Fiser Absite. Ch 03-05. Blood Products. Immunology. Infection Flashcards by jeremy linson

Which blood products do not carry the risk of HIV and hepatitis because they are heat treated?

albumin and serum globulins

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Who gets CMV-negative blood?

low birth-weight infants, bone marrow transplant pts and other transplant pts

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What is the number one cause of death from transfusion reaction?

Clerical error leading to ABO incompatibility

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Stored blood is low in ____ causing a left-shift

2,3 DPG

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Back pain, chills, tachycardia, fever, hemoglobinuria in pt that has been transfused. May present as diffuse bleeding in anesthetized patient.

acute hemolysis (ABO incompatibility, antibody mediated)

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What is the treatment for acute hemolysis (ABO incompatibility)

fluids, diruetics, HCO3-, pressors, histamine blockers

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What is the most common transfusion reaction and what is the pathophys?

febrile nonhemolytic transfusion reaction. recipient antibody reaction against WBCs in donor blood

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What is the treatment for febrile nonhemolytic transfusion reaction?

stop transfusion and use WBC filters for subsequent transfusions

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Anaphylaxis after transfusion. What is usually the pathophys?a and was is the tx?

Usually IgG against IgA in IgA-deficient patient. Tx: fluids, Lasix, pressors, steroids, epi, histamin blockers

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What is the pathophys of transfusion related acute lung injury (TRALI)?

antibodies to recipient’s WBCs, clot in pulmonary capillaries

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Dilutional thrombocytopenia occurs after transfusion of ___ units of PRBCs.

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What electrolyte abnormality can occur with massive transfusion?

hypocalcemia

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Antiplatelet antibodies develop in ___% of pts after 10-20 platelet transfusions

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Hetastarch (Hespan) can be used up to ___ L without the risk of bleeding complications.

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Most common bacterial contaminate of transfused blood?

GNRs usually e. coli

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Most common blood product source of contamination?

platelets (not refrigerated)

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What parasitic disease can be transmitted with blood transfusion?

chagas disease

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What is the most common blood type?

O+

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Predominant release of proinflammatory cytokines (IL-2, INF-gamma). Involved in cell-mediated responses

Th1 helper T cells (CD4)

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Predominant release of anti-inflammatory cytokines (IL-4 -> inhibits macrophages). Involved in atopy and allergic responses.

Th2 helper T cells (CD4)

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IL-___ causes B-cell maturation into plasma cells (antibody secreting).

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IL-___ causes maturation of cytotoxic T cells

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Recognize and attack non-self antigens attached to MHC class I receptors (e.g. viral gene products)

Cytotoxic T cells (CD8)

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Infections associated with defects in ___ immunity - intracellular pathogens (TB, viruses)

cell-mediated

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Can increase T-cell mediated immunity.

Nucleotides

What are the types of MHC class I

A, B and C

What are the types of MHC class II

DR, DP and DQ

CD8 cell activation. Present on all nucleated cells. Single chain with 5 domains. Target for cytotoxic T cells.

MHC class I

CD4-cell activation. Present on B cells, dendrites, monocytes, and antigen-presenting cells. 2 chains with 4 domains each. Activator for helper T cells. Stimulate antibody formation.

MHC class II

___ infection - endogenous viral proteins produce, are bound to class I MHC, go to cell surface, and are recognized by CD8 cytotoxic T cells

Viral

___ infection - endocytosis, proteins get bound to MHC class II molecules, go to cell surface, recognized by CD4 helper T cells -> B cells which have already bound to the antigen are then activated by the CD4 helper T cells; they then produce the antibody to that antigen and are transformed to plasma cells and memory B cells.

Bacterial

Not restricted by MHC, do not require previous exposure. Not considered T or B cells. Recognize cells that lack self-MHC. Part of the body's natural immunosurveillance for cancer.

Natural killer cells

Initial antibody made after exposure to antigen. Is the largest antibody, having 5 domains (10 binding sites).

IgM

Most abundant antibody in body. Responsible for secondary immune response. Can cross the placenta and provides protection in newborn period.

IgG

Found in secretions, in Peyer's patches in gut, and in breast milk; helps prevent microbial adherence and invasion in gut.

