Care of Patients

with Immune
Disorders
Adult Health Nursing
June 16, 2009

Key Terms

Antibody a protein substance developed by

the body in response to and interacting with a
specific antigen.
Antigen substance that induces production of
antibodies.
B-cells cells that are important for producing a
humoral immune response.
Cellular immune response the immune
systems third line of defense, involving the
attack of pathogens by T-cells.
Cytokine generic term for non-antibody
proteins that act as intercellular mediators, as
in the generation of immune response.

Genetics engineering emerging technology

designed to enable replacement of missing
or defective genes.
Helper T-cells lymphocytes that attack
foreign invaders (antigen) directly.
Humoral immune response the immune
systems second line of defense, often
termed the antibody response.
Immunity the bodys specific protective
response to an invading foreign agent or
organism.
Immunology the study of the immune
system.

Lymphokines substances released by

sensitized lymphocytes when they come in
contact with specific antigens.
Macrophages any phagocytic cell involved in
defense against infection.
Memory cells are responsible for recognizing
antigens from previous exposure and
mounting an immune response.
Natural killer cells (NK cells) lymphocytes that
defend against microorganisms and
malignant cells.

Phagocytic cells they engulf, ingest,

and destroy foreign bodies or toxins.
Phagocytic immune response the
immune systems first line of defense,
involving white blood cells that have
the ability to ingest foreign particles.
Stem cells precursors of all blood cells,
that reside primarily in bone marrow.

Immunity is the quality of being insusceptible to

or unaffected by a particular disease or
condition.
It refers to bodys specific protective response
to an invading foreign agent or organism.
The immune system functions as the bodys
defense mechanism against invasion and
allows a rapid response to foreign substances
in a specific manner.

The body exhibits a wide array of adaptations to

protect against antagonistic forces that are
constantly attacking and threatening its integrity
The word immune is derived from the Latin
word immunis, meaning free from burden.

Immunology is an evolving science that

essentially deals with the bodys ability to
distinguish self from non-self; and it is
accomplished through a complex network of
highly specialized cells and tissues that are
collective called immune system.
Immune system also called the host defense
system is critical to our survival.

Three main functions of the immune system:

1. to protect the bodys internal environment
against invading organisms
2. to maintain homeostasis by removing damaged
cells from the circulation
3. to serve as a surveillance network for
recognizing and guarding against development
and growth of abnormal cells.

Immunocompetence a condition wherein the

immune system responds appropriately to a
foreign stimulus, and able to maintain the bodys
integrity.
Immunocompetence is possible because the
immune system is able or has the capacity to
mobilize and use its antibodies and other
responses to stimulation by an antigen.
If the immune system response is to weak or too
vigorous, homeostasis is disrupted, causing a
malfunction or immunoincompetence.

Four categories of inappropriate responses of

the immune system:

Hyperactive responses against environmental

antigens such as allergic reaction.
Inability to protect the body as in
immunodeficiency disorders such as in AIDS.
Failure to recognize the body as self, as in
autoimmune disorders such as in systemic lupus
erythematosus, rheumatoid arthritis.
Attacks on beneficial foreign tissue as in organ
transplant or transfusion reaction.

TWO TYPES OF IMMUNITY

a) Innate or Natural - The bodys first line of
defense
Provides physical and chemical
barriers to invading pathogens and
protects against the external environment.
b) Adaptive or Acquired Immunity second
line of defense

The innate immune system is composed of:

Skin and mucous membranes
Cilia
Stomach acid
Tears
Saliva
Sebaceous glands
Secretions and flora of the intestine and vagina
Innate immunity does not always work, then
adaptive immunity is the next line of defense.

TWO TYPES OF IMMUNITY, cont..

A) INNATE OR NATURAL - The bodys first
line of defense
B) ADAPTIVE, OR ACQUIRED, IMMUNITY This is the bodys second line of defense
against disease. It provides a specific
reaction to each invading antigen and has
the unique ability to remember the antigen
that cause the attack. It is composed of
highly specialized cells and tissues,
including the thymus, spleen, bone
marrow, blood and lymph.

ADAPTIVE, OR ACQUIRED, IMMUNITY Adaptive, or acquired, immunity includes

both humoral and cell-mediated immunity.
The characteristics of an adaptive immune
system are specificity (i.e., being specific)
and memory.
This special immunity results from
the production of antibodies in the cells.
Antibodies develop naturally after infection
or artificially after vaccinations.

