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Immunity is classified as innate or acquired. Innate immunity is present at birth, and its primary role is first-line defense against pathogens. It involves a specific/nonspecific response, and neutrophils and monocytes are the primary WBC's involved. Innate immunity is not ____ specific so it can respond within minutes to an invading microorganism without prior exposure to that organism. Acquired immunity is the development of immunity, either actively or passively. Describe the 2 types of immunity
Immunity is classified as innate or acquired. Innate immunity is present at birth, and its primary role is first-line defense against pathogens. It involves a nonspecific response, and neutrophils and monocytes are the primary WBC's involved. Innate immunity is not antigen specific so it can respond within minutes to an invading microorganism without prior exposure to that organism. Acquired immunity is the development of immunity, either actively or passively.
Active acquired immunity - results from the invasion of the body by foreign substances such as microorganisms and subsequent development of antibodies and sensitized lymphocytes. With each reinvasion of the microorganisms, the boyd responds more rapidly and vigorously to fight off the invader. This type of immunity may result naturally from a disease or artificially through inoculation of a less virulent antigen (immunizations). Because antibodies are synthesized, immunity takes time to develop but is long lasting.

Passive acquired immunity- implies that the host receives antibodies to an antigen rather than synthesizing them. This can take place naturally through the transfer of immunoglobulins across the placenta. Artificial passive acquired immunity occurs through injection w/ gamma globulin (serum antibody). Benefit of this immunity is its immediate effect. However, it is short lived because the host did not synthesize the antibodies and consequently does not retain memory cells for the antigen.
_______s start the immune response.
______s are immunoglobulins produced by __________ in response to antigens.

True or False: All cells have antigens
Antibodies are Immunoglobins are produced by lymphocytes in response to antigens
Antigens start the immune response

True
________ is a state of responsiveness to foreign substances such as microorganisms and tumor proteins.
immunity
Immune responses serve what 3 functions?
Defense- body protects against invasions by microorganisms and prevents the development of infection by attacking foreign antigens and pathogens.

Homeostasis- Damaged cellular substances are digested and removed. Through this mechanism, the body's different cell types remain uniform and unchanged.

Surveillance- Mutations continually arise in the body but are normally recognized as foreign cells and destroyed.
What type of acquired immunity (active/passive, natural/artificial) is physical contact with antigen through clinical infection such as chickenpox, measles, or mumps?
active, natural
What type of acquired immunity (active/passive, natural/artificial) is transplacental and colostrum transfer from mother to child of maternal immunoglobulins to neonate?
passive, natural
What type of acquired immunity (active/passive, natural/artificial) is injection of serum from immune human i.e. injection of gamma globulin
passive artificial
What type of acquired immunity (active/passive, natural/artificial) is immunizations or vaccines?
active artificial
An antigen is a substance that elicits an immune response. Most antigens are composed of _____. However, other substances such as large polysaccharides, lipoproteins, and nucleic acids can act as antigens. All of the body's cells have antigens on their surface that are unique to that person and enable the body to _____ ____. The immune system becomes "tolerant" to the body's own molecules so it is nonresponsive to "self antigens."
An antigen is a substance that elicits an immune response. Most antigens are composed of proteins. However, other substances such as large polysaccharides, lipoproteins, and nucleic acids can act as antigens. All of the body's cells have antigens on their surface that are unique to that person and enable the body to recognize itself. The immune system becomes "tolerant" to the body's own molecules so it is nonresponsive to "self antigens."
The lymphoid system is composed of central (or primary) and peripheral lymphoid organs. What organs make up each group?
Central- thymus gland, bone marrow (bursa equivalent)
(The thymus differentiates T cells into different types, T cells are "educated" for antigen specificity through the thymus)
Peripheral-
tonsils
gut-- associated lymphoid tissue
genital- assoc. lymphoid tissue
bronchial assoc. lymph. tissue
skin-associated lymphoid tissue
lymph nodes
spleen
The normal immune response consists of many cells including ___nuclear p______s, which have a critical role in the immune system. When they're in the tissue, they're known as ______ when they're in the blood, they're known as _____. What are the functions of these cells?
Mononuclear phagocytes. When they're in the tissue, they're known as macrophages when they're in the blood, they're known as monocytes. Capture, process, and present antigens to lymphocytes to initiate a humoral or cytotoxic/ cell mediated response
Captures antigens by phagocytosis and brings to attention of appropriate lymphocyte
The normal immune response consists of many cells including B lymphocytes which
differentiate into _____ cells when activated. These cells produce _____ or (___) that are specific for a certain antigen. Do these cells work in the cell or outside the cell?
The normal immune response consists of many cells including B lymphocytes which
differentiate into plasma cells when activated. These cells produce antibodies (immunoglobulins).
Work in fluid OUTSIDE cell
The 2 important functions of lymph nodes are..
filtration of foreign material brought to site

circulation of lymphocyte
Cells that migrate from the _____ _____ to the ____ differentiate into T lymphocytes (thymus dependent cells). The thymus secretes hormones, including thymosin, that stimulate the maturation and differentiation of T lymphocytes. T cells compose 70% to 80% of the circulating lymphocytes and are primarily responsible for immunity to Intracellular ____, ____ cells, and ____. T cells can live from a few months to the life span of an individual and account for ___-____ immunity. What are the different types of T Cells?
Cells that migrate from the bone marrow to the thymus differentiate into T lymphocytes (thymus dependent cells). The thymus secretes hormones, including thymosin, that stimulate the maturation and differentiation of T lymphocytes. T cells compose 70% to 80% of the circulating lymphocytes and are primarily responsible for immunity to Intracellular viruses, tumor cells, and fungi. T cells can live from a few months to the life span of an individual and account for long-term immunity.

T Cytotoxic, T Helper
Describe T Cytotoxic Cells
T Cytotoxic cells (CD8)- Attack antigens on cell membranes of foreign pathogens and destroy infected cells. Antiviral properties that work inside the infected cell. Release cytotoxic substances that destroy pathogens. (as in humoral response a second exposure to the antigen will result in a more intense and rapid cell-mediated immune response)
Describe T Helper Cells
T Helper cells (CD4)- regulate cell-mediated immunity and humoral antibody response
Act as messengers by directing B cells and T cytotoxic cells to make more cells, how many to make, what to do etc. Also produce cytokines.
Natural Killer Cells are also involved in what kind of immunity? These cells are T cells, B cells, both, or neither? Do they require prior sensitization? These cells are involved in recognition and killing of virus-infected cells, ____ cells, and are the culprit in ____ ____ rejections. They have a significant role in immune surveillance for _____ cell changes.
Natural Killer Cells- are involved in cell-mediated immunity. They are neither T nor B cells but are large lymphocytes with numerous granules in the cytoplasm.
Do they require prior sensitization? No
These cells are involved in recognition and killing of virus-infected cells, tumor cells, and are the culprit in transplant graft rejections. They have a significant role in immune surveillance for malignant cell changes.
______ cells make up a system of cells that are important to the immune system, especially the ___-mediated immune response. They primarily function to capture antigens at sites of contact with the external environment such as in the ____, _____ membranes, ___ tract and and then transport an antigen until it encounters a T cell with specificity for the ____. In this form, they have an important function in ____ing the immune response. A common type is the _______ cells.
Dendritic cells make up a system of cells that are important to the immune system, especially the cell-mediated immune response. They primarily function to capture antigens at sites of contact with the external environment such as in the skin, mucous membranes, GI tract and and then transport an antigen until it encounters a T cell with specificity for the antigen.In this form, they have an important function in activating the immune response.
A common type is the Langerhan's cells
The _____ is an important organ as the primary site for filtering foreign antigens from the blood.

Review complement system p. 188....
spleen

...
Ig___ is found in the plasma and interstitial fluid and is the only immunoglobulin that crosses the placenta and is responsible for secondary immune response. Titers are usually checking this.
IgG


76% of serum concentration
Ig___ is found in body secretions including tears, saliva, breast milk, and colostrum. It lines mucous membranes and protects body surfaces.
IgA

15% of serum concentration

(not that important for test)
Ig_ is found in plasma. It is responsible for primary immune response and forms antibodies to ABO blood antigens.
IgM

8% of serum concentration
Ig__ is found in plasma and is present on lymphocyte surface. It assists in the differentiation of B lymphocytes.
IgD

1% of serum concentration

(not that important for test)
Ig__ is found in plasma and interstitial fluids, it causes symptoms of allergic reactions. It fixes to mast cells and basophils. Assists in defense against parasitic infections.
IgE

0.002% of serum concentration
______ are soluble factors secreted by WBC and a variety of other cells that act as messengers between cell types. They instruct cells to alter their proliferation, differentiation, secretion, or activity.
What are the main classifications of cytokines?
Cytokines
Interleukins-enhance NK cell action
Interferons- antiviral properties (Immunoregulatory functions- enhance NK cell action, inhibit tumor cell growth)
Tumor necrosis factor-
Colony-stimulating factors (growth stim. hematopoetic cells)
Eythropoietin - Epogen

