MLS Immunology Exam
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| The Complement System | A series of 35 proteins that are synthesized by the liver, monocytes, macrophages, and epithelial cells. The main functions of these proteins are to defend the host against infection, clear immune complexes, and join the innate +adaptive immune system
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| Three Pathways of the Complement System | Classic, Alternative, Mannose-binding Lectin. All three of these converge at the activation of C3.
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| Mannose binding Lectin Pathway | This pathway does not have C1, but MASP1 and MASP2. Initiated by a certain surface molecule.
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| Alternative Pathway | This pathway does not have C1, or C4, but Factor B, D and properdin. Initiated by a certain surface molecule.
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| MAC (Membrane Attack Complex) | This makes an intracellular "hole" for lysis. Includes C6, C7, C8 and C9.
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| Anaphylatoxins | These fragments of the complement system have a certain function. C3a, C4a, and C5a are all _______. They cause histamine release, smooth muscle contractions and an increase in vascular permeability
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| Opsonins | These fragments of the complement system have a certain function. C3b, iC3b and C4b are all _________. They bind receptors on phagocytic cells to increase phagocytosis and aid in clearing immune complexes.
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| Complement Regulators | C1INH controls both classic and MBL pathways. C1INH causes C1r and C1s to dissociate from C1q in classic pathway. C1INH prevents binding of MBL to MASP2 in lectin pathway.
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| Agglutination and Precipitation | These two immunoassays rely on multiple binding sites of both Ab and Ag. Soluble Ag rxn = ___________ while a particulate antigen rxn = ______________.
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| Precipitation | Ab and Ag combine to form insoluble lattices. Examples include electrophoresis and nephelometry
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| Equivalence (Agg. & Precip) | Ag and Ab at which binding sites and epitopes are roughly equal. Has the highest amount of precipitation.
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| Prozone | Too much Ab - little or no precipitation occurs and thus would test negative for Ab. Must dilute patient sample.
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| Postzone | Too few Ab - little or no precipitation occurs and thus would test negative for Ab. Must redraw blood to increase titer.
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| Immunodiffusion / Ouchterlony | A double diffusion gel precipitation. Ab & Ag diffuse through gel. Ab and Ag are in adjacent wells. A precipitin line forms where Ab and Ag are at equivalence. Determines antigenic relatedness of unknown test with known Ag.
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| Ouchterlony- Identity | Two wells filled with same Ag diffuse to make line of identity.
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| Ouchterlony- Patrial Identity | Teo wells filled with same Ag but different epitopes.
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| Ouchterlony- Nonidentity | Two wells filled with different Ag that form a line of _______.
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| Radial Immunodiffustion | Quantitative immunoprecipitation technique. Different Ag concentrations but constant Ab. Diameter related to concentration of Ag
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| Nephelometry and Turbidimetry | Optical analysis methods to acquire and analyze Ab/
Ag lattice formations.
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| Turbidimetry | Initial cloudiness is measured by passing a light through solution. Measures light the gets across solution which is proportional to the concentration of molecules
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| Nephelometry | Measures light scatter at different angles than incoming light source, Some limitations due to excess in solution
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| Labels/ Labeled Immunoassays | These are attached to Ab or Ag to increase sensitivity of detection. Includes radio, enzymes , fluorescence, chemiluminsescense
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| Enzyme Labels | This kind of label requires the addition of a substrate that in turn produces a color change, fluorescens or a flash of light
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| Heterogenous Assay Labels | Radiolabels, enzymes/substrates, fluorescence (FITC apple green)
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| Direct vs Indirect Immunoassays | Labeled Ab + Ag or labeled Ag + Ab. VS
Unlabeled Ag + unlabeled Ab + labeled antiglobulin
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| Sandwich (Capture) Immunoassay | Captures Ag between two Ab, one of which is attached to a solid phase and the other is labeled.
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| Competitive Immunoassay | Small Ag with one epitope. Limited reagent,
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| Western Blot | Gel electrophoresis separates proteins of pathogens. Separated proteins are transferred to nitrocellulose paper. Nonspecific binding sites blocked by dried milk. Add patient sample containing Ab to paper, add 2nd labeled Ab and substrate.
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| Direct vs Indirect Fluorescence Assays | Sample fixed to slide conjugate specific to Ab is laid on sample, labeled Ab bind to Ag ex. Flow
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| Flow Cytometry | Cell measured as they pass through a light source in a fluid stream. Combines immunofluorescent assay with cell sampling and cell optics.
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| AIDS | Less than 200 CD4 T cells is indicative of what disease?
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| Hypersensitivity Reaction | A problem in the function of either part of or total function of the immune system, creating partial or total immunodeficiency. Friendly fire from the immune system towards an innocuous Ag. Depends on host response and not nature of Ag.
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| Allergen | Harmless Ag that stimulates an IgE response
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| ACID 1- Anaphylaxis 2. Cell Mediated 3. Immune Complex 4. Delayed | What are the four types of hypersensitivity and the acronym used to remember them?