Adaptive or Acquired Immunity

If the components of innate or natural
immunity fail to prevent invasion or destroy
a foreign pathogens the adaptive or
acquired immunity is summoned to assist
the fight.
Adaptive or acquired immunity provides a
specific reaction to each invading antigen
and has the unique ability to remember
(memory) the antigen that caused the
attack.

The major components/structure of the

immune system include the:
Bone marrow
White Blood cells produced by bone
marrow
Lymphoid tissues including:
the

thymus gland,
the spleen,
the lymph nodes,
the tonsils, and adenoids, and similar tissues in
the GI tract, respiratory, and reproductive
system

Adaptive immunity protects the internal

environment.
It is acquired during life but not present at birth,
usually develops as a result of prior exposure to
an antigen through immunization (vaccination) or
by contracting a disease, both generate a
protective immune response.
Adaptive immunity utilizes cells in defending the
body. It includes both humoral (B-cells) and cellmediated immunity (T-cells).
A specific type of white blood cell, known as
lymphocyte, is involved in the defense.

*
Acquired or Adaptive immunity is further
classified into two:
1. Active
2. Passive

Active Acquired Immunity the immunologic

defenses are developed by the persons own
body. It typically lasts many years or even
lifetime.
Individual develops antibodies in response to
having a disease process or by response to
artificial antigens such as a vaccine or toxoids.
Response can be boosted and maintained via
repeated injections.

Passive Acquired Immunity is temporary

immunity transmitted from a source outside
the body that has developed immunity
through previous disease or immunization.
Example: immune globulin or antiserum
obtained from the blood plasma of people
with acquired immunity is used in
emergencies to provide immunity to
diseases when the risk for contracting a
specific disease is great (after exposure to
hepatitis) that there is no enough time for a
person to develop adequate active
immunity.

Another example of passive acquired

immunity is the transfer of antibodies from
the mother to an infant in utero or through
breast feeding.
Passive acquired immunity requires an
antibody be introduced to individual, either
by maternal transfer (placenta and/or
colostrum) or immune serum antibody
injection, to promote a specific antigen
response. Another example is tetanus
immune globulin.

Macrophages (phagocytic immune

response)
When organisms pass the epithelial
barriers, phagocytes (macrophages)
become activated. They have the ability to
migrate through blood stream to the tissues
for the bodys second line of defense
against disease.
Phagocytes engulf and destroy
microorganisms that pass the skin and
mucous membrane barriers. These cells
also assist in the immune response by
carrying antigens to the lymphocytes.

Lymphocytes
Lymphocytes include the T and B cells, and
the large, granular lymphocytes also known
as natural killer, or NK cells.
T-cells (processed in the thymus)
Approximately 70% - 80% of lymphocytes
are T-cell lymphocyte. When activated Tcell release a chemical substance called
Lymphokine it attracts macrophages to the
site of infection or inflammation and
prepares them for attack.

T-cells cooperate with the B-cells to

produce antibodies but do not produce
antibodies themselves.
T-cells are responsible for cell-mediated
immunity and provide the body with
protection against viruses, fungi, and
parasites.
T-cells also provide protection in allograft
and against malignant cells.

Cellular Immunity
Cellular immunity is also called cellmediated immunity, results when T-cells
are activated by an antigen.
Once these T cells have been sensitized,
they are released into the blood and body
tissues, where they remain indefinitely. On
contact with the antigen to which they are
sensitized they will attach to the organism
and destroy it.

Cellular Immunity is important in:

Immunity against pathogens that survive inside

cells including viruses and some bacteria
(mycobacterium)
Fungal infections
Rejection of transplanted tissues
Contact hypersensitivity reactions
Tumor immunity
Certain immune diseases

B-cells (processed in the red marrow)

B-cells make up approximately 20% - 30%
of the lymphocytes.
B-cells cause the production of antibodies
and proliferate in response to a particular
antigen. B-cells migrate peripheral
circulation and tissues filtered from the
lymph and stored in the lymphoid tissue of
the body.

B-cells (processed in the red marrow)

B cells are responsible for humoral
immunity, produce antibodies and provide
protection against bacteria, viruses, and
soluble antigens.
T and B cells they both originate in red bone
marrow.

