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NURS 505


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Humoral immunity is a function of what?
B lymphocytes
When B lymphocytes encounter an antigen they do what?
Differentiate into plasma cells that secrete antibodies (immunoglobulins)
Where are immunoglobulins found?
Circulating everywhere in all the bodily fluids
What is the function of cytotoxic T cells and they are involved in what type of immunity?
They are involved in direct cell-cell contact and killing, they are involved in cell mediated immunity
What do cytotoxic T cells produce that kill the infected cell?
What do immunoglobulins do?
Recognize antigens and bind to them, also bind to phagocytes
When immunoglobulins bind to a phagocyte via their Fc portion this is an example of what?
Antigen-antibody complexes activate what and what does this do?
Complement and it is a chemoattractant to phagocytes (helps to kill)
What is the most commonly found antibody?
What types of properities does IgG have?
Antiviral, antitoxin, and antibacterial
What is the only antibody that crosses the placenta and why is this important?
IgG and this gives the newborn some protection against the environment when it is born, it lasts about 6 months after birth.
IgG acts as an opsonin how?
By binidng to the phagocytes via the Fc receptor
What is gammaglobulin?
A mixture of all the different IgG antibodies found in the blood.
What can gammaglobulin be used for?
It can be injected to impart immunity to an immunodeficient patient.
What is the first antibody present in the plasma in response to an antigen?
What antibody is responsible for the ABO blood incompatibilities?
IgM bound to an antigen activates what?
What is the first antibody produced by the newborn?
What antibody is found primarily in bodily secretions? (Saliva, nasal and respiratory secretions, breast milk)
What antibody is found on most epithelial surfaces in the GI and GU tract?
Which antibody is a major component of the barrier that prevents bacterial invasion?
What antibody binds to mast cells?
What antibody is involved in parasitic infections, allergies, and hypersensitivity reactions?
Where is IgD found and what is its purpose?
On the cell membrane of B lymphocytes, and it serves as a receptor.
What is IgD required for?
The maturation of B lymphocytes
What is the function of the thymus?
During fetal development and through early childhood it provides immunocompetent T lymphocytes for all other lymphoid tissues
What is red pulp?
Erytrocyte storage and disposal.
What is white pulp?
Large collection of lymphoid tissue (B and T cells, and macrophages)
What removes the antigen-antibody complexes?
Spleen and liver
Lymph nodes contain what?
B and T cells, as well as macrophages and plasma cells.
Where are B lymphocytes "programmed"?
Lymph nodes
What is the function of the lymph nodes?
To filter lymph (interstial fluid filtered out of the blood)
Where is humoral immunity usually initiated?
Lymph nodes
Lymphadenopathy is what and is an indication of what?
Swollen lymph nodes and it is the first indication of the immune response.
What is the purpose of the MALT system?
To secrete antibodies onto the mucosal surface to participate in the barrier against bacterial invasion.
Innate or nonspecific immunity
Your natural resistance to disease, dependent on heredity, age, overall health, species, race and sex.
Acquired or specific immunity
used to describe the protection gained through exposure to an antigen or through the transfer of protective antibodies. (injection of immunoglobulins, or IgA in breast milk)
The administration of an antigen through vaccinatino with the purpose of achieveing a specific immunity.
Active immunity is acquired from where?
Immunization or actually having the disease
Passive immunity is acquired from where?
Gammaglobulins injections, IgA in breast milk, IgG crossing the placenta
With humoral immunity with initial exposure to the antigen how long does it take for immunoglobulins to appear in the serum?
Few days to weeks.
Why does it take time for immunoglobulins to appear in the serum?
Time is required for activation of B lymphocytes, activation of helper T cells, proliferation of activated B lymphocytes, and differentiation into sufficient numbers to plasma cells that secrete a specific class of antibody.
How long does it take for cell mediated immunity to ward off an invader?
Up to 10 days.
What fails in transient hypogammaglobulinemia?
The B lymphocytes do not differentiate into plasma cells because help from the helper T cells is deficient so there is no cytokine production.
True or False...
The number of B and T cells are normal is transient hypogammaglobulinemia
True, the numbers are normal but the functioning of the T cells is deficient meaning the number of plasma cells is low.
What do patients with transient hypogammablobulinemia normally present with?
About 6 months of age they start to present with repeated bouts of upper respiratory and middle ear infections.
In transient hypogammablobulinemia the germinal centers in lymph tissue are what?
Reduced or absent
When does transient hypogammaglobulinemia normally resolve and why?
2-4 years of age, and the reason is unknown
Are viral infections a problem in children with transient hypogammaglobulinemia?
No which indicates that there are some functions helper T cells.
X-Linked agammaglobulinemia is primarily a deficiency of what?
B cells.
X-linked agammaglobulinemia is what kind of trait and found in who?
Recessive and only in males
What are the serum levels in X-linked agammaglobulinemia?
Patients with agammaglobulinemia are susceptible to what types of infections?
Bacterial (Meningitis, recurrent ear, sinus and pulmonary infections)
X-linked ammaglobulinemia prevents the development of what?
Mature B lymphocytes and plasma cells
True or false...

