Chapter 19 Immune Basics


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Chapter 19 Immune Basics

  1. 1. Immune Basics Peggy D. Johndrow 2009
  2. 2. Immune System Body defense mechanisms
  3. 3. Body Defenses <ul><li>Skin, mucus membrane </li></ul><ul><li>GI secretions </li></ul><ul><li>Inflammatory response </li></ul><ul><li>Immune response - final defense! </li></ul>
  4. 4. Review Inflammatory Process
  5. 5. Inflammatory Response Any injury stimulates a response no matter what the cause
  6. 6. Inflammatory Process <ul><li>Response to injury or infection </li></ul><ul><li>Adaptive mechanism either destroy or dilute/weaken an injurious agent & prevent further injury </li></ul><ul><li>Promotes repair of damaged tissue </li></ul><ul><li>Cardinal signs of inflammatory response: pain, swelling, redness, heat, and impaired function </li></ul><ul><li>Inflammatory agents categorized as physical agent, chemical agent, or microorganism </li></ul>
  7. 7. 5 Cardinal Symptoms
  8. 8. Inflammatory Response
  9. 9. Immunology <ul><li>Response to Invasion </li></ul><ul><li>Phagocytic Response </li></ul><ul><li>Humoral or Antibody Immune Response </li></ul><ul><li>Cellular Immune Response </li></ul>
  10. 10. Blood <ul><li>Primary source of elements designed to provide protection against injurious agents </li></ul><ul><li>Transports to site of injury through vascular changes, concentrate material at site </li></ul><ul><li>Blood both fluid and cellular </li></ul>
  11. 11. Cellular Components <ul><li>Non specific response granulocytes(PMN’s) </li></ul><ul><li>Lymphocytes </li></ul><ul><li>Monocytes* most important phagocytic activity </li></ul><ul><li>Thrombocytes </li></ul><ul><li>Phagocytic WBC’s key nonspecific </li></ul><ul><li>Granulocytes enzymes to digest </li></ul><ul><li>Neutrophils most numerous & responsive </li></ul><ul><li>Phagocytes constantly available to move to the site of injury via blood stream </li></ul>
  12. 12. How do blood cells find injury to site? <ul><li>Chemotaxis </li></ul><ul><li>Attracted to an area by chemicals released during infection or injury </li></ul><ul><li>Cellular response to injury </li></ul><ul><li>Substance released called chemotactic substance </li></ul>
  13. 13. Phagocytic Immune Response <ul><li>Involves WBC’s (granulocytes and macrophages) </li></ul><ul><li>Special talents </li></ul><ul><li>Ingest foreign proteins </li></ul><ul><li>Move to site where they engulf and destroy invading agents </li></ul>
  14. 14. Humoral Immune Response <ul><li>Sometimes called the antibody response </li></ul><ul><li>B lymphocytes transform themselves into plasma cells that manufacture antibodies (stimulate the production of antibodies) </li></ul><ul><li>Antibodies transported in blood stream and attempt to disable invaders </li></ul>
  15. 15. Cellular Immune Response <ul><li>Involves T lymphocytes which can turn into cytoxic or (killer) T cells </li></ul><ul><li>Attack pathogens directly </li></ul>
  16. 16. Antigen (Immunogens) <ul><li>Substance when introduced into a person elicits formation of antibioties (sensitized cells) </li></ul><ul><li>Must be recognized as foreign within the body </li></ul>
  17. 17. Response <ul><li>Antigen stimulates the production of antibodies </li></ul><ul><li>Examples </li></ul><ul><li>small patch of protein on outer surface of microorganism </li></ul><ul><li>Single bacterium, Large molecule , toxin </li></ul><ul><li>Have markers on the surface which induce antibody production </li></ul>
  18. 18. Antibody (immunoglobulins) <ul><li>Contact with an antigen substance within the body produces a substances called an antibody. </li></ul><ul><li>Type of antigen determines immune response </li></ul><ul><li>Circulating antibodies are called globulins (blood stream), associated with gamma globulin </li></ul>
