HEMATOIMUNOLOGI

Anita Lidesna Shinta A.

Jumat, 20 Mei 2016 1

 PRE-TEST
 Jelaskan tentang RBC, WBC and Platelets.
 Sebutkan faktor-faktor koagulasi dan
prosesnya.
 Sebutkan sel-sel terkait sistem imun dan
fungsinya.
 Jelaskan tentang sistem imun dan tahapan
inflamasi.
 Jelaskan tentang antigen, antibodi dan
komplemen.
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 FUNGSI DARAH
 1. RESPIRASI: Pengangkutan O2 & CO2.
 2. NUTRISI: Pengangkutan zat-zat gizi.
 3. EKSKRESI, Misal: pengangkutan urea untuk dibuang.
 4. KESEIMBANGAN ASAM-BASA
(adanya sistem buffer dalam darah).
 5. KESEIMBANGAN AIR (plasma & cairan jaringan).
 6. PENGATURAN SUHU TUBUH: panas yang terbentuk akibat
metabolisme di jaringan-jaringan dibawa darah ke
permukaan tubuh untuk dipancarkan keluar.
 7. PERLINDUNGAN TERHADAP INFEKSI: mengandung
antibodi, leukosit.
 8. TRANSPOR HORMON & ENZIM.
 9. TRANSPOR METABOLIT.

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 2 jenis metabolisme pada sel
darah merah dewasa:

 Glikolisis
 Fosfoglukonat (HMP-shunt)

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 Leukocyte infiltration into tissues
= diapedesis (extravasation):

Taken from:
Halliwell, Gutteridge,
Oxford University Press, 1999

 Leukocytes are slowed down by the interaction of their mucins with

selectines on the surface of endothelial cells (EC)
 Cytokines on the surface of EC interact with the receptors of leukocytes
 A strong adhesion mediated by the interaction of integrins with molecules
on the surface of EC → migration of leukocytes into the tissue directed by
cytokins released by inflammatory cells or EC
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PEMBEKUAN DARAH

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Hemostasis, Coagulation and Fibrinolisis

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Blood Clot Formation - Coagulation Factors

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Structure & function of hemoglobin
(PORFIRIN)
Hemoglobin

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 Types of adult hemoglobin

3–6 %

HBA: the major hemoglobin in humans

HBA2: first appears 12 weeks after birth- a minor
component of normal adult HB
HBF: normally synthesized only during fetal
development
HBA1C : has glucose residues attached to b-globin chains –
increased amounts in DM
Sickle Cell

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 Biolgical
Process

Immune
System
Process

Somatic
Antigen Diverification
Leukocyte Immune Immune Tolerance Activation
Leukocyte Processing Of Immune Leukocyte
Activation Response System Induction Of Immune
Migration And Receptors Homeostasis
Development Response
presentation

Immune Organ or
Inflammatory
Immune Innate Humoral Response Tissue Adaptive
Response
Effector Immune Immune To Tumor Specific Immune
To Antigenic
Process Response Response Cell Immune Response
Stimulus
Response

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Imunologi
1. IMMUNITY / IMUNITAS :
Reaksi terhadap bahan asing
Cellular
Events
Fisiologik Molecular
( Patologik ) ( I. Protection from disease )

2. IMMUNOGEN / IMUNOGEN :
Bahan → Inang → Stimulasi respon imun
→ dapat ikat Ab / sel imun ( dapat dideteksi )
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3. ANTIGEN / Ag
>  Imunogen
> Hanya mampu ikatan dengan antibody

4. ANTIBODY / Ab
Protein ← hasil stimulasi Ag
↓
Mampu mengikat Ag tersebut

5. IMMUNE SYSTEM / SISTEM IMUN

Sel-sel & molekul-molekul dalam sistem jaringan yang
bekerja pada imunitas

6. IMMUNE RESPONSE / RESPON IMUN

↓
Reaksi sel-sel & molekul-molekul → Ag →
coordinated → Respon spesifik 24
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 IMUNISASI

Tindakan ~ usaha → respon imun spes.

• Imunogen / Vaksin → stimulasi
( active immune response ) → untuk
pencegahan dan pengobatan
• Adoptive transfer ( passive immune
response ) → untuk pengobatan

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 IMUNITAS
I. Imunitas alami
Natural ( innate ) Immunity
Physicochemical barrier ( skin, mucosal
surface )
Phagocytic cells ( in blood & tissue )
Natural killer ( NK ) cells
Various Blood – Borne Molecules :
complement, interferon, C reactive
protein, lisozyme, lactoferin, sitokin, dll
Not descriminate most foreign substances
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II. Imunitas spesifik
Acquired / spesific immunity
Distimulasi bahan asing ( imunogen ) → respon
spesifik terhadap imunogen tersebut & mampu
respon terhadap paparan bahan asing tersebut
berikutnya.
Karakteristik :
➣ Specificity ~ self / nonself discrimination
➣ Memory ~ responsive / increasing the
second response to exposure Ag
➣ Self regulation

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OXYGEN – DEPENDENT MECHANISMS :
Glucosa + Hexose monophosphate Pentose phosphate
NADP+ O2 burst +
Shunt + NADPH generation of
NADPH + O2 Cytochrome b-245 NADP+ + O2 superoxide anion

