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Immunology > Exam 4 > Flashcards

Exam 4 Flashcards

1
Q

Type I Immediate Hypersensitivity (Anaphylactic)

A

This type of immune reaction is responsible for an allergic disease, which is dependent on antigen-mediated activation of IgE coated tissue mast cells. The mast cells release mediators that cause increased vascular permeability, vasodilation, bronchial and visceral smooth muscle contraction and local inflammation.

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2
Q

Type II Cytotoxic(antigens on cell)

A

Antibody dependent (IgM or IgG)
Complement or phagocytosis involved to destroy cells
Transfusion reactions

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3
Q

Type III Hypersensitivity

A

Occurs when antibodies associated in immune complexes are deposited into the surfaces of vascular tissues. The complexes cause the activation of complement and the attraction of phagocytes to the area and leads to tissue damage. Diseases that are associated with this include post streptococcal glomerulonephritis and systemic lupus erythematosis

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4
Q

Type IV Delayed hypersensitivity (CD4’s)

A

Ran by T cells
CD8’s T cell mediated by cytotoxicity
Contact sensitivity

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5
Q

In Type III hypersensitivity why is there an antigen-antibody complex causing problems?

A

Neutrophils and macrophages should have cleared the complexes. But they don’t, so it causes problems.

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6
Q

Why is skin testing widely used to test for type I hypersensitivity?

A

It has good sensitivity (mast cells are in the tissue), but they cause false positives

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7
Q

What is the immune response involved in contact hypersensitivity?

A

Hapten-carrier complex is recognized by T cells

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8
Q

What immune elements are involved in a positive skin test for tuberculosis?

A

T cells (CD4’s) and macrophages

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9
Q

Organ specific autoimmune disorder

A

Antibodies and lesions are confined to a specific organ. Clinical serologic overlap (thyroid, stomach, etc). The antigens are only available to lymphoid system in low concentrations and evoke organ specific antibodies. Example: Grave’s disease

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10
Q

Non organ systemic autoimmune disorder

A

Antibodies and lesions are not confined to a single organ. Antigens are at high concentrations, familial tendency to develop connective tissue disease. Example: SLE

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11
Q

What are immunopathogenic mechanisms of autoimmune disorders specifically caused by complement

A

Self cell with surface antigen, with antibody bound on the surface binds complement leading to lysis of cell and inflammation

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12
Q

What are immunopathogenic mechanisms of autoimmune disorders specifically caused by cytoloxic T cells

A

T cells have a specificity toward “self” and contribute to autoimmune responses

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13
Q

What are immunopathogenic mechanisms of autoimmune disorders specifically caused by NK cells

A

Recognize a “self” cell as foreign and attack and kill cells

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14
Q

Warm reactive autoantibodies

A

Most common—antibody IgG will bind to RBC and be destroyed in the RE system

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15
Q

Cold reactive autoantibodies

A

<20%–IgM attaches to RBC’s in colder areas of body during circulation, bind complement leading to lysis

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16
Q

Paroxysomal cold hemoglobinuria

A

Often after viral infections—transient. IgG antibody is biphasic-reacts with antigen in cold and lysis when it is warm

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17
Q

Drug induced

A

(20%) RBC’s are coated with drug and antibody complexes

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18
Q

Describe the different types of Systemic Lupus Erythematosus?

A

The individuals with this disease produce multiple autoantibodies. In the laboratory antinuclear antibodies appear, immune complex problems, decreased complement levels, tissue deposition of Ig’s and complement

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19
Q

What is the main cause of tissue injury in systemic lupus erythematosus?

A

Deposition of immune complexes

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20
Q

Which antibodies can be detected using FANA technique?

