CHAPTER 50 Immune system disorders

(P.H.A.G.I.S)
ASSESSMENT OF IMMUNE Hypersensitivity
FUNCTION
 Exaggerated response of the body to
antigens

Immunity Auto-immunity

 Protective response of the body to  Immune systems attack the body

foreign objects or organisms  Coup de etat ANATOMY OF THE
o Bacteria
IMMUNE SYSTEM
Gammopathies
o Viruses
o Microorganisms  Overproduction of immunoglobulins
o Foreign objects
 Balanced state wherein cells have the Immune deficiencies
capability to fight off infections
Primary
Immune memory
 Congenital or inherited
 Ability of the immune system to protect  Improper development of immune cells
the body against harmful microorganisms  Development problem
despite re-exposure
Secondary
Tolerance
 Immune system has already been
 Mechanism of the immune system to developed
self-accept antigens in order to  Interference of the immune system
eliminate microbes, toxins, and cellular
mutations

Immunopathology

 Immuno= immune system

 Pathology= study of cells
 Studying the science, causes and effects
of diseases of the immune system
1. Thymus  The security to the bloodstream 2 TYPES OF IMMUNITY

 Only clearly individualized 1⁰ lymphoid Secondary follicle (Germinal center) 1. Adaptive immunity (develops after birth)
organ  is site of B cell proliferation, mutation, 2. Natural immunity (present at birth)
differentiation
Function  Specificity is high
o production of thymic  >90% of B cells die through apoptosis
lymphocytes  After Ag stimulation lymphocyte
numbers up by 50X in efferent lymphatic
o A major organ for proliferation
vessel
of lymphocytes in body.
o Plays key role in determining
4. Tonsils
the differentiation of T cell
 Filters out older RBCs
2. Bone marrow  Responds to Ag in circulatory system
 Produces activated B cells
Function
 Hematopoiesis 5. Appendix
 B cell maturation and selection
 WBC production  Responds to Ag
 Role in GI immune response NATURAL IMMUNITY / INNATE IMMUNITY

6. Mucosa-Associated Lymphoid Tissue  First line of defense

(MALT)  The response to an invading MO is the
same with the next
 Lymphoid tissues below epithelium  Broad spectrum type of immunity
 Presence of B cells
 Ag presented through unique cell (M cell)
 Preferentially responds with IgA
antibody FIRST LINE OF DEFENSE

1. White blood cell action

7. Spleen 2. Inflammatory response
3. Physical and chemical barriers
 Composed of red pulp and white pulp 4. Immune regulation
 Red pulp= where old RBC are destroyed
SECOND LINE OF DEFENSE
 White pulp= concentration of
lymphocytes 1. Inflammatory response
3. Lymph nodes

Function FUNCTIONS OF THE IMMUNE SYSTEM Cells involved

 1st line of response to antigens
Remove foreign antigens such as bacteria and 1. Monocytes
 Remove foreign material from the lymph
viruses 2. Macrophages
system before it enters the blood
 3. Dendritic cells  substances in sebaceous sweat glands
4. NK cells  sweat secretions
5. Basophils
6. Eosinophils
7. Granulocytes 1. Skin

2 stages of natural immune system mechanism The skin is the largest organ of your body. It acts
as a barrier between invaders (pathogens) and your
1. Immediate (within 4 hours)
body. Skin forms a waterproof mechanical barrier.
2. Delayed (4-96 hours after exposure)
Microorganisms that live all over your skin can’t
get through your skin unless it’s broken.

2. Tears, mucus and saliva

INFLAMMATORY RESPONSE
WHITE LOOD CELL ACTION Nose, mouth and eyes are obvious entry points for
Read chapter 6 for more information pathogens. However, tears, mucus and saliva
 Participates in natural and acquired
contain an enzyme that breaks down the cell wall
immune functions
of many bacteria. Those that are not killed
1. Granulocytes (granular leukocytes)
immediately are trapped in mucus and swallowed.
1.1 Neutrophils- Phagocytosis
Special cells line and protect the nose, throat and
1.2 Eosinophils – parasitic infections
other passages within your body. The inner lining
1.3 Basophils- allergies of your gut and lungs also produces mucus to trap
invading pathogens.
Called like this because they have granules in the
cytoplasm

