patho exam 2
Define adaptive immunity
"acquired" slower but more effective uses a "focused recognition
define antigens
"non self" substances or foreign substances
Describe monocytes and their role in processing and presenting in immunity.
"scavengers" that engulf & digest foreign cells, help fight off antigens until additive immunity can begin
Identify normal ranges of hematocrit discussing the important of the values and what knowledge a provider can gain from the values.
% of blood that consitfs of RBCs normal range for men is 45 to 52% where as women 37 to 48%
define innate immunity
'inborn" physical chemical molecular and cellular defences in place prior to infection
what are normal ranges for thrombocytes
150000 to 450000
discuss monocytes
3 to 7 % circulating WBCs when they leave circulation they mature to macrophages found in large quantities in the spleen; U shaped. their ability to synthesise & secrete cytokines, substances that enhance inflammation & stimulate function of other WBCs largest of WBCs
what are normal ranges for leukocytes
4000 to 11000
What is iron deficiency anemia?
S/S fatigue palor, palpitations, dsypena, and chest pain, pica most common symptom=compulsive eating of ice, clay, etc, treat-increase dietary intake of iron oral replacement with ferrous sulfate, and controlling chronic blood loss low Hgb, and Hct level is decrease serum iron and ferritin levels, caused by, decrease amount iron in diet, loss of iron thru bleeding, or increase demand of iron as with pregnancy
define septicemia
bacterial toxins in the blood
what is stage 3 hemostasis
blood cogulation, fibron clots, factors in the blood are activated causing clot formation, insintric pathway (initiated by factor XII) eccentric pathway (activated by tissue formation) both pathways lead to activation of factor x, conversions of fibrinogen to fibrin threads that hold the clot together
What is aplastic anemia?
bone marrow failure, decrease in all 3 blood cells can be caused by cancer, sepsis, or radiation exposure
what is penetration
break in skin or mucus membranes, result of injury, surgery, animal bites, or chicken pox
what is hemogobinpathies (thalassemias)
inherted genetic disorders (alpha&beta) occur due to absence or defect in synthesis of alpha or beta chains of adult hemoglobin , leads to deficient Hgb production a hypo chromic, mycrogticanemia alpha- missing alpha polypeptide chain of the Hgb molecule seen mostly in Asian, meditarrian, or Africa, characterised. by chronic haemolytic anemia that requires transfusions during febrile illness with certain meds beta-(cooleys) formation of Heinz bodies which impair DNA synthesis and damage red cell membrane, thalassemias minor and major long bones, ribs, vertebrae, @ risk for fracture new bone formation to face giving a "chipmunk" appearance treat-frequent transfusions
What is the prodromal stage?
initial appearance of symptoms may only begin w/ malaise most infectious stage
what is blood loss anemia
loss of iron containing RBCs from the body, nternal/external S/S depend on amount of blood lost and rate which blood was lost may include shortness of breath, pallor, weakness, and chest pain
what is anemia
low hemoglobin level or amount of RBCs in the blood, WHO defines as Hgb greater than 13g per decilitre in men and greater than 12 mg per decilitre in women causes excessive loss, as with bleeding, excessive destruction, as with hemolysis, deficient RBC production, as with bone marrow failure or lack of nutritional elements leads to decrease in haemoglobin causes tissue hypoxia & can lead to fatigue and weakness, dyspnea, angina, headache, pallor, tachycardia
Discuss natural killer cells and the role in innate immunity.
lymphocytes that work in innate immunity aka (effector cells) programmed to kill foreign cells autmoatically
Discuss T-Lymphocytes including where they are formed and mature, types and the roles each play in cell-mediated immunity.
made in bone marrow and mature in the thymus. Helper T cells (CD4) cells: master regulators of whole immune system. secrete cytokines that influence all other cells. cytotoxic T cells (CD8) immungolbin that is usually first to be informed bu the new born in response to an infection or th first to be present on secne of an immune rxn. once activated helper and cells start and to produce that active B & T cells as well as other immune cells
discuss lymphocytes
make up 20 to 35% of circulating WBCs 2 main types B lymphocytes (B cells ) and T lymphocytes (T cells) part of adaptive branch of immune system, endow body w/ long term immunity
what is chronic lymphocytic (CLL) and chronic myelogenous (CML) leukemias
malignancies involving the proliferation of well differentiated myeloid & lymphoid cells, CLL seen more in people over age of 50 CML more in people ages 30-50, CML associated with the presence go philedlphia chromosome (95% of cases have this chromosome)
discuss leukemias
malignant neoplasms of cells involving the hematopietic stem cells, bone marrows replaces w/ poorly differentiated, rapidly producing immature cells, classified as acute or chronic, neoplastic proliferation of blood cells
what is the acute stage
max impact of disease process S/S more pronounces immune inflammatory responses are in motion
Identify normal ranges of hemoglobin discussing the important of the values and what knowledge a provider can gain from the values.