A

Different patterns will be visible indicating specific antibodies
• Anti-dsDNA—present in Crithidia luciliae kinetoplasts
• Anti-histone antibody
• Anti-DNP (deoxyribonucleoprotein)
• Anti-Sm (uridine-rich RNA)
• Anti-SS-A/Ro (RNA protein)
• Anti-SS-B/La (Processing products of RNA polymerase)
• Anti-nRNP (RNA antibody-nuclear, against 7-8 nonhistone proteins)
• Anti-nucleolar RNA

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21
Q

Describe Fluorescent Antinuclear Antibody testing. Discuss the different patterns and antibodies involved

A

Usually human epithelial cells are placed on a glass slide. Patient serum is added to the slide. If the patient has antibodies to nuclear material it will bind to the cells on the slide. A wash phase is then completed to remove any antibodies that are not attaching. Anti-human antibodies with a fluorescent tag are then overlaid on top followed by a second wash step. If the patient antibody is present the AHG with the tag will bind and not be removed during the last wash phase.

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22
Q

Discuss crithidia FANA testing

A

Crithidia is an organism used as a substrate (usually on a solid phase). The kintoplast of the Crithidia is pure native dsDNA and can be used instead of another source like HEp-2 cells and is useful in IDing anti-dsDNA

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23
Q

Discuss the immunopathogenic mechanisms of rheumatoid arthritis

A

Rheumatoid factor is an antibody that has specificity for antigen determinants of the Fc fragment of human IgG’s, IgM’s and IgA’s.

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24
Q

What organ and manifestations are involved in Hashimoto’s disease?

A

thyroid, cytotoxic autoantibody production related to HLA-DR4 and DR5, (presence of anti-microsmal antibodies of the thyroid) has diffuse lymphocytic infiltration, hypothyroidism

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25
Q

What organ and manifestations are involved in Graves disease?

A

Type II hypersensitivity. This disease is a leads to a thyroid problem. Antibodies (IgG or IgM) bind to Thyroid Stimulating Hormone (TSH) receptor and causes their stimulation. This leads to the body thinking that more thyroid hormone is being bound to the receptors, but it is the antibodies leading to hyperthyroidism

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26
Q

Mechanism for Diabetes mellitus type I

A

Type IV hypersensitivity. Occurs when individual’s T cells attach the inslet cells within the pancreas. Causes impaired glucose metabolism and vascular disease. (90% have HLA DR3 and DR4)

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27
Q

Mechanism for myasthenia gavis

A

This occurs when antibodies (IgG and IgM) bind to acetylcholine receptors. Acetylcholine is a neurotransmitter found in the junctions of neurons, including muscle junctions and cause their stimulation. If the acetylcholine can’t bind, the stimulation won’t occur leading to muscle weakness and paralysis

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28
Q

Mechanism for Multiple Sclerosis

A

demyelinating disorder of CNS, T cell dependent disorder

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29
Q

Describe the principle of anti-nuclear antibody testing?

A
  1. Purchased cells are on a microscope slide such as HEp-2 cells
  2. Patient antibody is overlayed serum
  3. Wash phase
  4. Florescent tagged AHG is overlayed
  5. Wash phase
  6. View using a fluorescent Scope
  7. If the patient has anti-nuclear antibodies, characteristic patterns of fluorescent will appear
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30
Q

Describe sources of error in anti-nuclear antibody testing:

A 
False negatives
• No antigen on purchased slides
• Fixing or washing the purchased slide
• Binding of antinuclear factor to circulating immune complexes
• Non-specific staining
31
Q

In anti-nuclear fluorescent testing specific pattern indicate the likelihood of possible antibodies. Correlate specific patterns with these antibodies:

Homogenous pattern (diffused)

Chromatin positive

Peripheral or Rim pattern

Speckled pattern

Nucleolar pattern

Centromere

A

Homogenous - anti-n DNA

Chromatin - anti-dsDNA, anti-ssDNA or anti-histones

Peripheral or Rim - anti-nDNA, anti-dsDNA, anti-DNP

Speckled - anti-RNP, anti-Sm

Nucleolar - anti-nucleolar RNA

Centromere - Antibodies to centromeric chromatin (cells in metaphase or interphase)

32
Q

What is the cause of the pathology in autoimmune diseases?