IgA

Membrane-bound receptor on B-cells (serves as an antigen receptor). Which Ab?

IgD

Allergic reactions, parasite infections. Which Ab?

IgE

Which antibodies fix complement?

IgM and IgG (requires 2 IgGs or 1 IgM)

Immediate hypersensitivity-reaction. IgE mediated; mast and basophils release histamine, serotonin and bradykinin. Example include bee stings, peanuts, hay fever.

Type I

Hypersensitivity reaction where IgG or IgM reacts with cell-bound antigen. Examples include ABO blood type incompatibility, Graves disease, MG, ITP.

Type II

Hypersensitivity reaction that involves immune complex deposition. Examples include: serum sickness, rheumatoid arthritis and SLE

Type III

Delayed-type hypersensitivity. Antigen stimulation of perviously sensitized T-cells. Examples include: TB skin test, contact dermatitis.

Type IV

Converts lymphocytes to lymphokine-activated killer cells by enhancing their immune response to tumor. Also converts lymphocytes into tumor-infiltrating lymphocytes. Has been shown to be successful for melanoma.

IL-2

What is a tetanus-prone wound?

>6 hrs old; obvious contamination and devitalized tissue; crush; burn; frostbite, or missile injury

When to give tetanus toxoid or tetanus immune globulin

Non-tetanus prone wound - give toxoid only if pt has received <3 doses or tetanus status unknown.

Tetanus prone wound

always give toxoid unless pt has had >3 doses and it has been <5 years

Tetanus immune globulin is for

tetanus prone wounds in non-immunized pt or immunization status unknown.

What is the most common immune deficiency?

malnutrition

Which part of the GI tract is virtually sterile; some GPCs, some yeast?

stomach

Which part of the GI tract has 10^5 bacteria, mostly GPCs?

proximal small bowel

Which part of the GI tract has 10^7 bacteria, mostly GPCs, GPRs, GNRs?

distal small bowel

Which part of the GI tract has 10^11 bacteria, almost all anaerobes, some GNRs, GPCs?

colon

What are the most common organisms in the GI tract?

anaerobes

What is the most common anaerobe in the colon?

bacteroides fragilis

What is the most common aerobic bacteria in the colon?

E. coli

How does e coli trigger the release of TNF-a from macrophages and activate complement and coagulation cascade?

endotoxin (lipopolysaccharide lipid A) is released

What is the optimal glucose level in a septic patient?

100-120

How is c diff colitis diagnosed?

fecal leukocytes in stool, C. difficile toxin

What is tx for c diff?

oral vancomycin or flagyl; IV - flagyl; lactobacillus can also help; stop other abx or change them

___% of abdominal abscesses have anaerobes; ___% of abdominal abscesses have both anaerobic and aerobic bacteria

90, 80

Tx for abdominal abscess?

drainage

Abscesses usually occur how many days after an operation?

7/10/2013

When do you start abx for an abscess?

pts with DM, cellulitis, clinical signs of sepsis, fever, elevated WBC or with bioprosthetic hardware

Wound infection percentage for a clean operation (ie hernia)?

Wound infection percentage for a clean contaminated procedure (ie elective colon resection with prepped bowel)

3%-5%

Wound infection percentage for a contaminated procedure such as a GSW to colon with repair?

5%-10%

Most common organism overall in surgical wound infections?

s. aureus

How to tell the difference between staphlococcus aureus and staphlococcus epidermidis?

s aureus is coagulase positive

What is the most common GNR in surgical wound infections?

E. coli

What is the most common anaerobe in surgical wound infections?

B. fragilus

>___ bacteria needed for wound infection; less bacteria needed if foreign body present.

10^5

Recovery from tissue indicates necrosis or abscess (only grows in low redox state). Also implies translocation from gut. Which bacteria in infection?

B. fragilis

Which two types of bacteria can produce an invasive soft tissue infection that can be present within hours postoperatively (produce exotoxins)

Clostridium perfringens and beta hemolytic strep

Most common nonsurgical infection?

UTI (most commonly E. coli)

Leading cause of infectious death after surgery?

nosocomial pneumonia

2 most common organisms in ICU pneumonia?

