Exam 2 patho

Humoral steps in immunity

Bone Marrow B-Lymphocytes Antibodies Antigen

Primary Immunodeficiencies • Most are the result of a

single gene defect

B and T Lymphocytes-Cells that

specifically recognize and respond to foreign antigens (memory) • B cells--Humoral immunity • T cells--Cell-mediated immunity

Immunologic Mechanism Турe !

Турe ! Турe II Type II Type IV

• Secretory lymph organs

• pockets of lymphoid tissues around membranes of digestive, respiratory and urogenital tracts

Secondary Deficiencies • Also referred to as

acquired deficiencies

• IgA, IgM and newborn IgG develop shortly

after birth • Reach adult levels by 1 year of age

Type 1 hypersensitivity is an

allergic reaction that involves IgE and eosinophil activity which release histamine from mast cells, both H1 and H2.

Autoimmunity Group A strep throat-antigens on the bacteria mimic the antigens on the

heart, joints, skin and nervous system

• Secondary response-memory phase, rise in antibodies sooner and at a

higher level

IgE and eosinophils promote

histamine release from mast cells.

The nurse is assisting in administering immunizations as well as providing education to the clients who receive them at a health care clinic. Which statement by a client indicates that teaching was successful?

"Immunizations are a way to acquire immunity to a specific disease."

The nursing instructor is reviewing the plan of care with a nursing student who is caring for a client with an immune disorder, and they discuss the classes of human antibodies. Which statement by the nursing student indicates a need for further teaching?

"Immunoglobulin G (IgG) is the minor serum antibody."

The nursing student conducted a clinical conference on the role of B lymphocytes in the immune system. Which statement by a fellow nursing student indicates successful teaching?

"They produce antibodres.

Immunodeficiencies Secondary

(HIV/AIDS)

Immunodeficiencies Primary

(genetic)

Secondary lymphoid organs

(lymph nodes, spleen, secretory)

• IgE

-allergic reactions and defense against parasites

Type II reaction destroys

RBCS, lymphocytes and platelets

Type IV cell-mediated

Rash from poison ivy

Source of Antigen (Target)

1. Allergy 2. Autoimmunity 3. Alloimmunity 4. Immune Deficiency

Transplant Rejection • Major Histocompatibility Complexes =

= antigen presenting molecules, also called human leukocyte antigens

Immune Response • Fetal development

5 to 6 weeks

Type AB has no antibodies but has both

A and B antigens

Type O has antibodies against

A and B antigens, no antigens of its own

IgE

Active against parasites and important mediator of allergic responses

Type I IgE mediated

Anaphylaxis after being stung by a wasp

Allergy

Anaphylaxis after being stung by a wasp Rash from poison ivy

Type III hypersensitivity because

Antibody/Antigen complexes are deposited in the kidneys, brain, heart, lungs, GI tract, peritoneum, skin

Immune Response • Fetal development • Secondary lymphoid organs well develope at

Birth

Type II tissue specific

Blood transfusion reaction

Boalls Cells

Bone

Type A has antibodies against

B antigens and vice versa

creates antibodies, Do not kill Adaptive Immunity

B cell

Which cells are-Humoral immunity

B cells

Which cells produce antibodies?

B cells

extracellular microbes and toxins antibody-antigen complexes

B lymphocytes

The nurse is performing an assessment on a client who has been diagnosed with an allergy to latex. In determining the client's risk factors, the nurse should question the client about an allergy to which food item?

Bananas

Type IV

Cell-mediated

Active

Child does not develop Polio infection because he has been immunized against it Adult man does not develop another varicella infection because he had chickenpox as a child

Primary Immunodeficiencies • Five groups

Combined T and B cell deficiencies Antibody deficiencies Complement defects Phagocyte defects in number and function Innate immunity defects (candidiasis of the skin) Generally treated with replacement of the cell or stem cell transplant

• Acute

Days to months after transplant Cell-mediated response against unmatched HLA antigens (Type IV)

• B lymphocytes create antibody-antigen complexes leading to

neutralization or phagocytosis

The nurse has been assigned to care for a client with an immune disorder. In developing a plan of care for this client, the nurse incorporates knowledge that the immune system consists of specific major types of cells. Which types of cells are associated with the immune system? Select all that apply.

