Blood, Lymph, & Immune Systems

1. Blood, Lymph, & Immune Systems Part 2

2. Immune System • Resistance • Various body defense systems against disease and foreign (exogenous) molecules • Physical & Chemical Barriers • Skin, mm’s, saliva, neutrophils, gastric secretions, tears • Acquired Immune Response • Humoral and cellular (Ab’s and T cells)

3. Acquired Immune Response • Cellular component • Monocytes • Enter tissues, become macrophages, ingest invaders • Process invaders, place their Ag’s on monocyte’ surface (APC) • APC encounters lymphocyte that recognizes these Ag’s • Lymphocytes

4. Lymphocytes Two types of lymphocytes • B cells (memory cells) • Humoral immunity • Protects against extracellular Ag’s (bacteria, viruses) • Specialize (originate) for a specific Ag • Upon Ag contact, produce plasma cells that make Ab’s • T cells

5. Lymphocytes: continued • T cells • Cellular immunity • Protect against intracellular Ag’s (viruses & CA) • Made in bm, but mature in thymus • Four types • Cytotoxic T cell (TC) • Helper T cell (TH) • Suppressor T cell (TS) • Memory T cell (TM)

6. T Cells: continued • Cytotoxic T: destroys invading antigen • Helper T: actives cytokines • Chemical messengers for immune system • Suppressor T: monitors progress of the defense and shuts down immune system when defense is finished • Memory T: wait in the lymphatic system for next encounter with Ag

7. Combining Forms • Adeno- (gland) cervical lymphadenitis • Agglutino (clumping together) agglutination • Baso (base, alkaline) basophil • Blasto (embryonic) erythroblastosis • Chromo (color) hypochromic • Eosino (rose colored) eosinophilia • Erythro (red)

8. Combining Forms Granulo (granule) granulocyte • Hemo or hemato (blood) hemochromatosis • Immuno (immune, immunity) autoimmunity • Karyo or nucleo (nucleus) mononuclear • Leuko (white) • Lymphangio (lymph vessel) lymphangitic • Morpho (shape or structure) morphology

9. Combining Forms • Neutro (neutral, neither) neutrophil • Phago (swallowing, eating) phagocytosis • Plaso or plasto (formation) aplastic • Poikilo (varied, irregular) poikilocytosis • Reticulo (net, mesh) reticulocyte • Sidero (iron) sideropenia, hemosiderin • Sero (serum) seronegative

10. Combining Forms • Spleno (spleen) • Thrombo (blood clot) thrombotic, thrombus • Thymo (thymus) thymopathy • Xeno (foreign, strange) xenograft

11. Suffixes • -blast -globin (protein) oxyhemoglobin • -graft (transplanted tissue) autograft • -penia (deficiency) • -phil (attraction for) • -phoresis (carrying, transmission) electrophoresis • -phylaxis (protection) anaphylaxis

12. Suffixes • -poiesis (formation or production) • -stasis (standing still) hemostasis

13. Prefixes • A- (without) aplastic anemia • Allo- (other) allograft • Aniso- (unequal) anisocoria • Iso- (same) isoelectric, isochromic • Macro (large) macrocyte • Micor (small) microcyte • Mono (one) monocyte • Poly (many) polymorphonuclear cell

14. Pathology • Anemias • Condition of decreased oxygen-carrying capacity • Defect in hemoglobin, RBC, RBC production or destruction mechanisms, too few RBC’s

15. Types of Anemia • Iron-deficiency (most common) • Hemorrhagic (hypovolemia) • Pernicious (often geriatric age) • Chronic, due to Vit B12 deficiency • Hemolytic (excessive RBC destruction) • Jaundiced • Associated with transfusion rxn, drug effects, etc

16. Types of Anemia • Aplastic (bone marrow suppression) • Deficiency in all blood cells • Folic Acid deficiency • Poor diet, malabsorption, increased requirements • Hemoglobinopathies (inherited) • Sickle cell anemia • Cooley’s anemia

17. Anemias: other aspects • RBC’s may be normocytic, microcytic or macrocytic in size • May be normochromic or hypochromic (concentration of hemoglobin in RBC) • Symptoms: • Weakness, fatigue • Hypotension, tachycardia, dyspnea, pallor