Function 3. Cilia

Releases cell mediators that fight off infection or PHYSICAL AND CHEMICAL BARRIERS Very fine hairs (cilia) lining your windpipe move
toxins and foreign microorganisms mucus and trapped particles away from your lungs.
Physical barriers Particles can be bacteria or material such as dust
 Histamine or smoke.
 Bradykinin  skin
 Prostaglandin  mucus membranes
2. nongranular leukocytes  cilia 4. Stomach acid
monocytes or macrophages
Chemical barriers Stomach acid kills bacteria and parasites that have
Function been swallowed.
 mucus
Enters tissue spaces, and engulfs cells  gastric secretions
 enzymes in tears and saliva 5. Urine flow
Urine flow flushes out pathogens from the bladder  stops the immune system from going wild,
area. because if there is too much
ADAPTIVE IMMUNITY
inflammatory response, cytokines as well
as T cells mediation can cause tissue Acquired because a person has been exposed to an
6. Normal Flora ‘Friendly’ (beneficial) bacteria damage infection to through an antigen by immunization
Normal flora are growing on the skin, in the bowel
Recognizes specific foreign antigens
and other places in the body (such as the mouth
and the gut) that stop other harmful bacteria SECONDARY LINE OF DEFENSE
from taking over.
An inflammatory response begins when a pathogen 2 mechanisms
stimulates an increase in blood flow to the
infected area. Blood vessels in that area expand, 1. cell mediated response (activation of T
and white blood cells leak from the vessels to cells)
IMMUNE REGULATION
invade the infected tissue. These white blood cells, 2. effector mechanisms (B cell maturation
Dysfunction called phagocytes engulf and destroy bacteria. The and production of antibodies)
area often becomes red, swollen, and painful during
 occurs whenever there are an inflammatory response. (signs of inflammation)
o inactivation of immune
When a pathogen has invaded, the immune system 2 types of immunity
components
may also release chemicals that increase body
o prolongation of immune 1. Active immunity
temperature, producing a fever (pyrogens).
components from their Increased body temperature may slow or stop
beneficial effects pathogens from growing and helps speed up the  Immunity which is developed after
immune response. exposure to a pathogen or contracting an
Successful immune system infection

 elimination of responsible antigen Natural

Immunocompromised / immunodeficient  After infection, antibodies are created

 happens when immune system fails to Artificial

develop or when antigens are not cleared
or eradicated properly  Antibodies created after immunization

Autoimmune disorders

 when the immune system mistakes the 1. Passive immunity

cells of the body as “foreign”  Immunity acquired from a person or an
animal
Regulatory mechanisms
Natural
  Antibodies acquired from mothers  Lymph nodes release lymphocytes which
(breast milk) roam around the tissues as well as the
vessels
Artificial  Lymphocytes recirculates back to the
lymph nodes then back to the blood
 Antibodies acquired from serum medicine
stream, vice versa
 Lymphocytes recognize antigens as “non-
self” which will trigger the
RESPONSE TO INVASION (PHC) PROLIFERATION STAGE
2. Proliferation stage
1. Phagocytotic immune response
 T and B cells enlarge and
WBC such as the granulocytes (NEB) and proliferate
macrophages ingest foreign particles and destroy o Causes enlargement of the
invading MO lymph nodes
4. Effector stage
Apoptosis- programmed cell death or the process Circulating lymphocytes which detect anon-self
The stage where the antibody (CKT cells/ humoral
wherein the body destroys worn out cells which microbe sends signals to the NEAREST LYMPH
response) connects with the antigen of the
need to be renewed NODE (That’s why there is swelling on the lymph
foreign invader
nodes near the tissue which is directly affected)
2. Humoral or antibody immune response
HUMORAL IMMUNE RESPONSE
3. Response stage
B lymphocytes transform into plasma cells to
 ANTIBODIES are produced by B
manufacture antibodies that will disable the Differentiated lymphocytes (T cells or B cells) may
lymphocytes
invaders function
CHAIN OF EVENTS
3. Cellular immune response  Humoral capacity
1. Antigens bind to B cells.
T lymphocytes become cytotoxic t cells which Creation of antibodies from the B lymphocytes
attack the pathogens
 Cellular capacity 2. Interleukins or helper T cells co-
Antigen stimulate B cells. In most cases, both an
Stimulates near lymphocytes to transform into antigen and a co-stimulator are required
 Stimulates antibody production, is the cytotoxic T cells to attack microbes to activate a B cell and initiate B cell
structural part of the invading MO proliferation.
Increases the number of T lymphocytes
4 STAGES OF THE IMMUNE RESPONSE (RPRE) (lymphocytosis) 3. B cells proliferate and produce plasma
cells. The plasma cells bear antibodies
1. Recognition stage Seen in patients with mononucleosis, a with the identical antigen specificity as
viral illness the antigen receptors of the activated B
Accomplished by the lymph nodes
cells. The antibodies are released and
 circulate through the body, binding to
antigens.
CELLULAR IMMUNE RESPONSE
4. B cells produce memory cells. Memory
cells provide future immunity.  Utilization of T cells to transform into
CKT cells because antibodies are not
enough to protect the body against
ROLE OF ANTIBOIES pathogens

