By: Catherine M. Souribio, R.N.

Is an intricate network of specialized cells, tissues, and

organs designed to allow us to exist in an environment
that often includes hostile microorganisms. The system
has evolved to protect and defend the body against
invasion by bacteria, viruses, fungi, and parasites. It
also seeks out and destroys malignantly transformed
cells. The significance of a healthy immune system is
apparent in states or diseases characterized by
immunodeficiency, such as occurs in HIV infection or in
patients on immunosuppressive medication. Without an
effective immune system, an individual is at risk for the
development of overwhelming infection, malignant
disease, or both. On the other hand, excessive or
inappropriate activity of the immune system can result
in autoimmune disease, hypersensitivity states, or
immune complex disease.
 This chapter aims to assist you, nursing
students to develop the essential knowledge,
skills and attitudes to provide quality,
compassionate and humane care among
clients with immunologic disorders.
 The purpose of the Immune System is to
rapidly encounter and respond to any foreign
invader, it is not surprising that the cells,
tissues, and organs comprising the lymphoid
system are widely distributed throughout the
body. Furthermore, the mobility of immune
cells allows them to circulate and move in
and out of tissues so that they can survey the
body for pathogens, cellular debris, virus-
infected cells, and tumor cells.
 Immune System are located
throughout the body.
 Organs include: thymus, bone
marrow, lymph nodes, spleen,
tonsils, appendix, Peyer’s patches of
small intestine.
 Main cell types are WBC’s (especially
lymphocytes, plasma cells, and
macrophages)
 All originate from the same stem cell in bone
marrow, then differentiate into separate types:
(Cells of the Immune System)
 Granulocytes

a. Eosinophils: increase with allergies and

parasites.Protect humans against
helminth(parasitic worm such as intestinal
pinworms, and tapeworms.)
 b. Basophils: contain histamine and increase
with allergy and anaphylaxis.
 c. Neutrophils: involved in phagocytosis.
- neutrophils leave the vascular
compartment and enter tissue spaces searching
out bacteria or cell debris, which they can
phagocytize and destroy.
- In the process of phagocytosis, which
literally means cell eating, the bacteria or debris
are engulfed and taken up into the phagocytic
cells.
- neutrophils cannot replicate and die
following phagocytosis. The accumulation of
dead neutrophils contributes to the formation of
pus.
 Neutrophilia – An increase in circulating
neutrophils or characterized by an excess
number of immature neutrophils.

 Neutropenia - A decreased number of

circulating neutrophils, is primarily seen in
hematologic malignancies, cytotoxic therapy,
or aplastic anemia.
 Monocytes ( macrophages-
literally means big eaters)
eg..histiocytes( in the loose
connective tissue), Kupffer
cells( in the liver): Involved in
phagocytosis.
 Lymphocytes (T cells and B cells):
Involved in cellular and humoral
immunity.
 WBC – has 4000 to 10,000 cells per cubic
millimeter of blood.
*Leukocytosis – an increase in the circulating
number of WBCs.( occurs those leukocytes that
have marginated along the vascular endothelial
surface or entered tissue spaces or lymphatics.)
* Leukopenia – a decrease in the total number
of circulating WBCs.(occurs in bone marrow
suppression, or increased peripheral destruction
of WBC which might occur with splenomegaly.)
 Granulocytes: (because of the granular
appearance of their cytoplasm.)
1. Neutrophils – 40 to 75 % of blood
leukocytes.
2. Eosinophils – 2 to 5 % of leukocytes.
3. Basophils - 0.2 to 0.5 % of
leukocytes.
4. Monocytes - 2 to 6 % of the total WBC
count.
5. Lymphocytes – 20 to 35 % of the total
WBC count.
 B Cells - is thought to mature and become
immunocompetent in the bone marrow.
- When stimulated by an antigen, B
cells further differentiate into plasma cells,
which secrete soluble molecules called
antibodies into the body’s fluids.
- Antibodies mediate humoral
immunity.
* Both T and B lymphocytes continually
recirculate between blood, lymph, and lymph
nodes.
Primary Lymphoid organs:
- Bone marrow
- Thymus
Bone marrow - is the soft tissue inside the
hollow of long bones and is a major site for
proliferation and maturation of immune cells
from undifferentiated stem cells.
Thymus - is a multilobed gland located in the
mediastinum anterior to and above the heart.
 The thymus is large in the newborn and child
and gradually involutes with age.
 Occasionally, transient involution may occur