Dendritic cells B lymphocytes Helper T lymphocytes Cytolytic T lymphocytes

Primary Immunodeficiencies Examples:

DiGeorge syndrome

Alloimmunity = foreign tissue antigens

Directed against beneficial foreign tissues such as transplant or transfusion

• Effector Cells (Tc)-cytotoxic - CD-8+

Eliminate the antigen via apoptosis-cancer cells and viruses • Secrete cytokines to stimulating macrophages to increase phagocytosis

• Type 1 Hypersensitivity

Environmental antigens that cause atypical immunologic responses genetically predisposed individuals. IgE and eosinophils promote histamine release from mast cells. Pollens, molds, fungi, foods, animals, bee stings

Autoimmune inflammatory disorder

Formation of autoantibodies and immune complexes

Treatment for Immunodeficiencies

Gamma-globulin therapy • Transplantation or transfusion Treatment with soluble immune mediators Gene therapy

Antigens)

Guy BAD

antibodies formed from B lymphocytes

Humoral Immunity

Allergy

Hypersensitivity to environmental non-infectious substances

Туре I Нуpersensitivity

IgE mediated Against environmental antigens (allergens) • IgE binds to Fc receptors on surface of mast cells (cytotropic antibody) • Histamine release from mast cells • Hl and H2 receptors Antihistamines

• IgM can switch to

IgG

Rh- = forms

IgG antibodies against D antigen

Immunodeficiencies Antibiotic use is usually ineffective

True

Antibodies are usually of the

IgM class

Innate Immunity

Immediate The same (non-specific) Short-lived • No memory born with it

• Hyperacute

Immediate and rare Preexisting antibody to the HLA antigens of the transplanted tissue

Immunity Innate

Inflammation Vascular Cellular Acute Chronic Plasma-Derived Cellular (proteolytic) Leukocytes Clotting produce Kinin Arachidonic Metabolites Complement Fever Neutrophils Macrophages Platelets Mast Cells

• Maternal IgG protects

newborn for 6 months

Immune Deficiency

Insufficient protection against pathogens

T-cells

Kll

Alloimmunity

Liver transplant rejection Blood transfusion reaction

IgD

Low concentration in blood, surface receptor on developing B cells

promotes activity of T- lymphocytes

Lymph Nodes

Secondary Deficiencies Examples:

Malignancies Immunosuppressive therapy • AIDS

Autoimmunity = self-antigens

Misdirected against body's own cells

Chronic

Months or years Inflammatory damage to endothelial cells of vessels due to a weak cell-mediated reaction against minor HLA antigens

IgG

Most abundant class of Igs, transported via placenta

Ig A

Most abundant in body secretions (colostrum)

Passive

Neonate receives breastmilk from mother Adult woman does not develop infection because she was given Gamma globulin after being exposed to an infected person

IgM

Produced during primary response to antigen

Rh- mother forms antibodies against

Rh+ fetus that cross the placenta leading to hemolytic anemia of the newborn Treated with anti-D immunoglobulin (Rhogam)

Type III immune-complex- mediated

SLE

Autoimmunity

SLE, RA

(SLE)

Systemic lupus erythematosus Autoimmune Disease

Which lymphocytes direct most of the immune response?

T cells are direct fighters of foreign invaders and also produced cytokines, which are biological substances that help activate other parts of the immune system.

Adaptive Cellular

T-Lymphocytes T-regulatory cells T-effector Cells Regulate immune Kill microbes processes

Турe II

Tissue-specific

• ABO system

Two major carbohydrate antigens A and B (codominant)

Transplantation or transfusion is

Type 2 hypersensitivity and alloimmune reaction.

• Inflammation of heart valves, arthritis, nodules on skin, chorea--Type

Type II

• Type 1 Hypersensitivity Responses:

rhinitis, sneezing, anaphylaxis • Can be treated with clinical desensitization-minute quantities are injected at increasing doses over time.

