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Pathology: immunity Flashcards

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0
Q

Natural immunity

A
  • primitive, nonspecific from of immunity
  • inherited NOT dependent on previous exposure to foreign substances
  • Includes various mechanical factors such as skin or ciliated cells in the mucosa of the nose or bronchus in lung
  • Includes phagocytic cells such as macrophages and polymorphonutriphil cell (PMNs)
  • Includes NK (natural killer) cells
  • includes protective proteins found in tissues and plasma
  • complement
  • properdin - plasma protein that activates the alternate complement pathway
  • Lysozyme - protein found in tears, nasal and intestinal secretions, bactericidal
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1
Q

What is immunity

A

Protection from diseases, especially infectious diseases
Two kinds of immunity
Natural immunity- born with it /innate
Acquired immunity- develops with exposure

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2
Q

Acquired immunity

A

-complex system of reactions that evolve in response to foreign matter
-based on specific responses stimulated by substances known as antigens
-Antigen - any chemical substance that can elicit a specific immune response
-Based on the ability of the body’s immune system to
1. distinguish self from non-self and
2. generate an immunologic memory
3. Mount an integrated reaction of various cells
Acquired immunity relies on immunocompetance - the body’s ability to mount an appropriate immune response

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3
Q

Cells of immune system

A

Derived from stems cells in the bone marrow

  1. Lymphocytes - T Lymphocytes (T cells), T helper cells (CD4+ cells, marker for cell type), T suppressor/cytotoxic cells (CD8+ cells, killing bacteria), B lymphocytes (B cells)
  2. Plasma cells (releases histamine)
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4
Q

Lymphocytes - Primary lymphoid organs

A
  • small cells with a round nucleus and very little cytoplasm
  • Derived from bone marrow stem cells which give rise to two types of cells
  • The first type migrates to the thymus and matures into T lymphocytes
  • The second type stays in the bone marrow and matures into B lymphocytes
  • The bone marrow and thymus are called primary lymphoid organs
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5
Q

Lymphocytes -secondary organs

A
  • From primary lymphoid organs, the T and B Lymphocytes enter the blood circulation and colonize secondary lymphoid organs.
  • The most prominent secondary lymphid organs include spleen and lymph nodes
  • Also include GI tract and bronchial mucosa (mucosa-associated lymphoid tissue - MALT)
  • T Lymphocytes and B lymphocytes have very distinct functions but difficult to distinguish them morphologically
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6
Q

T Lymphocytes (T cells)

A

Lymphocytes that have matured in the thymus

  • Account for two thirds of all lymphocytes in the blood
  • also found in the lymph nodes and spleen
  • include T helper cells (CD4+ cells) and T suppressor/cytotoxic cells (CD8+ cells)
  • Common to all T cells is the surface T-cell receptor (TCR) which is linked to a protein called CD3
  • T cells use TCR for recognition of antigens
  • TCR-CD3 complex is essential for activity of T cells
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7
Q

Natural killer (NK) cells

A

T Cells that do not express TCR - CD3 Complex
Mediate innate immune reactions and are not involved in T cell and B cell mediated immune reaction
Their function is to react against virus-infected cells and to kill tumour and foreign cells without previous sensitization

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8
Q

T Helper (CD4+) cells

A

participate in the immune response to antigens, helping B cells produce antibodies
Express CD4 on their surface
Secrete cytokines (signaling molecule) including interleukins
Classified as TH1 or TH2 depending on which cytokines they produce

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9
Q

TH 1(T helper CD4+ 1) cells

A

Make interleukin 2 (IL-2) and interferon-gamma (IFN) which stimulate macrophages to become phagocytic and mediate the formation of granulomas

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10
Q

TH 2 (T Helper CD4+ 2) cells

A

make IL4, IL5, IL13 which are important for secretion of IgE and other immunoglobulins and activation of eosinophils

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11
Q

T suppressor/cytotoxic (CD8+) cells

A
  • Suppress unwanted antibody production
  • Mediate killing of virus-infected or tumour cells (recognized by body as foreign)
  • express CD8 on their surface
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12
Q

CD4+/CD8+

A

CD4 and CD8 are used as markers for T lymphocytes and for the counting of T helper and T supressor/cytotoxic cells in blood
-normal ratio of CD4(helper)/CD8(killer) is 2:1

