Flashcards in Immune System Deck (115):
What are the two types of immunity?
Innate and Adaptive
What are the components of the innate immune system?
What are the two types of adaptive immunity?
Humoral and Cell mediated
How is adaptive immunity obtained?
Naturally and Artificially
How does the innate immune system function?
Recognizes a common pathogen and requires no prior exposure
What are the non cellular elements of the innate immune system?
Physical barriers, competent factors, acute phase and contact activation pathway proteins
What are the cellular components of the innate immune system?
Neutrophils, Macrophages, Monocytes and Natural killer cells
Where are the cells of the innate immune system located?
In all body tissues
How do the cells of the innate immune system treat foreign cells?
They identify microbes via recognition signals from surface patterns of molecules indigenous to microorganisms
How are invaders destroyed by the innate immune system?
By release of toxic molecules or phagocytosis
What are the two pathways that activate the complement protein cascade?
Pathogen dependent (classical)
Pathogen independent (alternative)
How does the complement cascade help clear microorganisms?
Coats the agents with protein that facilitates phagocytosis
What results from defects in the classical pathway?
Predisposes to autoimmune inflammatory disorders
What results from deficiencies in C3 (common pathway)?
Usually fatal in utero
What results from deficiencies in terminal complement C5-C8?
Associated with recurrent infections
What is the primary organ of complement protein synthesis?
What is inflammation?
The means by which body defense cells and defense chemicals lave the blood and enter the tissue around the injures or infected site
What systems are involved in the inflammatory process?
Vascular, inhume and coagulation
What is adaptive immunity?
Immunity acquired by lymphocyte activation and subsequent delayed response
How does the adaptive immune system display specificity?
Cells and antibodies are generated targeted to unique proteins found on an invading microbe
How does the memory of adaptive immunity function?
Upon re-exposure, dormant cells are generated and mount a quick defense against invading organisms
What are T-helper cells?
CD4 cells that carry T-cell receptors that respond to a single antigen
What is the function of the CD4 helper molecules that are secreted when an antigen is recognized?
Further enhance macrophage function and activate CD8 (cellular immunity) and B-lymphocyte (humoral immunity)
What is the function CD8 lymphocytes?
Cytotoxic cells, seek out and destroy infected body cells with microbe specific to its T-cell receptor
What is the function of B-lymphocytes
When activated by an antigen specific to the b-cell receptor and molecules from the T-helper cells secrete antibodies
What are the four cell types of T-cells?
Regulatory helper cells
What is the function of Pro inflammatory cells?
Chronic inflammation and autoimmune disease
What is the function of regulatory helper cells?
Promote tolerance, autoimmune, allergic and inflammatory responses
How are foreign invaders recognized by T and B cells?
Antigen presenting cells
What is the importance of antigen presenting cells?
They are the link between the innate and adaptive immune system
How do invaders hide from the immune system?
They have evolved proteins that interfere with the antigen presentation by major histocompatibility complex?
What is the often the cause of neutropenia?
Drug related, marrow usually recovers once the drug is withdrawn
What is the first step of the infection process?
Migration of granulocytes out of the circulation and into the bacterial invasion
What is neutrophilia?
Occurs when the neutrophil count increases 2-fold within hours of onset of a severe infection
At what WBC count is a deep seated infection considered?
What is granulocytosis?
When the WBC count exceeds 50,000
What is granulocytosis often associated with?
Indicated non infectious malignant process
In what conditions does monocytosis usually occur?
Lupus, RA and Sarcoidosis
What is angioedema?
Swelling that occurs under the skin instead of on the surface
What are the two mediators of angioedema?
Mast cell release and Bradykinin
What surgical procedures are triggers of angioedema?
Dental surgery or any surgery requiring ETT
What pathology is associated with defects of antibody production?
Cold autoimmune diseases
What pathology is associated with defects in t-lymphocytes?
DiGeorge syndrome and Combined immune system defects
What is the cause of acquired immunodeficiency syndrome?
A RNA virus that transcribes DNA and becomes incorporated into the host genome where it replicates freely
Infects T helper lymphocytes and destroys them
What is the result acquired immunodeficiency syndrome?
The host is more susceptible to opportunistic infections and malignancies
What is the most common mode of transmission of acquired immunodeficiency syndrome?
Sexual intercourse 60-70%
What are additional modes of transmission of acquired immunodeficiency syndrome?
Mother to child
Blood products and organ donation
How is AIDS classified?
According to its associated clinical symptoms
What kind of side effects are associated with AIDS drug treatment?
Cancer, allergic and autoimmune disorders
How many types of immune mediated allergic reactions are there?
Four I, II, III, IV
What is a type I mediated allergic response?
What is a type II mediated allergic response?
Cytotoxic reaction mediated by IgG and IgM and complement
What is a type III mediated allergic response?
Reactions produce tissue damage via immune complex formation and deposition
What is a type IV mediated allergic response?
Reactions are marked by T-lymphocyte mediated delayed hypersensitivity
What is the difference between anaphylactic and anaphylactoid reactions?
Identical clinical picture seen as a result of the degranulation of mast cells and basophils BUT, anaphylactoid reaction are NOT mediated through IgE
What is an example of a type II cytotoxic reaction?
The immune system response to antigen A and B found on RBC surfaces
What is a transfusion reaction?
When A or B antigens are not present and anti A and anti agglutinogens develop in the plasma
What reaction occurs in the body from a transfusion reaction?
Clumping and hemolysis occurs to form small clots which plug small blood vessels especially in the kidney
What cell pathology is seen as a result of a transfusion reaction?
What causes deposits to form in a type III mediated hypersensitivity reaction?
Large complexes are cleared from the circulation by macrophages but macrophages have difficulty disposing of small immune complexes
Where are the deposits typically left in a type III mediated hypersensitivity reaction?