during childhood because of severe infection,

stress, trauma, or burns.
 Within the thymus T lymphocytes multiply

and become capable of an immune response.

 Lymph nodes - are dispersed along lymphatic
vessels and form cluster in the neck, axillae,
abdomen, and groin.
- enlarged nodes are useful diagnostic
sign of infection or malignant disease.
 Spleen – is located in the upper abdomen and
contains two types of tissue: the red pulp and
white pulp.
*Red pulp – contains phagocytic cells
that dispose of damaged or aged red blood cells.
* White pulp – contains lymphoid tissue.
 Tonsils – palatine tonsils in the oropharynx
 Adenoids (pharyngeal tonsil)
1. Cellular Immunity
a. Mediated by T cells: Persist in
tissues for months or years.
b.Functions: transplant rejection,
delayed hypersensitivity,
tuberculin reactions, tumor
surveillance/destruction,
intracellular infections.
2. Humoral Immunity
- Mediated by B cells:
a. Production of circulating antibodies
(gamma globulin)
b. Only survive for days.
- Functions: bacterial phagocytosis,
bacterial lysis, virus and toxin
neutralization, anaphylaxis, allergic hay
fever and asthma.

1.
Self-or Non-Self Recognition –
normally recognizes host cells as
non-antigenic and responds only to
foreign and potentially harmful
agents, living or non-living as
antigens.
 2. Antibody Production – produces
specific antibodies for specific
antigens for destruction.
 3. Memory – remembers antigens
that have invaded the body in the
past, allowing a quicker response.
 4. Self – Regulation– monitors its