A

Circulating immune complex

33
Q

Define autoimmunity:

A

Loss of tolerance to self antigens

34
Q

What is tolerance in relation to immunology?

A

The body’s ability to ignore self antigens

35
Q

Which testing will give the least definitive result for the diagnosis of rheumatoid arthritis?

A

FANA’s because in that form of testing antinuclear antibodies are screened, not IgG’s, IgM’s or IgA’s that have Fc receptors for IgG

36
Q

Describe the principle for rapid slide testing in the detection of rheumatoid factor?

A

Latex particles are coated with denatured human gamma globulin. If Rheumatoid Factors (RF) are present the RF antibody will bind to Fc region of the IgG antibody on the latex particle and cause agglutination.

37
Q

What immunologic substance is decreased in active stages of systemic lupus erythematosus?

A

Complement 3

38
Q

What is the purpose of testing for anti-islet antibodies?

A

Early markers for Type I diabetes caused by antibodies mediating beta pancreatic cell distruction

39
Q

List diseases that commonly give a positive pattern in fluorescent anti-nuclear antibodies?

A

Systemic Lupus erythematosus, Sjogren’s syndrome, rheumatoid arthritis, mixed connective tissue

40
Q

Which fluorescent anti-nuclear antibody pattern is most closely associated with systemic lupus erythematosus?

A

Rim pattern

41
Q

What is the latex agglutination titer for rheumatoid arthritis considered as the lower limit of positivity?

A

1:160

42
Q

Autoimmune diseases are associated the most with which MHC antigens?

A

MHC-B and MHC-D

43
Q

Which disease is associated with antibodies to smooth muscle?

A

Active chronic hepatitis

44
Q

If you are evaluating an ELISA assay to replace your fluorescent anti-nuclear antibody test and the correlation is only 60%, what should be done next?

A

Refer the discrepant specimens for testing by another method

45
Q

If an intermediate pattern occurs in an indirect immunofluorescent assay, what corrective action may help?

A

Dilute the sample and re-test

46
Q

What is molecular mimicry?

A

Bacterial or viral antigen that are close to self antigen—when immune response against bacterial or viral antigen is made the attack may focus on self antigen

47
Q

Monoclonal and Polyclonal gammopathies

A

Mono - usually only cause and elevation of one of the antibodies

Poly - there are several plasma cells involved and are sometimes secondary to infection or inflammation of a chronic nature

48
Q

Multiple myeloma and waldenstroms disease characteristics

A

M.M - monoclonal gammopathy, IgG is most common, cause is unknown

Wald - monoclonal gammopathy, IgM is most common, t(8:14) and Trisomy 12

49
Q

Light and Heavy chain

A

Light - Bence Jones proteins, or Kappa chains or Lambda chains. Patient have defect in humoral and not cellular immunity

Heavy - Usually a monoclonal protein. Alpha heavy chain disease is most common

50
Q

Gammopathies with more than one band

A

Elevation of two or more immunoglobulins produced by several clones
Often a secondary response to infection or inflammation

51
Q

What class of antibody is being overproduced in Waldenstrom’s macroglobulinemia?

A

IgM

52
Q

Categorize the following diseases into the appropriate group of disorders: B cell deficiency

A

Hypogammaglobulinemia in infancy

Common variable immunodeficiency

X-linked brutons agammaglobulinemia

53
Q

Complement-Mediated Cytotoxicity

A

Patient lymphocytes are added to wells containing specific antibody to MHC system. Complement is added and a dye. If an antigen antibody reaction occurs than complement is bound, cells lyse and bring in dye-indicative of a match. If no reactions occur it is most likely due to complement inactivation