men 13.5 to 17.5 g per dl, women 12 to 15.5 g per dl carriers o2 to cells & carriers CO2 away from cells, greatly dependent on availability of iron lack of iron is low O2 normal Hgb is HgbA
Explore defects in coagulation including von Willibrand Discuss etiology, clinical manifestations, and treatment options of each.
most common diagnosed in adults deficiency in vWF which causes reduced platelet adhesion since vWF carries factor VIII, there may be a decrease platelet adhesion & increased bleeding, s/s=brusing, excessive menstrual flow, bleeding from mouth and nose, & Gi tract treat with factor VIII products that contain vWF or DDAVP if case is mild
what is hemoglobinpathies of G6PD
most common inherited enzyme defect causes haemolytic anemia, enzyme allows RBCs to maintain metabolic processes in presence of injuries, including certain types of drugs (aspirin, sulfate drugs) java beans, hypoxemia, infectious acidosis, or fever, SO with G6PD def exposure to one of these stressors, will cause hemoglobin to form and formation of Heinz bodies leading to hemolysis
Identify normal ranges of mean corpuscular hemoglobin concentration discussing the important of the values and what knowledge a provider can gain from the values.
normal 32 to 36 average amount go Hgb in avg RBC, normochromic-normal in color, hypo chromic-decrease color or matte, low indicates pale color of RBCs categorised as microcytic anemia occurs in iron deficiency
Explore factors that affect wound healing.
nutrition, age, adequate blood low (oxygenation ) infections; wound separation decrease immune and inflammatory responses and obesity
what is acquired immunodeficiency
occurs later in life ex (AIDS)
what is community acquired
outside healthcare facility
what is direct contact
passed directly on to hosts thru mucus membranes WITHOUT a break in skin or mucus membrane integrity (ex STDs passed from mom to baby)
what is congenital
passed from mom to baby
what is the incubation stage
pathogen actively replicating, no S/S may be short or long depending on pathogen
discuss the thrombocytosis cause of hypercoagulability
platelet count of less than 750000 plaques may form in the heart vessels smoking, high cholesterol levels may cause plaques or vessel injury activating platelet accumulation 2 types primary-essential thrombocytosis (ET) occurs in the bone marrow, increase number of platelet enhances risk of clot formation secondary- reactive thrombocytosis caused by another primary condition (iron def anaemia, cancer, inflammation, infection, surgery, or myleoprliferative disorders, excessive number of platelets does not cause excessive clotting
what is stage 2 of hemostasis
platelet plug forma, platelets begin to adhere to injured site (platelet adhesion) must have von willebrand factor in order to have platelet adhesion, release of ADP calls out more platelets& causes platelet aggression
Give examples of opportunistic infections characteristic of AIDS.
primary infection phase: signs of systematic infection: fever, sore throat, fatigue, HA, myalglas seroconversion: immune system responds & antibodies against HIV appear later N/A, S/S replicating, TH cell count less goes down may last 10-11ys overt AIDS: TH cell count less than 200 cells per litre and AIDS defining oppurtuitic infection malaria, toxoplasmosis, TB
List the different types of infectious agents.
prions hard to get rid of small modified infectious host proteins just like out proteins but abnormally shaped causes our proteins to turn into more prions causing degenerative diseases in the CNS (ex mad cow disease )
Describe macrophages and their role in processing and presenting in immunity.
process and present the antigen to lymphocyte so adaptive immunity can kick in
discuss lymphomas and what is Hodgkins lymphoma
proliferation of B& T lymphocytes in lymphoid tissue B cell enlarge lymph node may be present lymph node biopsy (reed Sternberg cells: malignant B cells w/ 2 nuclei, appear as owl eyes) treatment - combo chemo and radiation, immunotherapy
what is hemostasis
proliferative mechanism where by the formation of a thrombus prevents excessive blood from the body, normal platelet 150000 to 450000
defne immunity
protection from disease
what are different mediators released by WBC, plasma, and damged cells (complement)
protein that eliminates infectious micros and has the ability of antibodys and phagocytic cells to clear pathogens from organisms
Discuss B-Lymphocytes including where they are formed and mature, role in humeral immunity and specifics related to immunoglobulin types (IgG, IgA, IgE, IgD, IgM).
