Principles of Immunology by S.S.Eghbali,MD 5/10/1380

IMMUNE SYSTEM  Non specific IMMUNITY  Specific Immunity

Specific Immunity  Humoral Immunitiy  Cellular Immunity

Humoral Immunity

Cellular Immunity  T CD4/TCD8 ratio  Cytokines IL-2, G-IFN, IL-4,IL-5  CTL  NK-Cells

CELL IMMUNITY IS AFFECTED BY  AGE  Malnutrition  Cancers  Chronic diseases

Immuno assays  Precipitation Immunoassay  Particle Immunoassay  Radio Immunoassay  Enzyme Immunoassay  Chemiluminescent Immunoassay

Precipitation Immunoassay

A)Qualitative  Single Immunodiffusion  Double Immuno diffusion  Immuno electro phoresis  Electro Immuno Fixation B)Semi-Quantitative  Single radial immunodiffusion  Single dimension electro immunodiffusion (Rocket electrophoresis)

Particle Immunoassay  Hemaglutination e.g Treponema pal.  Gelatin particle agglutination HBV,HCV,HIV  Latex agglutination HCG

Radio Immuno assay  Competitive RIA  Non competitive RIA (Sandwich or IRMA)

Enzyme Immunoassay  Colorimetric EIA  Fluorescent EIA  Chemiluminscent EIA

PRESENTATION OF POSSIBLE IMMUNODEFICIENCY * Frequent bacterial infection * Unusually severe systemic reaction to a virus * Development of infection with an unusual organism such as fungus or protozoan * Systemic reaction following live virus vaccination * Family history of recurrent infections * Exposure to the human immunodeficiency virus.

BASIC SCANNING IMMUNOLOGY STUDIES Complete blood count / differential Lymphocyte subpopulation analysis (numbers and percentages of T and B cells) by flow cytometry Lymphocyte activation in vitro to mitogens and microbial activators

Serum immunoglobulins, including immunoglobulin subclasses if evidence of clinical infections with encapsulated bacteria. In some cases, immunoglobulin levels are normal but heterogeneous nonbinding antibodies are produced; thus, additional studies are needed.

CONFIRMING AND FIRST-STAGE ANALYTICAL STUDIES * Radiograph for thymic shadow * Skin test * Natural Killer cell activity ( if child is 6 months or older) * Cytokine production in response to activation T-helper 1, T-helper 2 (IL-2, interferon-y, IL-4, and so on) * Mixed lymphocyte culture reaction with patient as stimulator and patient as responder * Response to immunization

* Test for presence of age- appropriate specific antibodies * Naturally occurring antibody *Response to isohemagglutinins (anti- A and – B blood group substances) if patient has A, B, or O blood type * Test for adenosine deaminase and purine nucleoside phosphorylase enzyme deficiency

‍‍ ANALYTICAL AND IMMUNOREGULATORY STUDIES * Development of activation antigens during ersponse to stimulation, such as Tac antigen, transferrin receptor, up-regulation for MHC class II on T cells, soluble receptor, and so on * Early activation response (e.g., calcium channels)

Immunoregulation Response to IL-1, IL-2, interferons Development of effector functions Immunoglobulin synthesis in vitro Cytotoxic T-cell activity Suppressor cell/factor analysis Gene activation, cell cycle analysis Response to immunization: de novo immunization