54
Q

Mixed lymphocyte reaction

A

Patient B cells are mixed with radiation inactivated donor B cells. Addition of radioactive dye. If the patient B cells are not compatible to the donor B cells, they will activate and draw in the radioactivity within the cell. Interpretation = not compatible

55
Q

Regular graft rejection

A

usually type II hypersensitivity with the recipients T cells slowly rejecting the donor cells

56
Q

Graft vs. host disease

A

immunocompetent T cells from donor overtakes the immunosuppressed individuals immune system and kills entire recipients not just the organ

57
Q

Hyperacute rejection

A

Occurs within minutes of transplantation. Characterized by thrombosis of graft vessels and ischemic necrosis of graft. Mediated by circulating antibodies that are specific for antigens on graft endothelial cells and that are present before transplantation

58
Q

Accelerated rejection

A

It is considered the same mechanism as the hyperacute but slower

59
Q

Acute rejection

A

Occurs within days or weeks after transplantation and is the principle cause of early graft failure. Mediated by T cells and antibodies specific for alloantigens in the graft. May be either CD4 or CD8 which react against the graft. May also react against cells in graft vessels. Antibodies contribute by antibody mediated injury to the graft vessels caused mainly by complement activation

60
Q

Chronic rejection

A

Occurs over months or years, leads to progressive loss of graft function. May be manifested as fibrosis of the graft and the gradual narrowing of graft blood vessels=graft arteriosclerosis. T cells react with graft alloantigens and secrete cytokines, which stimulate the proliferation and activates of fibroblasts and vascular smooth muscle cells. Alloantibodies also contribute

61
Q

If there are no anti-rejection drugs given in an ABO compatible donor organ transplant, what level of rejection usually occurs?

A

Acute Rejections

62
Q

Discuss T cell involvement with graft rejection

A

T cells are major players (CD4s)
Host CD4’s T cells attack graft cells
Host cytotoxic T cells (CD8) cause a destructive effect on donor cells & activation of macs and antibody

63
Q

Define and describe bone marrow transplants

A

The transplantation of hematopoietic stem cells taken from the blood or bone marrow; it is performed clinically to treat cancers affecting blood cells (leukemia), immunodeficiency diseases, and diseases of defective hematopoesis

64
Q

Autograft

Syngraft

Allograft

Xenograft

A

Autograft - Transplant from one spot to another on same body

Syngraft - Graft between monozygous twins

Allograft - Graft between individuals of same species

Xenograft - Graft between individuals of different species

65
Q

What immune element is usually responsible for the destruction of a donor organ?

A

Recipient T cells

66
Q

What are the antigen groups in MCHI, MCHII and MCHIII molecules?

A

MHC I = A, B, C
MHC II = DR, DQ, DP
MHC III = Complement

67
Q

Which donor that is a relative may make the best organ donor?

A

Sibling

68
Q

Identify and discuss current markers used in tumor immunology testing and the organs involved with the markers

Tumor

Enzyme

Hormone

A

Tumor - AFP, CEA, β-hcG, CA125

Enzyme - Prostate-specific antigen (PSA) Prostate

Hormone - hCG, ACTH

69
Q

Tumor markers are most often tested by what laboratory technique?

A

Immunoassays

70
Q

CA-125, a tumor marker for ovarian cancer, was high before treatment but remained low after treatment despite the recurrence of the tumor, why might this occur?

A

Ca-125 is not sensitive enough to be used alone to monitor tumor development…poor sensitivity

71
Q

Categorize the following diseases into the appropriate group of disorders: T cell Deficiencies

A

DiGeorge Anomaly

Purine nucleoside

72
Q

Categorize the following diseases into the appropriate group of disorders: Combined deficiencies

A

Ataxia Telangiectasia

Severe Combined Immunodeficiency

Wiskitt Aldrich Syndrome

73
Q

Categorize the following diseases into the appropriate group of disorders: Neutrophil deficiencies

A

Leukocyte adhesion deficiency

Chronic Granulomatus disease

Immunology (4 decks)

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