Immunological Disorders

FROM : SANJAY SIR

LECTURER
GOVT. COLLEGE OF NUIRSING
NEW CIVIL HOSPITAL
SURAT

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 Immunological Disorders
Introduction
A. There are three types of immunological
disorders
1. Hypersensitivity
2. Autoimmune disease
3. Immunodeficiency
B. Hypersensitivity reactions to usually
harmless substances are often called
allergies or allergic reactions

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 Immunological Disorders

1. allergens – antigens that cause allergic

reactions
C. Most allergic reactions fall into one of four
major types:
1. Type I: Immediate IgE-mediated
2. Type II: Cytotoxic
3. Type III: Immune complex-mediated
4. Type IV: Delayed cell-mediated

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 Immunological Disorders
Type I Hypersensitivity
A. Also called IgE Mediated Hypersensitivity
B. Mechanism
1. First exposure to antigen induces an
IgE antibody response leading to
sensitization
A) Antigen is taken up by dendritic cells
(APC-antigen presenting cell
(macrophage) and merged with
MHC(major histocompatibility
complex-series of genes located on
chromosome-6 that code for antigens)
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 Immunological Disorders

B) APC presents the antigen to T-cells

C) Activated T-cells release cytokines that
stimulate B-cells to produce plasma cells
which secrete large amounts of IgE
D) IgE antibodies bind to mast cell
receptors and the individual is now
“sensitized”

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 Immunological Disorders

2. During the subsequent exposures, antigens

activate IgE antibodies on the mast cell
causing it to degranulate
A) Histamines, leukotrienes, prostaglandins,
and/or cytokines are released
B) These chemicals are the cause of hives,
hay fever, asthma and anaphylactic shock
3. Reactions generally occur within 30 minutes of
exposure
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 Immunological Disorders

C. Localized Anaphylaxis
1. Hives – an allergic skin condition
characterized by the formation of a wheal
and flare pattern
A) Frequently the result of seafood allergies
B) These reactions are due to the release
of histamine which causes dilation of tiny
blood vessels and the leaking of plasma
into the area
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 Immunological Disorders

2. Hay fever – itchy, teary eyes, sneezing, and

runny nose; occurs when allergic person
inhales an antigen rather than ingests it
A) also mediated by histamine
3. Asthma – inhaled allergen causes chemical
mediators from IgE to stimulate increased
mucus secretions and spasms of the bronchi
A) leukotrienes and prostaglandins are
responsible
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 Immunological Disorders

D. Generalized Anaphylaxis
1. Antigen enters the bloodstream and
becomes widespread and the reaction
affects almost the entire body (systemic)
2. Loss of fluid from the blood vessels into
tissues causes swelling and possibly shock
3. Reactions may be fatal within minutes
4. Bee sting, peanut, and penicillin allergies
account for most cases
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 Immunological Disorders

5. Can usually be controlled by

epinephrine injections
E. Immunotherapy
1. Desensitization or immunotherapy is
often effective in decreasing the Type I
hypersensitivity state

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 Immunological Disorders

A) Repeated injections of very small amounts

of antigen are given over several months
B) This regimen leads to the formation of
specific IgG antibodies
C) The IgG reacts with antigen before it can
bind to IgE and therefore it blocks the IgE
reaction that might result in allergic
reactions
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 Immunological Disorders
Type II Hypersensitivity
A. Also called Cytotoxic Hypersensitivity
because it utilizes antibodies that can
destroy normal cells by complement lysis or
by antibody-dependent cellular cytotoxicity
(ADCC)
B. Generally occur within hours after exposure
C. Transfusion Reactions – the ABO blood
groups are the major cause of hemolytic
anemia in blood transfusion patients
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 Immunological Disorders

1. Recall that persons with A type blood

possess the A antigen and the natural
antibody anti-B
2. Persons with B type blood possess the B
antigen and the natural antibody anti-A
3. Persons with O type blood lack both the
A and B antigens but possess both the
natural antibodies anti-A and anti-B
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 Immunological Disorders

