TEST 3 - WBC, INFL, IMMUNITY Flashcards
ANY substance that can elicit an immune response
Antigen
An antigen can be an exogenous substance that enters the. Body or an endogenous substance. TRUE/FALSE
TRUE
Antigen is usually a ________
Protein
Can by secreted by microorganisms and can be antigens
Polysaccharides
Lipids
Toxins
An antigen is anything whatsoever that induces an ________ in the host.
Immune response
All living cells express antigens on their cell ________; all living cells considered antigenic.
Membranes
Projections on antigen; elicit different responses from the immune system
Epitopes
Antigens are genetically determined through ________
Gene (DNA) inheritance
Antigens are cell _______ and differentiate self from ________.
Cell markers
Self from non-self
Normally ______ antigens do not activate the person’s immune system.
Self antigens
Non-self/foreign antigens that can activate the immune system in an attempt to destroy the antigen
Microorganisms
Rbc antigens
Transplant antigens
Determines a person’s ABO antigen profile or blood type
Genes from each parent
Rh stands for what
Rhesis
Rh is also inherited from parents. TRUE/FALSE
TRUE
Rh+; about _____ % of ppl have the Rh gene and express this antigen on their RBC’s
85%
Rh-; about ___% of ppl do not inherit the Rh gene and do not express the antigen on their RBCs
15%
There are naturally occurring antibodies for Rh antigen. TRUE/FALSE
FALSE
There are NO naturally occurring antibodies for Rh antigen
Antibodies for Rh antigen are only developed when Rh__ individual is exposed to Rh___; when can this happen?
Rh- exposed to Rh+
Pregnancy; have to do tests
When can fetus develop antibodies and cause an immune response?
If baby is Rh- and mom is Rh+??
Where are antigens located?
On the RBC
Where are antibodies located?
In the plasma
If have antigen A (type A), what type of antibodies to you have?
Anti-B antibody
If have antigen B (type B), what type of antibodies to you have?
Anti-A antibody
If have antigens A and B (type AB), what type of antibodies to you have?
Neither anti-A or anti-B
If have neither antigen A or B (type O), what type of antibodies to you have?
Anti-A and Anti-B antibodies
Universal recipient blood type; no antibodies against type A or B
Type AB
Universal donor; antibodies against type A and type B
Type O
Donor for O- recipient
O- only
Donors for O+ recipient
O-
O+
Donors for A- recipient
O-
A-
Donors for A+ recipient
O-
O+
A-
A+
Donors for B- recipient
O-
B-
Donors for B+ recipient
O-
O+
B-
B+
Donors for AB- recipient
O-
A-
B-
AB-
Donors for AB+ recipient
O-/O+
A-/A+
B-/B+
AB-/AB+
ALL OF THEM
Why is AB+ the universal recipient?
Do not have to worry about Rh and no antibodies present
Trauma blood
O-
Plasma donor for O recipient
O
A
B
AB
Plasma donor for A recipient
A
AB
Plasma donor for B recipient
B
AB
Plasma donor for AB recipient
AB
We have to worry about Rh antigen and antibodies when giving plasma. TRUE/FALSE
FALSE
Only has antibodies; no Rh antigen
Universal PLASMA donor
AB
Universal plasma recipient
Type O
Each person inherits __ MHCs from each parent for a total of __ MHC’s in each person
6 MHC’s
12 total
MHCs are Divided into class ___ and class____
I
II
MHCs are expressed on all _______ body cells
Uncleared
Allow immune system to differentiate self form non-self antigens
MHCs
Types of body cells MHC’s not expressed on
RBC
Plts
Class___ MHCs designated MHC- A, B, or C
Class I
Class I MHCs combine with ________ antigens to form a complex that is displayed on the cell ________
Intracellular antigens
Cell’s surface
Class I/ ______ antigen complex prompts the immune system to ______ the displaying cell
Foreign
Destroy
Class I MHCs mainly interact with what type of T cells?
Cytotoxic (CD8+) cells
Designated MHC- DB, DQ, or DR
Class II MHCs
Class I MHCs expressed on what type of cells?
Nucleated body cells
Class II MHCs expressed on antigen-presenting cells such as?
B cells
Macrophages
Monocytes
Dendritic cells
Antigen presenting cells–_________ of foreign antigens–antigens broken down and combine with class ___ MHCs– class __ MHC/antigen complex presented to other _______ cells
Endocytosis of foreign
Combine with class II
Class II/antigen complex
Immune cells
Class II MHCs mainly interact with _______ T cells
Helper (CD4+) T cells
Very large proteins; MW 150,000-900,000 daltons
Immunoglobulins (Ig)
Immunoglobulins are produced by what in response to antigens?
