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