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Type II to Type IV Hypersensitivity > Type II Hypersensitivity > Flashcards

Type II Hypersensitivity Flashcards

1
Q

Also known as antibody-mediated cytotoxic hypersensitivity.

A

Type II Hypersensitivity

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2
Q

The immunoglobulins involved in the mechanism of type II hypersensitivity

A

IgG and IgM

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3
Q

The IgM and IgG are directed against?

A

Antigens found on the cell surface

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4
Q

The three major effects that can happen wen the antibody binds to a cell

A

(1) The cell can be destroyed
(2) the function of the cell can be inhibited
(3) the function of the cell can be increased above normal.

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5
Q

Cell damage can occur by several different mechanisms which involve complement as well as antibodies:

A

(1) Activation of the classical pathway of complement can lead to the formation of the membrane attack complex and cell lysis.
(2) Coating of the cell surface by antibodies can promote opsonization and subsequent phagocytosis of the cells.
3) Cell damage can result from the mechanism of antibody-dependent cellular cytotoxicity (ADCC)

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6
Q

Opsonization can occur through?

A

Binding of IgG antibody to Fc receptors on macrophages and neutrophils OR binding of cell surface C3b to complement receptors on phagocytic cell

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7
Q

It is mediated through binding of IgG antibody to its corresponding antigen on the target cell and to Fc receptors on macrophages or natural killer cells.

A

Antibody-dependent cellular cytotoxicity (ADCC)

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8
Q

Clinical examples that involve destruction of cells by type II hypersensitivity includes

A
  • Blood transfusion reactions
  • Hemolytic disease of the newborn
  • Autoimmune hemolytic anemia.
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9
Q

What will happen when antibody blocks the binding of a physiological ligand to its receptor?

A

Dysfunction of the cell

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10
Q

An example of autoimmune disease that results to dysfunction of the cell (esp. affects the neuromuscular junctions > muscle weakness)

A

Myasthenia gravis

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11
Q

Overproduction of cells can result on what autoimmune disorder of the thyroid gland?

A

Graves’ disease

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12
Q

What hormone is affected in Graves disease?

A

TSH

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13
Q

An example of cell destruction that results from antibodies combining with heteroantigens.

A

Transfusion reactions

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14
Q

Major groups involved in transfusion reactions

A

ABO, Rh, Kell, Duffy, and Kidd systems

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15
Q

Anti-A and anti-B antibodies are naturally occurring antibodies that are also called as

A

Isohemagglutinins

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16
Q

These are probably triggered by contact with identical antigenic determinants on microorganisms

A

Isohemagglutinins

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17
Q

The extent of the reactions depends on the following factors (6)

A

*The temperature at which the antibody is most active
* The plasma concentration of the antibody
* The immunoglobulin class involved
* The extent of complement activation
* The density of the antigen on the RBC
* The number of RBCs transfused40

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18
Q

If a reaction occurs only below 30°C, what is the next step?

A

Disregard (*because antigen–antibody complexes formed at colder temperatures tend to dissociate at 37°C)

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19
Q

May occur within minutes or hours after receipt of incompatible blood

A

Acute hemolytic transfusion reactions

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20
Q

Most often associated blood group and antibody in acute hemolytic transfusion rxn

A

ABO blood group, IgM class

21
Q

Occurs because of complement activation, resulting in the release of hemoglobin and vasoactive and procoagulant substances into the plasma.

A

Intravascular hemolysis

22
Q

Intravascular hemolysis may induce?

A

Disseminated intravascular coagulation (DIC)
Vascular collapse
Renal failure.

23
Q

Reactions occur within the first 2 weeks following a transfusion and are caused by an anamnestic response to the antigen to which the patient has previously been exposed

A

Delayed hemolytic reactions

24
Q

Antibody responsible for Delayed hemolytic reaction

A

IgG

25
Q

Antigens/Blood group involved in delayed hemolytic reaction

A

Rh, Kell, Duffy, and Kidd blood groups

26
Q

In, delayed reaction, antibody-coated RBCs are removed extravascularly in what organs?

