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Immune System Outlin

Clinical Medicine II

Three functions of the immune system protection from foreign substances, tumor surveillances, self recognition
What are tissue components to immune system bone marrow, thymus, lymph nodes, spleen
Cellular components to immune system leukocytes, marcrophages, antigen presenting cells
Proteins involved in the immune system immunoglobulins , complement proteins
Two types of immunity humoral and cellular
Parts of humoral immunity B cells→ plasma cells→ abs
Types of celluar immunity T cells: cytotoxic, activate phagocytes, direct humoral immune response
Types of congenital defects B,T or combined defects
Types of acquired immune def Human immunodeficiency, malignancy(Cll, lymphoma, myeloma), chemo, radiation
3 functions of the spleen Hematopoiesis, filtering, immune defense
Do we need the spleen important organ but can live w/o it
Major site of hematopoiesis during fetal life spleen, mostly during the second trimester
How does the cell “kill” foreign cells as blood trickles through it Very acidic, ↓glucose, ↓ o2
What are howell-jolly bodies w/ removal of spleen, RBC have reminents of its nucleus that the spleen normally removes
What are Heinz bodies insoluble globin proteins within RBC’s d/t no spleen
Functions for immune defense of the spleen 25% lymphoid mass, 50% total ab producing B cells-clear bacteria from circulation
What is the spleen especially good at removing encapsulated bacteria like S. peumo, H.flu, and N. meningitides
What type of organ is the spleen lymphoid organ, largest one being 25% lymphoid material
What is a spleen enlarged when you can feel it
What causes splenomegaly liver dz, hematolgic malignancy, infx, congestion/inflammation, 1 splenic dz
Causes massive splenomegaly CML myelofibrosis, gaucher dz, lymphoma, parasitic infx, thalassemia
Indications for splenectomy clinical infxs, diagnostic, therapeutic
Can we biopsy the spleen not usually good candidate, leaky jelly like supstance, will leak post biopsy
Consequences of splenectomy leukocytosis: 10-15, thrombocytosis, Howell-jolly bodies, infx risk
Nuclear remnants in RBC howell-jolly bodies
Huge complication of a splenectomy splenectomy sepsis w/I 3 years of splenectomy ~5% lifetime risk
What is PSS commonly caused by Strep pneumo, H. flu, N. meningitides
How do we prevent PSS those 3 vaccines for those bugs 2 weeks before, prior to splenectomy, but can get vaccines at any time and an annual influenza vaccine
Who do we prophalactically treat to prevent PSS kids until age 5 (pen or amoxicillin) or 3 years after, highly immunocomprimised adults, adult survivers of pneumococcal PSS
When do we give empiric abx if no spleen, give abx for febrile illnesses 7-10days
5 types of WBCs neutrophils, lymphocytes, monocytes, eosinophils, basophils
Polymorphoncuclear cells (PMNs) Neutrophils, 45-75% all WBC
Fxns of Neutrophils find, ingest, kill invading microganisms (creates pus)
What ↑ neutrophil count bacterial infx, physiologic stress, corticosteroids
What ↓ neutrophil count viral infx, drugs/toxins, some bacterial infxns: brucella
When do we compaire ↑ vs ↓ neutrophil count CBC w/ diff, look at the percentage
ANC, levels that create risk absolute neutrophil count nl >1500, sig risk 100-500, great risk <100
What cells are primary for generating the immune response lymphocytes: B, T and NK cells 20-45% all white cells
What are signs for most viral infections lymphocytosis
Where are lymphocytes circulating in blood and in lymphoid tissue: lymph nodes, spleen
Where does differentiation of B lymphocytes occur and maturation D: in bone marrow, M: in llymphoid tissues
Functions of B lymphocytes synthesize immunoglobulins (abs)
MC lymphocyte and location of them and types T lymphocytes, Helper T (CD4) Cytotoxic suppressor (CD8) 60-85%
Fxn of Helper T cells regulators of immune sys, influence production of abs by B cells
Fxn of cytotoxic suppressor T cesll recognize kill virus, ↓ regulate ab production by B cells
