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Nrsg 200 sp 2011 immunolgy hematology
- 1. NRSG 200: Complex Medical-Surgical Nursing Concepts of Immunology & Autoimmune Disorders
- 2. What is Immunity? Overview
- 4. Organs of the Immune System
- 15. Cells of the Immune System
Editor's Notes
- There are two types of specific immune responses; humoral and cell mediated . Humoral immunity is mediated by B Lymphocytes that produce antibodies (IgG, IgM, IgA, IgE) and is especially important in combating acute bacterial infections. Cellular immunity is mediated by T Lymphocytes which are processed in the thymus. Cellular immunity is especially important in combating intracellular organisms such as TB, performing tumor surveillance, mediating transplant rejection, and fighting fungal and viral infections. It also mediates the delayed type hypersensitivity reaction, which underpins skin test like the one to assess for TB exposure.
- The Organs of the Immune System Bone Marrow -- All the cells of the immune system are initially derived from the bone marrow through hematopoiesis. During hematopoiesis, bone marrow-derived stem cells differentiate into either mature cells of the immune system or into precursors of cells that migrate out of the bone marrow to continue their maturation elsewhere. The bone marrow produces B cells, natural killer cells, granulocytes and immature thymocytes, in addition to red blood cells and platelets. Thymus -- The function of the thymus is to produce mature T cells. Immature thymocytes leave the bone marrow and migrate into the thymus. Through maturation process sometimes referred to as thymic education, T cells that are beneficial to the immune system are spared, while those T cells that might evoke a detrimental autoimmune response are eliminated. The mature T cells are then released into the bloodstream. Spleen -- The spleen is an immunologic filter of the blood. It is made up of B cells, T cells, macrophages, dendritic cells, natural killer cells and red blood cells. In addition to capturing foreign materials (antigens) from the blood that pass through the spleen, migratory macrophages and dendritic cells bring antigens to the spleen via the bloodstream. An immune response is initiated when the macrophage or dendritic cells present the antigen to the appropriate B or T cells. This organ can be thought of as an immunological conference center. In the spleen, B cells become activated and produce large amounts of antibody. Also, old red blood cells are destroyed in the spleen. Lymph Nodes -- The lymph nodes function as an immunologic filter for the bodily fluid known as lymph. Lymph nodes are found throughout the body. Composed mostly of T cells, B cells, dendritic cells and macrophages, the nodes drain fluid from most of our tissues. Antigens are filtered out of the lymph in the lymph node before returning the lymph to the circulation. In a similar fashion as the spleen, the macrophages and dendritic cells that capture antigens present these foreign materials to T and B cells, consequently initiating an immune response.
- Bone marrow produces stem cells which are undifferentiated – based on the bodies needs at the time the stem cell is maturing and the presence of specific hormones the stem cells develop into different types of mature cells – ie RBCs platelets, different types of WBCs The WBCs are the immune system cells
- Our bodies first line of defense is intact skin, mucous membranes, natural flora, - lysozymes in tears, HCl in the stomach, etc When our body is invaded by a foreign body (non self) our innate (natural) or non specific immunity kicks in = immune function of the WBCs leading to inflammation – it provides initial , limited protection And our bodies 3 rd line of defense when inflammation alone can’t solve the problem is Learned or Acquired Immunity – cell mediated and antibody mediated immunity
- See Chart 50-1 on page 1788
- IgG = 75% of immunoglobulins. See Chart 50-2 on page 1790