Also review table 14-6
Cytokines have a beneficial role in hematopoiesis and immune function. They can also have detrimental effects such as those seen in ____ inflammation, a_______ diseases, and sepsis.
Cytokines have a beneficial role in hematopoiesis and immune function. They can also have detrimental effects such as those seen in chronic inflammation, autoimmune diseases, and sepsis.
Cytokines such as erythropoiten, colony-stimulating factors, and interleukin-2 are used clinically to do what 3 things?
stimulate hematopoiesis
stimulate bone marrow to make WBCs
treat various malignancies
_________ is a type of cytokine that helps the body's natural defenses attack tumors and viruses. In addition their anti____ properties, they have immunoregulatory functions such as enhancement of NK cell production and activation, and inhibition of tumor cell growth.
INTERFERON is a type of cytokine that helps the body's natural defenses attack tumors and viruses. In addition their antiVIRAL properties, they have immunoregulatory functions such as enhancement of NK cell production and activation, and inhibition of tumor cell growth.
What are the clinical uses for the cytokine: a-Interferon (Roferon-A, Intron A)?
hairy cell leukemia
chronic myelogenous leukemia
malignant melanoma
multiple myeloma
renal cell carcinoma
ovarian cancer
Kaposi sarcoma
hepatitis B & C
What is the clinical use for the cytokine: b-Interferon ?
multiple sclerosis
What are the clinical uses for the cytokine- G-CSF, a colony-stimulating factor?
chemotherapy-induced neutropenia
What are the clinical uses for the cytokine: GM-CSF, a colony-stimulating factor?
neutropenia
myeloid recovery after bone marrow transplantation
What is the clinical use for the cytokine: Soluble TNF receptor (tumor necrosis factor)?
Rheumatoid Arthritis (RA)
What are the clinical uses for the cytokine: Interleukin-2
metastatic renal cell carcinoma
metastatic melanoma
What are the clinical uses for the cytokine: Interleukin 11 ?
prevention of thrombocytopenia following chemo
What are the clinical uses for the cytokine Erythropoietin?
anemia of chronic cancer
anemia r/t chemo
anemia of chronic kidney disease
What is the clinical use for the cytokine IL-1 Receptor Antagonist?
Rheumatoid Arthritis (RA)
Review P. 215 Table 14-6
Review Table 14-14 anaphylaxis
Assessment Table 14-13
Autoimmune disease Table 14-16
...
______ immunity is also known as Antibody-mediated immunity. Antibodies are produced by _____ cells. It protects against bacteria, extracellular viruses, respiratory pathogens, GI pathogens.(differentiated B lymphocytes)
Describe each type.
IgG –
IgA –
IgM –
IgD –
IgE -
Humoral immunity is also known as Antibody-mediated immunity. Antibodies are produced by plasma cells. It protects against bacteria, extracellular viruses, respiratory pathogens, GI pathogens.(differentiated B lymphocytes) IgG – primary antibody in a secondary immune response IgA – found in body secretions
IgM – responsible for primary immune response
IgD – assists in differentiation of B lymphocytes
IgE - causes symptoms of allergic reaction
Cell Mediated Immune response initiated through specific antigen recognition by ___ cells
and involves NK cells, T lymphocytes, and macrophages
T
Humoral or Cell mediated or both?
Produces antibodies
Humoral
Humoral or Cell mediated or both?
memory cells present
both
Humoral or Cell mediated or both?
B lymphocytes
humoral
Humoral or Cell mediated or both?
T lymphocytes
cell mediated
Humoral or Cell mediated or both?
Protects against bacteria
humoral
Humoral or Cell mediated or both?
protects against extracellular viruses
humoral
Humoral or Cell mediated or both?
protects against intracellular viruses
cell mediated
Humoral or Cell mediated or both?
Protects against respiratory and GI pathogens
humoral
Humoral or Cell mediated or both?
Protects against tumor cells
cell mediated
Humoral or Cell mediated or both?
protects against chronic infectious agents
cell mediated
Humoral or Cell mediated or both?
Example: bacterial infection
humoral
Humoral or Cell mediated or both?
Example: contact dermatitis
cell mediated
Humoral or Cell mediated or both?
Example: graft rejection
cell mediated
Humoral or Cell mediated or both?
Example: destruction of cancer cells
cell mediated
Humoral or Cell mediated or both?
Example: anaphylactic shock
humoral
Humoral or Cell mediated or both?
Example: atopic diseases
humoral
Humoral or Cell mediated or both?
Example: fungal infections
cell mediated
Humoral or Cell mediated or both?
Example:transfusion reaction
humoral
Humoral or Cell mediated or both?
Example: tuberculosis
cell mediated
Humoral or Cell mediated or both?
produces antibodies
humoral
Humoral or Cell mediated or both?
produces sensitized T cells & cytokines
cell mediated
Humoral or Cell mediated or both? involves T lymphocytes & macrophages
cell mediated
Read about humoral and cell mediated immunity page 215-17
and review powerpoint to make sure I didn't miss anything! Stuff is all over the place this time...
..
Ig_ crosses the placental membrane and provides newborn with passive acquired immunity for at least ___ months. Infants may also get some passive immunity from Ig__ in breast milk and colustrum.
IgG crosses the placental membrane and provides newborn with passive acquired immunity for at least 3 months. Infants may also get some passive immunity from IgA in breast milk and colustrum.
The primary immune response becomes evident ___ to___ days from initial exposure to antigen. Ig__ is the first type of antibody to be formed. Because of the large size, this ig is confined to the _______ space. As the immune response progresses Ig__ is produced and can move from intravascular to extravascular space. When the individual is exposed to the antigen a second time, the secondary antibody response occurs. This response is faster, ___ to ___ days, is ____er, and lasts for a shorter/longer time than a primary response. _____ cells account for the memory of the first exposure to the antigen and the more rapid production of antibodies. Ig__ is the main antibody found in _______ immune response.
The primary immune response becomes evident 4 to 8 days from initial exposure to antigen. IgM is the first type of antibody to be formed. Because of the large size, this ig is confined to the intravascular space. As the immune response progresses IgG is produced and can move from intravascular to extravascular space. When the individual is exposed to the antigen a second time, the secondary antibody response occurs. This response is faster, 1 to 3 days, is stronger, and lasts for a longer time than a primary response. Memory cells account for the memory of the first exposure to the antigen and the more rapid production of antibodies. IgG is the main antibody found in secondary immune response.
Is bone marrow effected by advancing age?

Blood tests for allergies can involve what types?
No, its relatively unaffected.

Blood test- really just lookin at titers
Cutaneous- scratch different potential allergens on back, look for reaction "wheal and flair" which is positive result
Intercutaneous- for those who don't respond to cutaneous, chance for anaphylaxis is increased, use arm so tourniquet can be used to stop. Don't leave patient alone! Really with either one.
RAST- in vitro testing. More expensive, less risky, but less sensitive
_____ is an immunodeficient condition characterized by lack of or diminished reaction to an antigen or group of antigens.
anergy
What are some the effects of aging on the immune system that make older adults more susceptible to infections?
Book:
Ig levels ↓ - leads to suppressed humoral immune response
Thymic involution (shrinking)
↓ # of T cells
Both T & B cells show deficiencies in activation, proliferation, & transit time thru cell cycle
Delayed hypersensitivity reactions
↓ IL-1 and IL-2 synthesis
↓ expression of IL-2 receptors
Decreased primary & 2ndary antibody responses
↑ autoantibodies
↑ incidence of tumors
As thymic output of T cells diminishes, differentiation of T cells increases, causing an accumulation of memory cells rather than new precursor cells responsive to previously unencountered organisms.

Lecture:
↓ in size and activity of thymus
Both T and B cells show deficiencies in activation with increasing age
↓ primary and secondary antibody responses ↑ susceptibility to infections
↑ autoantibodies
↓ cell-mediated immunity
↓Delayed hypersensitivity reaction
↑ incidence of tumors
When the immune response is overreactive against foreign antigens or reacts against its own tissue, resulting in tissue damage, it is called a ______ reaction. _________ diseases, a type of this kind of response, occur when the body fails to recognize self-proteins and reacts against self-antigen.
When the immune response is overreactive against foreign antigens or reacts against its own tissue, resulting in tissue damage, it is called a hypersensitivity reaction. autoimmune diseases, a type of this kind of response, occur when the body fails to recognize self-proteins and reacts against self-antigen.
Classification of hypersensitivity reactions may be done according to the source of the antigen, the time sequence (immediate or delayed), or the basic immunologic mechanism causing the injury. There are 4 types?
I, II, III : immediate and involve humoral immunity

IV: delayed, r/t cell mediated immunity
Describe Type I: IgE Mediated reactions
Antigen: exogenous pollen, food, drugs, dust
Initially edema and itching at site of exposure
Anaphylaxis is the Systemic response and shock can occur rapidly
Multi-organ involvement
Life threatening – bronchial constriction, airway collapse, vascular collapse
Can be presented as asthma, allergic rhinitis, skin reactions such as atopic dermatitis, urticaria, and angioedema (more localized, less serious, usually due to environmental exposure)
Skin test is wheal and flare
What is the tx for anaphylaxis?
Recognize Sx (MOVE QUICKLY!)
Maintain airway
Prevent spread
Administer Drugs
Epinephrine, Benadryl, Tagamet
Treat for shock if indicated
Blood volume expanders, vasopressor drugs
Continue to Monitor
Type II: Describe Cytotoxic and cytolytic reactions
Way too much,... but read this:
Type II reactions involve direct binding of IgG or IgM antibodies to an antigen on the cell surface. Antigen-antibody complexes activate the complement system, which mediates the reaction. Cellular tissue is destroyed either by activation of the complement system resulting in cytolysis or enhanced phagocytosis. Target cells frequently destroyed in type II reactions are erythrocytes, platelets, and leuykocytes. Some of the antigens involves are the ABO blood group, Rh factor, and drugs. Pathophysiologic disorders characteristic of Type II reactions include both Rh and ABO incompatibility transfusion reactions, autoimmune and drug-related hemolytic anemia, leukopenias, thrombocytopenias, erythroblastosis fetalis, and Goodpasture syndrom. The tissue damage usually occurs rapidly.

