Immune Disorders Test 3 PDF

**Normal Immune Response** - Immunity: the body's ability to resist disease. There are three functions that immunity serves\... - Defense: the body protects against invasions by microorganisms and prevents the development of infection by attacking foreign antigens and p...

**Normal Immune Response** - Immunity: the body's ability to resist disease. There are three functions that immunity serves\... - Defense: the body protects against invasions by microorganisms and prevents the development of infection by attacking foreign antigens and pathogens - Homeostasis: damaged cellular substances are digested and removed. Through this mechanism, the body's different cell types stay uniform and unchanged. - Surveillance: mutations continually arise. They are recognized as foreign and cells destroyed - There are two different types of immunity: innate and acquired. - Innate: is when the immunity is present at birth which involves a nonspecific response. These cells respond within minutes to an invading pathogen without prior exposure to that organism. - Acquired: is developed either passively or actively. **Types of acquired specific immunity** ---------------------------- ------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------- **Type** **[Natural ]** **[Artificial ]** **[Active ]** Natural contact with antigen through actual infections like chicken pox Immunization with antigens like the vaccine for chicken pox **[Passive ]** Transplacental and colostrum transfer from mother to child Injections of serum with antibodies from 1 person to another person who does not have antibodies **Altered Immune Response** - Immunocompetence is when the body's immune system can identify and inactive or destroy foreign substances. When the immune system is incompetent or under responsive, severe infections, cancers, and immunodeficiency diseases may occur. When the immune system overreacts, **[hypersensitivity]** disorders such as allergies and autoimmune diseases may develop. - Hypersensitivity reactions: when the immune system overreacts against the foreign antigens or reacts against its own tissue, it can begin destroying its own tissues (tissue damage). **[Autoimmune disease is a type of hypersensitivity response, occurs when the body does not recognize self-proteins and reacts against self-antigens. We classify these reactions by the source of the antigen, time sequence or immunologic mechanism causing the injury. There are 4 types]**. - Types 1, 2, and 3 are immediate and are examples of humoral immunity. - Type 4 is a delayed reaction r/t cell-mediated immunity +-----------------+-----------------+-----------------+-----------------+ | **Type I: | **Type II: | **Type III: | **Type IV: | | IgE-Mediated | Cytotoxic and | Immune-Complex | Delayed | | reactions** | Cytolytic | Reactions** | Hypersensitivit | | | reactions** | | y | | | | | reactions** | +=================+=================+=================+=================+ | - Allergic | - These | - when your | - It takes | | reaction | reactions | body's | 24-48 hours | | that | involve the | immune | for a | | happens | direct | system | response to | | when your | binding of | creates | occur. | | immune | IgG and IgM | \"clumps\" | Contact | | system | antibodies | of | dermatitis | | overreacts | to an | antibodies | is one | | to | antigen on | and foreign | example of | | something | the cell | particles | this | | that\'s | surface. | (like | reaction | | usually | | bacteria or | | | harmless, | - Pathophysio | other | - Contact | | like | logic | harmful | dermatitis: | | pollen, | disorders | stuff), and | the most | | dust, or | characteris | these | common | | certain | tic | clumps get | antigenic | | foods. | of type II | stuck in | substances | | | reactions | different | are metal | | - **Sensitiza | includes | parts of | compounds, | | tion**: | ABO | your body, | rubber | | The first | incompatibi | causing | compounds, | | time your | lity | problems. | poison ivy, | | body | transfusion | | poison oak, | | encounters | reaction, | - Common | and poison | | an allergen | Rh | diseases | sumac, | | (like | incompatibi | related to | cosmetic | | pollen), | lity | Type 3 | and some | | your immune | transfusion | reactions | dyes. | | system | reactions, | include | | | mistakenly | etc. | conditions | - The | | thinks | | like lupus | involved | | it\'s | - Hemolytic | or | area | | harmful. | transfusion | rheumatoid | itches, may | | So, your | reactions: | arthritis, | burn or | | body | when your | where | sting and | | produces a | body | immune | when it | | special | attacks and | complexes | becomes | | antibody | destroys | build up in | chronic, | | called IgE. | red blood | the body | lesions | | This IgE | cells from | and cause | resemble | | attaches to | a blood | chronic | atopic | | certain | transfusion | inflammatio | dermatitis | | cells in | because the | n. | because | | your body | blood you | | they are | | called | received is | | thickened, | | **mast | not a good | | scaly, and | | cells** and | match for | | lichenified | | **basophils | your own | |. | | **, | blood type. | | The | | which are | | | difference | | found in | - Blood type | | between | | places like | mismatch, | | atopic and | | your skin, | what | | contact | | lungs, and | happens: | | dermatitis | | intestines | your immune | | is that | | | system sees | | contact is | | - **Subsequen | the foreign | | localized | | t | blood cells | | and | | Exposure**: | as harmful. | | restricted | | The next | | | to the area | | time you | - Attack on | | exposed | | come into | the New | | while | | contact | Blood: Your | | atopic is | | with that | body's | | widespread. | | same | immune | | | | allergen, | system will | | | | your body | recognize | | | | recognizes | the | | | | it because | mismatched | | | | of the IgE | blood cells | | | | antibodies. | as | | | | This | \"invaders\ | | | | triggers | " | | | | the mast | and attack | | | | cells and | them, | | | | basophils | trying to | | | | to release | destroy | | | | chemicals | them. This | | | | like | is what we | | | | **histamine | call a | | | | **. | hemolytic | | | | | reaction. | | | | - Histamine | | | | | is part of | - If the | | | | your | recipient | | | | body\'s | is | | | | defense | transfused | | | | system, but | with | | | | it can | incompatibl | | | | cause | e | | | | uncomfortab | bloods | | | | le | antibodies | | | | symptoms | immediately | | | | when your | coat the | | | | immune | foreign | | | | system | erythrocyte | | | | overreacts | s, | | | | to harmless | causing | | | | things like | agglutinati | | | | pollen or | on | | | | certain | (clumping) | | | | foods. | which leads | | | | | to | | | | - **Reaction* | bleeding. | | | | *: | Then | | | | The release | because of | | | | of | the | | | | histamine | bleeding | | | | and other | internally, | | | | chemicals | cell lysis | | | | causes the | occurs, | | | | symptoms of | which | | | | an allergy, | causes the | | | | like | release of | | | | sneezing, | hemoglobin | | | | itching, | into the | | | | swelling, | urine and | | | | or | plasma. | | | | difficulty | | | | | breathing. | - Symptoms | | | | This is | could | | | | what we | include | | | | call an | fever, | | | | **allergic | chills, | | | | reaction**. | pain (back, | | | | | chest, | | | | - Common | kidneys), | | | | allergic | dark urine, | | | | reactions | and | | | | include | difficulty | | | | [anaphylaxi | breathing. | | | | s] | | | | | and [atopic | - What | | | | reactions]{ | Happens | | | |.underline}. | Inside the | | | | | Body: When | | | | - Anaphylacti | the red | | | | c | blood cells | | | | reaction: | are | | | | **severe, | destroyed, | | | | rapid-onset | it can lead | | | | allergic | to kidney | | | | reaction** | damage, and | | | | that can be | your body | | | | life-threat | might not | | | | ening | get enough | | | | if not | oxygen, | | | | treated | which can | | | | immediately | be | | | |. | dangerous. | | | | It's the | | | | | extreme | | | | | form of an | | | | | allergic | | | | | response | | | | | where the | | | | | body's | | | | | immune | | | | | system | | | | | overreacts | | | | | to | | | | | something | | | | | it | | | | | mistakenly | | | | | sees as | | | | | harmful, | | | | | like | | | | | certain | | | | | foods, | | | | | insect | | | | | stings, or | | | | | medications | | | | |. | | | | | | | | | | - Atopic | | | | | reactions: | | | | | people will | | | | | have | | | | | inherited | | | | | tendency to | | | | | become | | | | | sensitive | | | | | to | | | | | environment | | | | | al | | | | | allergens, | | | | | including | | | | | allergic | | | | | rhinitis, | | | | | asthma, | | | | | atopic | | | | | dermatitis, | | | | | hives, and | | | | | angioedema. | | | | | | | | | | - Allergic | | | | | rhinitis | | | | | aka hay | | | | | fever: most | | | | | common type | | | | | I reaction. | | | | | the target | | | | | areas | | | | | affects are | | | | | the | | | | | conjunctiva | | | | | and the | | | | | mucosa of | | | | | the upper | | | | | resp. | | | | | tract. | | | | | Which is | | | | | where the | | | | | "seasonal | | | | | allergies" | | | | | is r/t. | | | | | | | | | | - Atopic | | | | | dermatitis: | | | | | the skin | | | | | lesions are | | | | | more | | | | | generalized | | | | | and involve | | | | | blood | | | | | vessel | | | | | vasodilatio | | | | | n | | | | | which | | | | | causes | | | | | interstitia | | | | | l | | | | | edema with | | | | | vesicle | | | | | formation. | | | | | | | | | | - Hives | | | | | (urticaria) | | | | | : | | | | | transient | | | | | wheals that | | | | | vary in | | | | | size and | | | | | shape occur | | | | | all over | | | | | the body. | | | | | Can last | | | | | minutes to | | | | | hours. | | | | | Histamine | | | | | causes | | | | | localized | | | | | vasodilatio | | | | | n | | | | | (erythema), | | | | | transudatio | | | | | n | | | | | of fluid | | | | | (wheal)m | | | | | and flaring | | | | | (due to | | | | | dilated | | | | | blood | | | | | vessels on | | | | | edge of the | | | | | wheal). | | | | | Histamine | | | | | causes | | | | | itching r/t | | | | | lesions | | | | | | | | | | - Angioedema: | | | | | similar to | | | | | hives but | | | | | deeper in | | | | | the skin. | | | | | Common | | | | | around the | | | | | eyelids, | | | | | lips, | | | | | tongue, | | | | | larynx, | | | | | hands, | | | | | feet, GI | | | | | tract, and | | | | | genitalia. | | | | | The | | | | | swelling | | | | | usually | | | | | begins in | | | | | the face | | | | | and then | | | | | progresses | | | | | to the | | | | | airways and | | | | | other parts | | | | | of the | | | | | body. | | | | +-----------------+-----------------+-----------------+-----------------+ **Diagnostic studies** - A **[CBC]** with WBC differential is done with an absolute lymphocyte count and eosinophil count. - **[T-cell and B-cell quantification]** can diagnose specific immunodeficiency syndromes. - **[The eosinophil count and serum IgE level]** are high in type I hypersensitivity reactions. The serum IgE level also serves as a diagnostic indicator for atopic diseases. - We can test **[sputum and nasal and bronchial secretions]** for the presence of eosinophils - **[Skin testing]**: identifies the specific allergens that are causing the allergy symptoms. We cannot do skin testing on patients who cannot stop taking medications that suppress histamine response or patients with food allergies. Instead, blood allergy testing is used. - Procedure: can either be a skin prick or scratch, intradermal test, or a patch test. Typically, on the arms or back area. - Results: the scratch and intradermal test results come back within 5-10 minutes and the patch test comes back within 48-72 hours. - Precautions: anti-inflammatory cream is applied if a severe reaction occurs during a skin test. For intradermal testing, a torniquet is applied. The patient may even need an injection of epinephrine (epi-pen) **Nursing management: Anaphylaxis** - The key principles in the management is speed of \... 1. Recognizing the s/s of the reaction 2. Maintaining a patent airway 3. Giving drugs 4. Treating for shock - Epinephrine is the drug of choice to treat an anaphylactic reaction. It must be given IM or IV!! Patients receiving B-blockers may be resistant to the epi pen. - Those who use the epi pen may experience hypotension and bradycardia, and those with that should receive glucagon. **Drug therapy** - Antihistamines: best drug choice for treating allergic rhinitis, itching, and hives. - Do not prevent bronchoconstriction - They act by competing with histamine for H1-receptor sites, thus blocking the effect of histamine. - Corticosteroids: best for relieving s/s of allergic rhinitis - Mast cell-stabilizing drugs: cromolyn - It inhibits the release of histamine - Used to manage allergic rhinitis **Immunotherapy R/t allergic disorders** - It is recommended treatment for control of allergic symptoms when the allergen cannot be avoided, and drug therapy is not effective. - It definitively indicated for those with anaphylactic reaction to insect venom. - This therapy involves giving small titers of an allergen extract in increasing strengths until hyposensitivity to specific allergen is achieved. - Foor allergies cannot be safely treated with this therapy - Eczema may worsen with immunotherapy **Latex allergies r/t food syndrome** - Latex food syndrome: some foods may cause an allergic reaction in people who are also allergic is latex. To the right are the list of foods. **Multiple chemical sensitivity:** a subjective illness marked by recurrent, vague, nonspecific symptoms attributed to low levels of chemical, biologic, or physical agents - Commonly used substances are smoke, pesticides, plastics, fabrics, scented products, etc. - Women ages from 20-50 are most at risk. MCS is a controversial diagnosis, and some organizations do not recognize this as an actual diagnosis - s/s (nonspecific, widespread): headache, fever, dizziness, nausea, congestion, itching, sneezing, sore throat, chest pain, breathing problems, muscle pain/stiffness, skin rash bloating, gas, confusion, difficulty concentrating, memory problems, and mood changes. These symptoms are usually subjective - the diagnosis is based on the pt health history - treatment for this is psychotherapy, which is the recommended treatment. Patients who are unwilling