Immunology II
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show | receive preformed Ab like IgA in breat milk, antitoxin or just Ig. rapid onset but short half life
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How is active immunity acquired, what is its onset and duration? | show 🗑
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In what 4 diseases are Pt given preformed Ab in order to rapidly clear the infection? | show 🗑
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What is a Live attenuated vaccine? What type of response does it ellicit? | show 🗑
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What are some pros and cons of live attenuated vaccine? | show 🗑
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show | live attenuated vaccine
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What is an inactivated or killed vaccine? What type of immunity does it induce? | show 🗑
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What are some pros and cons for using an inactivated or killed vaccine? | show 🗑
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show | inactivated or killed vaccine
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What is Type I hypersensitivity? What cells mediate it and how fast is the onset? | show 🗑
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show | I, II, III
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show | scratch test, radioimmunosorbent assay
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What are the general characteristics of Type II hypersensitivity? | show 🗑
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show | 1. Ab opsonizes cells or activates complement 2. Ab recruit neutrophils and macrophages causing tissue damage 3. ab bind to normal receptors and interfere with their fx
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show | direct and indirect coombs test
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What is immune complex type III hypersensitivity? | show 🗑
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show | Ab to foreign proteins are produced (5 days). Immune complexes form are are deposited on mebranes where they cause damage by fixing complement
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What most commonly causes type III hypersensitivity serum sickness? What is seens | show 🗑
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What is Arthus reaction type III hypersensitivity? What is seen? | show 🗑
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show | A-Ab complexes.
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What is the test for Type III hypersensitivity? | show 🗑
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show | Delayed, T cell mediate type. sensitized T cells encounter Ag and release lymphokines, activating macrophages. No ab involved
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Can type IV hypersensitivity be transferred by serum? | show 🗑
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show | 4Ts: Tcells, Transplant rejection, Tb skin tests, touching (contact dermatitis)
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show | patch test (PPD)
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show | ACID: Anaphylactic and atopic (I), Cytotoxic (Ab mediated II), Immune complex (III), delayed (IV, cell mediated)
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show | Type I hypersensitivity
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What is the presentation of Type I hypersensitivity? | show 🗑
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What type of hypersensitivity are hay fever, allergies, eczema, hives and asthma? | show 🗑
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What is the presentation of type II hypersensitivity? | show 🗑
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What type of hypersensitivity is erythroblastosis fetalis, acute tranfusion reactions, Rheumatic fever, Goodpastures, Graves, Myasthenia gravis? | show 🗑
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What type of hypersensitivity might be associated with a vasculitis or systemic manifestations? | show 🗑
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What type of hypersensitivity mediates SLE, theumatoid arthritis, polyarteritis nodosum, Post strep GN, serum sickness, farmers lung? | show 🗑
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What hypersensitivty mediates swelling and inflammation after a tetanus shot? | show 🗑
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What type of hypersensitivity mediates Type I DM, Ms, Guillan -Barre, Hashimoto's thyroiditis, Graft rejection, and contact dermatitis (poison)? | show 🗑
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show | Type I hypersensitivity against plasma proteins. see uticaria, prutitis, wheezing fever
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How do you treat an allergic reaction to blood transfusions? | show 🗑
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show | Sever reaction, as in an IgA deficient person must get products lacking IgA. see dysnea, bronchospasm, hypotension, respiratory arrest, shock.