18. Acquired Immunodificiency Syndrome (AIDS) • Infection with human immunodificiency virus (HIV) • Virus is replicated via the helper T cells and the patient becomes immunocompromised • Gets opportunistic infections • PCP, TB, syphilis • Symptoms & Signs: lymphadenopathy, Kaposi sarcoma, weight loss, fever, malaise

19. Allergy • Through humoral or cellular immunity • Host is sensitized • Immunoglobin E involved • Involves histamine release • Symptoms and Signs • Urticaria, rhinitis, conjunctivitis, bronchospasm, GI symptoms, anaphylactic shock

20. Autoimmune Diseases • Components of the immune system treat host cells/molecules as if they are exogenous. • Usually multisystemic diseases • Have exacerbations and remissions • MG, SLE (lupus), ITP, RA, vasculitis

21. Edema • Abnormal fluid collection in ICF spaces • May be localized (e.g. pedal) or diffuse • Many causes: • Venous disease • Right sided heart failure • Hypoproteinemia • Increased capillary permeability

22. Hemophilia • Hereditary disorder of clotting mechanisms • Sex-linked, mostly seen in male patients • Signs: hematomas, hemarthroses • Hemophilia A • Factor VIII deficiency • Hemophilia B • Factor IX deficiency

23. Other bleeding disorders • Abnormal bleeding may be caused by: • Deficiency/dysfunction of clotting factors • Deficiency/dysfunction of platelets • Deficiency/dysfunction of fibrin • Disorders of regulation of clotting • Excessive or decreased signals to clot • May use all the other clotting factors above and precipitate DIC

24. Infectious Mononucleosis • Viral infection (Epstein-Barr virus) • Usually disease of young people • Lasts 6-8 weeks, almost always gives lifelong immunity • Symptoms, signs: • Sore throat, fatigue, fever, night sweats, lymphadenopathy, splenomegaly, hepatomegaly, anorexia

25. Oncology • Leukemias • Hodgkin Disease • Kaposi Sarcoma • Connective tissue cancer (bone, fat, muscle, etc) • Associated with AIDS • Purple-brown macules, papules, nodules • Palliative treatment

26. Leukemia • Cancerous overgrowth (proliferation) of blood cells • Usually myelogenous (granulocytes) or lymphocytic • Blastic cells, blast crisis (many immature cells in periphery) • S/S: anemias, infections, bleeding disorders • Treatment: chemotherapy, radiation, bm transplantation, biologic therapy

27. Hodgkin Disease • Malignancy of lymphatic system, mostly LN • S/S: painless LN enlargement, pruritus, anemia, fever, weight loss, possible dysphagia, dyspnea • Abnormal CXR • Treatment: radiation, chemotherapy, bm transplantation, Px usually good

28. Related Terms • Anisocytosis • Graft rejection • Graft-versus-host reaction (GVHR) • Bone marrow transplant patients • Hemoglobinopathy • Hemolysis • Hemostasis

29. Related Terms • Immunity • Active: due to Ag exposure and Ab’s • Passive: maternal-fetal, Ig’s infused into patients • Lymphadenopathy • Lymphosarcoma • Serology: serum testing to detect Ab, Ag, Ig’s • Titer

30. Diagnostics • APTT (activated partial thromboplastin time) • PT (prothrombin time) • Blood culture • CBC (differential count) • ESR (erythrocyte sedimentation rate) • Hemoglobin (Hb or Hgb) • Hematocrit

31. Diagnostics • Monospot • RBC Indices (volume, size, concentration) • Schilling Test : determines B12 absorption by GI tract (radioactive B12 used) • Bone marrow aspiration • Biopsy (LN or bm)

32. Procedures • Lymphangiectomy • Transfusion autologous or homologous • Transplantation autologous: from the patient homologous: from another individual

33. Pharmacology • Anticoagulants • Thrombolytics • Antineoplastics • Hemostatics • Anti-infectives • Antibiotics, antiprotozoals, antivirals • Fat-soluble vitamins • Vitamin K