In X-linked agammablobulinemia T lymphocytes are present in normal numbers but they do not function correctly
False... they are present in normal numbers and they function properly.
In agammaglobulinemia the germinal centers in lymphoid tissue are ____
In agammaglobulinemia patient's are able to clear viral and protozoal infections why?
Because the cytotoxic, and helper T cell function is normal.
What therapy is avaliable for patients with agammaglobulinemia?
Administration of gammaglobulin and appropriate antibotics
What disorder is present in common variable immunodeficiency?
B cells fail to differentiate into plasma cells.
What is the numbers of antibodies in common variable immunodeficiency?
Marked reduction but still present
What is the number of B cells in common variable immunodeficiency? (High, Normal, Low)
When is the onset of common variable immunodeficiency and who is it seen in?
15-35 years of age, and both males and females
What is the treatment for common variable immunodeficiency?
Same as agammaglbulinemia, administration of gammaglobulin and antibiotics.
Why are T-cell immunodeficiencies much rarer than B-cell immunodeficiencies?
Because they are much more severe and the patients usually do not survive very long.
What does DiGeorge syndrome normally result from?
Partial or total lack of development of the thymus during fetal development
What does DiGeorge syndrome result in?
Lack of immunocompotent T lymphocytes.
IgG levels are low in DiGeorge Syndrome because?
Lack of helper T cells
The lack of T lymphocytes in DiGeorge syndrome results in a deficient immune response in which type?
What types of infection are patients with DiGeorge Syndrome at risk for.
All types of infections
Number of B cells is normal in DiGeorge Syndrome but the number of plasma cells is low, why?
Because there are no helper T cells with cytokines.
For children that survive the neonatal period in DiGeorge Syndrome what are some treatment options?
Thymus transplantation, or a bone marrow transplant.
What is a secondary T cell immunodeficiency and what is an example?
Depletion of the T cell population because of an acute viral infection. Classic example is HIV
What do most primary disorders of the complement system involve?
One or more of the distinct complement proteins.
What is the defincieny in Primary complement deficiencies?
Formation of the proper component or the compononent is defective
In primary complement deficiencies symptomes may be mild to severe why?
It depends on which complement is deficient to how the symptoms are going to be manifested.
What types of infections does primary complement deficiencies make patients susceptible to?
Bacterial infections, the inflammatory response is surpressed
What is the secondary complement deficiency normally due to?
Severe liver disease/illness
Where are complement proteins made?
the liver
With acute infections what happens to the serum level of complement and why?
It is depleted or used up because it happens faster than the liver can make complement
Patients with disorders of phagocytosis are prone to what types of infections?
Bacterial and fungal
List three secondary disorders of phagocytosis and how they effect it.
Lack of opsonins- either a complement deficiency, or an immunoglobulin deficiency
Corticosteroid and cyclosporine administration- inhibit inflammation and thus phagocytosis
Diabetes- due to altered chemotaxis
What is Chediak-Higashi a type of?
Primary disorder of Phagocytosis
How is Chediak-Higashi passed?
Inherited as an autosomal recessive trait
In chediak-higashi what happens with the phagocytes?
They internalize the pathogen but can't digest them and phagocytes exhibt poor mobility.
What infections are children with chediak-higashi susceptible for?
Repeated cutaneous and respiratory infections
Chediak-Higashi syndrome, and DiGeorge Syndrome can sometimes be treated with what?
Stem cell transplantation from an unaffected donor
Where can stem cells be collected from?
Whole blood, bone marrow, and umbilical cord blood
Hypersensitivity disorders
An immune response to antigens that produce inflammation that can cause unwanted tissue injury.
Hypersensitivity reactions can come from ________ ________, or in reaction to _________ _________
autoimmune diseases, foregin antigens
Type I hypersensitivity
Allergy, including anaphylaxis
Type II hypersensitivity
cytotoxic hypersensitiy, antibody mediated mechanisms
Type III hypersensitivity
Immune complex disease (Anitgen-antibody complexes)
Type IV Hypersensitivity
Cell mediated
What is the most common and immediate of the hypersensitivity reactions?
Type I- Allergy
How long does it take the immune system to response in a Type I hypersensitivity reaction?
Within minutes
Where does Type I hypersensitivity occur?
Organs exposed to the enviornment, GI, skin, and respiratory systems.
List two antigens that can be responsible for a Type I hypersensitivity reaction
Pollen, food, animal dander, insect bites/stings
The process by which IgE binds to a mast cell and becomes a receptor for the mast cell.
In a type I hypersensitivity what happens with reexposure to the antigen?
It combines with the IgE bound on the mast cell and the mast cell release secretory vesicles including histamine
In type I hypersensitivity what do the potent inflammatory mediators do?
Increase mucus secretion, vasodilation, increased vascular permeability, edema, and contraction of the airway smooth muscle
What are two examples of type I hypersensitivity
Asthma, anaphylaxis, hay fever, and allergic dermatitis.
What distinguishes anaphylaxis from hay fever is the mechanism is the same?
Anaphylaxis is systemic where hay fever is localized.
What is an example of Type II cytotoxic hypersensitivity?
Blood transfusion reactions.
What antibody is involved in blood transfusion reactions?
In type II hypersensitivity what happens when a drugs binds to an erytrocyte?
An antibody binds to the cells and the cell is destructed.
The destruction of red blood cells in Type II hypersensitivity results in a form of what anemia?
hemolytic anemia
What is the name of a disease that can cause a Type II hypersensitivity reaction?
Goodpasture's disease, myasthenia gravis, and Grave's disease
the immune system recognizes self antigens as foreign
Who is genetically predisposed to autoimmune diseases?
Females more than males and the elderly.
What may alter our own antigens to make our body recognize them as foreign?
Viruses, or other environmental stimuli

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