4. Persons with AB type blood possess both the

A and B antigens but posses no natural
antibodies
5. In the case of ABO incompatibility, the
antibodies cause reactions that include fever,
low blood pressure, pain, nausea, and vomiting
6. Cross-matching the bloods and other
techniques are used to ensure compatibility of
donor and recipient
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 Immunological Disorders

D. Hemolytic Disease of the Newborn

1. Also called Erythroblastosis fetalis
2. Results when mother is Rh- and baby
is Rh+
3. Upon delivery, Rh+ antigens are
transferred to the mother’s
bloodstream which causes her to
produce anti-Rh antibodies
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 Immunological Disorders
4. If the mother becomes pregnant again with an
Rh+ child, the antibodies cross the placenta,
enter the circulation of the fetus, and cause
extensive fetal erythrocyte damage
5. RhoGAM may be administered to prevent this
reaction
A) contains Rh antibodies and prevents the
mother’s natural production of them
B) widely used at 28 weeks and after delivery
during all susceptible pregnancies
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 Immunological Disorders

Type III Hypersensitivity

A. Also called Immune Complex-Mediated
Hypersensitivity
B. Occurs within hours or days after exposure
C. When there is a slight excess of antigen,
the antigen-antibody complexes activate
complements and stimulate neutrophil and
basophil degranulation

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 Immunological Disorders

1. Results in vasodilation, increased

vascular permeability, and inflammation
D. Small antigen-antibody complexes are
often deposited in the walls of small blood
vessels in skin, joints and kidneys where
they continue to cause inflammation and
eventually tissue damage

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 Immunological Disorders
E. The complexes can also precipitate causing clots to form in
the small blood vessels leading to failure or death of the
organ
1. Known as Disseminated Intravascular Coagulation(a
condition resulting from overstimulation of the blood
clotting mechanism in response to disease /injury such
as sever infection, acute leukemia, burns, trauma,
abruptio placenta or intrauterine fetal death. . The
overstimulation result in generalize blood coagulation &
excessive consumption of coagulation factors. The
resulting deficiency of these may lead to spontaneous
bleeding. Transfusion of plasma are given to replace the
depleted clotting factors, & Rx of underlying cause is
essential.
F. Examples of Type III Hypersensitivity are:
1. Arthus reaction – localized tissue death
A) ex. Chronic Obstructive Pulmonary Disease (COPD)
2. Serum sickness – seenprincess
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in individuals immunized/treated
20
with animal serum
 Immunological Disorders

Type IV Hypersensitivity
A. Also called Delayed Cell-Mediated
Hypersensitivity
1. occurs within days after exposure
B. T-cells rather than antibodies are involved
with this type
C. Examples of delayed hypersensitivity are:

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 Immunological Disorders

1. Tuberculin skin test – a positive test results

when circulating antibodies (which are only
present if the person has been exposed)
bind to the protein antigens of the
tuberculosis bacteria introduced under the
skin
A) peaks 2-3 days after exposure

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 Immunological Disorders

B) the redness results mainly from sensitized

T-cell reactions, the release of cytokines
and the influx of macrophages to the
injection site
C) false positive tests can result from
exposure to another species of
Mycobacterium or use of the BCG vaccine

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 Immunological Disorders
2. Contact hypersensitivity – mediated by T-cells
that release cytokines when they come into
contact with the same antigen
A) the cytokines cause inflammation which
attracts WBC to the site
B) these then release chemicals that result in
allergic dermatitis or contact dermatitis
C) Examples: poison ivy, poison oak, nickel
reactions, and latex reactions

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 Immunological Disorders

3. Delayed hypersensitivity to infectious diseases

– as T-cells destroy macrophages and sick
body cells, tissue damage results
A) Examples: leprosy, tuberculosis, and
herpes simplex infections