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What is a febrile non hemolytic transfusion reaction? | show 🗑
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show | fever, HA, chills, flushing
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show | Type II hypersensitivity. ABO incompatibility causes intravascular hemolyisis. extravascular hemolysis from host Ab reaction against foreign Ag on donor RBCs
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show | fever, hypotensioon, tachypnea, tachycardia, flank pain. hemoglobinemia (if intravascular), jaundice ( if extravascular)(
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What disorder has anti nuclear Ab (ANA)? | show 🗑
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show | SLE
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What disorder has antihistone Ab? | show 🗑
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What disorder has anti IgG (rheumatoid factor)? | show 🗑
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What disorder has anticentromeric Ab? | show 🗑
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What disorder has Anti-Scl-70 (anti DNA topoisomerase I)? | show 🗑
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What disorder has antimitochondrial Ab? | show 🗑
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show | Celiac disease
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What disorder has anti-basement membrane Ab? | show 🗑
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What disorder has anti-desmoglein Ab? | show 🗑
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What disorder has antimicrosomial, antithyroglobulin Ab? | show 🗑
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What disorder has anti-Jo-1 Ab? | show 🗑
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show | Sjogren's syndrome
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What disorder has anti-SS-B (anti-La) Ab? | show 🗑
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show | Mixed connective tissue disease
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What disorder has anti-Smooth muscle Ab? | show 🗑
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show | Type I DM
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What disorder has cANCA? | show 🗑
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show | other vasculitides, prominently microscopic polyangitis
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What do bacteria cause if a person lacks T cells? | show 🗑
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show | encapsulated: Strepto, staphylo, haemophilus, Moraxella
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show | staphy, pseudomonas
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show | Neisseria (no Mycobacterium avium)
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show | CMV, EBV, VZV. chronic infection with respiratory/ GI viruses
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What types of viruses are people without B cells vulnerable to? | show 🗑
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What types of fungi/parasites are people without T cells vulneerable to? | show 🗑
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What types of fungi/parasites are people without B cells vulnerable to? | show 🗑
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What types of fungi/parasites are people without granulocytes vulnerable to? | show 🗑
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show | Lack of T cells= more fungal and viral infections. Lack of B Cell= recurrent bacterial infection
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show | 1. Burton's agammaglobulinemia 2. Hyper IgM syndrome 3. Selective IgG deficiency 4. Common variable immunodeficiency
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What is the defect and inheritance in Burton's agammaglobulinemia? | show 🗑
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show | recurrent bacterial infections after 6 months (decr maternal IgG) due to opsonization defect. absence of thymic shadow
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What labs are seen in Burton's agammaglobulinemia? | show 🗑
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show | defective CD40L on TH= can't class switch
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What is the presentation of Hyper-IgM syndrome? | show 🗑
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show | incr IgM, very Decr IgG, A, E
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show | defect in isotype switch=a deficeincy is a specific class of Ig
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show | sinus and lung infections, mil allergies, diarrhea. anaphylaxis on exposure to IgA containing blood products
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show | IgA deficiency is most common. failure to mature into plasma cells. decr secretory IgA
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What is the defect in common variable immune deficiency (CVID)? | show 🗑
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What is the presentation of common variable immune deficiency? | show 🗑
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What labs are seen in common variable immune deficiency? | show 🗑
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What are 4 major T cell immune disorders? | show 🗑
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show | 22q11 delection; failure to develop 3rd and 4th pharyngeal pouches
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What is the presentation of thymic aplasia (DiGeorge Syndrome)? | show 🗑
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show | thymus and parathyroid fail to develop. decr T cells, decr PTH, decr ca2+. absent thymic shadow on CXR
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show | decr Th1 response
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What is the presentation of IL-12 receptor deficiency? | show 🗑
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show | decr IFN-gamma
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show | TH cells fail to produce IFN-gamma-->neutrophils can't respond to chemotactic stimuli
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show | FATED: coarse Facies,cold, staphylococcal Absesses, retained primary Teeth, incr IgE, dermatologic problems (eczema)
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What labs are seen in Hyper-IgE syndrome (Job's syndrome)? | show 🗑
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show | T-cell dysfunction
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show | Candida albicans infections on skin and mucous membranes
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What are 3 major B and T cell combined immune deficiencies? | show 🗑
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show | several types: defective IL-2 rector (most common and X linked), adenosine deaminase deficiency, failure to synthesize MHC II Ag
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show | recurrent viral, bacterial, fungal and protozoal infections. no thymic shadow, no germinal centrers in LN bipsy, no B cells on PBS
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show | only bone marrow transplant, no allograft rejection