Passive-antibodies

antibodies and T cells are transferred from a donor to a recipient

Type II is an immune response mounted against

antigen receptors on specific tissues such as the thyroid gland, platelets or red blood cells (hemolytic autoimmune anemia)

dendritic cells

antigen-presenting cells in the skin

Type 1 hypersensitivity Treatment

antihistamines.

Primary lymphoid organs

b cell and t cell (bone marrow and the thymus)

• IgG-protect against

bacterial and viral infections (maternal/child transfer), present in all body fluids, most abundant

Type III hypersensitivity when antigens circulate in the blood,

bind to antibodies then deposited in the kidneys

• B Lymphocytes Formed in

bone marrow

Antigens are substances foreign to the host that

can stimulate an immune response (immunogens). Bacteria Fungi Viruses Protozoa Parasites Nonmicrobial

Type 2 damages antigens and surrounding tissue via

complement-mediated lysis with antibodies, phagocytosis, neutrophil destruction, transplant rejection and causing receptors to malfunction.

(SLE) Treatment:

control symptoms • NSAIDS, glucocorticoids, immunosuppressants • Prevent exposure to ultraviolet light

Cytotoxic T cells

destroy pathogens and release chemicals called cytokines

T-cells

differenante 4 d Different types

Primary lymphoid organs (bone marrow and the thymus) : Provide

environment for immune cell production and maturation • Thymus Gland-produces mature, immunocompetent T-lymphocytes, but naïve

IgA-protects immunoglobulins found in

epithelial cells from degradation, prevents attachment of viruses to epithelium, present in saliva, tears, colostrum, and other secretions

• The antigen of a hypersensitivity reaction could be

exposure to environmental toxin or reactions to drugs, the body's own tissues or transplanted tissues

• IgM-1st immunoglobulin produced in

fetus, first produced during infection • IgM can switch to become IgG

MHC-2

forgein Invaders

B lymphocytes

form in the bone marrow and release antibodies that fight bacterial infections

Graft vs. Host disease =

graft has the antibodies against the cells of the host

Type 2 hypersensitivity can be

hyperacute, acute, or chronic.

Graft vs host disease is the

immune cells of the graft rejecting the host's cells.

• IgD-involved in

in B lymphocyte differentiation

MHC -1

in your body-Tagging our Own cells

• Memory Cells-remain

inactive until exposed to the same antigen, which then turns them into cytotoxic T cells (Tc)

Helper T lymphocytes

initiate immune response

• Hallmark is recurrent severe infections often with

opportunistic organisms, possibly multiple infections. • Pneumonia • Otitis media • Bronchitis Septicemia Meningitis • Invasive fungal infections • Failure to thrive due to chronic diarrhea and other chronic symptoms

(MALT)

passive Breast milk • Plasma cells secrete antibodies in tears, sweat, mucus, breast milk Prevents invasion and attachment of bacteria in the GI, GU, respiratory tracts

Rh blood group Rh+ =

presence of D antigen on blood cells (85%)

Secondary Deficiencies Far more common than

primary deficiencies

Secondary response

response-memory

Adaptive Immunity- Humoral Response • Primary response-takes

response-takes 1-2 weeks

Responses:

rhinitis, sneezing, anaphylaxis

Secondary lymphoid organs Function

to trap and process antigen and promote its interaction with mature immune cells

O blood type -no antigens so

universal donor, cannot receive

The nursing student conducting a clinical conference on immunity places an emphasis on active immunity. Which statement by fellow nursing students indicates successful teaching?

• 4. "Active immunity lasts for years and can be easily reactivated by a booster dose of antigen."

AIDS:

• Acquired Immunodeficiency Syndrome (AIDS) Secondary immunodeficiency

T Lymphocytes-formed in bone marrow and mature in the thymus gland they also do what

• Activate other T cells and B cells • Control intracellular viral infections • Reject foreign tissue grafts • Activate autoimmune processes • Active delayed hypersensitivity reactions

Active.