own performance, turning itself on

when antigens invade and turning
itself off when infection is
eradicated.
* In Autoimmune Response, there
is a breakdown in this distinction.
Because of the damage in the
immune system due to pathologic
changes, an autoimmune response
may occur in response to certain
body’s own protein resulting in
the production of autoantibodies.
1. IgG ( 75% of the total immunoglobulins)
* The most abundant antibodies.
* Can cross the placenta, responsible for
immunity in the newborn.
* Neutralizes toxins and viruses.
2. IgA ( 15% of the immunoglobulin pool)
* Located in the saliva, tears, colostrum and
mucus of the respiratory, digestive urinary
tracts, breast milk and reproductive tracts.
* Adds protection against enteric viruses in the
breastfed infant.
3. IgM ( 10% of the total plasma
immunoglobulin)
* The largest of the immunoglobulins in
molecular size.
* Second most abundant antibodies.
* First to appear in fetal life.
* First to form during viral or bacterial
infection.
4. IgE ( < 1.0% has trace amounts within the
blood)
* Responsible for some allergic
responses, triggers release of histamine.
5. IgD ( < 1.0% of the total circulating
immunoglobulins)
*Minute amounts.
* However, it is present in large numbers
on the cell membrane of circulating B
lymphocytes.
* Possibly a regulatory antibody, acts as
an antigen receptor of B cells.
 They neutralize the invader or make it more
vulnerable to attack from macrophages and
neutrophils.
 They can opsonize antigen and precipitate
soluble antigen, all of which make it more
susceptible to phagocytosis by macrophages.
 Antibodies can directly bind to bacterial toxins
and neutralize them.
 Antibodies can also coat foreign cells or tumor
cells and make them vulnerable to attack by
leukocytes. This is called antibody dependent cell
mediated cytotoxicity.
 There are two major types of immunity:
1. Natural (or Innate) Immunity
2. Acquired (or Adaptive) Immunity
A. Natural (Innate) Immunity
- Immune responses that exist
without prior exposure to an immunologically
active substance.
_ Genetically acquired immunity is
natural immunity.
B. Acquired (or Adaptive) Immunity
1. Immune responses that develop during
the course of a person’s lifetime.
2. Acquired Immunity may be further
classified as naturally or artificially acquired,
active or passive..
• Active Immunity – results when the body
produces its own antibodies in response to
an antigen.
• Passive Immunity – results when an antibody
is transferred artificially.
a. Naturally acquired active immunity:
- results from having the disease and
recovering successfully.
b. Naturally acquired passive immunity:
- antibodies obtained through placenta or
breast milk.
c. Artificially acquired active immunity:
- conferred by immunization with an antigen.
d. Artificially acquired passive immunity:
- antibodies transferred from sensitized
person (eg..,immune serumglobulin/ gamma
globulin)
Areforeign substances
which elicit an immune
response and are also
capable of combining
with products of the
immune system.
Antigen - Antibody Reactions
3. Neutralization - antibodies combine with
all toxin.
4. Lysis - antibodies attack all
membrane and cause cell
rupture.
5. Opsonization - antibodies coat bacteria
and increase their
susceptibility to phago-
cytosis.
 After exposure to an antigen, there is a delay or
latent period in which little or no antibody can be
measured in the serum. It is during this latent
period that the B cell recognizes antigen and
differentiates into a plasma cell.
 By 4 to 10 days after the initial exposure, serum
antibody levels rise with IgM appearing first and
then IgG. This is the Primary Immune Response,
and usually, the peak levels of antibody rapidly
decrease; however, memory cells are produced,
which are able to recall this antigen.
 Memory cells recirculate for several years
through body tissues and lymphoid organs,
seeking reexposure to the specific antigen
they are programmed to target.
 On reexposure to the same antigen, the

antibody is produced within 1 to 2 days, and

the level is often 50 times greater than that of
the primary response. The levels also remain
elevated for a longer period of time and fall
off slowly over the course of months.
 Thus, the secondary immune response
occurs faster, is more intense, and
has a longer duration of peak antibody
titer, all due to the presence of
memory cells. With subsequent
exposure, the antibody response can
be boosted to even higher levels.
 Genetics
* various immunodeficiency diseases can be
congenitally acquired as a consequence of an
embryologic insult or an enzyme defect, such as
adenosine deaminase deficiency.(ADA)
 Age
* The very young and the elderly are more
susceptible to infection.
*Components of both the innate, humoral,
and cell-mediated immune responses are
underdeveloped in the newborn.
 * Immunization of an infant typically does
not begin until approximately 3 months of
age because prior to this time, the infant is
incapable of producing antibody and memory
cells in response to the antigen in the
vaccination.
* In the elderly the thymus has atrophied
and there is a decrease in thymic hormones.
* The decline in immune function with age
may be related to the presence of chronic
illness in the elderly.
 Nutrition
* Adequate nutrition is vital to promote
optimum immune function.
* Protein deficiency impairs humoral and
cell mediated immune responses because
proteins are required for the proliferation of
leukocytes, the synthesis of immunoglobulins
and the proteins of the complement cascade.
* Trace elements, such as copper and
zinc, and vitamins are important, in
maintaining a healthy immune system.
 Medications
* A large number of medications can
depress the immune system.
* Some medications may be taken
specifically for their anti-inflammatory or
immunosuppressive properties, whereas
others taken for unrelated indications have
side effects that suppress immunity.
 Stress
* Acute physical stressors, such as trauma
and burns are accompanied by depressed
immune cell function, and if the affected
individual survives the initial insult, he or she
will be at risk for infection.
*Stress, both emotional and physical,
triggers activation of the autonomic nervous
system and the endocrine system. Both of
these systems can in turn affect the immune
response.