What are natural killer cells (NK) large lymphocytes w/ small number of granules important in preventing growth and spread of tumors
When do we see monocytosis chronic infx: TB, lymphomas, granulomatous dz like sarcoid
Fxns of monocytes phagocytize and kill microorganisms
What is significant when monocytes are highly fxns secrete cytokines that induce fever and inflammation
What are 4 things that cause ↑ eosinophilic invasive parasitic dz, chronic inflammatory skin d/o, hypersensitivity states (allergies, vasculitis), certain malignancies (Hodgkins lymphoma)
Problem w/ eosinophils chronic infiltatrion can cause organ damage by release of granular contents
When do basophils come into action in allergic d/o’s and myeloproliferative dz (CML, Polycythemia vera)
What do basophils differentiate into mast cells
What signals for basophils IgE causes histamine release
Causes for leukopenia and leukocytosis know it pg 7
When would we call a hematologist or just recheck it call 0-2,000 2,000-4,000 usually recheck it
What does lymphocytosis signify viral infx (usually ↓ neutorphils)
What is leukemia cancer of the blood and bone marrow
What are the two types of leukemia acute: block in differentiation of immature WBC: rapid, dead days-wks, Chronic: excess proliferation of more mature WBCm insidious,survive yrs even if untreated
Initial presentation of non specific
Abno CBC examples pancytopenia, marked leukocytosis
Leukemia classifications acute vs. chronic, myeloid vs. lymphoid
Excess proliferation of a nl WBC chornic leukemia, still fxns nl but way more than there should be, ex CLL or CML
Block in differenctiation of immature WBC’s Acute leukemia, can’t make nl RBCs death fast
4 types of leukemia and MC ALL CLL AML CML MC is CLL hight dealths AML
MC types is young kids, and Old ppl Y: ALL, Old: AML, CML
How to tell b/w acute and chronic acute: sxs fast, chronic slow and often diagnosis is mistaken CBC
Tx for leukemia Chemo, stem cell trx, prognosis varies widely
3 phases of Acute leukemia chemo, induction, consolidation, maintenance
Highly curable in kids w/ chemo ALL
Not curable ~10% in adults need bone marrow trx cure ALL
Seen rarely in kids, mostly young/middle aged adults, tx CML tx:
What is Gleevec in CML Philidelphia chromosome croses: 9 and 22→BCR protein→rapid proliferation, gleevec stops this BCR protein
Common lymph nodes you can feel and nl size cervical, supraclavicular, axillary, inguinal nl: 1cm
Soft, tender mobile lymph node often infx/inflammation
Firm, rubbery, mobile lymph node lymphoma
Hard, fixed, non-tender carcinoma
Cancer of the lymphoid tissues lymphoma
Which is more common HL or NHL NHL
Dx of lymphoma CBC renal and LFTs, coags, LDH, peripheral blood immunophenotyping, CT< MRI, PET, biopsy
Nodes on both sides of diaphragm stage iii
1 node group stage I
Marrow or other extranodal site Stabe IV
>1node gropu, same side of diaphragm stage II
What does A or B staging of lymphoma B + for fever, night, sweats, wt loss
CT scans for internal lymph nodes eyes to thighs
Tx for lymphoma chemo, radioation, stem cell tx
Excess production of gamma globulin protein by a single clone of B cells/plasma cells monoclonal gammopathy
MGUS monoclonal gammopathy of underteerminded significance
Why is MGUS so important! 10-20% develop myeloma but can take more than 10 years
How dx MGUS monoclonal paraprotein band less than 30 g/L (< 3g/dL);
Malignant proliferation of plasma cells multiple myeloma
Where is MM seen more often AF’s and rare in Asians
What are clinical manifestations of MM monoclonal protein (causein renal failure, hyperviscosity,amyloidosis, lytic bone lesions causing bone pain, pathologic frx, hypercalcemia, anemia and infections
Major criteria for MM plasmacytoma, >30% plasma cells in bone marrow, serum M-smike, Urine M-smike
Minor criteria for MM 10-29% plasma cells, smaller M-smike, lytic bone lesions, ↓ immunoglobulin levels
How do we dx MM 1 major + 1 minor or 3 minor
Tx MM chemo effective, not dcurative, survival 2.5-3 yrs w/ chemo
Created by: becker15
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