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13
Q

B lymphocytes

A
  • Lymphocytes that differentiates into antibody-producing plasma cells when stimulated by antigens
  • an antibody is a protein produced by plasma cells in response to stimulation by an antigen
  • antibodies are produced to help fight against antigens
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14
Q

Plasma cells

A

Fully differentiated descendants of B lymphocytes
Oval shape and eccentrically located round nucleus
Cytoplasm contains an abundance of ribosomes and RER (Rough endoplasmic reticulum)
RER is the site of synthesis of antibodies, the primary secretory products of plasma cells

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15
Q

Antibodies

A

Proteins of the immunoglobulin class that are secreted by plasma cells
Each antibody is made up of about 110 amino acids
Includes IgA, IgD, IgE, IgG, IgM

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16
Q

IgM

A

Composed of five basic units
-functions to neutralize microorganisms
-The largest immunoglobulin
-Their first immunoglobulin to appear after immunization
-natural antibody against blood group ABO antigens
-complement activator
Mega - most largest!

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17
Q

IgG

A

Smallest immunoglobulin
-The most abundant
-produced in small amount on initial immunization, but production is boosted on re-exposure to antigen
-can cross placenta
-act as opsonin (opsonization…coats bacteria and make them taste better and facilitates their phagocytosis)
SMALL GOURMET

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18
Q

IgA

A

Found in mucosal secretions (tears, nasal secretions), milk, intestinal contents
Ace it, 1st line of defense!

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19
Q

IgE

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A

Secreted by plasma cells in tissue

  • Locally attached to mast cells - secrete histamine
  • Mediates allergic reactions such as hay fever or asthma
  • present in trace amounts in serum
20
Q

IgD

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A

Found exclusively on B cells
-cell membrane bound
-participates in antigenic activation of B cells
-Is not released into serum or body fluids
DOMINANT IN B CELLS

21
Q

Antibody production

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A

Begins with contact between an antigen and the cells of the immune system

  • Any substance identified by the body as foreign may serve as an antigen and elicit an immune response
  • To elicit antibody production, the antigen must bind to the B-lymphocyte antigen receptor complex
  • B cells can internalize the antigen and function as antigen -presenting cells (APCs) by presenting internalized antigen to T cells
  • antibody production requires the support of T helper cells
22
Q

Major Histocompatibility Complex (MHC)

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A

All processed antigens are presented to T cells in the context of the major histocompatibility complex (MHC)

  • Proteins presented on the surface of antigen presenting cells (APCs)
  • T helper cell produces cytokines
  • Cytokines transform the B cell into a plasma cell
  • Plasma cell produces antibodies
23
Q

Ag-Ab reaction

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A

Ag are multivalent (more than one binding site or epitope)

