1. Assessment of immune function Management of patients with immunodeficiency disorders

2. Disorders of Immune System
Defenses against infection
Immune system disorders
Autoimmune diseases
Immunodeficiency

3. Defenses Against Infection
Barriers (non-specific)
Skin
Mechanical removal (coughing, vomiting, diarrhea, skin sloughing)
Normal flora
Antimicrobial secretions
Inflammation (non-specific)
Immunity (specific)

4. Immune Response Natural vs. Acquired Active vs. Passive
Primary vs. Secondary
Humoral vs. Cell-Mediated

5. Humoral Immunity B Lymphocytes (Plasma Cells) Produced in bone marrow
Make antibodies (immunoglobulins)

6. Antibodies Protein molecules produced by B-cells
Specific shapes allow binding to specific molecules (antigens)
Allow body to respond defensively to presence of specific potential threats

7. Antibody Types
IgG
IgM
IgA
IgD
IgE

8. IgG Most common antibody type Only antibody that crosses placenta
Prime mediator of secondary immune response
Principal defender against bacteria, viruses, and toxins

9. IgM Macroglobulin Confined to bloodstream
First antibody to appear in response to presence of antigen
Agent of primary immune response

10. IgA Secretory antibody
Found in saliva, tears, respiratory secretions, GI tract secretions
Frontline bacterial, viral defense

11. IgD Role not fully understood Low serum levels
High concentrations on B-cells
May act as receptors that trigger production of other antibodies

12. IgE Very low serum levels Primarily bound to mast cells in tissues
Controls allergic response
Prevents parasitic infections

13. Antigen-antibody binding initiates reactions that:
Neutralize bacterial toxins
Neutralize viruses
Promote phagocytosis
Activate components of inflammatory response

14. Cell-Mediated Immunity
T Lymphocytes
Originate in bone marrow
Altered by passage through thymus
Responsible for mediation of cellular immunity

15. T Lymphocyte Types Helper cells (T4 cells)
Cytotoxic cells (Killer T cells)
Suppressor cells
Memory cells

16. Helper T-Cells Master “on-switch” of immune system Recognize antigens
Secrete lymphokines that activate all other immune system cells
Stimulate B-cells to begin antibody production

17. Cytotoxic (Killer) T-Cells
Respond to presence of antigens and lymphokines produced by T-4 cells
Seek out, bind to, and destroy:
Cells infected by viruses
Some tumor cells
Cells of tissue transplants
Can deliver lethal hits on multiple cells in sequence

18. Suppressor T-Cells
Produce lymphokines that inhibit proliferation of B and T cells
Downregulate or dampen immune response

19. Memory T-Cells Have previously encountered specific antigens
Respond in enhanced fashion on subsequent exposures
Induce secondary immune response

20. Inflammation Occurs in vascularized tissue
Nonspecific response to injury
Response is same regardless of agent that initiates it

21. Inflammation: Physiology
Triggered by cellular injury
Injury activates mast cells
Mast cells release chemical mediators:
Histamine
Heparin
Leukotrienes (SRS-A)
Eosinophil chemotactic factor

22. Inflammation: Pathology
Mediators cause:
Vasodilation (redness, heat)
Vascular permeability (swelling)
White cell movement to and infiltration of affected area (pus)
Nerve ending stimulation (pain)
“Dolor, Calor, Tumor, Rubor”

23. Inflammation: Purposes
Confines injurious agents
Increases blood cell, plasma movement to injured areas
Enhances immune response
Destroys injurious agents
Promotes healing

24. Inflammation: Cellular Components
Neutrophils
Phagocytic cells
Engulf foreign material/organisms
Arrive early
Short-lived

25. Inflammation: Cellular Components
Macrophages
Phagocytic cells
Engulf foreign material/organisms
Arrive later
Long-lived
Transfer antigens back to T4 cells
Help initiate immune response to specific agents

26. Inflammation: Cellular Components
Eosinophils
Secrete caustic proteins
Dissolve surface membranes of parasites

27. Disorders of Immunity

28. Autoimmune Disease
Clinical disorder produced by an immune response to a normal tissue component of a patient’s body

29. Autoimmune Diseases Hyperthyroidism Primary myxedema Type I diabetes
Addison’s disease
Multiple sclerosis
Myasthenia gravis

30. Autoimmune Diseases Rheumatic fever Crohn’s disease Ulcerative colitis
Rheumatoid arthritis
Systemic lupus erythematosis

31. Systemic Lupus Erythematosis
Primarily occurs in 20- to 40-year old females
Also in children and older adults
90% of patients are female
Autoimmune reaction to host DNA
Mortality after diagnosis averages 5% per year

32. Systemic Lupus Erythematosis
Signs/Symptoms
Facial rash/skin rash triggered by sunlight exposure
Oral/nasopharyngeal ulcers
Fever
Arthritis

33. Systemic Lupus Erythematosis
Signs/Symptoms
Serositis (pleurisy, pericarditis)
Renal injury/failure
CNS involvement with seizures/psychosis
Peripheral vasculitis/gangrene
Hemolytic anemia

34. Systemic Lupus Erythematosis
Chronic management
Anti-inflammatory drugs
Aspirin
Ibuprofen
Corticosteroids
Avoidance of emotional stress, physical fatigue, excessive sun exposure

35. Immunodeficiency Diseases
Disorders of Immunity
Immunodeficiency Diseases

36. Immunodeficiency Diseases
Congenital
Acquired

37. Immunodeficiency Diseases: Congenital
B cell deficiency
Agammaglobulinemia
Hypogammaglobulinemia

38. Immunodeficiency Diseases: Congenital
T cell deficiency
IgA deficiency
Severe combined immune deficiency syndrome (B and T cell deficiency)

39. Immunodeficiency Diseases: Acquired
Nutritional deficiency
Iatrogenic (drugs, radiation)
Trauma (prolonged hypoperfusion)
Stress
Infection (AIDS)