  19. 19. Antibody <ul><li>Once antibody produced released into the blood stream </li></ul><ul><li>Carried to the attacking organism </li></ul><ul><li>Combines with antigen like jigsaw puzzle </li></ul><ul><li>To render pathogen harmless </li></ul><ul><li>See Figure 46-3 </li></ul>
  20. 20. Four Stages of Immune Response <ul><li>Recognition Stage </li></ul><ul><li>Proliferation Stage </li></ul><ul><li>Response Stage </li></ul><ul><li>Effector Stage </li></ul>
  21. 21. Recognition Stage <ul><li>Lymph Nodes and lymphocytes survey body through the blood stream </li></ul><ul><li>When they encounter foreign material, macrophages either remove or imprint structure(memory) </li></ul><ul><li>Body knows it’s own structure (self) recognizes foreign markers (nonself) </li></ul><ul><li>Triggers second stage Proliferation </li></ul>
  22. 22. Proliferation Stage <ul><li>Lymphocyte returns to lymph node with the antigenic message </li></ul><ul><li>Stimulates T and B lymphocytes to enlarge, divide, and proliferate </li></ul><ul><li>T lymphocytes (cytoxic T killer) </li></ul><ul><li>B lymphocytes stimulate production and release of antibodies </li></ul>
  23. 23. Response <ul><li>Changed lymphocytes function either in humoral or celluar fashion </li></ul>
  24. 24. Humoral <ul><li>B-lymphocytes stimulate the production of antibodies </li></ul><ul><li>Production of antibodies by B-lymphocytes in response to an antigen begins the Humoral Response </li></ul><ul><li>Humoral refers to the fact antibodies are released into the bloodstream and reside in the circulating plasma </li></ul>
  25. 25. Cellular <ul><li>Sensitized cells return to lymph nodes </li></ul><ul><li>They stimulate lymphocytes known as cytoxic cells (killer) T cells </li></ul><ul><li>Attack microbes directly </li></ul>
  26. 26. Effector Stage <ul><li>Either antibody or (killer) T cells reaches the antigen on the surface of the foreign invader </li></ul><ul><li>Coupling initiates series of events which leads to total destruction of invading microbe or neutralization of the toxin </li></ul><ul><li>Series of events involve antibodies, complement, and action by (killer) T cells </li></ul>
  27. 27. Complement <ul><li>Primary role of complement is to provide specific lysis of cell membrane </li></ul><ul><li>Complement is a series of 11 proteins </li></ul><ul><li>Complement works with antibioties which are already bound to rupture the cell </li></ul><ul><li>Serves to complete the action of an Antibody </li></ul><ul><li>Antibody by itself can’t produce cell lysis </li></ul>
  28. 28. Complement <ul><li>Complement considered nonspecific </li></ul><ul><li>Component of plasma </li></ul><ul><li>No immune substance can activate </li></ul><ul><li>Not increased by immunizations </li></ul>
  29. 29. Roles of Celluar and Humoral Immune Response <ul><li>Humoral (B Cells) </li></ul><ul><li>Bacterial lysis </li></ul><ul><li>Anaphylaxis </li></ul><ul><li>Allergic hay fever and asthma </li></ul><ul><li>Immune complex disease </li></ul><ul><li>Bacterial and some viral infections </li></ul><ul><li>Cellular (T Cells) </li></ul><ul><li>Transplant Rejection </li></ul><ul><li>Delayed hypersensitivity (TB reaction) </li></ul><ul><li>Viral, fungal, and parasitic </li></ul><ul><li>Graft vs host disease </li></ul><ul><li>Tumor surveillance or destruction </li></ul><ul><li>Intracellular infections </li></ul><ul><li>infections </li></ul>
  30. 30. B Cells and T Cells <ul><li>Both B & T Cells role is to recognize presence of antigen & initiate disposal and recognize self Antigen triggers response of events that leads to full immunologic response </li></ul><ul><li>Antigen triggers response of events that leads to full immunologic response </li></ul>
  31. 31. Humorally <ul><li>Major immunity against the following </li></ul><ul><li>Bacteria producing infection ie. Staph, strep, etc. </li></ul><ul><li>Bacterial endotoxins diptheria, botulinal, tetanus </li></ul><ul><li>Viruses polio hepatitis </li></ul><ul><li>Organism that enter body from mucosal tissue ie. Colds, influenza </li></ul>