  • Ag and Ab bind to form complexes
  • Complexes enlarge util phagocytosed in spleen/liver by fixed macrophages
  • smaller complexes may bind on RBCs/Endothelial cells
  • AgAb complexes binding on RBCs cause clumping known as agglutination (clumping of RBCs and their separation from serum)
  • If the Ag-Ab complexes activate complement cascade then RBC lysis (hemolysis) occurs
24
Hypersensitivity reactions
AKA allergic disorders | -an abnormal immune response to exogenous antigen or a reaction to endogenous auto-antigens (auto-immune disorders)
25
Hypersensitivity 4 types
- Type I Anaphylactic type reaction (IgE) - Type II- Cytotoxic Ab-mediated reaction (Ig G) - Type III-Immune complex-mediated reaction - Type IV-Cell medicated, delayed-type reaction
26
Type I Hypersensitivity
Mediated by IgE and mast cells or basophils - IgE produced by plasma cells sensitized to foreign proteins (e.g. pollen) - Re-exposure leads to antigen-antibody complex on mast cells triggering release of vasoactive granules (histamine) - Release is instantaneous - increased vascular permeability, edema, eosinophilia
27
Type I Hypersensitivity pathology
Atopic dermatitis (eczema) Anaphylactic shock Bronchial asthma
28
Atopic dermatitis (eczema)
``` Type I hypersensitivity Typically disease of childhood Chronic skin irritation Genetic predisposition Associated with hyperproduction of IgE in response to potential environmental allergens Generally improves with age ```
29
Bronchial asthma
Type I hypersensitivity Several forms and not always immunologically mediated -coughing and wheezing associated with constriction of bronchi and overproduction of mucous by bronchial glands
30
Anaphylactic shock
Type I hypersensitivity Life threatening, severe, systemic response to an allergen to which the body was previously sensitized -marked by a massive release of histamine and other vasoactive substances into the circulation -symptoms include circulatory collapse, wheezing, pulmonary edema, fainting
31
Type II hypersensitivity
Re-exposure results in HS reaction/disease i.e. autoimmune diseases
32
Type II hypersensitivity pathologies
Goodpasture'syndrome Hemolytic anemia Graves Disease Myasthenia Gravis
33
Good pasture's syndrome
Type II Hypersensitivity - Autoimmunity of collagen type IV - Renal and pulmonary pathologic damage
34
Hemolytic anemia
Type II Hypersensitivity - acute hemolytic reaction-transfusion of mismatched blood - systemic Lupus Erythematosus (SLE) - RBC autoimmunity
35
Graves Disease
Type II Hypersensitivity Form of hyperthyroidism in women with antibodies to thyroid-stimulating hormome (TSH) receptor resulting in overproduction of thyroid hormones
36
Myasthenia Gravis
Type II Hypersensitivity -Severe muscle weakness resulting from antibodies to acetylcholine receptor of striated muscles Prevents binding causing progressive weakness even paralysis
37
Type III Hypersensitivity
Meadiated by immune complexes between Ag and appropriated Ab - systemic reaction: Ab-Ag complexes in circulation - Localized reaction: complexes in tissues - Immune complexes are filtered through basement membranes of glomeruli/anterior eye chamber/brain choroid plexus/pericardium/lung - trapped complexes activate complement, attract PMNs (polymorphneutriphils) and result in acute inflammation characterized by fibrinoid necrosis
38
Type III Hypersensitivity pathologies
Systematic Lupus Erythematosus (SLE) Post-streptococcal glomerulonephritis Polyarteritis nodusa
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Systematic Lupus Erythematosus
Type III hypersensitivity
40
Post-streptococcal glomerulonephritis
Acute renal disease following upper respiratory tract infection Antibodies to streptococcal antigen stuck on glomerular basement membrane - complement mediated inflammation
41
Polyarteritis nodusa
``` Type III hypersensitivity Localized immune complexes Occurs in various forms of vasculitis Damaged vessels thrombose and occlude Arterial occlusion causes infarcts and ischemic symptoms ```
42
Type IV Hypersensitivity
AKA cell mediated or delayed type immune reaction Involves T-lymphocytes and macrophages -Aggregate and form granulomas at injurysite -macrophages or langerhan's cells of epidermis function as APCs -Process Ag-complex and present to T lymphocytes -T helper cells are exposed to Ag complex -This forms immune memory-important for subsequent exposure -Occurs in response to complex Ag of M. tuberculosis, Mycobacterium leprae and various fungi -Accounts for granulomas developing in response to tumours and idiopathic granulomatous diseases: sarcoidosis -Most common clinical form: contact dermatitis i.e. gold, rubber gloves, poison ivy
43
Transplantation
Solid tissue transplant.graft will only "take" if donor and recipient are immunologically similar enough to avoid rejection Immunosuppressive drugs used to facilitate acceptance of transplants
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Types of Transplantation
Autografts - self donor - skin, hair blood vessels Isografts - Idential twins Homografts/allografts - same species not genetically identical Xenografts - Transplants between different species
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Blood transfusion
Type of transplant Because RBC in greater number than WBCs, success depends on matching RBCs Major blood surface antigens lead to formation of four groups with specific antibodies
46
Blood transfusion reaction
Transfusion reaction e.g. if blood group of A donor is infused into B group, the recipient's blood antibodies will hemolyze donor's RBCs Leads to chills, shivering, fever and eventually shock
47
Rh Factor Incompatibility
Rh+ people express certain antigens on their RBCs If mother is Rh- and 1st child is Rh+, mother may create Rh antibodies during delivery If 2nd child is Rh+, antibodies will destroy fetal RBCs Preventable by immunizing mother against Rh immediately following first delivery

General Pathology (12 decks)

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