- The bone marrow is the source of all blood cells – including immune cells An immature undifferentiated cell is called a stem cell and it is pluripotent = multipotent = totipotent – meaning it is has multiple potentials for maturation – what type of cell it becomes is determined by the bodies needs at the time as well as the presence of cytokines = hormones that direct maturation. Erythropoietin is a cytokine made in the kidney that is necessary for erythrocyte formation WBCs are the immune system cells – in general they function to Recognize self vs non self Perform phagocytosis of foreign antigens Perform lytic destruction of antigens and unhealthy self cells Produce antibodies Perform complement activation Produce cytokines that stimulate further production of leukocytes from stem cells and stimulate leukoctye growth and activity Remember from anatomy and physiology Granulocytes = 3 phils Agranulocytes = 2 cytes : macrophages or monocytes and lymphocytes
- The body has 3 types of lymphocytes – T cells, B cells, and NK cells T-Cells -- T lymphocytes are usually divided into two major subsets that are functionally and phenotypically (identifiably) different. The T helper subset, also called the CD4+ T cell, is a coordinator of immune regulation . The main function of the T helper cell is to augment or potentiate immune responses by the secretion of specialized factors that activate other white blood cells to fight off infection. Later we will earn that these are the cells that become defective in HIV. T killer/suppressor subset or CD8+ T cell. These cells are important in directly killing certain tumor cells, viral-infected cells and sometimes parasites . The CD8+ T cells are also important in down-regulation of immune responses. Both types of T cells can be found throughout the body . They often depend on the lymph nodes and spleen as sites where activation occurs, but they are also found in other tissues of the body, most notably the liver, lung, blood, and intestinal and reproductive tracts. Natural Killer Cells -- often referred to as NK cells, are similar to the killer T cell subset (CD8+ T cells). They function as effector cells that directly kill certain tumors such as melanomas, lymphomas and viral-infected cells, most notably herpes and cytomegalovirus-infected cells. NK cells, unlike the CD8+ (killer) T cells, kill their targets without a prior "conference” in the lymphoid organs = they possess memory for past invaders and help prevent disease when similar invader is encountered again. However, NK cells that have been activated by secretions from CD4+ T cells will kill their tumor or viral-infected targets more effectively. The T cells and NK cells are involved in CMI B Cells -- The major function of B lymphocytes is the production of antibodies in response to foreign proteins of bacteria, viruses, and tumor cells. Antibodies are specialized proteins that specifically recognize and bind to ONE particular protein. Antibody production and binding to a foreign substance or antigen, often is critical as a means of signaling other cells to engulf, kill or remove that substance from the body. Involved in AMI Granulocytes or Polymorphonuclear (PMN) Leukocytes -- Granulocytes are composed of three cell types identified as neutrophils, eosinophils and basophils, based on their staining characteristics with certain dyes. These cells are predominantly important in the removal of bacteria and parasites from the body. The neutrophils are the primary phagocytic cell - They engulf these foreign bodies and degrade them using their powerful enzymes. Eosinophils – parasites and allergies and Basophils signs/symptoms of inflammation. Macrophages = monocytes that have migrated from bloodstream and entered tissue – share the “vacuum cleaner – phagocytic function of neutrophils – but they live much longer. They are often referred to as scavengers or antigen-presenting cells (APC) because they pick up and ingest foreign materials and present these antigens to other T cells and B cells so that the pathogens can be recognized and killed or an antibody response can be mounted. This is one of the important first steps in the initiation of an immune response. Involved in inflammation and assist in AMI and CMI Dendritic cells are specialized antigen-presenting cells . They are found in the circulation, in peripheral tissues and in lymphoid organs. Maturing dendritic cells travel from the periphery to secondary lymphoid organs, where they present antigens to T lymphocytes.
