Immune responses and transplants

the body’s ability to resist disease

immunity

what are the 3 functions the immune response serves

defense

homeostasis

survaeillance

______- a substance that elicits and immune response

• unique to the person and enables body to recognize itself

• Self: HLA proteins label cells of the individual; immune system ignores self-cells

  Non-self: immune system recognizes specific non-self antigens as foreign; development of a specific response to that particular antigen; memory cells produced to respond quickly to antigen

antigen

what are the 3 common problems occuring when the immune response is altered

-Inflammation

-Infection

-Tissue integrity

explain the primary and secondary immune responses

Primary response

-First exposure to antigen

-1 to 2 weeks before antibody titer reaches efficacy

Secondary Response

-Repeat exposure to the same antigen

-More rapid response, with efficacy in 1 to 3 days

explain innate immunity

explain acquired immunity

explain the central (primary) lymphoid structures and cells

explain the peripheral lymphoid structures and cells

explain macrophages:

explain lymphocytes:

explain B lymphocytes

explain T lymphocytes:

explain NK cells:

explain dendritic cells:

explain cytokines:

what are antibodies?

explain the different types of antibodies

what is the complement system?

list the chemical mediators

explain humoral immunity

explain cell mediated immunity

what are the effects of aging on the immune system (immunosenescence)

what are some lab/ diagnostic tests for immun responses and transplants

Titer - Measures levels of serum immunoglobulins

Indirect Coombs’ test - Detects Rh blood incompatibility

ELISA (enzyme-linked immunosorbent assay) – Detects antibodies such as IgE, HIV & other diseases

Increased with Type I hypersensitivity

Used when taking a drug that interferes with testing such as steroids or antihistamines) and cannot stop taking, cannot tolerate skin scratches, or has a skin disorder

Major histocompatibility complex (MHC) typing - Tissue matching before transplantation procedures

Antinuclear Antibody (ANA) determination

-Used for differential diagnosis of autoimmune disease

-Positive result is not confirmatory

CBC with WBC differential

-Decrease lymphocyte count with immunodeficiency

-Increase eosinophil count with Type 1 hypersensitivity

explain skin testing:

explain the post procedure of skin testing:

for skin testing, what is a negative response

wheal is less than 0.5 cm in diameter after 15-30 mins of application

what are the different ways there can be an altered immune response

__________ occurs when the body does not recognize self-proteins and reacts against self-antigens.

Autoimmune disease

explain a type 1- allergic reaction hypersensitivity reaction:

what is anaphylaxis/ anaphylactic shock manifested by

causes of allergic rxns and anaphylaxis

Drugs

§Aspirin

§Chemotherapy drugs

§Insulin

§Local anesthetics

§NSAIDs

§Antibiotics – cephalosporins, penicillins, sulfonamides, tetracyclines

Foods – eggs, milk, nuts, peanuts, shellfish, fish, chocolate, strawberries

Insect Venoms

§Wasps, hornets, yellow jackets, bumblebees, ants

Treatment Measures

§Allergenic extracts used in immunotherapy

§Blood products

§Iodine-contrast media for CT scan

Animal Sera

§Diphtheria antitoxin

§Rabies antitoxin

§Snake venom antitoxin

§Tetanus antitoxin

explain prevention of hypersensitivity reaction

allergic rxn manifestations

interventions for allergic rxns without anaphylaxis:

anaphylaxis clinical manifestations

anaphylaxis treatment:

explain a type II cytotoxic hypersensitivity reaction:

-IgG or IgM binds to antigen on cell surface-activates complement resulting in cytolysis or enhanced phagocytosis

-Hemolytic Transfusion Reactions – recipient receives ABO-incompatible blood from a donor

explain goodpasture syndrome:

§ rare autoimmune disorder most common in young adults who smoke

§Autoantibodies are made against the glomerular and alveolar basement membrane

§Usually not diagnosed until significant involvement occurs

§Clinical manifestations: shortness of breath, hemoptysis, decrease urine output, edema, weight gain, hypertension, tachycardia, hematuria, weakness, anemia

§Treatment: suppress the autoimmune response with medications such as corticosteroids and plasmaphoresis

explain a type III hypersensitivity reaction

explain a type IV hypersensitivity reaction:

explain a latex allergy

latex cross reactive foods

latex allergy prevention and interventions:

guidelines for preventing allergic latex reactions

what are the hypersensitivity medications

Antipruritic Drugs

-Topical – protect skin and relieve itching

-Ex: calamine lotion, coal tar solutions, camphor

Mast Cell-Stabilizing Drugs

-Inhalant or intranasal

-Used in allergic rhinitis

-Ex: Cromolyn

Leukotriene Receptor Antagonists

-Blocks leukotriene-allergic inflammatory process

-Oral treatment of allergic rhinitis and asthma

-Ex: Montelukast (Singulair)

Antihistamines

-Block histamine receptors, alleviating the effects of histamine

-Take at onset of symptoms

-Ex: diphenhydramine

Decongestants

-Ex: phenylephrine, pseudoephedrine

Sympathomimetics

-Ex: epinephrine IM or IV

-Treatment of choice for anaphylaxis-related vasodilation & bronchodilation

Corticosteroids

-Anti-inflammatory effects – intranasal or oral

explain immunotherapy or allergy shots

nursing management for immunotherapy:

explain hypersensitivity therapies:

explain immunodeficiency:

explain primary deficiencies and secondary or acquired immunodeficiencies:

explain transplantation:

types of transplantation:

explain hematopoietic stem cell transplantation

what are the types of donor stem cells

explain the harvest procedure for transplantation

what are the conditioning regimens for transplantation

what are the general pre-transplantation care guidelines

explain transplantation

explain engraftment

explain post- transplantation care:

explain tissue and organ transplant rejection

Chronic, late rejection: Occurs after months or years:

Due to antibody-mediated immune responses

Causes fibrosis and scarring

Difficult to manage

Treatment is supportive & outcomes not as good as the acute rejection

Interventions: Life-long immunosuppressive medications

Increase current dose of medications

Add corticosteroids if already discontinued

Add polyclonal or monoclonal antibodies if not already taking

explain graft vs host disease

treatment and prevention of graft vs host disease