Chapter 9: Inflammation and Immunity & Chapter 11: Malignant disorders of WBC

immune system

has evolved to protect the body against bacteria, viruses, and foreign substances

two defense systems that coperate to protect the body…

1. innate immunity

2. adaptive immunity

innate immunity

early rapid responses (skin, mucous membranes, phagocytic leukocytes)

adaptive immunity

slower responders (t-cells, b-cells)

antigens

are foreign substances or proteins found on cells that activate the immune system to produce specific antibodies

antibodies

class of proteins called immunoglobulins and they bind to specific antigens in a way similar to a lock and key and destroy them

immunity can be acquired

1. actively

2. passively

active immunity

by the host being exposed to an antigen that it recognizes as foreign

• development of antibodies or t cells in repose to antigen to body

passive immunity

immunity being trasnferred from another source (person or animal)

types of acquired immunity

1. natural active

2. artificial active

3. natural passive

4. artificial passive

natural active

antibodies form in response to pathogens (memory B and T cells remain and initiate a faster secondary immune response

• immunity not immediate, usually lasts forever

artificial active

antibodies form in response to vaccines (uses toxoid vaccine - weakened bacteria toxin that acts as antigen for body to form antibodies)

natural passive

antibodies pass via the placenta and breast milk

artificial passive

antibodies are injected into the person in the form of an antiserum

antiserum

antibodies from another person or the patient / recipient

herd immunity

vaccination rates are high so the occurrence of many diseases has declined, thus decreasing an individual’s chance of acquiring a disease when a large # of people in the pop. are vaccinated

extranodal

the spreading of the lymphoma to organs

lymphomas

collectively are a group of malignant hematologic diseases of lymphocytes of which there are no benign forms

• type of cancer that affects lymphocytes

hematologic diseases

blood cancer that often begins in lymphatic tissues

main types of lymphomas

1. Hodgkin’s lymphomas, HL (hodgkins disease)

2. non-hodgkins lymphoma (non-hodgkins disease)

Hodgkins lymphoma

• develops from the malignant lymphocytes called Reed-Sternberg cells

• stage I-IV:

  • stage I the cancer is less widespread

  • stage IV the cancer is most advanced

• stage I and II have highest survival rates

• occurs between 15-40 or 55 years

• rare in children

• twice as freuquent in white men

Reed Sternberg cells

are abnormally large multi-nucleated cells located in the lymph nodes

• how we diagnose hodgkins lymphoma

age for HL

occurs in 15-40 or after 55 yrs

pathology of HL

• HL is diagnosed by the presence of Reed Sternberg cells in lymph nodes (lymph nodes are destroyed in HL due to hyperplasia of monocytes and macrophages)

• after diagnosis, disease begins in lymph nodes, typically cervical region then travels through the lymphatic system to the nearest lymph node (spread from above diaphragm lymph node to below the diaphragm lymph nodes)

• most come initial symptom = swelling felt in the cervical, axillary, or inguinal region caused by one or more enlarged lymph nodes

most common symptom of HL

swelling felt in the cervical, axillary, or inguinal region

path of HL

in cervial lymph nodes then travels through the lymphatic system to below the diaphagram lymph nodes or the nearest lymph node

how is HL diagnosed

by reed sternberg cells located in lymph nodes

stage I

characterized by presence of the disease in a single lymph node (cervical lymph node)

stage II

stage indicates present of disease in 2 or more lymph node regions but still on the same side of the diaphragm

stage III

characterized by further spread of the disease to lymph node regions above and below the diaphragm and may include movement of spleen

stage IV

disease is widespread and extranodal, affecting one or more organs such as liver or intestines

multiple myeloma

a neoplastic cancer that originates in the plasma cells of bone marrow and is often asymptomatic until the cancer has progressed, can be malignant or benign (neoplastic B cell cancer characterized by the proliferation of malignant plasma cell that infiltrate bone marrow causing antibody production to be inhibited)

neoplastic cancer

means abnormal cells are growing and multiplying uncontrollably (for myeloma abnormal cells are plasma cells)

characteristics of multiple myeloma

• rare and uncommon / idiopathic in nature

• after 40 (average is 65)

• predisposing factors - genetic factors, specifically a mutation in chromosome 13

clinical manifestations of myeloma

starts slowly and insidiously, they often do not manifest as recognizable symptoms until the disease has progressed and skeletal pain is recognized

• hyper viscosity syndrome (triad of mucosal bleeding, visual changes and neurological symptoms) being common issue

• chronic overwhelming infection typical cause of death due to compromised immune system

• most manifestations tend to be skeletal and neurologically related

what is the role of neutrophils?

neutrophils are active in phagocytosis and the inflammatory process

what is the main function of b cells?

stimulate antibody production

which of the following are t cells found in the body?