- The body has 3 types of lymphocytes – T cells, B cells, and NK cells T-Cells -- T lymphocytes are usually divided into two major subsets that are functionally and phenotypically (identifiably) different. The T helper subset, also called the CD4+ T cell, is a coordinator of immune regulation . The main function of the T helper cell is to augment or potentiate immune responses by the secretion of specialized factors that activate other white blood cells to fight off infection. Later we will earn that these are the cells that become defective in HIV. T killer/suppressor subset or CD8+ T cell. These cells are important in directly killing certain tumor cells, viral-infected cells and sometimes parasites . The CD8+ T cells are also important in down-regulation of immune responses. Both types of T cells can be found throughout the body . They often depend on the lymph nodes and spleen as sites where activation occurs, but they are also found in other tissues of the body, most notably the liver, lung, blood, and intestinal and reproductive tracts. Natural Killer Cells -- often referred to as NK cells, are similar to the killer T cell subset (CD8+ T cells). They function as effector cells that directly kill certain tumors such as melanomas, lymphomas and viral-infected cells, most notably herpes and cytomegalovirus-infected cells. NK cells, unlike the CD8+ (killer) T cells, kill their targets without a prior "conference” in the lymphoid organs = they possess memory for past invaders and help prevent disease when similar invader is encountered again. However, NK cells that have been activated by secretions from CD4+ T cells will kill their tumor or viral-infected targets more effectively. The T cells and NK cells are involved in CMI B Cells -- The major function of B lymphocytes is the production of antibodies in response to foreign proteins of bacteria, viruses, and tumor cells. Antibodies are specialized proteins that specifically recognize and bind to ONE particular protein. Antibody production and binding to a foreign substance or antigen, often is critical as a means of signaling other cells to engulf, kill or remove that substance from the body. Involved in AMI Granulocytes or Polymorphonuclear (PMN) Leukocytes -- Granulocytes are composed of three cell types identified as neutrophils, eosinophils and basophils, based on their staining characteristics with certain dyes. These cells are predominantly important in the removal of bacteria and parasites from the body. The neutrophils are the primary phagocytic cell - They engulf these foreign bodies and degrade them using their powerful enzymes. Eosinophils – parasites and allergies and Basophils signs/symptoms of inflammation. Macrophages = monocytes that have migrated from bloodstream and entered tissue – share the “vacuum cleaner – phagocytic function of neutrophils – but they live much longer. They are often referred to as scavengers or antigen-presenting cells (APC) because they pick up and ingest foreign materials and present these antigens to other T cells and B cells so that the pathogens can be recognized and killed or an antibody response can be mounted. This is one of the important first steps in the initiation of an immune response. Involved in inflammation and assist in AMI and CMI Dendritic cells are specialized antigen-presenting cells . They are found in the circulation, in peripheral tissues and in lymphoid organs. Maturing dendritic cells travel from the periphery to secondary lymphoid organs, where they present antigens to T lymphocytes.
- The body has 3 types of lymphocytes – T cells, B cells, and NK cells T-Cells -- T lymphocytes are usually divided into two major subsets that are functionally and phenotypically (identifiably) different. The T helper subset, also called the CD4+ T cell, is a coordinator of immune regulation . The main function of the T helper cell is to augment or potentiate immune responses by the secretion of specialized factors that activate other white blood cells to fight off infection. Later we will earn that these are the cells that become defective in HIV. T killer/suppressor subset or CD8+ T cell. These cells are important in directly killing certain tumor cells, viral-infected cells and sometimes parasites . The CD8+ T cells are also important in down-regulation of immune responses. Both types of T cells can be found throughout the body . They often depend on the lymph nodes and spleen as sites where activation occurs, but they are also found in other tissues of the body, most notably the liver, lung, blood, and intestinal and reproductive tracts. Natural Killer Cells -- often referred to as NK cells, are similar to the killer T cell subset (CD8+ T cells). They function as effector cells that directly kill certain tumors such as melanomas, lymphomas and viral-infected cells, most notably herpes and cytomegalovirus-infected cells. NK cells, unlike the CD8+ (killer) T cells, kill their targets without a prior "conference” in the lymphoid organs = they possess memory for past invaders and help prevent disease when similar invader is encountered again. However, NK cells that have been activated by secretions from CD4+ T cells will kill their tumor or viral-infected targets more effectively. The T cells and NK cells are involved in CMI B Cells -- The major function