-
nonspecific
- innate immunity
- 1st line
- 2nd line
-
specific
- adaptive immunity
- granulocytes increase
- neutrophils - bacteria (shift to the left)
- eosinophils - allergy (hypersensitivity), parasitic
- lymphocytes - viral
-
inflammation
- blood/WBCs to local area
- neutralize/destroy invader
- initiate repair
- s/s - heat, swelling, pain, redness
-
chemical mediators
- histamine - triggers inflammatory response (Benadryl)
- leukotriene - allergies/asthma (Singular)
- bradykinin - pain
- complement - 20 proteins
- prostaglandin - pain (Advil)
-
histamines
- released by mast cells (resp/GI)
- s/s sneezing, itchiness, runny eyes, nasal congestion
- H1 histamine - respiratory (Benadryl)
- H2 histamine - stomach acid (Zantac)
-
lymph system
- spleen - destroys old RBC's
- thymus - decrease as we age
- bone marrow - produce blood cells
-
myeloid line
- -----reticulocyte (nucleus)
- -----------erythrocyte (no nucleus)
- -----leukocytes (neutro, eosino, baso, monocytes)
- -----thrombocytes
-
lymphoid line
- -----lymphocytes
- ---------plasma cells
- ------------B cells (humural/antibodies/Type 1)
- ------------T cells (cellular/viral/Type 4)
-
self recognition
- HLA - human leukocyte antigen - proteins on self cells
- antigen - nonself
-
humural
- B-lymphocytes
- mature in bone marrow
- develop antibodies (immunoglobulins)
- requires protein - need good diet, liver
- first exposure causes antibodies to be created
-
cellular
- T-lymphocytes
- mature in thymus
- attacks antigen directly
-
T-helper
- CD4
- "on swicth"
- activate T and B cells (via cytokines)
- attacked by HIV
- must > 500 - s/b 500-1500
-
T-suppress
- "off switch"
- deactivates T and B cells
-
-
IgG
- most abundant of all antibodies
- neutralizes toxins
- enhances phagocytosis
- only antibody transferred from mom to fetus
-
IgM
first antibody released after exposure to antigen
-
IgE
- found on surface of basophils and mast cells
- cause massive release of histamine when exposed to antigen
- Type 1 hypersensitivity
-
active immunity
- you get the antigen and develop antibodies
- natural - you get sick
- artificial - you get a vaccine
-
passive immunity
- you get antibodies from somewhere else
- natural - from mom
- artificial - immunogloubin IV/IM
-
abnormal immune responses
- hyperresponsiveness - overreacts (allergies)
- --autoimmunity - failure to recognize self - attacks self (more in females d/t estrogen)
- --allergies
- --transplant reactions
- immunodeficiency
- --AIDS (CD4 < 200)
- --Cancer
-
Type 1 hypersensitivity
- allergies/anaphylaxis
- immediate reaction
- IgE mediated
- antigen = allergen
- chemical mediators: histamine, leukotrienes, prostaglandins
- permeable capillary membranes (edema)
- bronchoconstriction (airway - EPI)
- vasodilation - (decreased BP, decreased cardiac output - EPI)
- 1. Epi SQ or IV (must be slow)
- 2. O2
- 3. fluids (increase cardiac output)
- 4. benadryl/zantac (block histamines)
- 5. prednisone (block immune response)
-
Type 2 hypersensitivity
- tissue specific
- transfusion reactions
- hemolytic anemia - body breaks down RBCs (PCN, sulfa)
- IgG or IgM mediated
- remove problem to treat
- airway (if issues)
- limit hemolysis (stop transfusion)
- give benadryl/prednisone
-
Type 3 hypersensitivity
- immune complex - combinations of antigens and antibodies that do not get cleared from circulation
- ex: post strep glomerular nephritis, lupus
- maintain kidney function
- benadryl/prednisone
-
Type 4 hypersensitivity
- delayed reaction 48-72 hours
- T-cell mediated
- ex: contact dermatitis, PPD
- benadryl/prednisone
-
Allergy Diagnostics
- allergy testing
- complement assay - low = immune system problems
- RAST - IgE blood test (allergies)
- WBC/diff - increased eosinophils
- Type and cross - prevent Type 2 reaction
- immune complex assays - Type 3
- Coombs - blood type
-
**Pharm**
- sympathomimetic agents - epi
- mucolytics - expectorants - drink water
- antihistamines - Benadryl
- leukotriene inhibitors - Singulair
-
allergy shots
- small amounts of allergy to develop tolerance
- monitor pt for a while - epi/albuterol nearby
-
organ transplant
- (Type 2 reaction possible)
- skin
- cornea
- bone
- kidney
- lungs
- heart
- bone marrow
-
transplant categories
- isograft - donor and recipient identical twins
- autograft - self-transplant
- allograft - same species (different genotype and HLA)
- xenograft - animal to human
-
**prednisone**
- hyperglycemia
- osteoporosis
- lipid redistribution (moon face/buffalo hump)
- water/sodium retention
- HTN
- risk for infection
- delayed wound healing
-
donor criteria
- brain dead
- <70
- no IV drug use
- free of systemic disease
- organ removed and preserved right after death
-
organ rejection
- host fights graft
- s/s - fever, redness, inflammation, pain, labs
- hyperacute - immediate - < 4 days - poor prognosis
- acute - < 4 months - best prognosis
- chronic - > 4 months - poor prognosis with chronic decline
-
graft vs host disease
- graft fights host
- BMT complication
- cellular immune response
- Ab attacks liver, skin, GI
- s/s: nausea, abd pain, DHR, rash, increased AST/ALT
- acute GVHD - within 100 days
- chronic GVHD - after 100 days
-
pre-transplant
- blood type/Rh factor
- crossmatch
- HLA histocompatibility
- MLC assay - lymphocyte matching
- Ultrasound/MRI
- meds: antibiotics/antivirals to prevent infection (Bactrim, Acyclovir)
-
post-transplant
- Ultrasound/MRI
- tissue biopsy - signs of rejection
- corticosteroids/prednisone
- Cyclosporine - anti-rejection med
- --nephrotoxic - monitor BUN/Creat, K+
- --no grapefruit juice
- --monitor serum levels for toxicity
- Imuran - anti-rejection med
- --hepatotoxic - monitor ALT/AST
- Cellcept - anti-rejection med
- **monitor WBC - will run low (4-6)**
- **watch for low grade fever - muted symptoms of infection - cannot mount inflammatory response**
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