hemolytic transfusion reactions- If the recipient is transfused with incompatible blood, antibodies immediately coat the foreign erythrocytes, causing agglutination (clumping). The clumping of cells blocks small blood vessels in the body, uses up existing clotting factors, leading to bleeding. Within hours, neutrophils and macrophages phagocytize the agglutinated cells. As complement is fixed to the antigen, cytolysis occurs. Cellular lysis causes the release of hemoglobin into the urine and plasma. In addition, a cytotoxic reaction causes vascular spasms in the kidney that further block the renal tubules. Acute renal failure can result from the hemoglobinuria.
and
Goodpasture syndrome- a disorder involving the lungs and kidneys. An antibody-mediated autoimmune reaction occurs involving IgG deposits in glomerular and alveolar basement membranes. This reaction may result in pulmonary hemorrhage and glomerulonephritis.
Type III: Tissue damage in Immune-complex reactions occur secondary to antigen-antibody complexes. Soluble antigens combine with IgG and IgM classes to form complexes that are too small to be effectively removed by the mononuclear phagocyte system. Therefore the complexes deposit in tissue or small blood vessels. They cause the fixation of complement and the release of chemotactic factors that lead to inflammation and destruction of the involved tissue. The clinical manifestations depend on the number of complexes and the location in the body, which can be localized or systemic. Common sites for deposit include the ____, ____, ____, ______ vessels, and ____. Severe type III reactions are associate with what 3 diseases/conditions?
Type III: Common sites for deposit include the kidneys, skin, joints, blood vessels, and lungs Severe type III reactions are associated with SLE, RA, and acute glomerulonephritis
Type IV: Delayed hypersensitivity reactions
are ____ _____ reactions involving a reaction of sensitized B/T cells. It takes about ___ to ___ hours for a response to occur. What are some examples?
Type IV: Delayed hypersensitivity reactions
are cell mediated reactions involving a reaction of sensitized T cells. It takes about 24 to 48 hours for a response to occur.
Hypersensitivity reactions to bacterial, fungal, and viral infections, and transplant rejections. Some drug sensitivity reactions also fit this category.
Examples: Contact dermatitis
Microbial hypersensitivity reactions- TB
Transplant rejections
(read about these p. 221)
____ ______ is a chronic, inherited skin disorder characterized by exacerbations and remissions. It is caused by several environmental allergens that are difficult to identify. The skin lesions are more generalized than the wheal-and-flare type I reactions. The skin lesions involve vasodilation of blood vessels, resulting in interstitial edema with vesicle formation.
atopic dermatitis
A 2 step TB test is often done to wake up the immune system, causing the second one to more likely react if exposure or infection is present. The test is done in two steps in order to prevent a false ____.
negative
It can take ___ to ___ days for memory cells to form to the antigen. On subsequent exposure to the substance, a sensitized person develops a response which is stronger and faster than the first exposure.
7 to 14
____ is another name for hives and is a cutaneous reaction against local/systemic allergens occurring in atopic persons. It is characterized by trans___ ____ (pink, raised, edematous pruritic areas) that vary in size and shape and may occur throughout the body. It develops slowly/rapidly after exposure to an allergen and may last _____ or _____. _____ causes localized _____ (erythema), transudation of fluid (____), and flaring. Flaring is due to blood vessels on the edge of the wheal dilating in response to a reaction augmented by the sympathetic nervous system. Histamine is responsible for the pruritis associated with the lesions.
Urticaria is another name for hives and is a cutaneous reaction against systemic allergins occurring in atopic persons. It is characterized by transient wheals (pink, raised, edematous pruritic areas) that vary in size and shape and may occur throughout the body. It develops rapidly after exposure to an allergen and may last minutes or hours. Histamine causes localized vasodilation (erythema), transudation of fluid (wheal), and flaring. Flaring is due to blood vessels on the edge of the wheal dilating in response to a reaction augmented by the sympathetic nervous system. Histamine is responsible for the pruritis associated with the lesions.
Angioedema is a localized/systemic cutaneous lesion similar to _____ but involving ____er layers of the skin and the submucosa. What are the principle areas of involvement? Swelling usually begins in the ____ and then progresses to the _____s and other parts of the body. Dilation and engorgement of the ______s secondary to the release of ______ cause the diffuse ___ing. ____ are not apparent as in urticaria, the outer skin appears normal or has a ___ish hue. The lesions may burn, sting, or itch and can cause acute ______ pain if in the GI tract. The swelling may occur suddenly or over several hours and usually lasts for ___ h.
Angioedema is a localized cutaneous lesion similar to urticaria but involving deeper layers of the skin and the submucosa. The principle areas of involvement include the eyelids, lips, tongue, larynx, hands, feet, GI tract, and genitalia. Swelling usually begins in the face and then progresses to the airways and other parts of the body. Dilation and engorgement of the capillaries secondary to the release of histamine cause the diffuse swelling. Welts are not apparent as in urticaria, the outer skin appears normal or has a reddish hue. The lesions may burn, sting, or itch and can cause acute abdominal pain if in the GI tract. The swelling may occur suddenly or over several hours and usually lasts for 24 h.
How do you differentiate between contact dermatitis and atopic dermatitis?
In acute contact dermatitis, the skin lesions appear erythematous and edematous and are covered with papules, vesicles, and bullae. The involved area is very pruritic but may also burn or sting. When contact dermatitis becomes chronic, the lesions resemble atopic dermatitis because they are thickened, scaly, and lichenified. The main difference between contact dermatitis and atopic dermatitis is that contact dermatitis is localized and restricted to the area exposed to the allergens, whereas atopic dermatitis is usually widespread.
Guidelines for preventing allergic latex reactions
Use nonlatex gloves for activities that aren't likely to involve contact with infectious materials (e.g. food preparation, housekeeping)
Use powder-free gloves with reduced protein content
Don't use oil-based hand creams or lotions when wearing gloves.
After removing gloves, wash hands and dry thoroughly.
Frequently clean work areas that are contaminated with latex-containing dust.
Know the symptoms of latex allergy, including skin rash; hives; flushing; itching; nasal, eye, or sinus symptoms; asthma; and shock.
If s'/s of latex allergy develop, avoid direct contact with latex gloves and products.
Wear a Medic Alert bracelet and carry an epinephrine pen.
_______ are the best drugs for treatment of allergic rhinitis and urticaria. They are more/less effective for severe allergic reactions. They act by competing with histamine for H1-receptor sites and thus blocking the effect of histamine. When are antihistamines best taken? Antihistamines can be used effectively to treat edema and pruritis. They are effective/ineffective at preventing bronchoconstriction. With seasonal rhinitis, antihistamines should be taken during peak pollen sites. What are some examples? What's a common side effect?
Antihistamines are the best drugs for treatment of allergic rhinitis and urticaria. They are more/less effective for severe allergic reactions. They act by competing with histamine for H1-receptor sites and thus blocking the effect of histamine. Best results are achieved if they are taken as soon as allergy signs and symptoms appear. Antihistamines can be used effectively to treat edema and pruritis. They are ineffective at preventing bronchoconstriction. With seasonal rhinitis, antihistamines should be taken during peak pollen sites. Examples: Benadryl, Claritin, Zyrtec. Common side effect: drowiness
The major sympathomimetic drug is ________, which is the drug of choice to treat an ______ reaction. This drug is a hormone produced by the _____ medulla that stimulates alpha and beta adrenergic receptors. Stimulation of the a-adrenergic receptors causes vasoconstriction of peripheral blood vessels. B-receptor stimulation relaxes ____ smooth muscles. Epinephrine also acts directly on mast cells to stabilize them against further _______. The action of epinehprine lasts how long? For the treatment of anaphylaxis, the drug must be given _______ly (IM or IV).
The major sympathomimetic drug is epinephrine (Adrenalin), which is the drug of choice to treat an anaphylactic reaction. This drug is a hormone produced by the adrenal medulla that stimulates alpha and beta adrenergic receptors. Stimulation of the a-adrenergic receptors causes vasoconstriction of peripheral blood vessels. B-receptor stimulation relaxes bronchial smooth muscles. Epinephrine also acts directly on mast cells to stabilize them against further degranulation. The action of epinephrine lasts only a few minutes. For the treatment of anaphylaxis, the drug must be given parenterally (IM or IV).
Several specific, minor sympathomimetic drugs differ from epinephrine because they can be taken ____ or _____ and last for several ___. Included in this category are phynylephrine (Neo-Synephrine) and pseudoephedrine (____). The minor sympathomimetic drugs are used primarily to treat ____ ______.
Several specific, minor sympathomimetic drugs differ from epinephrine because they can be taken orally or nasally and last for several hours. Included in this category are phynylephrine (Neo-Synephrine) and pseudoephedrine (Sudafed). The minor sympathomimetic drugs are used primarily to treat allergic rhinitis.
Corticosteroids commonly used for allergic disorders include ____ and ____. We avoid ___ corticosteroids and tend to use ____ sprays unless manifestations of allergies are truly incapacitated.
Corticosteroids commonly used for allergic disorders include hydrocortisone and Flonase. We avoid oral corticosteroids and tend to use nasal sprays unless manifestations of allergies are truly incapacitated.
Topically applied _____ drugs are most effective when the skin is...
These drugs protect the skin and provide relief from ___ing. Common OTC types include _____ lotion, coal tar solutions, and c____. Menthol and phenol may be added to other lotions to produce a similar effect. Some more potent drugs require an rx such as methdilazine (Tacaryl) and trimeprazine (Temaril)/ These drugs should be used with caution because of the associated risk of _________.
Topically applied antipruritic drugs are most effective when the skin is not broken.
These drugs protect the skin and provide relief from itching. Common OTC types include calamine lotion, coal tar solutions, and camphor. Menthol and phenol may be added to other lotions to produce a similar effect. Some more potent drugs require an rx such as methdilazine (Tacaryl) and trimeprazine (Temaril) These drugs should be used with caution because of the associated risk of agranulocytosis.
Mast-Cell stabilizing drugs include ...... (2) that inhibit the release of histamines, leukotrienes, and other agents from the mast cell after antigen-Ig__ interaction. They are available as an inhalant nebulizer solution or a nasal spray. They are used in the management of _____ and treatment of ___ ____. An important feature of these drugs is a very high/low incidence of side effects.
Mast-Cell stabilizing drugs include .Cromolyn (Intal, Nasalcrom) and nedocromil (Tilade) that inhibit the release of histamines, leukotrienes, and other agents from the mast cell after antigen-IgE interaction. They are available as an inhalant nebulizer solution or a nasal spray. They are used in the management of asthma and treatment of allergic reactions. An important feature of these drugs is a very low incidence of side effects.
Leukotriene Receptor Antagonists (LTRAs) block leukotriene, one of the major mediators of the allergic inflammatory process. These medications can be taken ____. They may be used in the treatment of allergic rhinits and asthma. What is a common example?
Leukotriene Receptor Antagonists (LTRAs) block leukotriene, one of the major mediators of the allergic inflammatory process. These medication can be taken orally. They may be used in the treatment of allergic rhinits and asthma. Singulair is a common example.
_______ are the best drugs for treatment of allergic rhinitis and urticaria. They are more/less effective for severe allergic reactions. They act by competing with histamine for H1-receptor sites and thus blocking the effect of histamine. When are antihistamines best taken? Antihistamines can be used effectively to treat edema and pruritis. They are effective/ineffective at preventing bronchoconstriction. With seasonal rhinitis, antihistamines should be taken during peak pollen sites. What are some examples? What's a common side effect?
Antihistamines are the best drugs for treatment of allergic rhinitis and urticaria. They are more/less effective for severe allergic reactions. They act by competing with histamine for H1-receptor sites and thus blocking the effect of histamine. Best results are achieved if they are taken as soon as allergy signs and symptoms appear. Antihistamines can be used effectively to treat edema and pruritis. They are ineffective at preventing bronchoconstriction. With seasonal rhinitis, antihistamines should be taken during peak pollen sites. Examples: Benadryl, Claritin, Zyrtec. Common side effect: drowiness
What type of hypersensitivity reaction is anaphylaxis?
Type I: IgE mediated reaction
What type of hypersensitivity reaction is Goodpasture Syndrome (a disorder which causes deposits of IgG to form along the basement membranes of the lungs and kidneys)?
Type II: Cytotoxic & Cytolytic reaction
What type of hypersensitivity reaction is allergic contact dermatitis?
Type IV: Delayed Hypersensitivity Reaction
What type of hypersensitivity reaction are autoimmune diseases such as SLE, RA, and acute glomerulonephritis?
Type III: Immune-Complex reaction
What type of hypersensitivity reaction are hemolytic transfusion reactions (Rh & ABO incompatibility)?
Type II: Cytotoxic & Cytolytic reaction
What type of hypersensitivity reaction is the body's defense against the tubercle bacillus (tuberculosis)?
Type IV: Delayed hypersensitivity reaction
What type of hypersensitivity reaction is allergic rhinitis?
Type I: IgE Mediated Reaction
What type of hypersensitivity reaction is atopic dermatitis?
Type I: IgE Mediated Reaction
What type of hypersensitivity reaction is poison oak?
Type IV: Delayed hypersensitivity reaction
What type of hypersensitivity reaction are autoimmune and drug-related hemolytic anemias?
Type II: Cytotoxic and Cytolytic Reactions
What type of hypersensitivity reaction is urticaria? What's another name for this?
Type I: IgE Mediated Reactions
hives
What type of hypersensitivity reaction are leukopenias and thrombocytopenias?
Type II: Cytotoxic and Cytolytic Reactions
What type of hypersensitivity reaction is erythroblastosis fetalis (a hemolytic disease of the newborn)
Type II: Cytotoxic and Cytolytic Reactions
What type of hypersensitivity reaction is angioedema?
Type I: IgE Mediated Reactions
What type of hypersensitivity reaction involve a response to bacterial, fungal, and viral infections?
Type IV: Delayed hypersensitivity reaction
What type of hypersensitivity reaction is usually a the type of reaction presented after exposure to antigenic substances such as rubber or metal compounds?
Type IV: Delayed Hypersensitivity Reaction
What type of hypersensitivity reaction involves a wheal and flare, such as with a mosquito bite?
Type I: IgE Mediated
What type of hypersensitivity reaction is usually a the type of reaction presented after exposure to cosmetics and some dyes?
Type IV: Delayed Hypersensitivity Reaction
What type of hypersensitivity reaction is Grave's Disease
Type II: Cytotoxic & Cytolytic Reactions
What type of hypersensitivity reaction is a transplant rejection?
Type IV: Delayed Hypersensitivity Reaction
Which type(s) of hypersensitivity reactions involve complement?
Type II Cytotocic
Type III Immune Complex
Which antibody or antibodies are involved with each type of hypersensitivity reaction?
I IgE
II IgG, IgM
III IgG, IgM
IV None
What are some common foods that can cause anaphylactic shock?
eggs
milk
nuts
peanuts
shellfish/ fish
chocolate
strawberries
______ is contained in mast cells and basophil granules.
HISTAMINE is contained in mast cells and basophil granules.
Histamine is contained in ___ cells and ______ granules. It increases/decreases vascular permeability. It dilates/constricts smooth muscle. It stimulates/blocks irritant receptors. The clinical outcomes include ____ of the airways and larynx, bronchial ______, u_____, ____edema, pr____, nausea, v_____, d______, and sh__.
Histamine is contained in MAST cells and BASOPHIL granules. It INCREASES vascular permeability. It CONSTRICTS smooth muscle. It STIMULATES irritant receptors. The clinical outcomes include EDEMA of the airways and larynx, bronchial CONSTRICTION, URTICARIA, ANGIODEMA, PRURITIS, nausea, VOMITING, DIARRHEA, and SHOCK.
________ is a mediator of the allergic response and causes bronchial constriction and enhances the effect of histamine on smooth muscle.
leukotrienes
_________ cause the wheal-and-flare reaction on skin, hypotension, and bronchospasm.
prostaglandins
What are possible signs of a systemic anaphylactic reaction?