of B lymphocytes is the production of antibodies in response to foreign proteins of bacteria, viruses, and tumor cells. Antibodies are specialized proteins that specifically recognize and bind to ONE particular protein. Antibody production and binding to a foreign substance or antigen, often is critical as a means of signaling other cells to engulf, kill or remove that substance from the body. Involved in AMI Granulocytes or Polymorphonuclear (PMN) Leukocytes -- Granulocytes are composed of three cell types identified as neutrophils, eosinophils and basophils, based on their staining characteristics with certain dyes. These cells are predominantly important in the removal of bacteria and parasites from the body. The neutrophils are the primary phagocytic cell - They engulf these foreign bodies and degrade them using their powerful enzymes. Eosinophils – parasites and allergies and Basophils signs/symptoms of inflammation. Macrophages = monocytes that have migrated from bloodstream and entered tissue – share the “vacuum cleaner – phagocytic function of neutrophils – but they live much longer. They are often referred to as scavengers or antigen-presenting cells (APC) because they pick up and ingest foreign materials and present these antigens to other T cells and B cells so that the pathogens can be recognized and killed or an antibody response can be mounted. This is one of the important first steps in the initiation of an immune response. Involved in inflammation and assist in AMI and CMI Dendritic cells are specialized antigen-presenting cells . They are found in the circulation, in peripheral tissues and in lymphoid organs. Maturing dendritic cells travel from the periphery to secondary lymphoid organs, where they present antigens to T lymphocytes.
- The body has 3 types of lymphocytes – T cells, B cells, and NK cells T-Cells -- T lymphocytes are usually divided into two major subsets that are functionally and phenotypically (identifiably) different. The T helper subset, also called the CD4+ T cell, is a coordinator of immune regulation . The main function of the T helper cell is to augment or potentiate immune responses by the secretion of specialized factors that activate other white blood cells to fight off infection. Later we will earn that these are the cells that become defective in HIV. T killer/suppressor subset or CD8+ T cell. These cells are important in directly killing certain tumor cells, viral-infected cells and sometimes parasites . The CD8+ T cells are also important in down-regulation of immune responses. Both types of T cells can be found throughout the body . They often depend on the lymph nodes and spleen as sites where activation occurs, but they are also found in other tissues of the body, most notably the liver, lung, blood, and intestinal and reproductive tracts. Natural Killer Cells -- often referred to as NK cells, are similar to the killer T cell subset (CD8+ T cells). They function as effector cells that directly kill certain tumors such as melanomas, lymphomas and viral-infected cells, most notably herpes and cytomegalovirus-infected cells. NK cells, unlike the CD8+ (killer) T cells, kill their targets without a prior "conference” in the lymphoid organs = they possess memory for past invaders and help prevent disease when similar invader is encountered again. However, NK cells that have been activated by secretions from CD4+ T cells will kill their tumor or viral-infected targets more effectively. The T cells and NK cells are involved in CMI B Cells -- The major function of B lymphocytes is the production of antibodies in response to foreign proteins of bacteria, viruses, and tumor cells. Antibodies are specialized proteins that specifically recognize and bind to ONE particular protein. Antibody production and binding to a foreign substance or antigen, often is critical as a means of signaling other cells to engulf, kill or remove that substance from the body. Involved in AMI Granulocytes or Polymorphonuclear (PMN) Leukocytes -- Granulocytes are composed of three cell types identified as neutrophils, eosinophils and basophils, based on their staining characteristics with certain dyes. These cells are predominantly important in the removal of bacteria and parasites from the body. The neutrophils are the primary phagocytic cell - They engulf these foreign bodies and degrade them using their powerful enzymes. Eosinophils – parasites and allergies and Basophils signs/symptoms of inflammation. Macrophages = monocytes that have migrated from bloodstream and entered tissue – share the “vacuum cleaner – phagocytic function of neutrophils – but they live much longer. They are often referred to as scavengers or antigen-presenting cells (APC) because they pick up and ingest foreign materials and present these antigens to other T cells and B cells so that the pathogens can be recognized and killed or an antibody response can be mounted. This is one of the important first steps in the initiation of an immune response. Involved in inflammation and assist in AMI and CMI Dendritic cells are specialized antigen-presenting cells . They are found in the circulation, in peripheral tissues and in lymphoid organs. Maturing dendritic cells travel from the periphery to secondary lymphoid organs, where they present antigens to T lymphocytes.