B Cells -The cells of the immune system

that make antibodies to invading pathogens
like viruses.
They form memory cells that remember
the same pathogen for faster antibody
production in future infections.

Humoral Immune Response

Humoral immunity responds to antigen such as
bacteria and foreign tissue.
It is the result of the development and continuing
presence of circulating antibodies in the plasma.
It is sometimes called the antibody response.
Humoral immunity begins with the Blymphocytes, which transforms themselves into
plasma cells that manufacture antibodies in
response to antigen challenge.
The concept of memory is important to success
of humoral immunity.

Differences in Cellular and

Humural Immune responses
Cellular Responses (T-Cells)

Humoral Responses (B-Cells)

Transplant rejection

Bacterialphagocytosis&lysis

Delayed hypersensitivity (TB

PPD)

Anaphylaxis

Graft-versus-host disease

Allergic hay fever &asthma

Tumor surveillance or destruction

Immune complex disease

Intracellular infection

Bacterial and some viral infections

Viral, fungal, and parasitic

infections

Antigen or allergen
Antigen or allergen is the invading or
attacking organism that is responsible for
stimulating antibody production.

Example of allergen or antigen:

A single bacterium or large molecule, such as
diphtheria or tetanus toxin may have several
antigens, or markers, on its surface, thus inducing
the body to produce a number of different
antibodies.
Once produced, an antibody is released into the
bloodstream and carried to the attacking
organisms. There it combines with the antigen,
binding it like an interlocking piece of jigsaw
puzzle.

There are four (Rs) well defined stages in

an immune response:
Recognition recognized self from non-self
Respond produce antibodies
Remember ability to remember
Regulate self-regulation, ability to turn off
thus preventing chronic inflammatory
response

Immunocompetence is the ability of an immune

system to mobilize and deploy its antibodies and
other responses to stimulation by antigen.
Both the number and functions of the helper and
suppressor T cells help determine the strength
and persistence of an immune response.
The normal ratio of helper T cells to suppressor T
cells in the body is 2 : 1, when this ratio is
disrupted, autoimmune and immunodificient
disease occur.

COMPLEMENT SYSTEM
The complement system is a system of
approximately 25 serum enzymatic proteins
that interact with one another and with other
components of the innate (natural) and
adaptive (acquired) immune systems.
Normally, complement enzymes are
inactive in plasma and body fluids.

COMPLEMENT SYSTEM
When an antigen and antibody interact, the
complement system is activated.
Complement functions in a step-bystep series much like the clotting
mechanism, but with different purpose. The
complement system can destroy the cell
membrane of many bacterial species, and
this action attracts phagocytes to the area.

Genetic Control of Immunity

More is being discovered about the genetic
role in immunity. There is a genetic link to
both well-developed immune system and
poorly developed or compromised immune
systems.

The immune system develops at

different rates and at different times in fetal
and early life. For humans, bone marrows
provides the continuous service of stem
cells and all the other cells involved in the
immune response.

EFFECTS OF NORMAL AGING ON THE

IMMUNE SYSTEM
With advancing age, there is a decline in
the immune system.
The

primary clinical evidence for this

immunosenescence is the high incidence of
tumors in older adults.
A greater susceptibility also occurs to infections
(such as influenza and pneumonia) from
pathogens that an older person has been
relatively immunocompetent against earlier in
life.

EFFECTS OF NORMAL AGING ON THE

IMMUNE SYSTEM
Aging does not affect all aspects of the
immune system. The bone marrow is
relatively unaffected by increasing age.
However, aging has a pronounced effect on
the thymus, which decreases in size and
activity with aging.
These changes in the thymus are probably
a primary cause of immunosenescence.

EFFECTS OF NORMAL AGING ON THE

IMMUNE SYSTEM
However, the most significant alterations
seem to involve T cells. As thymic output of
T cell diminishes, the differentiation of T
cells in peripheral lymphoid structures
increases. Consequently, there is an
accumulation of memory cells rather than
new precursor cells responsive to
previously unencountered antigens.

EFFECTS OF NORMAL AGING ON THE

IMMUNE SYSTEM
Delayed hypersensitivity response is
frequently decreased or absent in older
adults. The clinical consequences of a
decline in cell-mediated immunity are
evident.
Diminished responses to delayed
hypersensitivity skin tests in older adults are
related to an increased risk of cancer
mortality, as well as mortality in general
(Older Adult Considerations box).

To be continued..