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| Type 1 Hypersensitivity- Anaphylaxis | Immediate, IgE mediated, localized or systemic. Reaction is a result of release of mediators from mast cells and basophils, only activated at second exposure. Ag stimulates Ab IR by activating CD4. Ex. Allergic Rhinitis and certain foods. Causes uticaria.
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| Sensitization | Previously exposed to an Ag, have developed an immune response
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| Type 2 Hypersensitivity- Cell/Surface Bound Ab | mediated by IgG and IgM. Cellular destruction as a result of Ab/complement mediated lysis, opsonization and cytotoxicity. Results in tissue destruction. Ex. Hemolytic Anemia
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| Type 3 Hypersensitivity- Immune Complex Mediated | Inflammatory response via complement system responds directly to Ag itself. Complexes precipitate into tissue. Ex. SLE, RA
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| Type 4 Hypersensitivity- Delayed | Mediated by CD4 and CD8 cells that release cytokines and recruits inflammatory cells at exposure site. Results in localized tissue damage, contact dermatitis. Ex. Poison ivy/oak and nickel.
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| Autoimmunity | Affects females more than males, HLA and MHC thought to be influential. Includes molecular mimicry.
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| SLE | Titers greater than or equal to 80 indicate ______.
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| Staining patterns in nuclei | Homogenous - SLE
Speckled - MCTD, Sjorgen's, SLE, Scleroderma
Nucleolar - SLE, Scleroderma
Centromere - CREST
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| Liver | This organ has metabolic functions as well as storage, immune and endocrine.
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| Metabolic Functions of Liver | Breaks down carbs, amino acids, lipids, hemoglobin. Breaks down ammonia to urea and removes toxins
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| Synthetic Functions of Liver | Makes plasma proteins (albumin), lipids, triglycerids, fatty acids, coag proteins and RBCs in infants
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| Storage Function of Liver | Vitamins, minerals and carbs in the form of glycogen
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| Immune Functions of Liver | Mononuclear phagocytic system, removal of immune complexed from circulation
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| ALT, AST, ALP, bilirubin, PT/INR | Increases with decreased liver function or biliary obstruction.
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| Cirrhosis | Fibrous tissue that forms due to damage to liver structure and impaired function
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| Cholestatis | Suppression of flow and or synthesis of bile due to impaired liver function related to hepatobiliary system or obstruction
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| 5 Causes of Hepatits | Primary viral, secondary viral (CMV, EBC, Herpes), bacterial, drug/toxins (ethanol) , parasites
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| HAV Serological Tests | HAVT Ab, HAVIgM Ab, HAVIgG Ab, NO AG TESTS
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| HBV Serological Tests | HBsAg, HBsAb, HBeAg, HBeAb, HbcT and HBcIgM - NO AG for C!!
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| HCV Serological Tests | HCV Ab, HC RNA Qualitative, HC RNA Quantitative, HC Genotyping - NO AG
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| HDV Serological tests | HDAg, HDAb
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| HEV Serological Tests | HEAb - NO AG
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| Spirochetes | A group of motile, anaerobic, gram negative bacteria with axial flagella. Examples include syphilis, Lyme disease and leptospirosis.
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| Lyme Disease | This disease is spread by deer ticks and is due to the presence of Borrelia burgdorferi. A bullseye rash (erythema chronicum migrans) may appear 3-30 days post infection. Tested with IFA, ELISA and confirmed with Western Blot. Tests look for Ab, NOT Ag.
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| Treponema Pallidum; mostly transmitted sexually | What is the bacteria responsible for syphilis and how is it transmitted?
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| When is syphilis considered primary? What are the symptoms? | 10-90 days; Chancres at transmission site and swollen lymph nodes
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| When is syphilis considered secondary? What are the symptoms? | 2-8 weeks; rash and lesions occur as well as warts and flu like symptoms. This stage is most contagious.
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| When is syphilis considered latent? What are the symptoms? | 5-20 years, but can be earlier; usually asymptomatic
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| When is syphilis considered tertiary? What are the symptoms? | as early as 1 year; issues with CNS and cardiac system, formation of granulomas
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| Syphilis Testing | Detects organism directly, treponemal and non-treponema, IFA, ELISA, PCR, Multiplex Flow Assay (Bioplex), VDRL (venereal disease research lab, requires CSF), RDR, TPPA
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| Non-treponemal syph screenings | Bioplex, RPR (Rapid Plasma Reagin which is a flocculation test), VDRL
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| HIV | An incurable virus that attacks the immune system. Detected by low # of CD4 cells. Belongs to Lentivirus family and has 2 types, oral and genital.
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| Structure of HIV | This organism has 2 copies of RNA, proviral DNA and 3 structural genes
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| 3 Structural Genes of HIV | Gag- capsid, matrix, nucleocapsid
Pol- integrase, reverse transcriptase, protease
Env- gp120 and gp41 which bind to cells for infection
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| Viral IgG | develops 1-2 weeks after primary infection, peaks at 4-8 weeks and remains detectable throughout life
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| Viral IgM | found within first few weeks of infection, becomes undetectable after a few months, A fourfold raise in titer indicates active infection
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