(Hint: involves 5 body systems)
RESPIRATORY
hoarseness
coughing
wheezing
stridor
dyspnea
tachypnea
sensation of narrowed airway
respiratory arrest

CARDIOVASCULAR
hypotension
dysrhythmias
tachycardia
cardiac arrest

GASTROINTESTINAL
cramping
abdominal pain
nausea
vomiting
diarrhea

NEUROLOGICAL
headache
dizziness
paresthesia
feeling of impending doom

SKIN
erythema
urticaria
angiodema
pruritis
What type of hypersensitivity reaction is described below...
-skin lesions appear erythematous and edematous and are covered with papules, vesicles, and bullae
-involved area is very pruritic
but may also burn or sting
-When it becomes chronic, the lesions become thickened, scaly, and lichenified
-the reaction is localized and restricted to the area exposed to the allergens
acute contact dermatitis (type IV delayed hypersensitivity reaction)
What type of hypersensitivity reaction is described below...
-chronic, inherited skin disorder characterized by exacerbations and remissions
-Involve vasodilation of blood vessels, resulting in interstitial edema and vesicle formation
-Skin lesions are more generalized and widespread.
atopic dermatitis (type I: IgE medaiated reaction)
Are type III immune complex reactions local or systemic? Immediate or delayed?
Trick question...
Type III can be any of these.
People with chronic allergies should be advised to identify or recognize the allergen through allergy testing if needed. They should control exposure in their environment and try to avoid the allergen. People with allergies to insect stings should always carry a kit containing _____ and a ____.
People with chronic allergies should be advised to identify or recognize the allergen through allergy testing if needed. They should control exposure in their environment and try to avoid the allergen. People with allergies to insect stings should always carry a kit containing epinephrine and a tourniquet.
What are some possible diagnostic findings in assessments of allergies?
Eosinophilia of serum, sputum, nasal, or bronchial secretions
increased serum IgE levels
positive skin tests
abnormal chest and sinus x-rays
_________ is the recommended treatment for control of allergic symptoms when the allergen cannot be avoided and drug therapy is not effective. Few patients with allergies have symptoms so intolerable that they require this.
immunotherapy
Immunotherapy is absolutely indicated in individuals with anaphylactic reactions to ___ ___.
Immunotherapy is absolutely indicated in individuals with anaphylactic reactions to INSECT VENOM.
Immunotherapy involves administration of small titers of an allergen extract in increasing strengths until hyposensitivity to the specific allergen is achieved. The patient should be advised to avoid the offending allergen whenever possible. Is complete desensitization possible? Unfortunately, not all allergy-related conditions respond to immunotherapy. ____ allergies can't be treated this way and ____ may worsen with immunotherapy.
Immunotherapy involves administration of small titers of an allergen extract in increasing strengths until hyposensitivity to the specific allergen is achieved. The patient should be advised to avoid the offending allergen whenever possible BECAUSE COMPLETE DESENSITIZATION IS NOT POSSIBLE. Unfortunately, not all allergy-related conditions respond to immunotherapy. FOOD allergies can't be treated this way and ECZEMA may worsen with immunotherapy.
Ig__ immunoglobulin level is elevated in atopic individuals. When Ig_ combines with an allergen in a hypersensitive person, a reaction occurs, releasing histamine in various body tissues. Allergens more readily combine with Ig__ than with other immunoglobulins. Therefore, immunotherapy involves injecting allergen extracts that will stimulate increased Ig__ levels.
IgE immunoglobulin level is elevated in atopic individuals. When IgEcombines with an allergen in a hypersensitive person, a reaction occurs, releasing histamine in various body tissues. Allergens more readily combine with IgG than with other immunoglobulins. Therefore, immunotherapy involves injecting allergen extracts that will stimulate increased IgG levels.
In immunotherapy, the binding of IgG to allergen-reactive sites interferes with the allergen binding to mast-cell-bound Ig__, preventing mast cell degranulation, and thus reducing the number of reactions that cause tissue damage. (Allergen-specific T suppressor cells also develop in individuals receiving immunotherapy.) What's the goal of long term immunotherapy?
In immunotherapy, the binding of IgG to allergen-reactive sites interferes with the allergen binding to mast-cell-bound IgE, preventing mast cell degranulation, and thus reducing the number of reactions that cause tissue damage. (Allergen-specific T suppressor cells also develop in individuals receiving immunotherapy.)
The goal of long term immunotherapy is to keep "blocking" IgG levels high
The allergens included in immunotherapy are chosen on the basis of the results of ___ testing with a panel of allergens found in the local geographic area. What route is the allergen injected and how often?
The allergens included in immunotherapy are chosen on the basis of the results of skin testing with a panel of allergens found in the local geographic area.
Subcutaneous injections of titrated amounts of allergen extracts are done biweekly or weekly. The dose is small at first and increased slowly until a maintenance dosage is reached.
How long does it generally take for immunotherapy to reach the maximal therapeutic effect? Therapy may be continued for about ___ years, then discontinuation is considered. In many patients a decrease in symptoms is maintained after treatment is discontinued. For patients with severe allergies or sensitivity to insect stings, maintenance therapy is continued indefinitely. Best results are achieved when immunotherapy is administered throughout the year.
It generally takes one to two years for immunotherapy to reach the maximal therapeutic effect. Therapy may be continued for about 5 years, then discontinuation is considered. In many patients a decrease in symptoms is maintained after treatment is discontinued. For patients with severe allergies or sensitivity to insect stings, maintenance therapy is continued indefinitely. Best results are achieved when immunotherapy is administered throughout the year.
_____ immunotherapy is another option that has a lower risk of severe adverse reactions than the traditional subcutaneous administration, yet is not yet available in the United States.
SUBLINGUAL immunotherapy is another option that has a lower risk of severe adverse reactions than the traditional subcutaneous administration, yet is not yet available in the United States.
True or False: Immunotherapy always carries the risk of a severe anaphylactic reaction.
true