202- + 2H+ Spontaneous H2O2 + 1O

2
Spontaneous
Dismutation
formation of further
O2- + H2O2 .OH + OH- + 1O2 microbidal agents

H2O2 + CI- myeloperoxidase OCI- + H2O Myeloperoxidase

generation of
OCI- + H2O 1O
2 + CI- + H2O microbicidal
molecules
202- + 2H+ Superoxide O2 + H2O2 Protective
Dismutase mechanisms used by
host + many
2H2O2 Catalase 2H2O + O2 microbes

OXYGEN – INDEPENDENT MECHANISMS :

Cationic proteins ( incl. cothepsin G ) Damage to microbial membranes
Lysozyme Splits mucopeptide in bacterial call wall
Lactoferrin Deprives proliferating bacteria of iron
Proteolytic enzymes variety of other Digestion of killed organisms
hydrolytic enzymes 36
 IMUNITAS SPESIFIK
1. SPESIFISITAS
• paratope / antigen binding site
pada antibodi / imunoglobulin
• Reseptor pada sel B / T
( Ig R / TCR )
~ sesuai / komplementer / kenal / respon dg
antigen determinant ( epitope )

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2. DIVERSITAS
> 109 reseptor / Ag binding site
! Pertahanan terhadap banyak
patogen di lingkungan

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3. INGATAN / MEMORY
Setiap Ag yang pernah masuk → stimulasi →
paparan berikut → mekanisme pertahanan efektif
pada respon imun sekunder ~ karena memory
cells ( prinsip vaksinasi )

4. DAPAT MEMBEDAKAN SELF / NONSELF

5. KOMPLEKSITAS
Koordinasi / ko stimulator / Regulasi reaksi
sel - sel & molekul – molekul yang kompleks
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6. SELF REGULATION
● ↑ Imunitas alami : IR ↑ pada fokus
infeksi ( Ag masuk ) → eliminasi Ag
> baik
● Perlu partisipasi phagocyte & C

7. TIPE IMUNITAS SPESIFIK

1. Imunitas humoral : Antibodi
2. Imunitas seluler
( CMI : Cell Mediated Immunity )
sel limposit T dan B
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Antigen Host
Mikroba respons imun
- humoral
- seluler
Serologic Diagnostic ~ serum
Saat ini deteksi Antibodi / Antigen
~ Interaksi Molekul Ab – Ag
~ Sifat molekul
- soluble
- particle
~ Valensi
- Monovalen
- Divalen
- Polivalen Menentukan jenis interaksi52
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EIA : HEPATITIS B : HB2, Ag, ANTI-HBS, ANTI-HBC
HEPATITIS C : ANTI – HCV
HIV : ANTI - HIV 1,2 ; CHLAMYDIAL INF.
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WIDAL TEST, VDRL, HEMAGGLUTINATION
LATEX AGGLUTINATION
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TPHA (TAEPONEMA PALLIDUM HAEMAGGLUTINATION ASSAY 66
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WASSERMAN ‘ TEST – STS (SEROLOGIC TEST FOR SYRUL)
(WR)
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CHLAMYDIAL INFECTION : ANTI - CHL. TRACHOMATIS 69
• Imunomodulasi
metode – manipulasi respon imun untuk
terapi

• Prinsip Imunoterapi
– Imunotoleran – self Ag
– Meniadakan Ag (AgΘ)
– Regulasi Respon Imun :
! Sentral : Ag – Spec. T

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• Imunoterapi meliputi :
– Imunostimulan
– Imunosupresan
– Hiposensitisasi

Target / Hasil Ag. Spec.

Non Specific

Tx dengan imunospresan : Alergi, Otoimun

Transplantasi

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• Imunoterapi
– Sel – sel Imun
B, T, M0
+
– Ab.
– Humoral : C, Interleukin
IFN
(Mediator Imun)

– Sel
- – Ab
– humoral

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• Vaccine
– Live / Attenuated / Killed – Bacteria / Virus
– In Activated Bacterial Product
(e g. Toxin)
– Spec. single component of Bacteria
(e g. LPS; Prot.)
– Recombinant DNA segment
(e g. HBV)

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 Ag Suspension Fluid
Kandungan prot. , Preservative, Adjuvant
Lain ! Reaksi tdk Diinginkan

• Imunisasi aktif dengan Live Vaccine

Long – Lived I. R. (DPT. Single Dose)

• Faktor ! Imunisasi
– Booster
– Route Imunisasi
– Indikasi Save
Effective
– Umur Maturasi sel
Ab Sel
Anak / Dewasa
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• Imunoprofilaksis
– Imunisasi
induksi (Natural / Artifisial)
Respon Imun untuk terutama proteksi thdp
penyakit

– Tujuan : Prevensi thdp penyakit

Eradikasi (Populasi)

• Tipe Imunisasi
1. Imunisasi Aktif
Ag dimasukkan dalam TBH inang produksi
aktif - imunitas
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2. Imunisasi pasif
Ab (serum + Ab) Ag Spec. Cells sensitized cells
dimasukkan proteksi pasif

Ag = Vaccine Jenner
Imunisasi Aktif ~ Vaksinasi

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 PUSTAKA
Abbas, Abdul K. 2012. Cellular and Molecular Immunology. 7th ed.
Jewetz, Melnick and Adelberg’s, 2004, Medical Microbiology. 24th ed.
Joklik, Willett, Amos, Wilfert. 1988. Zinsser Microbiology. 19th ed.

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