B lymphocytes

52
Q

How do you test for antibody deficiency?

A

Routine measurement of IgG, IgA, and IgM. Measurement of serum IgD is not useful for the diagnosis of immune deficiency.

53
Q

What does a direct immunoassay do?

A

Detect presence of antigens. May use enzyme immunofixation or immuno-fluorescence
Agglutination of antigen and antibody

54
Q

What are some examples of direct immunoassay tests?

A

group A beta-hemolytic strep, H. influenza, S. pneumonia, N. meningitides

55
Q

What is ELISA?

A

used to detect the presence of an antibody or an antigen in a sample.

56
Q

What does an indirect immunoassay do?

A

Antigen provided—testing if pt antibodies are present

57
Q

What are some examples of indirect immunoassays?

A

Monospot (heterphile): EBV antibodies. HIV antibodies. Hepatitis A, B, and C. Autoimmune diseases

58
Q

How can agglutination be used to test for disease?

A

.Diseases can be diagnosed by a rising titer (antibody concentration in serum) or sero-conversion (from no antibodies to the presence of antibodies).

59
Q

What does direct agglutination do?

A

test patient serum against large, cellular antigens to screen for the presence of antibodies. Direct agglutination reactions can be used to determine antibody titer.

60
Q

What does indirect agglutination do?

A

To test patient serum for the presence of antibodies against soluble antigens serum is mixed with latex spheres with the soluble antigens attached.

61
Q

What does SPEP do?

A

detect monoclonal immunoglobulinopathies by quantifying major grps of serum proteins

62
Q

What serum proteins are quantified with SPEP?

A

Albumin. Alpha-1/2 globulins. Beta-globulins. Gamma-globulins

63
Q

How do you interpret SPEP results?

A

Normally only albumin should be high, if others “spike” then abnormal and further tests need to be run

64
Q

What does a CMI (cell mediated immunity) do?

A

Evaluates the integrity of cellular immunity.

65
Q

What interactions does CMI depend on?

A

T cells. Macrophages. Other immunoreactants

66
Q

What is cutaneous delayed-type hypersensitivity test (DTH) used for?

A

screening test in many instances of suspected cellular immune deficiency

67
Q

What does a qualitative functional assay of CMI do?

A

Evaluate/measure localized skin reaction to intradermal injection of a battery of antigens. Anergy (lack of skin reactivity) indicates depressed CMI

68
Q

What are some antigens of a qualitative functional assay of CMI?

A

Streptokinase -Diptheria toxoid
Streptodornase -Trichophyton
Tetanus toxoid -Candida

Immunology (8 decks)

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