provide protection and immunity is provided by antibodies to the immunoglobulins produced in bone marrow, mature in th spleen IgG(body fl easily enter tissue only one crosses placenta, late disease) IgA(saliva, tears, breastmilk, mom passes to baby in clostrum, protective, prentol to keep viruses from attaching ) IgE (mast cells respiratory and GItract not releated to infected usually people) IgD(surface B cells blind antigen to B cells early ) IgM(in blood, initiate complement activy and further immune response in blood, rxns, early infection, 1st on sence, 1st newborn produce
what are different mediators released by WBC, plasma, and damged cells (c reactive)
released. by liver during inflammation period and increase in presence of inflammation in the body, is considered a non specific "marker" for disease
describe various types of exudate
serous or transluscent- watery fluids from plasma entering site hemorrhagic- leakage of red blood cells from capillaries fibrinous- thick stick mesh work contains contains fibriogen membranous- develops on mucus membranes contain necrotic cells purulent- (supportive) contains must made of WBC, protiens, tissues, disease, abscess localised area of inflammation that has a purulent and "wall"
Identify normal ranges of mean corpuscular volume discussing the important of the values and what knowledge a provider can gain from the values.
size of RBC, volume of one RBCto classify anemia and microcytic (small size), mesoblastic (large size)or normocytic normal value 80 to 100 femoliters
discuss granulocytes
sperchical and phagocytic 3 types (neutrophils, esonphils, and basophils) contain powerful digestive enzymes capable of killing microorganisms & then catablizing debris during phagocytosis
Define epidemiology
study of factors, events, and circumstances that influence the transmission of infections among humans
Discuss polycythemia including the differences in relative and absolute types
abnormally high total RBC mass with a Hct greater than 50 and Hgb greater than 20mg/d relative- caused by a decrease in plasma w/o a decrease in RBC volume absolute- increase in total RBC mass (primary or secondary)
define immodeficency
abnormally in one or more beaches of immune system that Makes a person more susceptible to diseases normally prevented by an intact immune system
what is active immunity
acquired thru immunisation or actually have disease
Discuss the differences between acute and chronic inflammation.
acute - neutrophils accumulate in area of injury leads to immediate blood vessels changes(dilation and permeability) damged cells release imflammatory mediators that may produce fever, pain ,etc chronic- macrophages accumulate in damged area and keep releasing inflammatory mediators continuing inflammatory process
Discuss the inflammatory responses at the local and systemic levels, the cellular and acute phase responses of the systemic response.
acute phase response- lekocytes release interleukins and tumor necrosis factor affect thermoregulatory center leads to fever affect CNS leads to lethargy and (sleepy) (lymphadenopathy) skeletal muscle breakdown if severe/ prolonged, liver makes fibrinogen and c reactive protien, facilitate clotting, and bind to pathogens moderate inflammatory responses cellular phase response- WBC response inflammatory mediators cause WBC production, WBC increase immature neutrophils (bands) released into blood stream
what is immune thrombocytopenic purport (ITP)
autoimmune disorder antibodies form & cause destruction of platelets, in children onsets before age 5 after viral infection; sudden petechiae &purpura, in young, does not follow acute infection, may see nose bleeds, bleeding &bruising platelet counts greater than 20000
what is hemoglobinpathies (sickle cell)
autosomal recessive, presence of abnormal hemoglobin S, which transforms the RBC into a sickle shape when deoxygenated, affects African Americans, hemolysis or destruction of sickled cells causing anemia vessel occulsion causes severe pain (abdomen, chest, bones, joint ) causes increased deoxygenated RBCs cold exposure, stress, physical exertion, infections, dehydration, acidosis no know cure, give oxygen, pain control, iv fluids
what is passive immunity
temporary type of immunity that is transferred from another source
define thrombocytopenia
term for low number of platelets, less than 100000/ , decrease in amount of circulation platelets
Discuss the process of erythropoiesis.