Always anticipate adverse reactions, especially when using a new-strength dose, after a previous reaction or after a missed dose. Early s/s of a systemic reaction include pruritus, urticaria, sneezing, laryngeal edema, and hypotension.
In immunotherapy administration, describe a local reaction according to the degree of redness and swelling of the injection site. If the area is greater than the size of a _____ in an adult, report the reaction to the HCP so that the allergen dosage may be decreased.
quarter
Record keeping must be accurate in administering immunotherapy. It is important in the prevention of an adverse reaction to the allergen extract. Before giving an injection, what should be checked?
patient's name with the name on the vial
vial strength
amount of last dose
any information about a previous reaction
In immunotherapy, always administer the allergen extract away from a ____ so that a tourniquet can be applied for a severe reaction. The site should be _____ for each injection. An injection directly into the bloodstream can cause an anaphylactic reaction. What should we do to prevent this?
After the injection is given, carefully observe the patient for ____ minutes because systemic reactions are more likely to occur immediately. However, warn the patient that a delayed reaction can occur as long as 24 hours later.
In immunotherapy, always administer the allergen extract away from a joint so that a tourniquet can be applied for a severe reaction. The site should be rotated for each injection. An injection directly into the bloodstream can cause an anaphylactic reaction. To prevent this, aspirate for blood before giving an injection.
After the injection is given, carefully observe the patient for 20 minutes because systemic reactions are more likely to occur immediately. However, warn the patient that a delayed reaction can occur as long as 24 hours later.
Two types of latex allergies that can occur are Type __ allergic ___ _____ and Type __ allergic reactions.
Two types of latex allergies that can occur are Type IV allergic contact dermatitis and Type I allergic reactions.
Type IV contact dermatitis is caused by....
It is a _____ reaction that occurs within 6 to 48 hours. Typically, the person first has dryness, pruritis, fissuring and cracking of the skin, followed by redness, swelling and crusting at 24 to 48 hours. Chronic exposure can lead to lichenification, scaling, and hyper______. The dermatitis doesn't/may extend beyond the area of physical contact with the allergen.
Type IV contact dermatitis is caused by the chemicals used in the manufacturing process of latex gloves.
It is a delayed reaction that occurs within 6 to 48 hours. Typically, the person first has dryness, pruritis, fissuring and cracking of the skin, followed by redness, swelling and crusting at 24 to 48 hours. Chronic exposure can lead to lichenification, scaling, and HYPERPIGMENTATION. The dermatitis may extend beyond the area of physical contact with the allergen.
A type I allergic reaction to latex is a response to the natural ____ latex ____ and occurs within _____ of contact with the ____s. The manifestations of these allergic reactions can vary from skin redness, urticaria, rhinitis, conjunctivitis, or asthma to full blown anaphylactic shock. Systemic reactions to latex may result from exposure to latex protein via various routes including the skin, mucous membranes, inhalation, and blood.
A type I allergic reaction to latex is a response to the natural RUBBER latex PROTEIN and occurs within MINUTES of contact with the PROTEINs. The manifestations of these allergic reactions can vary from skin redness, urticaria, rhinitis, conjunctivitis, or asthma to full blown anaphylactic shock. Systemic reactions to latex may result from exposure to latex protein via various routes including the skin, mucous membranes, inhalation, and blood.
Because some proteins in rubber are similar to food proteins, some foods may cause an allergic reaction in people who are allergic to latex. This called ___ ____ ____. In people with latex allergy, at least 70% will have a positive allergy test to at least one related food. What are some examples of foods that are associated with a latex allergy?
Because some proteins in rubber are similar to food proteins, some foods may cause an allergic reaction in people who are allergic to latex. This called latex food syndrome. In people with latex allergy, at least 70% will have a positive allergy test to at least one related food. Some examples of foods that are associated with a latex allergy: bananas
avocado
chestnuts
kiwi
tomatoes
potatoes
water chestnuts
guava
hazelnuts
peaches
grapes
apricots
True or False: The greatest risk factor to acquiring a latex allergy is long-term multiple exposures to latex products (i.e. health care personnel, people who have had multiple surgeries, rubber industry workers, hair stylists).
True
Additional risk factors for a latex allergy include allergies to certain foods and people who have _____ or allergic _____. People with a type __ latex allergy should wear a ____ ____ bracelet.
Additional risk factors for a latex allergy include allergies to certain foods and people who have asthma or allergic rhinitis. People with a type I latex allergy should wear a medic alert bracelet.
________ is an immune response against the self in which the immune system no longer differentiates self from nonself. For some unknown reason, immune cells that are normally unresponsive (tolerant to self-___) are activated.
Autoimmunity is an immune response against the self in which the immune system no longer differentiates self from nonself. For some unknown reason, immune cells that are normally unresponsive (tolerant to self-antigens) are activated.
Normally, both T cells and B cells have the ability for tolerance to self-antigens. In autoimmune diseases, there is an alteration in __ cells alone or in both B cells and T cells that can produce ___antibodies and autosensitized __ cells to cause pathophysiologic tissue damage. The particular autoimmune disease manifested depends on which ___-____ is involved.
Normally, both T cells and B cells have the ability for tolerance to self-antigens. In autoimmune diseases, there is an alteration in T cells alone or in both B cells and T cells that can produce autoantibodies and autosensitized T cells, causing pathophysiologic tissue damage. The particular autoimmune disease manifested depends on which self-antigen is involved.
True or False: The cause of autoimmune diseases is still unknown. Age is thought to play some role because the number of circulating autoantibodies decreases in persons over age 50.
False. The number of circulating autoantibodies increases after age 50.
The principle factors in the development of autoimmunity are: the _____ of susceptibility genes, which may contribute to the failure of self-tolerance
and
initiation of autoreactivity by _____s such as infections, which may activate self-reactive lymphocytes
The principle factors in the development of autoimmunity are: the inheritance of susceptibility genes, which may contribute to the failure of self-tolerance
and
initiation of autoreactivity by triggers such as infections, which may activate self-reactive lymphocytes
True or False: A person with one autoimmune disease is less likely to experience another autoimmune disease.
False.
Autoimmune diseases tend to cluster, so that a given person may have more than one autoimmune disease such as RA and Addison's disease, or the same or related autoimmune diseases may be found in other members of the same family. This observation has led to the concept of genetic predisposition to autoimmune disease. Most of the genetic research in this area correlates to human leukocyte antigen (HLA) types with an autoimmune condition.
Even in a genetically, predisposed person, some trigger is required for the initiation of autoreactivity. This may include infectious agents such as a virus, which can cause changes in cells or tissues making them antigenic when they were not before. Viruses may be involved in the trigger of ____ ____ and type I ____ ___. Bacteria can also play a role such as group A beta hemolytic streptococci infection which trigger the development of rheumatic fever and rhuematic heart disease.
Even in a genetically, predisposed person, some trigger is required for the initiation of autoreactivity. This may include infectious agents such as a virus, which can cause changes in cells or tissues making them antigenic when they were not before. Viruses may be involved in the trigger of multiple scelerosis and type I diabetes mellitus. Bacteria can also play a role such as group A beta hemolytic streptococci infection which trigger the development of rheumatic fever and rhuematic heart disease.
Gender and hormones also have a role in autoimmune disease. Which gender are they more common? During pregnancy, many autoimmune diseases get better/worse.
Gender and hormones also have a role in autoimmune disease and they are more common in women. During pregnancy, many autoimmune diseases get better. Following delivery, the woman with an autoimmune disease frequently has an exacerbation.
Systemic lupus erythematosus (SLE) is a classic example of a systemic autoimmune disease characterized by damage to multiple organs. It occurs most frequently in men/women ages ___ to ___ years old. The etiology is unknown, but it appears to be a loss of self-tolerance for the body's own ___ antigens.
Systemic lupus erythematosus (SLE) is a classic example of a systemic autoimmune disease characterized by damage to multiple organs. It occurs most frequently in women ages 20 to 40 years old. The etiology is unknown, but it appears to be a loss of self-tolerance for the body's own DNA antigens.
Apheresis has been effectively used to treat autoimmune diseases and other diseases and disorders. Apheresis is the use of a procedure to separate components of the ___ followed by the ____ of one or more of these components. Compound words are used to describe the particular apheresis procedure, depending on the blood components being collected. For example, plateletpheresis, leukocytapheresis, lymphocytapheresis. Another type of apheresis is peripheral stem cell collection (hematopoietic progenitor cell collection) which is used to collect stem cells from peripheral blood to repopulate a person's bone marrow after high-dose chemo.
