Immunology

Immunology
Chapter 14
Copyright 2014 by Mosby, an imprint of Elsevier Inc.
Course Objectives
Integrate multiple
factors in construction
of holistic plans of care.
Analyze inter- and intraprofessional
communication and
collaborative strategies
used to deliver
evidence-based, clientcentered care.
Evaluate healthcare
outcomes of clients
with complicated acute
and chronic illnesses
using data from
multiple relevant
sources.
Analyze factors that

contribute to client
potential for restoration
to wellness.
Analyze the healthcare
needs of clients with
complicated acute and
chronic illnesses across
the lifespan.
Synthesize principles
and concepts from
liberal arts and science
and nursing science
into plans of care for
selected clients. Copyright 2014 by Mosby, an
imprint of Elsevier Inc.
Learning Objective
1. Describe immune system
2. Describe difference between cell mediated and
humoral immunity
3. Characterize the five types of immunoglobulins
4. Differentiate among the four types of
hypersensitivity reactions
5. Identify manifestations and treatment of
anaphylaxis
6. Describe assessment and strategies to manage
chronic allergies
7. Describe relationship between HLA and disease
8. Describe etiologic features of autoimmune disorders
9. Describe etiologic features of immunodeficiency
disorders
Copyright 2014 by Mosby, an
10.Differentiate among
different types of transplant
Concepts
SAFETY
Avoidance,
prevention,
assessment,
and
amelioration of
adverse
outcomes
VULNERABILI
TY
Susceptibility
to disease,
injury and
disability

Normal Immune Response
L.O.#1
Immunity
Is the bodys ability to resist
disease
Serves three functions
Defense
Homeostasis
Surveillance
Types of Immunity
Innate
Present at birth
First-line defense against
pathogens
Acquired
Developed immunity
Active
Passive
Is it Innate or Acquired?
Flushing action of tears
Skin protection against
invasion of microbes
Inflammation
Mucous membranes
Immunoglobulins
B Cell and Cytotoxic T Cell

https://
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om/objects/elr/Lewis/medsurg
9e/animations/14_001.html
https://
coursewareobjects.elsevier.c
om/objects/elr/Lewis/medsurg
9e/animations/14_002.html
Copyright 2014 by Mosby, an imprint of Elsevier Inc .

Antigens
Substances the body
recognizes as foreign that elicit
an immune response
Most are composed of protein.
Antibodies
Immune globulins produced by
lymphocytes in response to
antigens
Innate and Adaptive

Immunity
https://
www.youtube.com/watch?v=i
VMIZy-Y3f8
Organs of Immunity
Copyright 2014 by Mosby, an imprint of Elsevier Inc .
Immune Response to Virus

Lymphoid Organs
Central (primary) lymphoid
organs
Thymus gland
Thymus gland shrinks with age.
Involved in the differentiation and
maturation of T lymphocytes
Bone marrow
Produces red blood cells, white
blood cells, and platelets

Lymphoid Organs
Peripheral lymphoid organs
Lymph nodes- filtration &
circulation
Tonsils
Spleen- primary site for filtering
foreign antigens from the blood
Lymphoid tissues associated

with the gut, genitals, bronchi,
and skin
Macrophages and
Lymphocytes in Immune
Response
Copyright 2014 by Mosby, an imprint of Elsevier

Inc.
16
Normal Immune System

Cells of Immune Response
Mononuclear phagocytes
Include monocytes in the blood
and macrophages found
throughout the body
Capture, process, and present
antigens to lymphocytes to
initiate an immune response
Capture antigens by
phagocytosis
Normal Immune System

Cells of Immune Response
Lymphocytes
Produced in the bone marrow
Eventually migrate to
peripheral organs
Differentiate into B and T
lymphocytes
T Cytotoxic cells
T Helper cells
Types of Lymphocytes
T cells
B cells
Natural killer (NK)
cells
70%
80%
10%
20%
<10%

Dendritic Cells
Important in activating the
immune response
Capture antigens at sites of
contact with the external
environment
Transport an antigen until it
encounters a T cell with specificity
for the antigen

Cytokines
Soluble factors secreted by
WBCs and a variety of other
cells in the body
Act as messengers among cell
types
Instruct cells to alter their
proliferation, differentiation,
secretion, or activity

Cytokines
Currently at least 100 different
cytokines
Have a beneficial role in
hematopoiesis and immune
function
Can have detrimental effects
Chronic inflammation
Autoimmune diseases

Cytokine types
Interleukins
Interferons
Tumor necrosis factor
Colony-stimulating factors
Erythropoietin

Cytokines
IL-1
Augments immune response
Inflammatory mediator
Promotes maturation and clonal
expansion of B cells
Enhances activity of natural
killer cells
Activates T cells and
macrophages