the process of producing RBCs in bone marrow all begin as pluripotent stem cells in bone marrow that are stimulates to become erythroid precursor cells, each goes thru a series of changes until it becomes. mature erythocyte released by the bone marrow, nucleus of RBC is expelled in one of the last stages of erythropoiesis, why RBC has no genetic material, last stage of erythropoiesis involves formation of reticulocyte (immature RBCs) avg life of mature 120 days spleen :removes aged, lysed, and dead rbcs
what is thrombotic thrombocytopenia purpura (TTP)
thrombocytopenia, hemolytic anemia, vascular occlusions, fever, neurological abnormalities, renal disease, deficiency in ADAMTS13 that works on vWF unmodified vWF causes platelet aggression & widespread clot formation, onset is abrupt, may be fatal as widespread occlusions affect RBCs kidney, brain, liver, MI, stroke
what is the resolution stage
total elimination of disease no S/S
identify 5 cardinal signs of inflammaion
tumor (swelling), calor(heat) rubor(redness) functio läsa (function loss)
Discuss the inflammatory responses at the local and systemic levels, including the cellular and vascular responses at the local level
vascular stage- prostaglandins & lekotriens affect blood vessels (histamine) arteries and venues dilate which increase blood flow to injuries area( red and warm result ) capillaries become more permeable allows exudate t escape into tissues (swelling and pain) cellular stage - WBc enter injured tissue destroying infective organisms removing damged cells and releasing more infalmmaroty mediators to control further inflammation and healing
what are different mediators released by WBC, plasma, and damged cells (bradykinin)
very important for permeability "pain" a conpound released in blood in some characteristics that causes contraction of smooth muscle and dilation of blood vessels
what is stage 1 process of hemostasis
vessel spasm, onset of injury to the vessel, immediate vasoconstriction of the vessel, which reduces blood flow, release factors such as TXA2 ( thromboxine A2)& nervous reflexes help with vasocontriction
Define autoimmunity and identify two examples.
when immune system can not distinguish btwn self and and non self immune system attacks self-antigens ex (lupus&celiac disease)
Explore defects in coagulation including disseminated intravascular coagulation (DIC). Discuss etiology, clinical manifestations, and treatment options of each.
widespread coagulation & bleeding , usually a result of complication of conditions such was a OB complication of conditions, trauma, infections & cancers, S/S-usually more related to bleeding ---petechiae, prupura, bleeding from puncture sites & secure hemorrhage, may treat bleed with fresh frozen plasma& platelets; may treat clotting w/heparin
define antibodies
y shaped portions secreted by B cells function as antigen receptors on immune cells that recognise forging substances
What is megablastic anemia?
enlarged RBCs caused by impaired nucleic acid synthesis-mcv greater than 100 (combalamin vit b12 def)
what is ingestion
enters thru oral contact cavity
what is inhalation
enters thru respiratory tract
what are normal ranges for erythrocytes
female (4-5.5 mil per cubic mm) Male (4.5 -6.2 mil per cubic mm)
Explore defects in coagulation including hemophilia A Discuss etiology, clinical manifestations, and treatment options of each.
free bleeders-x linked recessive disorder, primarily affects males, factor VII gene, mild moderate & severe cases, bleeding seen in soft tissues, GI tract joints and muscles, treat with factor VII replacement or DDAVP in mild cases
Discuss Major Histocompatibility Complex and its function in immunity and protection in transplant rejections.
group go genes that code for proteins found on surface of cells that immune system recognise forging substances rejection of transplanted organs is the main barrier of transplantation today, it occurs as a result of hurl & cell-mediated responses by the recipient to specific antigens present in donor tissue
what are different mediators released by WBC, plasma, and damged cells (prostaglandins)
group of lipids made at sites of tissue damage or infection that are involved in dealing with injury and illness
what is drug induced thrombocytopenia
herapin, Lovenox, quinine, quidine, sulfa-containing antibiotics
what is nosocomial
hospital acquired infection
Explore innate and adaptive immunity differentiating between the two types of adaptive immunity: humoral and cell-mediated immunity.