Apheresis has been effectively used to treat autoimmune diseases and other diseases and disorders. Apheresis is the use of a procedure to separate components of the blood followed by the removal of one or more of these components. Compound words are used to describe the particular apheresis procedure, depending on the blood components being collected. For example, plateletpheresis, leukocytapheresis, lymphocytapheresis. Another type of apheresis is peripheral stem cell collection (hematopoietic progenitor cell collection) which is used to collect stem cells from peripheral blood to repopulate a person's bone marrow after high-dose chemo.
_______ is the removal of plasma containing components causing or thought to cause disease. It can also be used to obtain plasma from healthy donors to administer to patients as replacement therapy.
plasmapheresis
Plasmapheresis has been used to treat autoimmune disorders such as SLE, glomerulonephritis, Goodpasture syndrome, myasthenia gravis, thrombocytopenic purpura, rheumatoid arthritis, and Guillain-Barre syndrome. When plasma is removed, it is replaced by substitute fluids such as what 3?
saline, fresh-frozen plasma, or albumin
Drugs can also be precipitating factors for autoimmune disease. The medication methyldopa (Aldomet) can cause ____ _____ and procainamide (Pronestyl) can induce the formation of antinuclear antibodies and cause a ____-like syndrome.
Drugs can also be precipitating factors for autoimmune disease. The medication methyldopa (Aldomet) can cause hemolyitc anemia and procainamide (Pronestyl) can induce the formation of antinuclear antibodies and cause a lupus-like syndrome.
Many disorders for which plasmapheresis is used are characterized by circulating auto______ usually of the Ig_ class and antigen-antibody ______. The rationale for performing therapeutic plasmapheresis in autoimmune disorders is to remove _____ substances present in plasma. Immunosuppressive therapy has been used to prevent recovery of IgG production, and plasmapheresis has been used to prevent antibody rebound.
Many disorders for which plasmapheresis is used are characterized by circulating autoantibodies usually of the IgG class and antigen-antibody complexes. The rationale for performing therapeutic plasmapheresis in autoimmune disorders is to remove pathogenic substances present in plasma. Immunosuppressive therapy has been used to prevent recovery of IgG production, and plasmapheresis has been used to prevent antibody rebound. (???) P 226
In addition to removing antibodies and antigen-antibody complexes, plasmapheresis may also remove inflammatory mediators (_____) that are responsible for tissue damage. In the treatment of ___, plasmapheresis is usually reserved for the patient having an acute attack who is unresponsive to conventional therapy.
In addition to removing antibodies and antigen-antibody complexes, plasmapheresis may also remove inflammatory mediators (complement) that are responsible for tissue damage. In the treatment of SLE, plasmapheresis is usually reserved for the patient having an acute attack who is unresponsive to conventional therapy.
Plasmapheresis involves the removal of whole blood through an IV device and then the blood circulates through the apheresis machine. When blood is manually removed, only ___ ml may be taken out at a time. However, with the use of apheresis procedures, over __ L of plasma can be pheresed in two to three hours.
Plasmapheresis involves the removal of whole blood through an IV device and then the blood circulates through the apheresis machine. When blood is manually removed, only 500 ml may be taken out at a time. However, with the use of apheresis procedures, over 4 L of plasma can be pheresed in two to three hours.
When the immune system does not adequately protect the body, _________ exists. These disorders involve an impairment of one or more immune mechanisms which include
phagocytosis
humoral response
cell-mediated response
complement
a combined humoral and cell-mediated deficiency
Immunodeficiency disorders are primary/secondary if the immune cells are improperly developed or absent and primary/secondary if the deficiency is caused by illnesses or treatment. Primary/secondary disorders are rare and often serious, whereas primary/secondary disorders are more common and less severe.
When the immune system does not adequately protect the body, immunodeficiency exists. These disorders involve an impairment of one or more immune mechanisms which include
phagocytosis
humoral response
cell-mediated response
complement
a combined humoral and cell-mediated deficiency
Immunodeficiency disorders are primary if the immune cells are improperly developed or absent and secondary if the deficiency is caused by illnesses or treatment. Primary disorders are rare and often serious, whereas secondary disorders are more common and less severe.
What is the most common cause of immunosuppression?
Drugs
Generalized ____penia often results after immunosuppressive therapy prescribed to treat autoimmune disorders, prevent transplant rejection, and immunosuppression is a serious side effect of chemotherapy. The decreased WBC count causes a decreased humoral and cell mediated response. Secondary infections are common in immunosuppressed patients.
Generalized leukopenia often results after immunosuppressive therapy prescribed to treat autoimmune disorders, prevent transplant rejection, and immunosuppression is a serious side effect of chemotherapy. The decreased WBC count causes a decreased humoral and cell mediated response. Secondary infections are common in immunosuppressed patients.
Malnutrition alters the cell-mediated or humoral immune response? Which nutrient is mainly lacking that alters this response (fat/protein/carbohydrates)?
Malnutrition alters cell-mediated immune responses.When protein is deficient over a prolonged period, atrophy of the thymus gland occurs and lymphoid tissue decreases. An increased susceptibility to infections always exists.
_____ lymphoma greatly impairs the cell-mediated immune response, and patients may die from severe viral or fungal infections. Viruses, especially _____, may cause immunodeficiency by direct cytotoxic damage to lymphoid cells. Systemic infections can place such a demand on the immune system that resistance to a subsequent infection is impaired. R_____ for cancer treatment can destroy lymphocytes either directly or through depletion of stem cells. The procedure ______ectomy in children is especially dangerous and may lead to septicemia simply from respiratory infections. Stress may also alter the immune response.
HODGKIN'S lymphoma greatly impairs the cell-mediated immune response, and patients may die from severe viral or fungal infections. Viruses, especially RUBELLA, may cause immunodeficiency by direct cytotoxic damage to lymphoid cells. Systemic infections can place such a demand on the immune system that resistance to a subsequent infection is impaired. RADIATION for cancer treatment can destroy lymphocytes either directly or through depletion of stem cells. The procedure splenectomy in children is especially dangerous and may lead to septicemia simply from respiratory infections. Stress may also alter the immune response.
The antigens responsible for rejection of genetically unlike tissues are called the major histocompatibility antigens. These antigens are products of histocompatibility genes. In humans they are called ____ ____ ____. The genes for these antigens are linked and occur together on the __th chromosome.
The antigens responsible for rejection of genetically unlike tissues are called the major histocompatibility antigens. These antigens are products of histocompatibility genes. In humans they are called HUMAN LEUKOCYTE ANTIGEN (HLA). The genes for these antigens are linked and occur together on the 6th chromosome. (read more about it if you want.... p. 227-8)
Why do we care about HLA?
The early interest in HLAs was stimulated by the role of HLAs in matching donors and recipients of organ transplants. There are also strong associations between HLA type and susceptibility to certain diseases.
Transplantation success has improved with advances in surgical technique, advances in histocompatibility testing and more effective immunosuppressants such as cyclosporine. Most transplants are successful with good survival rates. What 2 organs would you expect to be needed for a patient with diabetes?
Pancreas
&
Kidney
(due to kidney failure from diabetes progression)
What are some factors that dictate how patients are matched to available donors?
ABO blood compatibility
HLA typing
medical urgency
time on the waiting list
geographic location
The recipient must receive a transplant from a ___ blood group compatible donor. Does Rh factor also need to be compatible?
The recipient must receive a transplant from an ABO blood group compatible donor. The Rh factor does not need to be the same between the donor and recipient.
___ typing is done on all potential organ or tissue donors and recipients. Currently, only the A, B, and DR antigens are thought to be clinically significant for transplantation. An attempt is made to match as many ___ as possible between the HLA antigens.Antigens matches of ___(#) and ___(#) antigens and certain ___(#) -antigen matches have been found to have better clinical outcomes, especially in ____ and ____ ___ transplants.
HLA typing is done on all potential organ or tissue donors and recipients. Currently, only the A, B, and DR antigens are thought to be clinically significant for transplantation. An attempt is made to match as many ANTIGENS as possible between the HLA antigens. Antigens matches of 5 and 6 antigens and certain 4-antigen matches have been found to have better clinical outcomes, especially in kidney and bone marrow transplants.
The degree of HLA matching required or deemed suitable for successful solid organ transplantation is dependent on....
the type of organ
Certain organ and tissue transplants require a closer histocompatibility match than other organs. A ____ transplant can be accepted by nearly any individual because this is avascular and therefore no antibodies reach it to cause rejection.
Certain organ and tissue transplants require a closer histocompatibility match than other organs. A CORNEA transplant can be accepted by nearly any individual because this is avascular and therefore no antibodies reach it to cause rejection.
In ____ and ___ ___ transplantation HLA matching is very important, as these transplants are at high risk for ___ ____.