#1 s. aureus, #2 pseudomonas

#1 class of organismis in ICU pneumonia?

GNRs

Top three organisms in line infections

S. epi, S aureus, yeast

Top three causes of necrotizing soft tissue infections

Beta-hemolytic streptococcus (group A), C. perfringens and mixed organisms

Tx for necrotizing soft tissue infections?

early debridement, high dose PCN

Myonecrosis, gas gangrene and gram stain showing GPRs without WBCs.

C. perfringens

Pulmonary sx most common; can cause tortuous abscess in cervical, thoracic and abdominal areas. What type of infection and what is the tx?

Actinomyces. Tx: drainage and penicillin G

Pulmonary and CNS sx most common. Tx is drainage and Bactrim. What is the organism?

Nocardia

Pulmonary sx most common. Mississippi and Ohio river valleys. What is the organism and what is the tx?

Histoplasmosis. Amphotericin for severe infections

Pulmonary sx in the Southwest. What is the diagnosis and what is the tx?

Coccidioidomycosis. Amphotericin for severe infections

What fungal infection has CNS symptoms most common and what is the tx?

Cryptococcus. Amphotericin for severe infections

What is the tx for candida infections?

fluconazole (some Candida resistant), amphotericin for severe infections

What is diagnostic of SBP?

PMNs > 500 cells/cc (fluid cultures negative in many cases)

SBP is monobacterial, what are the top 3?

50% e coli, 30% streptococcus, 10% Klebsiella

Tx for SBP?

ceftriaxone or other 3rd generation cephalosporin

If pt with SBP is not getting better on abx or if cultures are polymicrobial?

need to rule out intra-abdominal source (diverticular abscess, perforation)

Which abx for short term prophylaxis against SBP?

Fluoroquinolone

What is the cause of SBP?

decreased host defenses (intrahepatic shunting, impaired bactericidal activity in ascites); not due to transmucosal migration

What is the cause of secondary bacterial peritonitis?

intra-abdominal source (transmucosal migration, perforated viscus)

What are the most common organisms in secondary bacterial peritonitis?

B. fragilis, E. coli, Enterococcus

What is the tx for secondary bacterial peritonitis?

Usually need laparotomy to find source

Seroconversion after HIV exposure occurs in ___ weeks

6 to 12

What 2 drugs can help decrease seroconversion of HIV after exposure? Should be given within 1-2 hours of exposure.

AZT and lamivudine

2 most common reasons for laparotomy in HIV patients?

opportunistic infections (CMV most common), neoplastic disease (respectively)

Most common intestinal manifestation of AIDS. Can present with pain, bleeding or perforation.

CMV colitis

Lymphoma in HIV patients occurs most commonly which two locations?

stomach, rectum

Name two causes of upper GI bleeding in HIV patients?

Kaposi's sarcoma, lymphoma

Name three causes of lower GI bleeding in HIV patients?

CMV, bacterial, HSV

Tx of brown recluse spider bite?

dapsone initially, may need resection of area and skin graft for large ulcers later

Tx for acute septic arthritis?

drainage, 3rd-generation cephalosporin and vancomycin until cultures show organism

Tx for diabetic foot infection?

broad-sprectrum abx (Unasyn, Zosyn)

What bacteria is found only in human bites; can cause permanent joint injury?

Eikenella

What bacteria is found in cat and dog bites?

Paseurella multocida

What is the tx for cat/dog/human bites?

broad-spectrum abx (Augmentin)

What are the 2 bacteria usually found in furuncles (boil)?

S. epidermidis or S. aureus

What is a carbuncle?

A multiloculated furuncle

What are the two most common bacteria in peritoneal dialysis catheter infections?

s. aureus and s. epidermidis

Tx for peritoneal dialysis catheter infection?

intraperitoneal vancomycin and gentamicin; increased dwell time and intraperitoneal heparin

Need removal of peritoneal dialysis catheter for which type of infections?

all fungal, TB and pseudomonas infections

Fiser Absite. Ch 03-05. Blood Products. Immunology. Infection Flashcards

(114 cards)