1. killer t cells

2. helper t cells

3. memory t cells

what functions do chemical mediators of the complement system promote

1. inflammation

2. chemotaxis

3. phagocytosis

4. cellular damage

match the immunoglobulin with their function

IgG - are antibacterial, antiviral, and antitoxin antibodies

IgE - cause the release of histamine resulting in inflammation

IgA - bathes mucous membranes, provides protection to neonates

IgM - forms antibodies, involved in ABO incompatibility reactions

IgG

are antibacterial, antiviral, and antitoxin antibodies

IgE

causes the release of histamine resulting in inflammation

IgA

bathes mucous membranes, provides protection to neonates

IgM

forms antibodies, involved in ABO incompatibility reactions

which statement is true of natural immunity

• specific to each species

• explains why humans are not generally susceptible to animal infections

which statement correctly describes active immunity

active immunity develops over time with exposures to antigens

which statements describe active natural immunity

• generally lasts a lifetime

• remembered by memory b and t cells

• develops over time after exposure to an antigen

in which scenario is passive immunity occurring

when an infant receives breast milk

an illness stimulates antibody production

natural active

a vaccine stimulates antibody production

artificial active

antibodies cross the placenta to fetus

natural passive

antibodies are injected into a person

artificial passive

which are accurate statements regarding the epidemiology of non hodgkins lymphoma

• occurs more frequently in men than women

• most common form of blood related cancers

at which ages does HL usually occur

• after 55 years

• between 15-40 years

which is a predisposing factor for Hodgkin’s lymphoma

being HIV positive

hodgkin’s lymphoma is diagnosed by the presence of which specific cells?

reed sternberg cells

in which body part does hodgkins lymphoma typically begin

cervical lymph nodes

which are the prevalent clinical manifestations of non hodgkins lymphoma

• splenomegaly

• painless lymph nodes

• enlarged lymph nodes nodes

• symptoms arising in organs outside the lymphatic system

which are the four common initial clinical manifestations of hodgkins lymphoma

• cough

• b symptoms

• movable lymph nodes

• enlarged lymph nodes in the axillary region

which describes lymph nodes in non hodgkins lymphoma

enlarged and moveable

which are predisposing factors for non hodgkins lymphoma

• being over the age 60

• receiving radiation therapy

• having an autoimmune disease

• expose to chemicals in the environment

which factors increase the likelihood of developing non hodgkins lymphoma

• over age 60

• HIV infection

• epstein barr virus

• immunosuppressant drugs

cancer survival rates vary. which is the long term survival for HL

greater than 80%

match the characteristics of the b cell of origin to the type of lymphoma

burrito’s lymphoma - b cell blasts

hodgkins lymphoma - b cellls

which is true of HL arising above the diaphragm

causes frequent B symptoms

What pathophysiology do HL and non HL share

extranodal involvement

which are the possible progressions for the spread of hodgkins lymphoma

• cervical lymph nodes to axillary lymph nodes

• inguinal lymph nodes to cervical lymph nodes

• mediastinum lymph nodes nodes to axillary lymph nodes

• inguinal lymph nodes to mediastinum lymph nodes

which would be the clinical manifestations in a patient with stage III HL

spread of the disease to lymph node regions above and below the diaphragm and possible involvement of the spleen

which characteristic accurately describe the clinical manifestations of HL

• insidious onset

• cough and dyspnea

• possible progression to extranodal involvement

which demographic is most likely to develop multiple myeloma

african american male age 40

which factors increase the risk of developing multiple myeloma

• herbicides

• organic chemicals

• exposure to radiation

which represents the direct cause of multiple myeloma

genetic mutation in the DNA of plasma cells

which is produced in excess by plasma cells in multiple myeloma

m proteins

which organs are affected by the proliferation of malignant plasma cells and overproduction of immunoglobulin

• bone

• liver

• kidneys

which describes hyper viscosity syndrome

a triad of mucosal bleeding, visual changes, and neurological symptoms

which denotes the first sign of multiple myeloma

skeletal pain

which best describes multiple myeloma

a neoplastic B cell cancer characteized by the proliferation of malignant plasma cells

researchers attribute the cause of multiple myeloma to which factors

genetics mutation of chromosome 13

what is the result of a suppressed humoral immune response

pyelonephritis