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show | decr IL-2R= decr T cell activation. incr adenine=toxic to T and B cells (decr dNTPs, decr DNA synth)
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show | defects in ATM gene which codes for DNA repair enzymes
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show | triad: cerebellar defects (ataxia), spider angiomas (telangiectasia), IgA deficiency
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show | decr IgA
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show | X linked recessive defect. progressive deletion of T and B cells
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What is the presentation of Wiskott-Aldrich syndrome? | show 🗑
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What labs are seen in Wiskott-Aldrich syndrome? | show 🗑
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What are 3 major phagocyte dysfunction immune disorders? | show 🗑
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show | defect in LFA-1 integrin (CD18) protein on phagocytes
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show | recurrent bacterial infections, absent pus formation, delayed separation of the umbilicus
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show | neutrophilia
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What is the defect in Chediak-Higashi syndrome? | show 🗑
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show | recurrent pyogenic infections by Staphy and strep. partial albinism, peripheral neuropathy
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What is the defect in chronic granulomatous disease? | show 🗑
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show | incr susceptibility to catalase + organism (S. aureus, E. coli, aspergillus)
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show | negative nitroblue tetrazolium dye reduction test
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show | from self
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What is a syngeneic graft? | show 🗑
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What is an aloograft? | show 🗑
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show | from a different species
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show | within minutes onset. Type II hypersensitivity (Ab mediated) due to presence of preformed anti donor Ab in transplant recipient
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What are the major features of hyperacute transplant rejection? | show 🗑
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What is the onset and pathogenesis of acute transplant rejection? | show 🗑
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What are the features of acute transplant rejection? | show 🗑
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What is the onset and pathogenesis of chronic transplant rejection? | show 🗑
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What are the features of chronic transplant rejection? | show 🗑
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show | variable onset. grafted immunocompetent T cells proliferate in the irradiated ICPT and reject cells with foreign proteins resulting in severe organ dysfunction
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show | maculopapular rash, jaundice, hepatosplenomegaly, diarrhea. usually seen in BM and liver transplant (these organs are rich in lymphocytes). potentially beneficial in BM transplant
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show | binds to cyclophilis. complex then blocks differentiation and activation of T cells by inhibiting clacineurin, prevent production of IL-2 and its receptor
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show | surpresses organ rejection. also in select AIDs
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What are the major SE of cyclosporine? | show 🗑
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show | similar to cyclosporine. binds FK-binding protein, inhibiting IL-2 secretion and other cytokines
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show | potent immunosurpression in organ transplant patients
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What is the SE of tacrolimus (FK506)? | show 🗑
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What is the mech of sirolimus (rapamycin)? | show 🗑
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show | immunosurpression after kidney transplant in combo with cylclosporine and steroids. also used with drug eleuting stents
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show | hyperlipidemia, thrombocytopenia, leukopenia
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What is the mech of daclizumab? | show 🗑
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show | antimetabolite precursor for 6-mercaptopurine that interferes with metabolism and synthesis of nucleic acids. toxic to proliferating lymphocytes
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show | kidney transplants, AIDs (including GN and hemolytic anemia)
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show | bone marrow surpression, active metabolite mercaptopurine is metabolized by xanthine oxidase so toxicites might be incr by allopurinol
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What is the mech of muromonab-CD3 (OKT3)? | show 🗑
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What is the clinical use of muromonab (OKT3)? | show 🗑
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What are the major SE of muromonab-CD3(OKT3)? | show 🗑
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show | renal cell carcinoma, metastatic melanoma
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What is Eryhtropoetin used for? | show 🗑
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show | recovery of bone marrow
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show | recovery of bone marrow
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show | Hep B and C, Kaposi's sarcoma, leukemia, malignant melanoma
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show | multiple sclerosis
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show | chronic granulomatous disease
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show | thrombocytopenia
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What is thrombopoetin used for? | show 🗑
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show | target: CD3, use: prevents acute transplant rejection
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What is the target and use of daclizumab? | show 🗑
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What is the target and use of digoxin immune Fab? | show 🗑
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show | target: TNF-alpha use: Crohn's disease, RA, psoriatic arthritis, ankylosing spondylitis
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What is the target and use of adalimumab? | show 🗑
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What is the target and use of abciximab? | show 🗑
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What is the target and use of trastuzumab (Herceptin)? | show 🗑
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show | target: CD20 use: B-cell non-Hodgkin's lymphoma
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What is the target and use of omalizumab? | show 🗑
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