- The body has 3 types of lymphocytes – T cells, B cells, and NK cells T-Cells -- T lymphocytes are usually divided into two major subsets that are functionally and phenotypically (identifiably) different. The T helper subset, also called the CD4+ T cell, is a coordinator of immune regulation . The main function of the T helper cell is to augment or potentiate immune responses by the secretion of specialized factors that activate other white blood cells to fight off infection. Later we will earn that these are the cells that become defective in HIV. T killer/suppressor subset or CD8+ T cell. These cells are important in directly killing certain tumor cells, viral-infected cells and sometimes parasites . The CD8+ T cells are also important in down-regulation of immune responses. Both types of T cells can be found throughout the body . They often depend on the lymph nodes and spleen as sites where activation occurs, but they are also found in other tissues of the body, most notably the liver, lung, blood, and intestinal and reproductive tracts. Natural Killer Cells -- often referred to as NK cells, are similar to the killer T cell subset (CD8+ T cells). They function as effector cells that directly kill certain tumors such as melanomas, lymphomas and viral-infected cells, most notably herpes and cytomegalovirus-infected cells. NK cells, unlike the CD8+ (killer) T cells, kill their targets without a prior "conference” in the lymphoid organs = they possess memory for past invaders and help prevent disease when similar invader is encountered again. However, NK cells that have been activated by secretions from CD4+ T cells will kill their tumor or viral-infected targets more effectively. The T cells and NK cells are involved in CMI B Cells -- The major function of B lymphocytes is the production of antibodies in response to foreign proteins of bacteria, viruses, and tumor cells. Antibodies are specialized proteins that specifically recognize and bind to ONE particular protein. Antibody production and binding to a foreign substance or antigen, often is critical as a means of signaling other cells to engulf, kill or remove that substance from the body. Involved in AMI Granulocytes or Polymorphonuclear (PMN) Leukocytes -- Granulocytes are composed of three cell types identified as neutrophils, eosinophils and basophils, based on their staining characteristics with certain dyes. These cells are predominantly important in the removal of bacteria and parasites from the body. The neutrophils are the primary phagocytic cell - They engulf these foreign bodies and degrade them using their powerful enzymes. Eosinophils – parasites and allergies and Basophils signs/symptoms of inflammation. Macrophages = monocytes that have migrated from bloodstream and entered tissue – share the “vacuum cleaner – phagocytic function of neutrophils – but they live much longer. They are often referred to as scavengers or antigen-presenting cells (APC) because they pick up and ingest foreign materials and present these antigens to other T cells and B cells so that the pathogens can be recognized and killed or an antibody response can be mounted. This is one of the important first steps in the initiation of an immune response. Involved in inflammation and assist in AMI and CMI Dendritic cells are specialized antigen-presenting cells . They are found in the circulation, in peripheral tissues and in lymphoid organs. Maturing dendritic cells travel from the periphery to secondary lymphoid organs, where they present antigens to T lymphocytes.