Blood vessels. joints and glomeruli and react with the complement
Once activates, what is the role of the complement in a type III hypersensitivity reaction?
Complement mediates the induction of granule release from mast cells and recruitment of inflammatory cells into the tissue
What are examples of type III hypersensitivity reactions?
Lupus and Glomerulonephritis
What is the presentation of a type IV hypersensitivity reaction?
Cutaneous symptoms are most common and may be severe as Steven Johnson syndrome
What is DRESS and what hypersensitivity reaction is it associated with?
Drug rash with sodiniophilia and system symptoms in another sever form
What are risk factors for anaphylaxis during anesthesia?
Longer duration of anesthesia
Female (especially for NMBA and hypnotics)
Multiple past surgeries
Presence of allergic condition
What can be given to a patient prior to drug administration if a previous suspected reaction had been reported?
H1 and H2 blockers 16-24hrs before
Optimize volume status
Hydrocortisone 1g is patient is exposed to an agent with high allergic risk
What is may be the first sign on anaphylaxis in an anesthetized patient?
How might the provider confirm an anaphylactic reaction has occurred?
Elevated plasma trypase (stored in mast cells released with immune reaction) within 1-2hrs of the event
How long does it take histamine to return to normal after an anaphylactic reaction?
What is an idiosyncratic reaction?
An undesirable pharmacologic response to a drug independent of the dose
What is drug intolerance?
Undesirable pharmacologic effect at low doses
What is a localized reaction?
Histamine release along a vein after giving a drug
What should be done if a localized reaction occurs?
Stop the drug administration
What class of drugs are responsible for 60% of drug induced allergic reactions?
What type of muscle relaxants are the most likely to cause an anaphylactoid reaction?
Benzyl isoquinolimum compounds (atracurium and cisatracurium)
What drugs can be given to attenuate an anaphylactoid reaction?
Antihistamines and glucocorticoids
What drug has a cross reaction with neostigmine?
Morphine, both contain ammonium ions
How often do hypnotic agents cause anaphylaxis?
In what instance would you avoid propofol from fear of an allergic reaction?
The patient has a history of an egg or soy allergy
What type of local anesthetics are people allergic to?
Ester type LA are more commonly allergic
What should be done if a patient claims they are allergic to a LA?
They should be skin tested
What opioids cause histamine release from mast cells and basophils?
Morphine, codeine and meperidine
What type of reaction do people usually have to contrast dye?
Most are non-immune related and are managed with pretreatment
What effect does protamine have on the immune system?
Stimulates mast cells to release histamine and activates the complement pathway leading to thromboxane production
What types of effects does thromboxane production have on the body?
Bronchoconstriction, pulmonary arter HTN and systemic HoTN
What type of patients are most likely to have a reaction from protamine?
Allergic to sea food
Diabetics on protamine containing insulin
What is the second most common cause of anaphylaxis in the preoperative period?
What is the most common antibiotic allergy?
What class of antibiotics is said to have a cross reaction if allergic to PCN?
What is the second most common antibiotic allergy?
What is the leading cause of transfusion related lung injury?
What is a transfusion related lung injury?
Antibodies in the plasma of the donor blood react with the neutrophils on the pulmonary vascular endothelium
When is the onset and signs of a TRALI?
Within 6hrs of transfusion and presents with hypoxia and pulmonary edema
What type of hypersensitivity reactions are associated with latex allergy?
Type IV cell mediated delayed onset, usually contact dermatitis
Type I IgE mediated and most severe
Who is at risk for latex allergy?
Healthcare workers (ICU and PACU), multiple surgeries, allergy to bananas, avocado, tropical fruit and nuts, contact dermatitis, asthma, rhinitis
What is the onset difference between drug and latex allergies?
Reactions to drugs usually occur within 10min where latex can take up to 30min
What is the route of entry for latex allergy?
Mucus membranes and inhalation
What does the ASA suggest for surgical timing in patients with a latex allergy?
They should be the first case in the morning when the levels of latex airborne allergens are the smallest
What is thought to trigger autoimmune disorders?
Infection or environmental antigens: streptococcus, e-coli, staph aureus and certain drugs
What is the treatment for autoimmune disorders?
What are three categories to consider when caring for a patient with an autoimmune disease?
Vulnerable organs specific to disease
Risk of accelerated atherosclerosis and associated CV compromise
The consequence of therapy used to treat disorder
What is immunosenescence experience by the elderly?
The changes in the innate and adaptive immune response associated with increased age
What effects does age have on the immune system?
Increased susceptibility to infection
Decreased response to vaccines
Impaired wound healing
How do opioids affect the immune system?
Suppress NK, lymphocyte, neutrophil and macrophage functions
How does morphine affect the immune system?
Impairs antibody formation
How does ketamine, volatiles and thiopental affect the immune system?
Reduce NK cell activity and or number
How does nitrous oxide impair immune function?
Impair DNA and has been observed to depress hematopoietic and mononuclear cell synthesis and neutrophil chemotaxis
How does propofol impact the immune system?
Unclear but thought to inhibit neutrophil, monocyte and macrophage activity
What effect do non opioid analgesics have on the immune system?
Less effect than opioids, Tramadol may actually promote NK activity
COX 2 may actually possess anti tumor and anti angiogenic properties
What effect does regional anesthesia have on the immune system?
Reduces requirements for immunosuppressive drugs
May be associated with decreased cancer recurrence
What effects do lidocaine and ropivicane have on the immune system?
May suppress growth of tumor cells
What is the recommendation for surgery in patients with infectious disease?
No surgery except emergency or essential the nan acute infection because renal insufficiency can be caused by antimicrobial drugs
What is the leading cause of post op morbidity in patients with an acute infectious disease?
Sepsis, due to decreased SVR