Immune disorders

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  1. Inflammation cells
    leukocytes respond neutrophils, monocytes, eosinophils, basophils.
  2. antibody-mediated immunity cells?
    Humor=body fluid
    B-lymphocytes, plasma cell, Memory cells
  3. cell-mediated immunity cells?
    T-lymophocyte helper/inducer, cytotoxic NKC: natural killer cell.
  4. Manifestations of inflammation? and focused labs?
    • Warmth, redness, swelling, pain, decrease in function.
    • Labs focused: C-reactive protein,ESR, WBC differential-basophils.
  5. Antibody mediated immunity, AKA: Humoral immunity. Activation?
    • Antibody-antigen interactions
    • Antibodies produced by B-lymphocytes: memory cells, B cells recognize antigens circulating in the lymph or blood-they bind and a costimulator such as helper T-cell or interleukin will help to active the B cell and cause it to proliferate.
    • B-cells proliferate: creating plasma cells that carry antibodies.
    • Created from pluripotent cells from bone marrow=mature in spleen and present in lymph nodes, tonsils, peyers patches of intestine. 
  6. 5 types of antibodies? presence in the blood?
    • Made from globular proteins-Immunoglobulin
    • IgA: 10%-15% found in serum, saliva, bowel fluid, breast milk. Breast milk protects Baby GI tract from viral and bacterial infect. 
    • IgD: 1% present on memory B cell and induces antibody production
    • IgE: <1% Related to immunity reactions to parasites or allergies
    • IgG: 70%-75% main antibody in blood-only one that goes across placenta and protects baby up to 2 weeks after birth. 
    • IgM: 10% made of 5 antibodies-key role in initial immune system, found in blood.
  7. Natural active immunity? causes?
    Experiences the disease-creating antibodies
  8. artificial active immunity? causes?
    Vaccinations teach the body without experiencing the disease.
  9. Passive immunity? Causes?
    • Mother to fetus: breast feeding, IgG/IgA
    • Treatment for rabies or snack bite is similar
  10. Cell mediated immunity, activation?
    • Antigen presenting cell to T-cell-CMI mainly involves T-cells that respond to any cell presenting MHC markers=including invaded cells by pathogens, tumor cells and "transplanted cell"
    • Influences and regulates AMI
    • Regulates inflammation by producing and releasing cytokines
    • Controls T-cells and NKC
  11. NKC-Natural Killer Cells
    • Cytotoxic lymphocyte of innate immune system. Controls several types of tumors and microbial growth by limiting their spread and tissue damage.
    • Can recognize stressed cells without antibody markers. 
  12. Suppressor T-cells: T8
    Prevention?
    • Prevents over-reactivity of immune system
    • balances helper T-cell
  13. Deficiency of T8 suppressor cell, leads to?
    • Hypersensitivity and allergic reactions.
    • Can be mild
    • or 
    • life threatening.
  14. Allergy testing, Blood tests used when skin testing is not an option.
    • Allergens and controls placed on skin.
    • corticosteroids & histamines must be stopped 4 weeks prior to testing.
  15. Desensitization therapy? what is it?
    • Allergy shots: SC shots-small amounts of allergens-takes up to 5 years of treatment.
    • Trains IgG to bind to allergen before IgE can bind and produce allergic response. 
  16. Reasons for an under-reactive immune system?
    • HIV
    • Malnutrition
    • Neutropenia
    • Corticosteroids
  17. Malnutrition and underactive immune system?
    Focused labs?
    • Proteins for immunoglobulin production
    • Albumin levels to adequately control osmotic pressure
    • iron, folic acid, B12 for RBC
    • Copper for neutrophil production
    • Labs: Total Protein, Albumin, Prealbumin, CBC w/diff, cholesterol levels.
  18. Neutropenia? Labs?
    • Low neutrophils-prone to infection
    • Neutrophil+bands, Absolute count
    • Symptoms of neutropenic infection: Fever, cultures may not show source. Absolute neutrophil count less than 1000.
  19. Neutropenic precautions? for patient/ nurse.
    • hand washing
    • mask
    • no water or ice from machine
    • low bacteria diet( no raw foods)
    • Do not change pet litter box
    • avoid crowds
  20. Corticosteroids and immune deficiency? 
    Labs focused?
    • inhibit movement of neutrophils/monocytes
    • keeps T-cells in bone marrow causing less circulating T-cells in blood.
    • Interferes with IgG production reducing AMI. 
    • Labs:Glucose, sodium, potassium, WBC, Calcium.
  21. HIV and CD4 cell deficiency?
    • HIV hijacks the CD4 lymphocytes which is responsible for organizing squads of WBCs.
    • Turns helper T-cells into HIV factories.
    • Over time: causes lymphocytopenia-and increases risk of opportunistic infections.
  22. Acute phase of HIV infection? Focused labs?
    Kaposi's sarcoma is an opportunist infection.
