Primary Immunodeficiency (1) Flashcards
How is immunodeficiency classified? What causes them?
- Primary
- Secondary
- Physiological
What clinical features are suggestive of immunodeficiency?
Infection
What are features that suggest primary immune deficiency?
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What are the common lab tests we use to detect primary immunodeficiency?
Lab tests
What is the innate immune system made of?
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What are the functions of phagocytes?
Functions:
Name the polymorphonuclear cells (granulocytes). Where are they produced? What do they release?
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Name the monocytes of these organs. Where are monocytes produced? Where are they stored? What do they differentiate into?
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Describe the function of macrophages.
- Macrophages in site of infection.
- Endothelial cell activation increases expression of adhesion molecules.
- Mobilisation of phagocytes and precursors from bone marrow or within tissues.
- Increased neutrophil adhesion and migration into infected tissues.
- Phagocytosis of organism.
- Oxidative and non-oxidative killing
- Macrophages present to T cells
- Phagocytes die.
What are the causes of phagocyte deficiency?
- Failure to produce neutrophils.
- Defect of phagocyte migration.
- Failure of oxidative killing mechanisms.
- Cytokine deficiency
What are the causes of failure of production of neutrophils?
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What are the causes of defects of phagocyte migration?
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What are the causes behind failure of oxidative killing mechanisms?
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How can we investigate chronic granulomatous disease?
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What cytokine deficiency causes phagocyte deficiency? What is the normal process?
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What is the result of having a phagocyte deficiency?
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What tests would we use to detect phagocyte deficiency? What results would we expect?
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How do we treat phagocyte deficiencies?
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What are natural killer cells? Why are they important?
- Lymphocytes
- Have activating and inhibitory receptors.
- The inhibitory receptors are very important as they recognise HLA class 1 (or self-HLA) –> prevent inappropriate activation by normal self - overrides activation
- If a cell is infected, it loses the HLA 1 and the NK cell becomes activated and kills the cell
What are the types of natural killer cell deficiencies?
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What is the result of having NK cell deficiency?
Viral Infection as NK cells kill target cells.
What is the treatment of NK cell deficiencies?
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What disease does a patient with recurrent infections with high neutrophil count on FBC but no abscess formation have?
Leukocyte adhesion deficiency
What disease does a patient with recurrent infections with hepatosplenomegaly and abnormal dihydrorhodamine test have?
Chronic granulomatous disease.
What does a patient with recurrent infections with no neutrophils on FBC have?
Kostmann syndrome
What does a patient with infection with atypical mycobacterium and normal FBC have?
IFN gamma receptor deficiency
What does a patient with severe chickenpox and disseminated CMV infection have?
Classical NK cell deficiency
What is the complement system? What is their function
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Name the 3 pathways of complement activation
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Describe the classical pathway
Adaptive immune response.
Describe the MBL pathway.
Kicks in early.
Describe the alternate pathway
Kicks in quite early.
What is the significance of C3?
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What other roles do complement play in immune response?
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What happens if you have complement deficiency?
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What happens if you have classical pathway deficiency?
Fail to produce complement fragment - no phagocytes - nuclear debris –> autoimmune disorder.
What happens if you have MBL deficiency?
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What is shown in this image?
Meningococcal septicaemia - result of complement deficiency.
What can active SLE cause?
Low c4 and then low c3
What can nephritic factors cause?
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How do we investigate the complement pathway
- Function complement test:
- -CH50 –> classical pathway (1,2,3,4,5-9)
- -AP50 –> alternative pathway (3, 5-9)
What would the Ix show for c1q deficiency, properidin deficiency, C9 deficiency and SLE?
Properidin part of alternate pathway
How do we manage patients with complement deficiencies?
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Question
C7 deficiency
Question.
C1q deficiency