to undergo psychotherapy but willing to accept meds will take antidepressants as an alternative option. Drugs for anxiety and sleep are also used. **Organ transplantation** - patients are matched to available donors based on several factors: ABO blood and HLA typing, medical urgency, time on the waiting list, and geographic location. **Tissue typing:** the recipient usually receives a transplant from an ABO blood group-compatible donor. The donor and recipient do not need to share the same Rh factor. **HLA typing:** is done on potential donors and recipients - the degree of HLA matching needed or suitable for successful transplantation depends on the type of organ and degree of acceptable risk. Certain organ and tissue transplants need a closer histocompatibility match than other organs. - In kidney and bone marrow transplants, HLA matching is very important, since these transplants are at high risk for graft rejection. **Panel of reactive antibodies (PRA):** shows the recipient's sensitivity to various HLA's before receiving a transplant. Allows us to see if the pt is high or low reactivity to potential donors. - A high PRA means that the person has many cytotoxic antibodies and is highly sensitized. There will be a poor chance of finding a crossmatch-negative donor. **Crossmatch** - A crossmatch uses serum from the recipient mixed with the donor lymphocytes to test for any preformed anti-HLA antibodies to the potential donor organ. - A negative crossmatch means that no preformed antibodies are present, and it is safe to go ahead with transplantation. - A positive crossmatch means that the recipient has cytotoxic antibodies to the donor. This is an absolute contraindication in living donor transplants **Transplant rejection** - Immunosuppression therapy, performing ABO and HLA matching, and ensuring that the crossmatch is negative reduces the risk for rejection **Immunosuppressive therapy:** requires a lifelong balance between rejection and infection. The immune response must be suppressed to prevent rejection of the transplanted organ. - The transplant recipients must take immunosuppressants for life, so because of that, the risk for toxicity continues for the rest of their lives - Most patients are initially on triple therapy. The standard triple therapy usually includes a calcineurin inhibitor, a corticosteroid, and mycophenolate mofetil. +-----------------+-----------------+-----------------+-----------------+ | | Drug name | Actions | Drug alert | +=================+=================+=================+=================+ | Calcineurin | Tacrolimus | Most effective | -For these two, | | inhibitors | (Prograf) and | agents and | a substance in | | | Cyclosporin | serve as the | grapefruit and | | | (Sandimmune) | foundation of | grapefruit | | | | most | juice prevent | | | | immunosuppressi | metabolism of | | | | on | these drugs. | | | | regimens. | | | | | Calcineurin | -Consuming | | | | inhibitors work | grapefruit or | | | | by preventing a | grapefruit | | | | cell-mediated | juice while | | | | attack against | using these | | | | the | drugs can | | | | transplanted | increase their | | | | organ. They are | toxicity. | | | | usually used in | | | | | combination | | | | | with | | | | | corticosteroids | | | | | , | | | | | mycophenolate | | | | | mofetil, and | | | | | sirolimus. | | | | | Tacrolimus is | | | | | widely used. | | +-----------------+-----------------+-----------------+-----------------+ | | Mycophenolate | Inhibits purine | -When given IV, | | | mofetil | synthesis with | it can only be | | | (collect) | suppressive | reconstituted | | | | effects on T | on D5W | | | | and B cells. | | | | | The major | -Do not give as | | | | limitation of | IV bolus. Give | | | | this drug is GI | over 2 or more | | | | toxicity, | hours | | | | including n/v | | | | | and diarrhea. | | +-----------------+-----------------+-----------------+-----------------+ **Graft-versus-Host disease (GVHD)** - Occurs when an immunodeficient patient receives immunocompetent cells. - A GVHD response is most common in hematopoietic stem cell transplants - The response may begin 7-30 days after transplantation. Once the reaction is started, little can be done to change its course. - The target organs for GVHD are the skin, liver and GI tract. The skin disease may be a maculopapular rash, which may be itchy or painful. It initially involves the palms and soles of the feet. It can progress to a generalized erythema with bullous formation and desquamation (skin peels) - The biggest problem with GVHD is infection, with different types of infections seen in different periods. - There is no adequate treatment of GVHD once it is established. The use of immunosuppressive agents such as methotrexate and cyclosporine has been effective as a preventive rather then a treatment measure.