B-lymphocytes/plasma cells
B cells differentiate into plasma cells and the plasma cells produce antibodies
Ig’s are produced in response to _______
Foreign antigens
Each antibody is antigen ________.
Specific
Two regions of an antibody
Constant regions
Variable regions
Types of chains in antibody structure
Light and heavy chains
Region same form one antibody to the next
Constant region
Area modified in response to specific antigen on the antibody
Variable region
75% of all antibodies; activate complement system and promote phagocytosis
IgG antibody
IgG is the ____ antibody to respond to antigens
2nd to respond
Respond to bacteria, viruses, parasites, fungi and toxins
IgG
Largest size antibodies; first antibody to respond to antigens
IgM
IgM function is similar to Ig__
IgG
Antibody responsible for blood transfusion rxns
IgM
Second most abundant antibodies; present in body secretions
IgA
Major antibodies in allergic and inflammatory responses
IgE
Includes lymph, lymphatic vessels/tissue/nodules, tonsils, spleen and thymus
Lymphatic system
3 main fxns of lymphatic system
Fluid balance
Lipid absorption
Defense
What is stored in the middle of lymph nodes
A lot of WBC and other immune cells
Lymph fluid is carried out and into other lymph nodes, usually in sequence and then eventually returned to _________ veins and circulation
Subclavian
What happens to lymph nodes when chronically respond to bacteria and infection.
Examples?
Swell; lymphadenopathy
Chronic allergies; cancer, etc
Originate in terminal lymphatic spaces in interstitial spaces
Lymphatic vessels
Responsible for draining breast tissue, usually the ones that swell with breast cx/tumors
Infraclavicular lymph nodes
Spleen is reservoir for WBC and RBC; where are they sequestered here?
WBC white pulp
RBC red pulp
_________ response causes spleen to contract and release WBC/rbc into circulation
Sympathetic
Where T lymphocytes expressed; behind sternum
Thymus
Duct where lymph fluid returned back to subclavian
Thoracic duct
More lymphatic drainage to RIGHT/LEFT SIDE
LEFT
3 TYPES of WBC
Polymorphonuclear granulocytes
Lymphocytes
Monocytes
3 types of Granulocytes
Neutrophils
Eosinophils
Basophils
Types of lymphocytes
B-Lymphocytes
T-lymph’s
Types of T lymphocytes
Helper (T4/CD4 cells)
Cytotoxic (T8/CD8)
Memory
Suppressor
4 derivatives of WBCs
Macrophages
Mast cells
Natural killer cells
Plasma cells
Majority of leukocytes (50-70%); major role is phagocytosis
Neutrophils
Released by neutrophils; attracts other WBC
Chemotactants
Released by neutrophils; causes fevers
Pyrogens
Primary involved in allergic rxns and parasitic invasions
Eosinophils
Found in the blood stream; secrete histamine and heparin
Basophils
Transform in to plasma cells which secrete antibody
B-lymphocytes
B-lymphocytes are responsible for ________ immunity
Humoral
Stored in lymphoid tissue and respond rapidly to subsequent exposure to same antigen
Memory B lymphocytes
Initially produced in bone marrow, then mature in thymus and other lymphoid tissue
T-lympocytes
T-lymphocytes are responsible for ________ immunity
Cell mediated
T lymphocytes secrete ________; inflammatory mediators
Cytokines
T-cells that initiate b lymphocyte response
Helper
T cell that destroy foreign antigens directly
Cytoxic
T cells stored in lymphoid tissue and respond rapidly to subsequent exposure to the same antigen
Memory T cells
T cells slow down or stop immune response
Suppressor T cells or
“Regulator T cells”
Produced in the bone marrow; after leaving vascular system, transformed into tissue macrophages
Monocytes
Phagocytosis of foreign microorganisms and cellular debris; antigen-presenting cells (present to T lymph’s)
Macrophages
Locations for macrophage systems in the body
Alveoli
CNS: microglia
Sinusoids of the liver
Subcutaneous tissue
Found in tissues surrounding blood vessels; secrete histamine and heparin
Mast cells
Fxn similar to cytotoxic T cells; respond to tumor formation and virally infected cells
Natural killer cells
Derived from B-lymphocytes; secrete antigen-specific antibody
Plasma cells
Where B lymphocyes are processed?