- The body has 3 types of lymphocytes – T cells, B cells, and NK cells T-Cells -- T lymphocytes are usually divided into two major subsets that are functionally and phenotypically (identifiably) different. The T helper subset, also called the CD4+ T cell, is a coordinator of immune regulation . The main function of the T helper cell is to augment or potentiate immune responses by the secretion of specialized factors that activate other white blood cells to fight off infection. Later we will earn that these are the cells that become defective in HIV. T killer/suppressor subset or CD8+ T cell. These cells are important in directly killing certain tumor cells, viral-infected cells and sometimes parasites . The CD8+ T cells are also important in down-regulation of immune responses. Both types of T cells can be found throughout the body . They often depend on the lymph nodes and spleen as sites where activation occurs, but they are also found in other tissues of the body, most notably the liver, lung, blood, and intestinal and reproductive tracts. Natural Killer Cells -- often referred to as NK cells, are similar to the killer T cell subset (CD8+ T cells). They function as effector cells that directly kill certain tumors such as melanomas, lymphomas and viral-infected cells, most notably herpes and cytomegalovirus-infected cells. NK cells, unlike the CD8+ (killer) T cells, kill their targets without a prior "conference” in the lymphoid organs = they possess memory for past invaders and help prevent disease when similar invader is encountered again. However, NK cells that have been activated by secretions from CD4+ T cells will kill their tumor or viral-infected targets more effectively. The T cells and NK cells are involved in CMI B Cells -- The major function of B lymphocytes is the production of antibodies in response to foreign proteins of bacteria, viruses, and tumor cells. Antibodies are specialized proteins that specifically recognize and bind to ONE particular protein. Antibody production and binding to a foreign substance or antigen, often is critical as a means of signaling other cells to engulf, kill or remove that substance from the body. Involved in AMI Granulocytes or Polymorphonuclear (PMN) Leukocytes -- Granulocytes are composed of three cell types identified as neutrophils, eosinophils and basophils, based on their staining characteristics with certain dyes. These cells are predominantly important in the removal of bacteria and parasites from the body. The neutrophils are the primary phagocytic cell - They engulf these foreign bodies and degrade them using their powerful enzymes. Eosinophils – parasites and allergies and Basophils signs/symptoms of inflammation. Macrophages = monocytes that have migrated from bloodstream and entered tissue – share the “vacuum cleaner – phagocytic function of neutrophils – but they live much longer. They are often referred to as scavengers or antigen-presenting cells (APC) because they pick up and ingest foreign materials and present these antigens to other T cells and B cells so that the pathogens can be recognized and killed or an antibody response can be mounted. This is one of the important first steps in the initiation of an immune response. Involved in inflammation and assist in AMI and CMI Dendritic cells are specialized antigen-presenting cells . They are found in the circulation, in peripheral tissues and in lymphoid organs. Maturing dendritic cells travel from the periphery to secondary lymphoid organs, where they present antigens to T lymphocytes.
- HLAs = human leukocyte antigens There are two types of specific immune responses; humoral and cell mediated . Humoral immunity is mediated by B Lymphocytes that produce antibodies (IgG, IgM, IgA, IgE) and is especially important in combating acute bacterial infections. Cellular immunity is mediated by T Lymphocytes which are processed in the thymus. Cellular immunity is especially important in combating intracellular organisms such as TB, performing tumor surveillance, mediating transplant rejection, and fighting fungal and viral infections. It also mediates the delayed type hypersensitivity reaction, which underpins skin test like the one to assess for TB exposure. Misnomer – not just present on leukocytes – they are present on most cells What makes us unique as individuals – specify tissue type Normal part of the individual but they would act as an antigen if they entered another person’s body. The Immune cells in the body determine if an individual cell is self or non self (foreign) and takes action Humans have about 40 major HLAs that are specific antigens determined by genetics.
- Without immunity we would be sick most of the time. Inflammation and immunity are the 2 major defenses that protect a person against disease/illness When the body is injured or invaded by organisms. When these defenses are working well – the individual Is said to be immunocompetent.
- Self – tolerance – immune cells (WBCs) are the ONLY cells capable of determining self from non self. They accomplish this by looking at the different types of proteins present on cell membranes. Self tolerance is the special ability of WBCs to recognize healthy self cells and not attempt to attack or destroy them.
- The HIV virus would be recognized by the immune system as NON SELF
- See text Chap. 6, page 103
- Deformities are common with RA
- See Table 54-3 on page 1895. DMARDs are initiated early in tx.
- Onset may be insidious and dx delayed for many years.
- ANA may also be positive with RA, scleroderma TB, hepatitis, cancer; quinidine and procainamide can also cause increase in ANA