  32. 32. Cellular Response <ul><li>Chronic bacterial infections ie. Syphilis, TB </li></ul><ul><li>Viral infections ie. Measles, herpes, chicken pox </li></ul><ul><li>Fungal Infections </li></ul><ul><li>Parasitic </li></ul><ul><li>Tissue Transplants </li></ul>
  33. 33. Humoral Immune Response <ul><li>Production of antibodies by B lymphocytes </li></ul><ul><li>Either by direct antibody formation or by stimulation from T Helper cells </li></ul><ul><li>B lymphocytes stored in the lymph Nodes </li></ul><ul><li>Antigenic message returns stimulating the B lymphocytes with the memory to produce more exaggerated rapid response in person who is repeatedly exposed to the same antigen </li></ul>
  34. 34. Fluid Response <ul><li>Portion of fluid uncoagulated blood is plasma </li></ul><ul><li>Plasma transports circulating antibodies produced in a specific response to antigenic stimulation </li></ul><ul><li>Antibodies bind to antigens becoming sticky and help WBC’s locate, engulf and destroy </li></ul><ul><li>blood creates a coating effect: OPSONINS </li></ul>
  35. 35. Antibodies (immunoglobulins) <ul><li>Portion of fluid uncoagulated blood is plasma </li></ul><ul><li>Plasma transports circulating antibodies produced in a specific response to antigenic stimulation </li></ul><ul><li>Antibodies bind to antigens becoming sticky and help WBC’s locate, engulf and destroy </li></ul><ul><li>blood creates a sticky coating effect: OPSONIZATIONS </li></ul>
  36. 36. Five Classes of Immunoglobulins <ul><li>Produced within the body to protect Each varies in structure and distribution in the body </li></ul><ul><li>Protective function </li></ul><ul><li>IgA, IgD, IgE, IgG, IgM </li></ul>
  37. 37. Activates Complement <ul><li>IgG: protect against microorganism, toxins in blood and body fluids, Major immunoglobulin in serum and body fluid. Crosses placenta. Enhances phagocytosis </li></ul><ul><li>IgM: protects against microorganism in blood. Confined to the vascular system. First to react to bacterial and viral infections </li></ul>
  38. 38. Does not Activate Complement <ul><li>IgA: Appears in body fluids, protects mucous membranes from bacteria, virus, toxins in GI< respiratory, genitourinary urinary system. Prevents absorption of antigens from food </li></ul><ul><li>IgD: appears in small amounts in the serum, signal B cell differentiation, membrane of circulating B cells </li></ul><ul><li>IgE: Appears in the serum, protects against parasites, mediates allergic reactions and hypersensitivity reactions with membrane of mast cell and basophils </li></ul>
  39. 39. Role of T Lymphocytes <ul><li>T helper cells(T4 cells) activated on recognition of antigens </li></ul><ul><li>T4 helper cells stimulate the rest of the immune system by secreting cytokines </li></ul><ul><li>T cytoxic cells (T killer cells) attack antigens directly causing cell lysis </li></ul>
  40. 40. Role of T Lymphocytes <ul><li>T suppressor cells that decrease B cells production </li></ul><ul><li>Keep immune response at a level compatible with health ( sufficient to fight infection without attacking the body’s healthy tissue) </li></ul><ul><li>T memory cells responsible for recognizing antigens </li></ul>
  41. 41. Interferon <ul><li>Group of proteins produced by variety of cells with inflammatory process </li></ul><ul><li>In response to viral infection </li></ul><ul><li>Stimulates uninfected cells to production alterations to protect uninfected cells from viral multiplication </li></ul><ul><li>Antiviral action </li></ul>
  42. 42. Role of Interferon <ul><li>Antiviral and antitumor properties </li></ul><ul><li>Produced by T lymphocytes, B lymphocytes and macrophages in response to antigens </li></ul><ul><li>Suppress antibody production and celluar immunity </li></ul><ul><li>Facilitate cytoxic role </li></ul>
  43. 43. Immune System <ul><li>Ability to response while at the same time response with a specific action that produces antibiodies </li></ul>