Human bursa equivalent
Thymus
PHSC process to granulocytes/agranulocytes
PHSC–
CFU-GM–
WBCs
T-lymphocytes are processed in the fetal thymus; produce ________ of t-lymphs and laid down in lymphatic tissue
Clones
Group of T-lymphs that respond to a specific antigen; in theory one for every antigen to ever come in contact with
Clones
When T-lymph clones that would amount an immune response later in life against your own body cells are not destroyed, these lead to ________ diseases
Autoimmune
Examples of autoimmune diseases
DM I
Hoshimotos thyroiditis
Lupus
RA
Helps clones differentiate into different T lymphocyes
Exposure to antigen
Biochemicla mediators that promote inflammation
Vasodilation
Vascular permeability
Attracting WBC
Stimulating phagocytosis
Cellular destruction causes mast cells to produce histamine which results in what?
Purpose?
Local vasodilation
Increased vascular permeability
Gets more blood flow and oxygen can cross to tissue
Results of kinins (bradykinin)
Local vasodilation
Increased vascular permeability
Chemotaxis
Stimulation of pain receptors in area of injury
Stimuli that can elicit inflammatory process and release of eicosanoids
Physical
Chemical
Hormonal
Neuronal
Stimulation works with this enzyme and fatty acid in cell membrane to produce arachidonic acid
Phospholipase A2
Inhibits phospholipase A2; most effective class of drugs to effective treat the inflammatory process
Glucocorticoids
Prednisone, methylprednisone, dexamethasone, etc.
After arachidonic acid, what are the two pathways?
Lipoxygenase–
Leukotrienes–
Cyclooxygenase–
PGG2/PGH2 (various prostaglandins)
Leukotrienes are secreted from where?
Leukocytes
Mast cells
Plts
Lung and heart vascular tissue
Leukotrienes lead to what?
Inflammation
Smooth muscle contraction
Chemotactants
Increased vascular permeability
When are a lot of leukotrienes released?
Asthma attack
Resulted of PGG2/PGH2
Prostaglandins
PGI2 (prostacyclin)
TxA2 (thromboxane)
What do prostaglandins do?
Multiple effects; vasodilation
What does PGI2 (prostacyclin) do?
Platelet anti-aggregator
What does TxA2 (thromboxane) do?
Platelet aggregation/vasoconstriction
Prostaglandins, PGI2, and TxA2 have a built in _________
Counterbalance
Enhance NK cell activity
Interferons
Extremely pro-inflammatory and pro-catabolic; extremely pro-sleep.
Tumor necrosis factor
Promote development and differentiation of T and B lymphocytes
Interleukins 1,2.3.4.5.6…etc.
Complement system is composed to ~__ proteins
~20
The complement system is normally active. TRUE/FALSE.
FALSE
Normally INACTIVE
Complement system that begins when antibody binds with antigen
Classical pathway
Complement systemthat begins when protein C3 becomes active
Alternative pathway
Classical pathway begins with _______ complex
Antigen-antibody complex
Alternative pathway is activated by _______ substances and factors ____, ____, and ____
Foreign substances
Factors B, D, and P
At protein ____, alternative and classical pathways become a common pathway
C3
Promotes phagocytosis, inflammation, and chemotaxis; enhances/complements overall inflammatory process and immune response
Complement system
How does the complement system lyse cells?
Complement proteins form a membrane attack complex and drill holes in the wall of foreign material so water rushes in a lyses cell
Inflammatory response is _________ response to cell damage; may or may not involve foreign antigens
NONSPECIFIC
Example of inflammatory response but foreign antigens not present
MI; injury and inflammation present but no foreign antigen
Stimulates release of biochemical mediators such as histamine, kinins, eicosanoids, complement system
Cellular damage
What 3 things does release of biochemical mediators do?
Tissue macrophages migrate to area of injury (first line defense)
Margination and diapedesis of neutrophils
Vasodilation and increased vascular permeability
First line of defense in acute inflammatory response
Tissue macrophages migrate to area of injury
What is margination?
Where neutrophils start to line walls of the capillaries
What is diapedesis?
Neutrophils move through the spaces in capillaries and into tissue spaces
When do neutrophils become the primary line of defense in acute inflammatory defense?