In KIDNEY and BONE MARROW transplantation HLA matching is very important, as these transplants are at high risk for GRAFT REJECTION.
For ___ transplants, HLA mismatches have little impact on graft survival. Heart and lung transplants fall somewhere in between as far as the degree of HLA matching necessary, but minimizing HLA mismatches significantly improves survival. In addition, for liver, lung, and heart transplants, there are fewer donors available for these organs and it is difficult to get good HLA matches.
For LIVER transplants, HLA mismatches have little impact on graft survival. Heart and lung transplants fall somewhere in between as far as the degree of HLA matching necessary, but minimizing HLA mismatches significantly improves survival. In addition, for liver, lung, and heart transplants, there are fewer donors available for these organs and it is difficult to get good HLA matches.
As _______ has improved, HLA matching has become less/more important for successful transplantation overall. Another major consideration is the time and distance than an HLA-compatible organ has to be preserved. Increased storage time can result in damage to the donor organ. Therefore the need to have the "best" matches has to be balanced against the time it takes to get a donated organ and transplant it.
As immunosuppression has improved, HLA matching has become less important for successful transplantation overall. Another major consideration is the time and distance than an HLA-compatible organ has to be preserved. Increased storage time can result in damage to the donor organ. Therefore the need to have the "best" matches has to be balanced against the time it takes to get a donated organ and transplant it.
A panel of reactive antibodies (PRA) indicates the recipients ____ to various HLAs before receiving a transplant. To detect preformed antibodies to HLA, the recipient's serum is mixed with a randomly selected panel of donor lymphocytes to determine _____. The potential recipient may have been exposed to HLA antigens by means of previous blood transfusions, pregnancy, or a previous organ transplant. For PRA, the results are calculated in ______. A high PRA indicates that the person has a small/large number of cytotoxic antibodies and is highly/barely sensitized, meaning there is a good/poor chance of finding a crossmatch-______ donor. In patients awaiting transplantation, a PRA panel is usually done on a regular basis. _______ and IV ____ _____ have been used to raise/lower the number of preformed HLA antibodies to highly sensitized patients.
A panel of reactive antibodies (PRA) indicates the recipients SENSITIVITY to various HLAs before receiving a transplant. To detect preformed antibodies to HLA, the recipient's serum is mixed with a randomly selected panel of donor lymphocytes to determine REACTIVITY. The potential recipient may have been exposed to HLA antigens by means of previous blood transfusions, pregnancy, or a previous organ transplant. For PRA, the results are calculated in PERCENTAGES. A high PRA indicates that the person has a LARGE number of cytotoxic antibodies and is HIGHLY sensitized, meaning there is a POOR chance of finding a crossmatch-NEGATIVE donor. In patients awaiting transplantation, a PRA panel is usually done on a regular basis. PLASMAPHERESIS and IV IMMUNE GLOBULIN have been used to LOWER the number of preformed HLA antibodies to highly sensitized patients.
In more simple terms, the panel of reactive antibodies is the testing of the potential recipient's cytotoxic antibodies. A high number is a good/poor chance, a lower number is a worse/better chance of finding a crossmatch-negative donor.
In more simple terms, the reactive antibodies is the testing of the potential recipient's cytotoxic antibodies. A high number is a POOR chance, a lower number is a BETTER chance of finding a crossmatch-negative donor.
A ______ uses serum from the recipient mixed with donor lymphocytes to test for any preformed anti-HLA ______ to the potential ___ ____.
A CROSSMATCH uses serum from the recipient mixed with donor lymphocytes to test for any preformed anti-HLA ANTIBODIES to the potential DONOR ORGAN.
The crossmatch can be used as a screening test when multiple possible living donors are being considered or once a cadaver donor is selected. A final crossmatch is done when?
right before the transplant
A positive/negative crossmatch indicates that the recipient has cytotoxic antibodies to the donor and is an absolute ______ to transplantation. If transplanted, the organ would undergo _____ _____.
A POSITIVE crossmatch indicates that the recipient has cytotoxic antibodies to the donor and is an absolute CONTRAINDICATION to transplantation. If transplanted, the organ would undergo HYPERACUTE REJECTION.
True or False: A negative crossmatch indicates that no preformed antibodies are present and it is safe to proceed with the transplantation. Crossmatching is especially important for kidney transplants.
True
True or False: Crossmatching is done in an emergency setting
false, in a non-emergency setting
Rejection is one of the major problems following organ transplantation. Rejection of organs will occur as an abnormal/normal immune response to foreign tissue. How can rejection be controlled? (4 factors)
Rejection is one of the major problems following organ transplantation. Rejection of organs will occur as an NORMAL immune response to foreign tissue. How can rejection be controlled?
Crossmatch- confirm it's neg.
HLA matching
ABO matching
Immunosuppression therapy
(To prevent rejection, make sure you drink C-H-A-I before a transplant :)
True or False: Many HLA's exist and a perfect match for organ or tissue transplant is nearly impossible unless the tissue is from oneself or an identical twin.
true
Prevention, early diagnosis, and treatment of rejection are essential for long-term graft function. What are the 3 types of transplant rejections?
hyperacute (antibody mediated, humoral)
acute
chronic
A hyperacute (antibody-mediated, humoral) rejection occurs ____ to ____ after transplantation because the ___ ____ are rapidly destroyed. It occurs because the person had preexisting _____ against the transplanted tissue or organ. What is the treatment? What organ is most susceptible to a hyperacute reaction? Fortunately, this type of reaction is rare because the final ______ just before transplant will usually identify the recipient is sensitized to any of the donor HLAs. Sometimes, in rare cases, even after the final crossmatch, a hyperacute reaction can occur for unknown reasons.
A hyperacute (antibody-mediated, humoral) rejection occurs MINUTES to HOURS after transplantation because the BLOOD VESSELS are rapidly destroyed. It occurs because the person had preexisting ANTIBODIES against the transplanted tissue or organ. There is no treatment and the transplanted organ is removed. The kidney is most susceptible to a hyperacute reaction. Fortunately, this type of reaction is rare because the final crossmatch just before transplant will usually identify the recipient is sensitized to any of the donor HLAs. Sometimes, in rare cases, even after the final crossmatch, a hyperacute reaction can occur for unknown reasons.
An acute rejection most commonly manifests in the first ___ ____after transplantation. This type of rejection is usually mediated by the recipient's T/B cytotoxic ______s, which have been activated against the donated (foreign) tissue or organ. Another type of acute rejection occurs when donor antibodies develop after transplantation. It is common/uncommon to have at least one rejection episode, especially with organs from _____ donors. These episodes are usually irreversible/reversible.
An acute rejection most commonly manifests in the first SIX MONTHS after transplantation (can be days to months). This type of rejection is usually mediated by the recipient's T-CYTOTOXIC LYMPHOCYTES, which have been activated against the donated (foreign) tissue or organ. Another type of acute rejection occurs when donor antibodies develop after transplantation. It is COMMON to have at least one rejection episode, especially with organs from DECEASED donors. These episodes are usually REVERSIBLE.
Acute rejection of a transplanted organ is usually reversible with additional immunosuppressive therapy that may include increased corticosteroid doses or polyclonal or monoclonal antibodies. Unfortunately, immunosuppressants increase the risk of ____. To combat acute rejection, all patients with transplants require short/long-term use of immunosuppressants. The risk of _____ is highest when?
Acute rejection of a transplanted organ is usually reversible with additional immunosuppressive therapy that may include increased corticosteroid doses or polyclonal or monoclonal antibodies. Unfortunately, immunosuppressants increase the risk of INFECTION. To combat acute rejection, all patients with transplants require LONG-term use of immunosuppressants. The risk of INFECTION is highest in the first few months after transplant when the immunosuppression doses are highest.
Chronic rejection is a fast/slow, obvious/subtle, process that occurs over months or years and is reversible/ irreversible. It can occur for unknown reasons or from repeated episodes of ___ ____. The transplanted organ is infiltrated with large numbers of __ and __ cells characteristic of an ongoing, low-grade, immune-mediated injury. Chronic rejection results in _____ and ____ing. In heart transplants, it manifests as accelerated ___ ____ ___. In ___ transplants, it manifests as bronchiolitis obliterans. In ___ transplants, it is characterized by loss of bile ducts. In ____ transplants, it manifests as fibrolysis and glomerulopathy. There is no definitive therapy for this type of rejection. Treatment is primarily supportive. This type of rejection is difficult to manage and is not associated with a good prognosis. Patients with chronic rejection should be put on the transplant list in hope that they can be retransplanted.
Chronic rejection is a slow, subtle process that occurs over months or ears and is IRREVERSIBLE It can occur for unknown reasons or from repeated episodes of ACUTE REJECTION. The transplanted organ is infiltrated with large numbers of T and B cells characteristic of an ongoing, low-grade, immune-mediated injury. Chronic rejection results in FIBROSIS and SCARRING. In heart transplants, it manifests as accelerated CORONARY ARTERY DISEASE. In LUNG transplants, it manifests as bronchiolitis obliterans. In LIVER transplants, it is characterized by loss of bile ducts. In KIDNEY transplants, it manifests as fibrolysis and glomerulopathy. There is no definitive therapy for this type of rejection. Treatment is primarily supportive. This type of rejection is difficult to manage and is not associated with a good prognosis. Patients with chronic rejection should be put on the transplant list in hope that they can be retransplanted.