    • 50-90% acute infection within 4 weeks
    • takes up to 3weeks-3 months to create antibodies.
    • Labs: Lymphocyte counts, viral load, 4th gen HIV tests, P24antigen, CD4/T-cell count. Antibody tests-western blot, ELISA.
  23. HIV treatments?
    • Antiretrovirals
    • Protease inhibitors
    • fusion inhibitors
    • Non and nucleoside analog reverse transcriptase inhibitors.
  24. HIV treatment of opportunistic infections?
    • Yeast: Diflucan (fluconazole)
    • MAC, Tb: Rifadin (rifampin), INH, Biaxin, Zithromax
    • Herpes: Zovirax (acyclovir)
    • Crytosporidiosis, giardiasis : Flagyl (metronidazole)
    • Pneumocystis carinii pneumonia: Bactrim/ Septra
  25. TCCells, subset of suppressor cells. What does it do?
    • Destroy cells that contain a processed antigen
    • Most effective against self-cells infected by parasites: such as viruses & protozoa.Cause infected cell to lyse & die
  26. hygiene hypothesis?
    Body develops an overactive stimuli to allergic diseases because of lack of early exposure to infectious agents as a child. Allergies are more common in developed countries due to this. 
  27. Rheumatoid arthritis? because of what?
    caused by RF made by our IgG and IgM that attack healthy tissue. forms immune complexes-activates cytokines that cause inflammation and damage joints
  28. Early treatment for RA
    • NSAIDS
    • Exercise program
    • Elevate affected body part
    • Energy conservation
    • Stress managment
  29. Disease modifying anti-rheumatic drugs slow progression? examples?
    • Plaquenil (hydroxychloroquine) anti-malarial, anti-inflammatory properties
    • Azulfidine (sulfasalazine) inhibits prostaglandin synthesis; used for those intolerant of NSAIDS
    • Minocin (minocycline) tetracycline family-- Off label
    • Methotrexate immunosuppressant
  30. Autoimmune disorders? Lab focused?
    • CBC: for white blood cell suppression, anemia, increased platelets
    • ESR & CRP: increased in inflammatory diseases (unspecified)
    • Rheumatoid Factor: positive or increased in RA & other connective tissue disorders (CTD)
    • ANA: antinuclear antibody measures titer of unusual antibodies that destroy the nuclei of cells & cause tissue death
    • Complement C3 and C4: and complement total looks at the proteins that act as enzymes that aid in immune and inflammatory response
    • Albumin: decreased in chronic inflammation/infection
  31. Adipose and Arthritis?
    Excess weight increases inflammation.
    Inflammatory chemicals from fat such as cytokines and adipokines-promote joint inflammation.


    Other cytokines released from fat: Tumor necrosis factor alpha(TNF-alpha)-causes cancer.
  32. Lupus? autoimmune disorder: butterfly rash
    Treatment?
    • S/S:arthalgia, fatigue, malaise, wt loss, fever, joint involvement.
    • prevent skin infections
    • Prevent organ damage by preventing disease process-pharm.
  33. Hyperacute rejection? ABO incompatibility
    • Antigen-antibody complexes activate clotting cascade.
    • Can lead to acute rejection of organ transplant
    • CMI causes Tc-Cells and NK cells to penetrate the organ, start an inflammatory response, cause lysis of organ cells
  34. Chronic rejection?
    leads to chronic inflammation and scarring which leads to chronic ischemia. leading to organ rejections/ failure.
  35. Organ transplant info?
    • immunosuppressive medications
    • diet-low sodium
    • S/S of infection-teaching
    • S/S of rejection: fever, fatigue, SOB, tenderness, decreased urine output.
  36. MHC protein: Major Histocompatability complex
    set of cell surface proteins that are essential for the cell mediated immunity in recognizing foreign molecules.
  37. Lab Value interpretation
    CD4+ (NR: 332-1642)
    Value: 125 cells/mm^3
    HIV takes over CD4+ cells and turns them into "HIV factories". A low CD4+ value helps to confirm HIV infection
  38. Lab Value interpretation
    Comp C3 (NR: 83-177)
    Value: 250 mg/dL
    Comp C4 (NR: 12-36)
    Value: 78 mg/dL
    • Complement system in immunology are proteins that move freely through your bloodstream and play a role in the development of inflammation.
    • C3 & C4 are the most commonly checked and High values indicate autoimmune disorders
  39. Lab value interpretation.
    what does a high eosinophil count indicate?
    Eosinophils are present in allergic reactions.
  40. Lab value interpretation
    Neutrophils (NR: 43-75)
    Value: % 17
    Bands (NR: 3)
    Value: 7
    Neutropenia, bands indicate immature neutrophils.
  41. Kalestra=hyperglycemia
  42. yeast is found in Heb B vaccine
  43. ANA is used to assess autoimmune disorders
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Immune disorders
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