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 Immunological Disorders

Transplant Immunity
A. 4 types of transplants
1. Autografts – grafts from the same person
2. Isografts – grafts donated by a
genetically identical twin
3. Allografts – grafts between non-identical
humans
4. Xenografts – transplantation of tissue
from a non-human organism
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 Immunological Disorders

B. Transplantation rejection of allografts and

xenografts are caused largely by Type IV
cellular reaction
C. Transplant success is dictated by the
similarity of the MHC antigens on the
surface of human cells

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 Immunological Disorders

1. MHC tissue typing is done in an effort to

ensure that no major tissue
incompatibilities exist between patient
and donor
D. Often immunosuppressive drugs are taken
to reduce rejection
1. These drug treatments however, make
the patient susceptible to opportunistic
infections
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 Immunological Disorders

Autoimmune Diseases
A. Autoimmune diseases occur when the
immune system of the body responds to its
own tissues as if they were foreign
B. May result from normal reactions to
antigens that are similar, though not
identical, to the host’s normal antigens

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 Immunological Disorders

C. Autoimmune reactions occur over a spectrum

ranging from organ-specific to widespread
response not limited to any one tissue
1. Grave’s disease (thyroid) and Insulin-
dependent diabetes mellitus (pancreas) are
organ specific
2. Lupus and rheumatoid arthritis are
considered widespread

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Graves' disease(Toxic diffuse goiter,)

 Graves' disease, also known as toxic diffuse goiter, is

an autoimmune disease that affects the thyroid. It
frequently results in and is the most common cause
of hyperthyroidism. It also often results in an enlarged
thyroid. Signs and symptoms of hyperthyroidism may
include irritability, muscle weakness, sleeping problems,
a fast heartbeat, poor tolerance of heat, diarrhea, and
weight loss. Other symptoms may include thickening of
the skin on the shins, known as pretibial myxedema,
and eye bulging, a condition caused by Graves'
ophthalmopathy.. About 25% to 80% of people with the
condition develop eye problems.
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Graves' disease
The classic finding of exophthalmos and lid retraction in
Graves' disease
Specialty Endocrinology
Symptoms Enlarged thyroid, irritability,
muscle weakness, sleeping
problems, fast heartbeat,
[1]
poor tolerance of heat
[1]
Complications Graves' ophthalmopathy
[2]
Causes Unknown
Risk factors Family history,
[1]
other autoimmune diseases

Diagnostic method Blood

[1][3]
tests, radioiodine uptake
Treatment Radioiodine therapy,
medications, thyroid
[1]
surgery
Frequency 0.5% (males), 3%
[4]
(females)

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The classic finding of exophthalmos and lid
retraction in Graves' disease
Complication: Graves Ophthalmopathy
Causes: unknown
Risk factors: family history, other autoimmune
disease
Diagnostic: radioiodine uptake, blood test
Rx : radiation therapy, medication, thyroid
surgery
Frequency:
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3% female 35
Lupus(SLE):
 An inflammatory disease caused when the immune system
attacks its own tissues.
 Lupus (SLE) can affect the joints, skin, kidneys, blood cells,
brain, heart and lungs.
 Symptoms vary but can include fatigue, joint pain, rash and
fever. These can periodically get worse (flare up) and then
improve.
 While there's no cure for lupus, current treatments focus on
improving quality of life through controlling symptoms and
minimizing flare-ups. This begins with lifestyle modifications,
including sun protection and diet. Further disease management
includes medication such as anti-inflammatory and steroids.

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 Immunological Disorders

D. Treatment of Autoimmune diseases

1. Usually treated with immunosuppressive
drugs that kill dividing T-cells and thus
control the response
2. Also treated with drugs that interfere with T-
cell signaling such as cyclosporin
3. Steroids and other anti-inflammatory drugs
are often used to relieve symptoms

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 Immunological Disorders

4. Some patients require replacement therapy

(ex. insulin for diabetics)
5. Transplantation of damaged organ is a last
resort

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 Summarize
the topic

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 ASSIGNMENT

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