Antibodies Where do stem cells become T cells?

 Large proteins which are also called
immunoglobulins
 Releases vasoactive substances
o Histamine
 Defends against foreign invaders by
combining with the invaders
Agglutination
 When an antibody clumps with the
antigen, and the MO is cleared from the
body through phagocytosis
Opsonization
 Antigen antibody is covered with a sticky
substance
5 DIFFERENT TYPES OF IMMUNOGLOBULIN
In the bone marrow and thymus
CHAIN OF EVENTS
1. Self cells displaying foreign antigens bind
to T cells.
2. Interleukins (secreted by helper T cells)
co-stimulate activation of T cells.
3. If MHC‐I and endogenous antigens are
displayed on the plasma membrane, T
cells proliferate, producing cytotoxic T
cells. Cytotoxic T cells destroy cells
displaying the antigens.
4. If MHC‐II and exogenous antigens are
displayed on the plasma membrane, T
cells proliferate, producing helper T
cells. Helper T cells release interleukins
(and other cytokines), which stimulate B
cells to produce antibodies that bind to
the antigens and stimulate nonspecific
agents (NK and macrophages) to destroy
the antigens.

1. IgA TYPES OF T-LYMPHOCYTES

2. IgD
 Effector T cells
3. IgE
 Suppressor T cells
4. IgG
 Memory Tcells
5. IgM
2 MAJOR CATEGORIES

 Helper T cell
Stimulates the immune system when they have COMPLEMENT SYSTEM Plasma protein (mannose binding lectin) + mannose
received the antigen residue on the surface of microbes

Secretes cytokines which is responsible for 3. Alternative

 Attract and activate B cells when complement protein are activated on the
 Cytotoxic T cells surface of microbes
 NK cells
complement components recruit inflammatory
 Macrophages
cells, wherein activated neutrophils phagocytize
the MO.

 Cytotoxic T cell

Attacks the antigen by causing cell lysis or Is there a downside of this effect?
degradation to the invading pathogen
Yes, there is, if the cell which is attacked isfrom
 Suppressor T cells the HUMAN ORGANISM what would happen is
thatdisease and death may result. This is the
Decreases B cell production to make sure that cause for auto-immune diseases
there is no overproduction which would be
compatible as well as beneficial to health

 Memory Cells Autoimmune diseases

Complements= circulating plasma proteins
Recognizes antigens from previous exposures Infection which causes continued activation of
3 MAJOR PHYSIOLOGIC FUNCTIONS
complement components
The record holder for the pathogens who have 1. Defense against bacterial infection
entered and committed crimes to the body 2. Bridging natural and acquired immunity
3. Disposal of byproducts of inflammation
 Null Lymphocytes and Natural Killer Cells INTERFERONS
What happens if complements are activated
Lacks the characteristics of B cells and T cells,  Activates other components of the
however, it is responsible for detecting infected Infectious agents will be removed ad inflammation immune system
and stressed cells and responds by killing these would be mediated  Used to treat immune related disorders
cells o Multiple sclerosis
Classic pathways to trigger complements
 Used to treat inflammatory conditions
DESTROYS the antigens which are coated with
1. Classic o Chronic hepatitis
antibodies, they do this by having receptor sites to
 Have antivitral and antihumor
connect to the antibodies aka antibody dependent Antibodies + microbes properties
cell mediated cytotoxicity
2. Lectin Produced by the following in response to antigens
  T lymphocytes ASSESSMENT OF THE IMMUNE SYSTEM
 B lymphocytes
AREAS TO BE ASSESSED
 Macrophages