• Active-direct exposure to the antigen, immunization

Transfusion Reactions

• Antibodies against blood group antigens • Leads to agglutination or complement-mediated lysis

• Regulatory Cells (Treg)

• Assist in orchestrating, controlling and limiting the immune response autoimmune occurs

Autoimmunity

• Breakdown of tolerance • Body recognizes self-antigens as foreign • Can be triggered by infectious agent

HIV: Retrovirus

• Carries genetic info in RNA vs DNA form • Must attach to host cell to replicate by changing RNA into DNA via enzyme reverse transcriptase

• Defends against intracellular microbes such as viruses

• Cell-Mediated Cellular Immunity--T lymphocytes

• Helper cells (Th)ECD4+

• Differentiates into T cells that produce cytokines or regulatory cells that control the immune response • Help to develop Tc and B cells, activate macrophages, form T-regulatory cells (Treg)

Alloimmunity

• Directed against beneficial foreign tissues such as transplant transfusion, foreign tissue antigens

Humoral Response

• Driven by antibodies produced by mature B Lymphocytes

• Type 1 Hypersensitivity

• Environmental antigens that cause atypical immunologic responses in genetically predisposed individuals.

Spleen

• Filters antigens from blood • Important in systemic infections

Secondary lymphoid organs • Lymph Nodes do

• Found along axillae, groin, great vessels, neck, thorax, abdomen • Remove foreign material from lymph before it enters the blood stream • Proliferates and promotes activity of T- lymphocytes

Type of infection can lead to diagnosis of type of deficiency

• Gonorrhea suggests complement deficiency • Viral infections suggest T cell deficiency

HIV:

• Human Immunodeficiency Virus (HIV) Bloodborne pathogen • Infects and destroys the CD4+ T helper (Th) cells • CD4+ needed for development of B and T cells

• Transplant rejection classified according to time

• Hyperacute • Acute • Chronic

Allergy = environmental antigens

• Hypersensitivity to environmental non-infectious substances

Турe !

• IgE mediated

Type II

• Immune complex mediated

Alloimmunity

• Immune system reacts with antigens on the tissue of another individual • Transfusion reactions Transplant rejection

• Major Histocompatibility Complexes

• MHC 1 responds to endogenous cells that are injured or infected • MHC 2 responds to exogenous antigens

• Accessory cells

• Macrophages and dendritic • Function as antigen- presenting cells (APCS) by the processing of a complex antigen into epitopes required for the activation of lymphocytes

B lymphocytes

• Mediated by molecules in the blood • The principal defense against extracellular microbes and toxins • Create antibody-antigen complexes

• Cell-Mediated Immunity or Cellular Immunity-T lymphocytes

• Mediated by specific T lymphocytes • Defends against intracellular microbes such as viruses

Autoimmunity

• Misdirected against body's own cells, self-antigens

MALT

• Mucosal Associated Lymphoid Tissue (MALT)

• Other conditions associated with secondary deficiencies

• Normal conditions (pregnancy, infancy, aging) Psychological stress • Dietary insufficiencies • Infections Malignancies and treatment Physical trauma (burns) • Medical treatment Diseases (diabetes alcoholism sickle cell SI E Trisomy 21 and ot+her chromosomal ahnormalities)

• Autoantibodies against-self antigens:

• Nucleic acids, erythrocytes, coagulation proteins, phospholipids, lymphocytes, platelets, etc.

Mother to fetus, in breast milk Immunotherapy Immunoglobulins laced with antigens

• Passive-antibodies

• Type 1 Hypersensitivity would be

• Pollens, molds, fungi, foods, animals, bee stings

• Antibodies-recognize antigens

• Receptors on immune cells • Secreted proteins Formed from B cells

Immunodeficiencies

• Result of impaired function of T cells, B cells, phagocytes and/or complement

Adaptive Immunity Response

• Slow • Specific • Long-term • Memory

Cell-mediated immunity

• T Cell

Autoimmunity • Can be triggered by infectious agent

• Type 1 diabetes Multiple sclerosis • Rheumatoid arthritis • Rheumatic fever

Autoimmunity • Can be triggered by infectious agent like

• Type 1 diabetes Multiple sclerosis • Rheumatoid arthritis • Rheumatic fever

Evaluation of Immunity

•Complete blood count (CBC) with a differential Subpopulations of lymphocytes Quantitative determination of immunoglobulins Subpopulations of immunoglobulins Assay for total complement • Skin tests