A

Spleen and liver

27
Q

T/F: In delayed hemolytic reaction, intravascular hemolysis does not take place to any great extent because IgG is not as efficient as IgM in activating complement

A

True

28
Q

Appears in infants whose mothers have been exposed to blood-group antigens on the baby’s cells that differ from their own

A

Hemolytic Disease of the Newborn (HDN)

29
Q

Severe HDN is called

A

Erythroblastosis fetalis

30
Q

The mother produces what antibody that can cross the placenta to destroy the fetal rbcs

A

IgG antibody

31
Q

Most common antigen involved in severe reactions

A

D antigen, (RH blood group)

32
Q

Other antibodies associated with HDN include

A

anti-c, anti-C, anti-E, anti-e, and less commonly those associated with the Kell, Duffy, and Kidd blood groups

33
Q

Bilirubin levels above 20 mg/dL are associated with deposition in tissues such as the brain and result in a condition known as

A

Kernicterus

34
Q

If serum antibody titrations during the pregnancy indicate a high level of circulating antibody, this can be performed

A

Intrauterine transfusion

35
Q

Anti-D immune globulin, called Rhogam, is administered prophylactically at

A

28 weeks of gestation and within 72 hours following delivery

36
Q

An example of a type II hypersensitivity reaction directed against self-antigens because individuals with this disease form antibodies to their own RBCs.

A

Autoimmune Hemolytic Anemia

37
Q

When the underlying cause of antibody production is unknown; this is referred to as

A

Idiopathic autoimmune hemolytic anemia

38
Q

Associated diseases in autoimmune hemolytic anemia may include

A
  • Viral or respiratory infections (infectious mononucleosis, cytomegalovirus, or chronic active hepatitis)
  • Immunoproliferative diseases (chronic lymphocytic leukemia and lymphomas)
39
Q

Drugs that can act as haptens after binding to proteins on the RBC membrane. They can stimulate the production of anti-drug antibodies that destroy the RBCs, primarily through extravascular hemolysis

A

Penicillins and cephalosporins

40
Q

Drug that can modify the RBC membrane by facilitating binding of immunoglobulins and complement

A

Cephalosporin

41
Q

Drug that can stimulate the production of anti-drug antibodies that bind to the drug to form soluble immune complexes

A

Quinidine and phenacetin

42
Q

Drug that can induce hemolytic anemia by stimulating production of autoantibodies against the RBC membrane

A

Methyldopa

43
Q

Severity of the hemolysis is affected by what subclass of IgG involved

A

IgG3 and IgG1

44
Q

This antibody attaches to B cells and causes a decrease in antibody production. It can use as a treatmnet with warm autoimmune hemolytic anemia

A

Anti-CD 20 (rituximab)

45
Q

Can be produced secondary to certain infections, most notably Mycoplasma pneumonia and infectious mononucleosis but also respiratory viruses and HIV

A

Polyclonal cold agglutinins

46
Q

Occurs most often after infection with certain viral illnesses, including measles, mumps, chickenpox, and infectious mononucleosis. Px produces a biphasic autoantibody

A

paroxysmal cold hemoglobinuria

47
Q

Examples of type II hypersensitivity reactions to tissue antigens include some of the organ-specific autoimmune diseases

A

Goodpasture syndrome, Hashimoto’s disease, Myasthenia gravis and Insulin-Dependent Diabetes Mellitus

48
Q

Performed to detect transfusion reactions, HDN, and autoimmune hemolytic anemia. (Coombs discovery in 1945)

A

Direct Antiglobulin Test (DAT)

49
Q

Used in the crossmatching of blood to prevent a transfusion reaction. It can either determine the presence of a particular antibody in a patient or type patient RBCs for specific blood group antigens

A

Indirect Coomb’s test

Type II to Type IV Hypersensitivity (3 decks)

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