 Nutritional status
COLONY STIMULATING FACTORS
 Infections
 Responsible for the differentiation,  Immunizations
survival, and activation of hematopoietic  Allergies
cells  Disorders
 Disease states
ADVANCES IN IMMUNOLOGY o Autoimmune disorders

GENETIC ENGINEERING o Cancer

o Chronic illnesses
Using recombinant DNA  Medications
 Blood transfusions
 Combines genes
 Palpation of lymph nodes
o Allows manufacture of proteins,
 Inspection of skin, mucus membranes,
monokines, and lymphokines
respiratory, gastrointestinal,
which can enhance immune
musculoskeletal, genitourinary,
function
cardiovascular, and neurosensory systems

HEALTH HISTORY
STEM CELLS

 Capable of self renewal and self

regeneration
 Responsible for WBC & RBC synthesis
 Totipotent cells
 Can restore a destroyed immune system

Stem cell transplantation

 Done for patients who have severe

RESPIRATORY SYSTEM
combined immunodeficiency (SCID)
 SYSTEMIC LUPUS ERYMATOUS CARDIOVASCULAR SYSTEM
 RHEUMATOID ARTHRITIS
 SCLERODERMA GASTROINTESTINAL SYSTEM
 MULTIPLE SCLEROSIS
GENITOURINARY SYSTEM

MUSCULOSKELETAL SYSTEM
SKIN  Decreased GI secretions and motility= Fish oil is better compared to olive oil in terms of
proliferation of flora and infection immune suppressiveness
NEUROSENSORY SYSTEM causing gastroenteritis
Protein depletion
 Decreased renal functioning= UTI
GENDER
 Prostatic enlargement and neurogenic  atrophy of lymph nodes
Sex hormones have contributions to: bladder= impede urine passage, impair  depression of antibody responses
bacterial clearance in the urinary system  reduced T cells
 Lymphocyte maturation  Impaired pulmonary function= increased  impaired phagocytotic function
 Activation and synthesis of cytokines and exposure to smoke and tobacco can  INCREASES SUSCEPTIBILITY TO
antibodies increase the incidence of pulmonary INFECTIONS
infections
 skin becomes thinner and elastic= INFECTION AND IMUNIZATION
GERONTOLOGIC CONDITIONS decreased skin integrity can cause older
1. Ask about IMMUNIZATIONS
clients to have skin infections due to
Immunosenescence a. INFLUENZA
proliferation of skin flora
b. PNEUMOCOCCAL DISEASE
 Circulatory= impaired circulation= stasis
 Aging process stimulates the changes in c. PERTUSSIS
and pressure ulcers
the immune system d. HERPES SIMPLEX
 neurologic function= decreased
 Age associated alterations of the immune e. MMR
sensation and slowing of reflexes=
system 2. TEACH about the importance of
increases the risk to injuries, skin ulcers,
vaccination srecent exposure to any
EFFECTS TO THE BODY and abrasions
infections
 Decreased phagocytes NUTRITION 3. Exposure to STD
 Impaired function of B and T 4. Blood borne pathogens (HEPA A, B, C, D,
Nutrients play a vital role to the host’s defenses
lymphocytes E)
 CKT cells decrease 5. Medications
Iron
 Failure of immune system to
ALLERGY
differentiate self from non-self  may have beneficial or delirious effects
 Decrease in humoral immunity on the immune system 1. Ask for allergens
(production of antibodies  Pollen
vitamin D deficiency
 Natural immunity functions well  Dust
 increases the risk o cancers  Plants
AGE RELATED CHANGES
 autoimmune diseases  Cosmetics
 increased incidence of cancers  infectious diseases  Food
 anergy  Medication
Polyunsaturated fatty acids
 increased incidence of autoimmune  Vaccines
diseases  Latex
 decreases the severity of inflammatory
2. Continuous assessment for allergies
disorders
especially to medications
 is the skin. Burns also allow the loss of fluid which
is conducive to the loss of proteins such as
DISORDERS AND DISEASES PATHOPHYSIOLOGY immunoglobulins

