Bone Marrow Transplant

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Stem Cells become

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red blood cells
white blood cells
platelets

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Stem cells come from

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marrow
cord blood
peripheral

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HCT

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33 %

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Hemoglobin

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12-16 grams/Dl

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Types of WBCs

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Neutrophils
Monocytes
Lymphocytes

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Neutrophils

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primary defense against harmful bacteria

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Monocytes

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cells that assist in the fight against bacteria and fungi
- one of the macrophages which mainly fight fungal, protozoan, or parasitic

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Lymphocytes

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create antibodies
T-Cell and B-cell

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T-Cells

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recognize foriegn material
activate B-cells

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B-Cells

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to produce antibodies that recognize a previous infection

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Platelets

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blood clotting

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Engraftment

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ANC is greater than 500 for three consecutive days
as early as 14 days but usually closer to 30
first 100 days is the most critical

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HLA

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Human Leukocyte Antigen
an antigen is a substance on the surface of the lymphocyte cells
recognizes self and non-self

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Transfuse blood when hemoglobin is

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<8

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Transfuse platelets when hemoglobin is

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, 20

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Stre. Pneumoniae
Prophylaxis

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Pneumococcal polysaccharide vaccine 23 @ 12 and 24 months (not children <2)
TMP-SMZ

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Engraftment

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ANC > 500/mm3
& sustained platelets 20,000
lasting 3 consecutive without transfusion s

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Phase I, preengraftment

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first 30 days posttransplant
Cautions
1. prolonged neutropenia
2. breaks in the mucocutaneous barrier

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Phase II, postengraftment

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Impaired cell-mediated immunity
key factors: extent of GVHD and level of immunosuppressive

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CMV

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causes pneumonia, hepatitis, and colitisis and potentiates superinfection with opportunistic pathogens

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Antigen Presenting Cells

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is a cell that displays foreign antigen complex with MHC on its surface

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Antibodies

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circulate in the blood and bind to antigens on infectious agents
- inactivation of microorganism
- activation of inflammatory response

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Humoral immunity

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is the aspect of immunity that is mediated by secreted antibodies (B Cells)

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T Cells become

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T regulatory cells
Cytotoxic T Cells
Memory T Cells

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Cytotoxic T cells

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directly attack and kill targets directly
Cellular immunity

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Passive Acquired Immunity

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does not involve the host's immune response but rather occurs when preformed anitbodies or T lymphocytes are transferred from a donor to the recipient.
For example, IVIG administration

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CD

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Cluster of differentiation
large family of protiens found on the surface of cells

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antigens is immunogenic based on

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- foriengnness to the host
- appropriateness in size
- having an adequate chemical complexity
- being present in a suggicient quantity

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MHC

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major histocompatibility complex
recognition molecules
antigen presention is the primary role of molecules of the MHC
- glyco protien found on the surface of all human cells except RBC
Class I or II

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Humans have two copies of each MHC locus (one inherited from each parent) that are co-dominant so that molecules encoded by each parent's genes are expressed on the cell surfae.

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Within an individual, each locus will be expressing only one allele. For example, each person will have only two different A protiens ( one from each parent). However, with the tremendous number of possible alleles that can be expressed, it is likely that any two unrelated individuals will have different sets of MHC molecules on their cell surface.

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Rejection happens when

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a different set of MHC surface antigens than those of the recipient are seen as foreign.

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Six major HLA locations

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A, B, C, DR, DQ, and DP is termed a haplotype

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Haplotype

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Each individual has two haplotypes: one from teh paternal chromosome 6 and another from the mother

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Antigen presenting molecules

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Class I MHC
Class II MHC
CD 1

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CD1 molecules specialize in

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lipid antigens contained in lipoprotiens, glycoplipids, and other molecules. Usuaully bacterial with the Mycobacterium spp.
(e.g. Mycobacterium tuberculosis)

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anitbody

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immunoglobin
produced by plasma cells (B)

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5 types of immunoglobins

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IgG
IgA
IgM
IgE
IgD

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IgG

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most common
protect against infection
IG 1-4

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IgA

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IgA 1-2
A1 in the blood
A2 normal body secretions
mucosal epothelial cells that protect against degradation by enzymes
It is found in body secretions such as saliva, sweat, or tears. IgA prevents the attachment of viruses and bacteria to skin and intestinal lining surfaces.

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IgM

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initial/primary response to antigen
early on in an infection

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IgD

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on immature and developing B lymphocytes
low amounts in serum

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IgE

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least concentrated
allergic responses
defends against parasites

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cytokines

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chemical signals between cells
i.e IL 1
start + or - regulation responses
fx: target cells (1)to proliferate and differentiate, (2) create proteins
can effect not only lymphocytes but inflammatory responses and hematopoietic cells
can be antagonistc - inducing opposite effects on the cell

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IL1

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T cell to prolifteration and di fferentiation; induces acute phase proteins in inflammatory response; endogenous pyrogens

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neutrophils

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phagocytes
early inflammatory process
short lived
component of the purulent exudate - pus

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monocytes or macrophages

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same as neutrophils but for a longer time and in a later stage of the inflammatory process
activate the adaptive immune system

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Specialized Macrophages

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Kupffer cells - liver
Alveolar - lungs
brain - macroglia

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CD8

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mature cytotoxin cells

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CD4

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Mature helper cells

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Increased Na
> 145

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dehydration
polyuria
OCP
steroids
decreased h20
hyperadldosteronism

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Decreased NA
< 135

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CHF
Cirrhosis
v/d
Increased exercise
adrenal insufficiency
SIADH
nephropathy

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Increase K
> 5.0

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hemolysis
tissue damage
rhabdomyolsis
acidosis
dehydration
renal failure
Addison's

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Decreased K
< 3.5

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n/v, decreased intake
hyperaldosteronism
Cushing's
hyperglycemia

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Increased CL
> 107

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acid base imbalance
renal failure
resp. alkalosis
metabolic acidosis c diarrhea
hyperadenocortism

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Decreased CL
< 98

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v/d
chronic resp acidosis
DKA
SIADH
metbolic alkalosis

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Increased CO2
> 28

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metabolic alkalosis
comp resp acidosis
mineral corticoid excess

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Decreased CO2
< 22

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metabolic acidosis
comp resp aalkalosis
Faconi syndrome
volume overload

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Albumin
3.4- 4.7

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major component in plasma proteins/ binds proteins - used to monitor liver fx
> dehydration, shock, hemoconcentration
< decreased hepatic synthesis due to chronic liver disease

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Increased Glucose

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DM, steroids, cushing, chronic pancreatitis

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ESR

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> infection, inflammation, chronic renal failure
< polycythemia, scd, CHF

good correlation with c reative protein

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decreased CD4

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cmv, hiv, gvhd, all
helper t cells