Cytokines
IL-2
Induces proliferation and
differentiation of T cells
Activates T cells, NK cells, and
macrophages
Stimulates release of other
cytokines

Cytokines
IL-3 (multicolony-stimulating
factor)
Hematopoietic growth factor
for hematopoietic precursor
cells

Cytokines
IL-4
B-cell growth factor
Stimulates proliferation and
differentiation of B cells
Induces differentiation into TH2
cells
Stimulates growth of mast cells

Cytokines
IL-5
B-cell growth and
differentiation
Promotes growth and
differentiation of eosinophils

Cytokines
IL-6
T- and B-cell growth factor
Enhances inflammatory
response
Stimulates antibody secretion
Promotes differentiation of B
cells into plasma cells

Cytokines
IL-6
Induces fever
Synergistic effects with IL-1
and TNF

Cytokines
-Interferon (-IFN) and interferon (-INF)
Inhibit viral replication
Activate NK cells and
macrophages
Antiproliferative effects on
tumor cells

Cytokines
-Interferon (-IFN)
Activates macrophages,
neutrophils, and NK cells
Promotes B-cell differentiation
Inhibits viral replication
Mechanism of Action of
Interferon

Cytokines
Tumor necrosis factor (TNF)
Activates macrophages and
granulocytes
Promotes the immune and
inflammatory responses
Kills tumor cells
Responsible for extensive
weight loss
Associated with chronic

Cytokines
Colony-stimulating factors
(CSFs)
Granulocyte colony-stimulating
factor (G-CSF)
Granulocyte-macrophage
colony-stimulating factor (GMCSF)
Macrophage colony-stimulating
factor (M-CSF)

L.O.#2
Comparison of
Humoral and Cell-Mediated
Immunity
Humoral
Cellular
Cells
involved
Products
B
lymphocytes
T lymphocytes
Macrophages
Antibodies
Memory
Present
Sensitized T
cells
Cytokines
Present
36

Comparison of
Humoral and Cell-Mediated
Immunity
Humoral
Cellular
Protecti Bacteria
Viruses
on
Fungus
Viruses
(extracellular)
(intracellular)
Respiratory
Chronic
pathogens
infectious
Gastrointestinal agents
Tumor cells
pathogens
37

Humoral Immunity
Antibody-mediated immunity
Antibodies produced by
plasma cells (differentiated B
lymphocytes)
Primary immune response is
evident
4 to 8 days after initial
exposure to antigen.

Humoral Immunity
L.O.#3
Five classes of immune

globulins
Each has specific
characteristics
IgG
lgA
lgM
lgD
lgE

Humoral Immunity
When an individual is
exposed to an antigen for a
second time, the response is
faster (1 to 3 days) and lasts
longer.
Main product of secondary
response is IgG rather than
IgM.
Memory cells account for more
Primary and Secondary

Immune Response
Copyright 2014 by Mosby, an imprint of Elsevier

Inc.

Cell-Mediated Immunity
Immune responses initiated
through specific antigen
recognition by T cells
Several cell types involved in
cell-mediated immunity
T lymphocytes
Macrophages
NK cells

Cell-Mediated Immunity
Important roles
Immunity against pathogens
that survive inside cells
(viruses, some bacteria)
Fungal infections
Rejection of transplanted
tissues
Contact hypersensitivity
reactions
Effects of Aging on the

Immune System
Immunosenescence
Incidences of tumors
Greater susceptibility to
infection
Autoantibodies
Cell-mediated immunity
Thymic involution
Effects of Aging on the

Immune System
Immunosenescence
Delayed hypersensitivity
reaction
IL-1 and IL-2 synthesis
Expression of IL-2 receptors
Proliferation response of T
and B cells
Primary and secondary
antibody responses
Audience Response Question

A patient with a sore throat and rhinitis
has an elevated level of IgG in the blood.
The nurse explains that the patients
symptoms are most likely caused by
a.
b.
c.
d.
an allergy.
exposure to toxic fume.
an initial viral infection.
a re-infection by bacteria.
Hypersensitivity Reactions
L.O.#4
https://www.youtube.com/watch?v=E935RDEA5Qg
Type I
Type
II
Type
III
Type
IV
IgE
IgG; IgM
IgG; IgM
None
Transfusion
Reaction
Systemic
Lupus
Erythematou
s
StevensJohnson
Syndrome
Anaphylaxis
Chronic Allergies
L.O.#6
Type I Allergies are the most

common
What is the..Antigen (name
3)
What Antibody is Involved?
What is Complement?
Mediators of Injury
Examples?
Complement

Type I Hypersensitivity:
Anaphylaxis
Signs and
Symptoms

L.O.#5
Type II Hypersensitivity:
Blood Transfusion Reaction
https://
www.youtube.com/watch?v=a
vkazKWw37c
What are you going to do?
Type III Hypersensitivity:

Autoimmunity
https://
www.youtube.com/watch?v=
yZ6wWuAQnME

Type IV Hypersensitivity:
Delayed Reaction
Stevens-Johnson Syndrome
https://
www.youtube.com/watch?v=TapGX
OE3pPQ

Autoimmune
L.O.#8
Table 14-13 p.217

There is both genetic and environmental causes for
autoimmune disease
Genetic factors may create a predisposition towards developing these
autoimmune diseases.
They are characterized as a group by the presence of spontaneous overactivity
of the immune system that results in the production of extra antibodies into
the circulation.
The classicconnective tissue diseasesinclude:

Systemic lupus erythematosus(SLE) SUPPLEMENTAL POWER POINT
An inflammation of the connective tissues, SLE can afflict every organ system.
Rheumatoid arthritis
Rheumatoid arthritis is a systemic disorder in which immune cells attack and
inflame the membrane around joints. It also can affect the heart, lungs, and
eyes.
Scleroderma
an activation of immune cells that produces scar tissue in the skin, internal
organs, and small bloodCopyright
vessels.
2014 by Mosby, an
imprint
of
Elsevier Inc.
Sjgren's syndrome
Transplant Rejection
L.O.#10
Transplantation is the act of transferring an

organ, tissue, or cell from one place to
another.
Transplants are divided into three

categories based
on the similarity between the donor
and the recipient:
1-Autotransplants
2-Allotransplants
3-Xenotransplants
Autotransplant
Involve the transfer of tissue or
organs from one part of an
individual to another part of the
same individual. They are the
most common type of
transplants and include skin
grafts and vein grafts for
bypasses.
Allotransplant
Involve transfer from one
individual to a different
individual of the same species
the most common scenario for
most solid organ transplants
performed today.
Immunosuppression is required for
allograft recipients to prevent rejection
Xenotransplants
Involve transfer across species
barriers.
Currently, xenotransplants are
largely experimental and
relegated to the laboratory,
given the complex, potent
immunologic barriers to
success.
(pig valve
Transplant Rejection
The success of transplants today is due
in large part to control of the rejection
process, thanks to an ever-deepening
understanding of the immune process
triggered
by a involved
transplant.
The
main antigens
in triggering
rejection
are coded for by a group of genes known
as the
major histocompatibility complex (MHC).
In humans, the MHC complex is known as
the
It comprises a series of genes located on chromosome
human
leukocyte antigen (HLA)
6
Rejection and Graft

Damage
HLA molecules can initiate rejection
and graft damage, via humoral or
cellular mechanisms:
Humoral rejection mediated by recipient's
antibodies
. (e.g. blood transfusion, previous
transplant, or pregnancy)
Cellular rejection is the more common type
of rejection after organ transplants.
Mediated by T lymphocytes, it results
from their activation and proliferation
after exposure to donor MHC molecules.
Clinical Rejection
Graft rejection is a complex process
involving
several components:
T lymphocytes
B lymphocytes,
Macrophages, and
Cytokines, with resultant local
inflammatory injury and graft damage.
Rejection can be classified into the following
types based on timing and pathogenesis:
hyperacute, acute, and
Hyperacute Rejection
Hyperacute rejection is usually seen within
minutes after perfusion of the transplanted
Organ due to the presence of existing
antibodies in the recipient
These antibodies bind to the vascular
endothelium in the graft and activate the
complement cascade, leading to platelet
activation and to diffuse intravascular
coagulation.
The result is a swollen, darkened graft, which
undergoes ischemic necrosis.
Antibody Mediated Damage
Acute Rejection
Acute rejection is usually seen days to a few
months post-transplant
It is predominantly a cell-mediated process,
with lymphocytes being the main cells
involved
Immunosuppressive drugs may mask
symptoms of rejection
Picked up from routine lab results
(creatinine in kidney transplant; elevated liver
enzymes in liver transplant etc. or aGVHD in BMT)
Acute Graft Rejection type IV