humoral& immunity- B cells provide protection & immunity is provided by antibodies or immunoglobulins primary response (antigen introduced to body then latent period before antigen is recognised by antibody) secondary response (memory cells responds immediately' antibodies "boost the system" cell mediated-t lymphocytes & macrophages proved immunity against certain viruses, bacteria & carriers that replicate INSIDE the cells where e they can't be destroyed by antibodies
what is type 1 hypersensitivity focusing on examples, mechanisms, of action of each, specific immunoglobulins or mediators present in each
immediate aka allergic rxns: hay fever, food allergies, brachial asthma, hives. systematic or anaphylactic rxns IgE mediated helper T & mast cells are unique. mast cells 1st on site release histamine
what is type 3 hypersensitivity focusing on examples, mechanisms, of action of each, specific immunoglobulins or mediators present in each
immune complex: free floating antigen + antibody circulating immune complex that causes damage when makes contact with vessel lining or deposits in tissues such as the kidneys (ex. autoimmune vasuclitis as is lupus
what are fomites
inanimate objects
what are different mediators released by WBC, plasma, and damged cells (histamine)
increase permeability of vessels, and constricts mouth muscle, muscle and brochioles
identify the causes of inflammation
increase vessels permeability, heat-vasolidation, rubor-vasolidation, donor (pain) nervous stimulation and swelling infections, immune rxns, trauma, surgery, cancer, physical &chemical agents such as frost bite, tissue necrosis
Define hypercoagulability
increased tendency of blood thrombus, normally healthy response tp bleeding for maintaining haemostatsis involves the formation of a stable clot also called coagulation
discuss myelomas
incurable B celll malignancy that results in malignant plasma cells, cells that produce monoclonal proteins which are abnormal Ig fragments, usually a large amount of osteoclasts seen in the bone marrow causing bone breakdown, severe bone pain (mostly back pain ) & nerve
what is the convalescent stage
infection controlled body processing to eliminate the pathogen, may last days, wks, or mo
What is zoonosis?
infections passed from animals to humans
what is non Hopkins lymphoma
B,T &K cells, chromosomal translocations chromosomes 14&18, some pathogens (HIV, Hep C,, H.pylori) middle age & older adults are 50% more frequent in men that women, enlarges painless lymph node often first sign, DX:lymph node biopsy, treat-chemo (CHOP) immunotherapy, radiation, surgery
Identify the immunoglobulin that is present during most allergic reactions.
IgE
Identify the immunoglobulin that is most abundant.
IgG
Identify the immunoglobulin that is usually the first to be formed by the newborn in response to an infection or the first to be present on the scene of an immune reaction.
IgM
Discuss the three phases of wound healing
inflammatory- critical period begins at time of injury go injury, prepares wound for healing and involving haemostats, vascular and cellular phases of inflammation proliferative- 2-3 days after injury building of new tissue to fill wound space which is epilthelization, main cell is the fibroblast , accumulation of collagen remodelling - 3 wks after injury may last up to 6 mo, continued collagen syntheses and remodelling of scar tissue
what is type 4 hypersensitivity focusing on examples, mechanisms, of action of each, specific immunoglobulins or mediators present in each
delayed cell-mediated : sensitised T cells attack antigen rather than antibody mediated attack, direct cell: viral rxns, certain molecules have to develop on the T cells despite prior exposure TB test & allergic contact dermatitis
what is hemolytic anemia
due to hemolysis, premature destruction of RBCs may be intravascular or extravascular may be inherted or acquired inherited- disorders of the RBC membrane caused by protein deficencies, hemoglobinpathies-sickle cell thallasemias, enzyme defects-G6PD acquired- cause by drugs, chemicals, toxins and infections, mechanical heart valves
what is acute lymphocytic (ALL) and acute myelogenos (AML) leukemias
cancers of the hematopoitic stem cells, both usually have sudden on set with S/S associated with decreased bone marrow function ALL seen more in children, AML more n adults, diagnosis made w/ bone marrow & blood studies
what is stage 5 of hemostasis
clot dissolution or lysis, plasmaniogen converts to plasma via tissue plasminogen activator (t-PA) plasma digest fibrin strands, clot dissolves
what is stage 4 of hemostasis
clot retraction, actin& myosin in the platelet contract, fibrin strands pull together toward the platelet squeezing the serum out the clot & causing the clot to shrink
define symptomatology
collection of the S/S the host expresses during disease also known as the "clinical picture" or "disease presentation"
what is primary immunodeficiency
congenital or inherited ex (Ig, B cell & T cells deficiencies)
what is type 2 hypersensitivity focusing on examples, mechanisms, of action of each, specific immunoglobulins or mediators present in each
cytotoxic: IgG or IOM attack antigens on cell surface , antigens on red or WBC mismatch transfusion rxn Rh incompatability & drug rxns
Explore HIV discussing the lymphocytes affected by the virus as well as the differences in categories of illness.
effects cd4 + helper T cells, macrophages & dendritic cells