Margination and diapedesis
Purpose of “walling off effect” in acute infl response
Localized injury; prevents spread of toxins
The immune response is a ___________ response to exogenous or endogenous antigens
SPECIFIC
The immune response involves T and B lymphocytes. TRUE/FALSE
True
__-lymphocytes/antibodies respond to antigens in body fluids
B-lymphs
_______- lymphocytes respond to antigens inside body cells
Cytotoxic T-lymph’s
Once activated, the immune response provides __________ immunity against the specific antigen
Long-lasting
Macrophage recognition, processing, and presentation to helper-T lymphocytes
Phagocytose foreign antigen
Breaks it down and combines with class II MHC
Presented on surface of the macrophage
Stimulates the immune response and CD4 helper T’s to respond
Macrophages release this to help attract helper T cells
Interleukin-1
Secreted by helper T cells; acts on its own cells and causes differentiation and proliferation of the helper T cells; “T cell growth factor”
Interleukin 2
When a non-macrophage body cell is already infected, it is processed and combines with __________ MHC, and presented on the cell surface. This MHC and a ________ antigen Activates ______ cells.
Class 1
Foreign antigen
CD8 cells
Helps CD8 cells and allows them to differentiate and proliferate.
Interleukin-2 secreted by helper T cells
Cytotoxic T cells release _________ and do contact _________.
Cytokines
Contact killing
B lymphocytes directly identify and process foreign antigen, presents with ________ MHC, helper T responds and interleukins _________ are released
Class 2 MHC
Interleukins 4,5,6
What do interleukins 4,5,and 6 do after released from helper T cells?
4: differentiation of B cell
5: stimulate differentiation from B cell into plasma cell
6: promotes antibody production from the plasma cell
Outcomes of antigen-antibody complexing
Inactivation of antigens
Agglutination/clumping of antigens
Activation of complement via classical pathway
Enhances inflammatory processes; esp mast cells/basophils
Enhances phagocytosis by neut’s and macrophages
How are antigen-antibody complexes removed?
Phagocytosis by neutrophils and macrophages
Explain The primary response to a specific antigen
Small magnitude of response
Longer response time 3-14 days
Explain secondary response to specific antigen
High magnitude response
Shorter response time hours to a few days
Innate (natural) or Aquired immunity?
Species specific; intact skin
Innate
Innate (natural) or Aquired immunity?
IgA and enzymes in saliva, tears, perspiration
Innate
Innate (natural) or Aquired immunity?
Requires exposure to antigen; develops SPECIFIC to each antigen
Aquired
Innate (natural) or Aquired immunity?
Acid of stomach; GI tract enzymes and IgA
Innate
Innate (natural) or Aquired immunity?
Memory T and B lymphocyte/antibodies
Aquired
Innate (natural) or Aquired immunity?
Neutrophils and macrophages phagocytosis
Innate
Innate (natural) or Aquired immunity?
Complement alternative pathway; interferons
Innate
Innate (natural) or Aquired immunity?
Two types:
Passive and active
Aquired
Innate (natural) or Aquired immunity?
Natural antibodies; NKCs; various cytokines
Innate
Person recieves immunity but did not develop it on their own; such as mother/fetus
Passive immunity
Develop this type of immunity on your own after exposure; such as exposure to elements in nature
Active natural immunity
Develop this type of immunity on your own but after artificial presentation (immunizations)
Active artificial
How do we halt the immune response? (4)
Elimination of foreign antigen
Suppressor T-lymph’s
Feedback inhibition
Idiotypes (antiidiotypes–antianti…)
Subcomponent to antibody; body recognizes as a foreign substance and develops these to take care of it; helps to slow and stop the immune response
Idiotypes–antiidiotypes– antiantiidiotypes etc…
Most frequently encountered hypersensitivity rxn during anesthesia
Type I (allergy)
Type I allergy rxns are _____ mediated; what are some examples?
IgE mediated
Anaphylaxis, asthma
IgG, IgM, Complement mediated; ABO incompatibility
Type II (cytotoxic)
IgG, Complement, neutrophil mediated; RA, systemic lupus
Type III (immune complex)
T-cell mediated; multiple sclerosis
Type IV (cell mediated)
How often do allergic rxns happen during anesthetics
Once every 5,000-25,000 anesthetics
Mortality % for allergic rxns
3.4%
You have a ___ min time frame with allergic rxns
3 min
Respiratory identification of allergic rxns
Wheezing
Increased peak pressures
Decreased pulm compliance
Allergic identification cardiovascular signs
Hypotension
Tachycardia
Decreased SVR
Arrhythmias
Cutaneous identification of allergic rxn
Urticaria
Generalized edema
In management of allergic rxns a plan must be established when?
Before the event
Primary tx of allergic rxn
- Stop administration of offending agent
- Maintain airway and administer 100% O2
- DC anesthetic agents
- Intravascular volume expansion
- Epinephrine
Secondary treatment of allergic rxn
Diphehydramine
Bronchodilator
Corticosteroids