hypersensitivity reaction
What type of
hypersensitivit
y reaction is
Acute Graft
Rejection?
TYPE IV
hypersensitivity
Reaction (delayed)
Copyright 2011, 2007 by Mosby,
Inc., an affiliate of Elsevier Inc.
Chronic Rejection
This form of rejection occurs months to years
post-transplant.
Now that short-term graft survival rates have
improved so markedly, chronic rejection is an
increasingly common problem.
Histologically, the process is characterized by
atrophy, fibrosis, and arteriosclerosis.
Both immune and nonimmune mechanisms are
likely involved.
Clinically, graft and organ function slowly
deteriorates over months to years
Immunosuppression
The success of modern
transplantation
is in large part because of the
Successful development of
effective
Immunosuppressive agents
Rejection
Clinical Manifestations
Signs of dysfunction of transplanted
tissue/organ
Signs of failure of transplanted
tissue/organ
Evaluation
Biopsy of Grafted Tissue
Evaluation of Transplanted tissue/organ
function
Treatment
Immunosuppression
68
Antirejection medications
Organ Transplantation
.
Copyright 2011, 2007 by Mosby, Inc., an affiliate of
Elsevier Inc.
Immunosuppressive
Therapy
Included in the Supplemental Power
Point_Medications:Transplant
Corticosteroids
Calcineurin inhibitors
Sirolimus
Azathioprine
Mycophenolate mofetil
Cyclophosphamide
Polyclonal antibodies
Monoclonal antibodies
L.O.#11
Immunodeficiency
L.O.#9
Primary Immunodeficiency Disorders

Disorder
Affected Cells
Genetic Basis
Chronic
Granulomatous
Disease
PNMs, Monocytes
Job Syndrome
PNMs, Monocytes
Brutons X-linked
agammaglobulinemia
X-linked
Wiskott-Aldrich
Syndrome
B, T
X-linked
Ataxia-telangiestasia
B, T
Autosomal recessive

X-linked
Immunodeficiency
L.O.#9
Secondary Immunodeficiency Disorders

Drugs
Therapies
Stress
Chemotherapy
Radiation
Chronic Stress
Corticosteroids
Surgery
Trauma
Acquired Immunodeficiency Syndrome*

Chapter 15 covers HIV
Cirrhosis
Secondary Cancers such as Hodgkins Lymphoma
Nursing
RISK FOR INFECTION
HIGH RISK FOR INJURY
ALTERATION IN COMFORT
KNOWLEDGE DEFICIT

Immunodeficiency
L.O.#9
Chapter 15
Human Immunodeficiency
Virus


Immunology

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Immunology

Copyright 2014 by Mosby, an imprint of Elsevier Inc.

Analyze factors that

Copyright 2014 by Mosby, an

Normal Immune Response

Copyright 2014 by Mosby, an imprint of Elsevier Inc.

B Cell and Cytotoxic T Cell

Copyright 2014 by Mosby, an imprint of Elsevier Inc .

Normal Immune Response

Copyright 2014 by Mosby, an imprint of Elsevier Inc.

Innate and Adaptive

Copyright 2014 by Mosby, an imprint of Elsevier Inc.

Copyright 2014 by Mosby, an imprint of Elsevier Inc .

Immune Response to Virus

Copyright 2014 by Mosby, an imprint of Elsevier Inc.

Normal Immune Response

Copyright 2014 by Mosby, an imprint of Elsevier Inc.

Normal Immune Response

Lymphoid tissues associated

Copyright 2014 by Mosby, an imprint of Elsevier Inc.

Copyright 2014 by Mosby, an imprint of Elsevier

Normal Immune System

Copyright 2014 by Mosby, an imprint of Elsevier Inc.

Normal Immune System

Normal Immune Response

Normal Immune Response

Copyright 2014 by Mosby, an imprint of Elsevier Inc.

Normal Immune Response

Copyright 2014 by Mosby, an imprint of Elsevier Inc.

Normal Immune Response

Copyright 2014 by Mosby, an imprint of Elsevier Inc.

Normal Immune Response

Copyright 2014 by Mosby, an imprint of Elsevier Inc.

Normal Immune Response

Normal Immune Response

Copyright 2014 by Mosby, an imprint of Elsevier Inc.

Normal Immune Response

Normal Immune Response

Copyright 2014 by Mosby, an imprint of Elsevier Inc.

Normal Immune Response

Normal Immune Response

Copyright 2014 by Mosby, an imprint of Elsevier Inc.

Normal Immune Response

Normal Immune Response

Copyright 2014 by Mosby, an imprint of Elsevier Inc.

Copyright 2014 by Mosby, an imprint of Elsevier Inc.

Normal Immune Response

Copyright 2014 by Mosby, an imprint of Elsevier Inc.

Normal Immune Response

Copyright 2014 by Mosby, an imprint of Elsevier Inc.

Normal Immune Response

Copyright 2014 by Mosby, an imprint of Elsevier Inc.

Normal Immune Response

Copyright 2014 by Mosby, an imprint of Elsevier Inc.

Normal Immune Response

Copyright 2014 by Mosby, an imprint of Elsevier Inc.

Normal Immune Response

Five classes of immune

Copyright 2014 by Mosby, an imprint of Elsevier Inc.

Normal Immune Response

Copyright 2014 by Mosby, an imprint of Elsevier Inc.

Primary and Secondary

Copyright 2014 by Mosby, an imprint of Elsevier

Normal Immune Response