Immunosuppression requires a balance. The immune response needs to be suppressed enough to prevent rejection of the donated organ, but strong enough to prevent complications. What are the 2 major side effects of immunosuppressive therapy? How long does a transplant recipient take immunosuppressants? This increases risk of what?
Immunosuppression requires a balance. The immune response needs to be suppressed enough to prevent rejection of the donated organ, but strong enough to prevent complications. The two major side effects are increased risk of infection and increased risk of malignancy. A transplant recipient take immunosuppressants for life, which increases the risk of toxicity in addition to the above risks.
By using a combination of immunosuppressive agents that work during different ____ of the immune response, higher/lower doses of each drug can be given to produce effective immunosuppression while minimizing ___ ____. Most transplants are initially on single/double/triple/quadruple therapy which involves which drug(s)?
By using a combination of immunosuppressive agents that work during different PHASES of the immune response, LOWER doses of each drug can be given to produce effective immunosuppression while minimizing SIDE EFFECTS.
Most transplants are initially on TRIPLE therapy which includes a calcineurin inhibitor, a corticosteroid, and mycophenolate mofetil (CellCept).
When are Antilymphocyte globulin (ALG) and muromonab-CD3 medications used for transplant recipients?
Antilymphocyte globulin (ALG)
and muromonab-CD3
are used for short periods to prevent early rejection or to reverse acute rejection.
Transplant recipients are usually weaned off of ________ (type of med) or these medications aren't used at all because of he many side effects.
Corticosteroids
Calcineurin inhibitors can cause _____, ________,
________ and increase the risk of infection. Lymphoma, hypertension, tremors, hirsutism, leukopenia, and gingival hyperplasia are other possible side effects. What are 2 examples of this type of immunosuppressant? What is an important nursing implication for the major one used? What's wrong with the other one?
Calcineurin inhibitors can cause nephrotoxicity, hepatotoxicity, neurotoxicity (tremors, seizures) and increase the risk of infection. Lymphoma, hypertension, tremors, hirsutism, leukopenia, and gingival hyperplasia are other possible side effects. Examples: cyclosporine (Gengraf), tracrolimus (Prograf) Patients should avoid grapefruit juice with cyclosporines because it prevents metabolism of the drug and increases its toxicity. Prograf is even more toxic but more effective.
Calcineurin Inhibitors include ____ and ______. They are the most _____ immunosuppressants available. These drugs prevent ____-mediated attacks against the transplanted organ. Do these drugs alter the inflammatory response? Do they suppress bone marrow? Neoral and Gengraf, microemulsions of cyclosporine, are replacing Sandimmune because of better and more consistent absorption.
Calcineurin Inhibitors include tacrolimus (Prograf) and cyclosporine (Gengraf). They are the most effective immunosuppressants available. These drugs prevent cell-mediated attacks against the transplanted organ. NO suppression of bone marrow or alterations of inflammatory response. Neoral and Gengrad, microemulsions of cyclosporine, are replacing Sandimmune because of better and more consistent absorption.
____drugs as Sirolimus (Repamune) is an immunosupppressive agent approved for use in ___ transplant recipients. It is used in combination with other drugs. What are 3 common side effects? Another common drug in this class is ______ which has similar side effects.
Cytotoxic drugs as Sirolimus (Repamune) is an immunosupppressive agent approved for use in renal transplant recipients. It is used in combination with other drugs. Common side effects include anemia, leukopenia. and thrombocytopenia. Another common drug in this class is CellCept which has similar side effects.
Mycophenolate mofetil (CellCept) and sirolimus (Rapamunel) are examples of _____ drugs. What is the major side effect of CellCept?
Mycophenolate mofetil (CellCept) and sirolimus (Rapamunel) are examples of CYTOTOXIC drugs.
CellCept side effect: GI toxicities including nausea, vomiting, and diarrhea. Side effects can be diminished by lowering the dose or giving smaller doses more frequently.
_____ _____ are used for preventing and treating acute rejection episodes. What are some side effects? What should be done before administration to prevent side effects?
MONOCLONAL ANTIBODIES are used for preventing and treating acute rejection episodes. Side effects may include fever, chills, dyspnea, chest pain, nausea, and vomiting. They may also cause an anaphylactic reaction. Patients should receive acetaminophen, diphenhydramine (Benadryl), and IV corticosteroids before administering the dose.
Polyclonal antibodies are used in_____ therapy and to treat ____ rejection. The purpose of induction therapy is to severely immunosuppress the individual immediately after transplantation to prevent early rejection. Allergic reactions to the foreign proteins which come from an animal manifest as _____, ____, and _____. These side effects can be prevented by administering the preparation slowly, over ___ to ___ hours, and premedicating patients with _____, ______, and _____. The main toxicities of polyclonal antibodies are ____ and _____.
Polyclonal antibodies are used in induction therapy and to treat acute rejection. The purpose of induction therapy is to severely immunosuppress the individual immediately after transplantation to prevent early rejection. Allergic reactions to the foreign proteins which come from an ANIMAL (horse) manifest as fever, arthralgias, and tachycardia. These side effects can be prevented by administering the preparation slowly, over FOUR to SIX hours, and premedicating patients with Tylenol, Benadryl, and methylprenisolone (Solu-Medrol). The main toxicities of polyclonal antibodies are LYMPHOPENIA and THROMBOCYTOPENIA.
Graft-versus-host disease (GVHD) occurs when an _______ patient is transfused or transplanted with ______ cells. In most transplantation situations, the biggest concern is the patient's (host's) rejection of the organ or transplant. In GVHD, however, the graft rejects the ___ tissue.
Graft-versus-host disease (GVHD) occurs when an immunoincompetent (immunodeficient) patient is transfused or transplanted with immunocompetent cells. In most transplantation situations, the biggest concern is the patient's (host's) rejection of the organ or transplant. In GVHD, however, the graft rejects the HOST tissue.
A GVHD response may result from the infusion of any ____ product containing viable lymphocytes, and from the transplantation of fetal thymus, fetal liver, or ___ ___. When is the onset of a GVHD response? Once the reaction is started, little can be done to modify its course. The exact mechanism involved in this reaction is not completely understood. However, it involves ____ T cells attacking and destroying vulnerable ___ cells.
A GVHD response may result from the infusion of any BLOOD product containing viable lymphocytes, and from the transplantation of fetal thymus, fetal liver, or BONE MARROW. The onset of a GVHD response is seven to thirty days after transplantation. Once the reaction is started, little can be done to modify its course. The exact mechanism involved in this reaction is not completely understood. However, it involves donor T cells attacking and destroying vulnerable host cells.
What are the 3 target organs of GVHD? The biggest problem with GVHD is...
Thee 3 target organs of GVHD are the skin, liver, and GI tract. The biggest problem with GVHD is infection, with different types seen in different periods. Bacterial and fungal infections predominate immediately after transplantation. The development of interstitial pneumonitis is the primary concern later in the coarse of the disease.
There is no adequate treatment of GVHD once it is established. Although ______ are often used, they enhance susceptibility to infection. The use of immunosuppressive agents such as methotrexate and cyclosporine has been most effective as a preventative/treatment rather than a preventative/ treatmentmeasure. ____ of blood products before they are administered is another measure to prevent T cell replication.
There is no adequate treatment of GVHD once it is established. Although CORTICOSTEROIDS are often used, they enhance susceptibility to infection. The use of immunosuppressive agents such as methotrexate and cyclosporine has been most effective as a PREVENTATIVE rather than a TREATMENT measure. RADIATION of blood products before they are administered is another measure to prevent T cell replication. (huh?... read about it page 232, look over drug table on 231...)
Which transplant rejection is described, hyperacute, acute, or chronic?
Most commonly occurs with kidney transplant
hyperacute
Which transplant rejection is described, hyperacute, acute, or chronic?
Organ must be removed when it occurs
hyperacute
Which transplant rejection is described, hyperacute, acute, or chronic?
Infiltration of the organ with B & T lymphocytes
chronic
Which transplant rejection is described, hyperacute, acute, or chronic?
Treatment is supportive
chronic
Which transplant rejection is described, hyperacute, acute, or chronic?
The recipient's T-cytotoxic lymphocytes attack the foreign organ
acute
Which transplant rejection is described, hyperacute, acute, or chronic?
Usually reversible with additional or increased immunosupressant therapy
acute
Which transplant rejection is described, hyperacute, acute, or chronic?
Occurs when recipient has antibodies against donor's HLAs
hyperacute
Which transplant rejection is described, hyperacute, acute, or chronic?
long-term use of immunosuppressants necessary to combat rejection
acute
Which transplant rejection is described, hyperacute, acute, or chronic?
Irreversible, immune mediated injury to transplanted organ
chronic