AUTO-IMMUNE DISORDERS My own understanding Stress- increases serum cortisol levels and
contributes to the immune suppression
1. Lupus erythematous Large tumors releases antigens into the blood and
2. Rheumatoid arthritis prevents the antibodies from attacking tumor MEDICATIONS AND BLOOD TRANSFUSIONS
3. Multiple sclerosis cells. The tumor cells also contains or possesses
4. Psoriasis blocking factors which help them to be protected 1. ANTIBIOTICS
against Killer T Lymphocytes 2. ANTITHYROID DRUGS
5th cause of death of females in the reproductive 3. NON-STEROIDAL ANTI-
age Large tumors can release antigens into the blood, INFLAMMATORY DRUGS
and these antigens combine with circulating 4. ADRENAL CORTOCOSTEROIDS
Different autoimmune diseases within a family may antibodies and prevent them from attacking the 5. ANTINEOPLASTIC AGENTS
result to predisposition of more than one tumor cells. Furthermore, tumor cells may possess 6. ANTIMETABOLITES
autoimmune disease special blocking factors that coat tumor cells and
prevent their destruction by killer T lymphocytes. Blood transfusions may expose a patient to
During the early development of tumors, the body antigens which might be conducive to the patient
NEOPLASTIC DISEASE may fail to recognize the tumor antigens as foreign contracting diseases
and subsequently fail to initiate destruction of the
1. Ask for history of cancer in the family malignant cells. Hematologic cancers, such as
leukemia and lymphoma, are associated with
Immuno-suppression contributes to the
altered production and function of WBCs and
development of cancers because cancer is
lymphocytes.
immunosuppressive and the treatment of the
cancer is also immunosuppressive

2. Assess for treatment methods which are CHRONIC ILLNESSES AND SURGERY
used in cancer because there are
methods which cause immunosuppression Immune suppression may also result from chronic
illnesses as well as diseases
Radiation- destroys lymphocytes and decreases
the ability to mount an effective immune response

Whole body radiation- has a higher incidence of SPECIAL PROBLEMS

immunosuppression
Burns and other forms of injury and infection may
Chemotherapy- affects bone marrow function and contribute to altered immune system function
decreases the level of cells which contribute to an
Major burns- alteration of skin integrity which will
effective immune response
allow MO to enter the first line of defense which
 All they see is pain, Kung sakaling ito na ang ating huling yugto,

No one really understood, Mapapatawad mo ba ko kung ako’y susuko?

How beautiful blood could be every night,

How beautiful knuckles bruise when I punch every Hanggang kailan mag-aabang para lang matanaw,
dlicker of light
Ang iyong mga ngisi,

Nais kong pisilin ang iyong mga pisngi,

I never really saw everything in front of me,
Ngunit kung sakaling hanggang dun nalang
Everything seems dim, magtatagpo ang ating mga mata,

All I could see is the ground which was anything Sana matanggap ko na rin na hanggang dun na
clean but muddy, lamang ang ating huling pagkikita.

Hihilom pa ba ang mga sugat na dumudugo, Napakadaya talaga ng tadhana,

Sa bawat ihip ng hangin ay dahan dahang lumiliit Hindi man lamang nagsabi sa kung paano nakakagaan
ang mga baga sa aking puso, ng loob ang magpaalam,

Dahan dahan nang nawawla ang mga pangarap, Kumpara sa mga kamustahan na mauuwi sa luhaan.

Bakit parang ang layo ko na sa daan?

Makakalapit pa ba kaya?

Lumalakas ang kanilang mga bulong. Mahal,

Mahal pala ang mga panyo,

Nakikita mo ba ang mga ulap sa langit, Kaya braso mo nalang ang gagamitin ko,

Tanda mo pa ba kung paano natin sinungkit ang mga Sa pagpunas ng mga luhang pilit na tumatakbo sa
talang nananahimik tuwing gabi, gilid ng aking pisngi,

Sinaulo ko na ang hugis ng iyong pisngi habang ikaw Ang aking puso ang nalilito sa kung kailan ba ito
I wonder what people could see, ay niyayakap ng mahigpit, dapat tumibok,

Whenever I see monsters, Nagbabakasakaling makalimutan natin ang mga titig

na pumapaligid sa ating pagkatao,
Ako’y natatakot kasi dahan dahan ka nang lumalayo
sa aking piling.

Mahal