  44. 44. Recognition and Memory <ul><li>Recognizes self antigenic make-up and doesn’t produce antibodies against </li></ul><ul><li>Called recognition of self </li></ul>
  45. 45. REVIEW
  46. 46. Two Divisions <ul><li>Humoral mediated system </li></ul><ul><li>Cellular mediated system </li></ul>
  47. 47. T Cells <ul><li>Phagocytic activity T killer cells </li></ul><ul><li>Produce cells which control immune response </li></ul><ul><li>T helper cells which help immunoglobulin production by B cells, Stimulates B cells production </li></ul>
  48. 48. B Cells <ul><li>Produce immunogobulins in blood, lymph, mucus and al body fluids </li></ul><ul><li>Works in acute bacteria, biologic toxins tetanus, certain viral (cold, rabies, polio) </li></ul><ul><li>B Cells have immunoglobulins present on surface cells </li></ul>
  49. 49. “ Lymphokines” <ul><li>Macrophages which has been activated releases stimulatory, soluble substance called “Lymphokines </li></ul><ul><li>Soluble lymphokines attract microphage to site by chemotaxis </li></ul>
  50. 50. Thymus Serves as control organ Reaches peak in childhood and shrinks during puberty
  51. 51. Lymph Nodes and Spleen Primary site of localization of immune response Lymph Nodes and RES clear 80-90% Of antigen on a single pass
  52. 52. Cell Mediated <ul><li>Involves Sensitized T Cell Lymphocytes </li></ul><ul><li>Go to site of antigen entrance </li></ul><ul><li>Protects against disease where circulating immunoglobulins can’t reach </li></ul>
  53. 53. Combined Response <ul><li>Most antigens provoke both types </li></ul><ul><li>1st response T cells in the area of lymph nodes within 2 days, the B cells respond 3-5 days </li></ul><ul><li>T helper cells stimulate B cells with increase number of immunoglobulins </li></ul>
  54. 54. Health Assessment Important Factors <ul><li>Age </li></ul><ul><li>People at extremes of lifespan more likely to develop problems </li></ul><ul><li>Elderly have T and B lymphocyte production impairment </li></ul><ul><li>Autoimmune disease increase with aging </li></ul>
  55. 55. WHY? <ul><li>Change in body organ function </li></ul><ul><li>Environmental exposures </li></ul>
  56. 56. Nutritional State <ul><li>Adequate nutrition is necessary for optimal immune function </li></ul>
  57. 57. Autoimmune Disorders <ul><li>Identify the presence of any pre-existing autoimmune disease </li></ul><ul><li>Related to estrogen and androgen </li></ul><ul><li>Estrogen enhances immunity </li></ul><ul><li>Androgen tends to be immunosuppressive </li></ul>
  58. 58. Neoplastic Disease <ul><li>Immunosupression contributes to the development of cancer </li></ul><ul><li>Cancer itself is immunosuppressive </li></ul><ul><li>Celluar Immunity Impaired or defective increases risk for cancer </li></ul><ul><li>Cancer outdistances the immune system </li></ul><ul><li>Some surface antigens CEA, high alpha feta proteins </li></ul>
  59. 59. Chronic Illness <ul><li>Assess for history of Diabetes Mellitus, Renal Disease, COPD </li></ul><ul><li>Chronic illness contribute to the impairment of immune system </li></ul>
  60. 60. Special Problems <ul><li>Burns, injuries, and illness alter the immune system </li></ul><ul><li>Impaired skin integrity is the 1 st line of defense </li></ul>
  61. 61. Medications and Blood Transfusions <ul><li>Antibiotics, steroids, salicylates, nonsteroidal anti-inflammatory agents and anesthetics can cause immune suppression </li></ul><ul><li>Multiple transfusions create previous exposure to foreign antigens may be associated with abnormal immune function </li></ul>
  62. 62. Lifestyle <ul><li>ETOH consumption </li></ul><ul><li>Tobacco consumption </li></ul><ul><li>Dietary intake </li></ul><ul><li>Nutritional status </li></ul><ul><li>Exposures </li></ul>
  63. 63. Physical Exam <ul><li>Skin and mucous membranes </li></ul><ul><li>Lymph nodes </li></ul><ul><li>Joints function </li></ul><ul><li>Body Systems: </li></ul><ul><li>CV, Resp, GI, GU, Neuro </li></ul>