Genetics, Altered Immune Responses, and Transplantation Chapter 14 Overview Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc

Genetics, Altered Immune Responses, and Transplantation

Genetics, Altered Immune Responses, and Transplantation

Chapter 14 Overview

Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

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GeneticsGenetics

•Basic Principles of Genetics Genes Chromosomes DNA RNA Protein synthesis Mitosis Meiosis


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GeneticsGenetics

• Inheritance Patterns


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GeneticsGenetics


Fig. 14-1. Examples of family pedigrees. More detailed family pedigreesare shown in eFig. 14-2 available on the Evolve website for this chapter.

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GeneticsGenetics

•Human Genome Project•Genetic Testing•Gene Therapy


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Nursing Management: Genetics

Nursing Management: Genetics


Fig. 14-2. Punnett squares illustrate inheritance possibilities. A, If the mother and father are bothcarriers for cystic fibrosis, there is a 25% chance that offspring will have cystic fibrosis. B, If themother is a carrier for the hemophilia gene and the father has a normal genotype, there is a 50%chance that any male offspring will have hemophilia. There is a 50% chance that any femaleoffspring will be a carrier. C, If the mother has a normal genotype and the father has Huntington’sdisease, there is a 50% chance that offspring will have the disease.

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Stem CellsStem Cells


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Normal Immune ResponseNormal Immune Response

•Types of Immunity


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Table 14-4. Types of Acquired Specific Immunity.

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•Types of Immunity, continued Active acquired immunity Passive acquired immunity

•Antigens •Lymphoid Organs


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Fig. 14-3. Organs of the immune system.

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•Cells Involved in Immune Response Mononuclear phagocytes


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Fig. 14-4. The immune response to a virus. A, A virus invades the body through a break in the skinor another portal of entry. The virus must make its way inside a cell in order to replicate itself. B, Amacrophage recognizes the antigens on the surface of the virus. The macrophage digests the virusand displays pieces of the virus (antigens) on its surface. C, A T helper cell recognizes the antigendisplayed and binds to the macrophage. This binding stimulates the production of cytokines(interleukin-1 [IL-1] and tumor necrosis factor [TNF]) by the macrophage and interleukin-2 (IL-2)and γ-interferon (γ-IFN) by the T cell. These cytokines are intracellular messengers that providecommunication among the cells. D, IL-2 instructs other T helper cells and T cytotoxic cells toproliferate (multiply). T helper cells release cytokines, causing B cells to multiply and produceantibodies. E, T cytotoxic cells and natural killer cells destroy infected body cells. F, The antibodiesbind to the virus and mark it for macrophage destruction. G, Memory B and T cells remain behind torespond quickly if the same virus attacks again.

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•Cells Involved in Immune Response, continued Lymphocytes


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Fig. 14-5. Relationships and functions of macrophages, B lymphocytes, and Tlymphocytes in an immune response.

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•Cells Involved in Immune Response, continued Lymphocytes

• B lymphocytes• T lymphocytes

•T cytotoxic cells•T helper cells

• Natural killer cells Dendritic cells


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•Cytokines


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Fig. 14-6. Mechanism of action of interferon. When a virus attacks a cell, the cell begins to synthesize viral DNA and interferon. Interferon serves as an intercellular messenger. Interferon induces the production of antiviral proteins. Then the virus is not able to replicate in the cell.

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•Comparison of Humoral and Cell-Mediated Immunity Humoral immunity


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Fig. 14-7. Primary and secondary immune responses. The introduction of antigen induces a response dominated by two classes of immunoglobulins, IgM and IgG. IgM predominates in the primary response, with some IgG appearing later. After the host’s immune system is primed, another challenge with the same antigen induces the secondary response, in which some IgM and large amounts of IgG are produced.

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Table 14-6. Types and Functions of Cytokines*.

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Table 14-8. Comparison of Humoral Immunity and Cell-Mediated Immunity.

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•Comparison of Humoral and Cell-Mediated Immunity, continued Cell-mediated immunity


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Gerontologic ConsiderationsGerontologic

Considerations

•Effects of Aging on Immune System


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Gerontologic ConsiderationsGerontologic

Considerations


Table 14-9. Gerontologic Differences in Assessment.

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Altered Immune ResponseAltered Immune Response

•Hypersensitivity Reactions Type I: IgE-mediated

reactions


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Fig. 14-8. Steps in a type I allergic reaction.

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reactions, continued• Anaphylaxis


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Fig. 14-9. Clinical manifestations of a systemic anaphylactic reaction.

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reactions, continued• Atopic reactions


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Fig. 14-10. Atopic dermatitis of the lower leg.

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•Hypersensitivity Reactions, continued Type II: Cytotoxic and

cytolytic reactions • Hemolytic transfusion reactions• Goodpasture syndrome


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•Hypersensitivity Reactions, continued Type III: Immune-complex

reactions Type IV: Delayed

hypersensitivity reactions


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Fig. 14-11. Contact dermatitis to rubber.

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•Hypersensitivity Reactions Type IV: Delayed

hypersensitivity reactions, continued• Contact dermatitis• Microbial hypersensitivity reactions

• Transplant rejection


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Allergic DisordersAllergic Disorders

•Assessment•Diagnostic Studies

Skin tests• Procedure• Results• Precautions


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•Collaborative Care Anaphylaxis Chronic allergies

• Allergen recognition and control


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•Collaborative Care, continued Drug therapy

• Antihistamines • Sympathomimetic/decongestant drugs

• Corticosteroids • Antipruritic drugs • Mast cell–stabilizing drugs• Leukotriene receptor antagonists


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•Collaborative Care, continued Immunotherapy

• Mechanism of action • Method of administration


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Nursing Management: Immunotherapy

Nursing Management: Immunotherapy

•Latex Allergies Types of latex allergies Latex food syndrome


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Nursing and Collaborative Management: Latex

Allergies


Allergies

•Multiple Chemical Sensitivities


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Allergies


Allergies


Table 14-15. Guidelines for Preventing Allergic Latex Reactions.

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AutoimmunityAutoimmunity

•Autoimmune Diseases•Apheresis

Plasmapheresis


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Immunodeficiency Disorders


•Primary Immunodeficiency Disorders


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Table 14-17. Primary Immunodeficiency Disorders.

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•Secondary Immunodeficiency Disorders


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Human Leukocyte Antigen System



Fig. 14-12. Patterns of human leukocyte antigen (HLA) inheritance. A, HLA genes are located on chromosome 6. B, The two haplotypes of the father are labeled P1 and P2 and the haplotypes of the mother are labeled M1 and M2. Each child inherits two haplotypes, one from each parent. C, Therefore only four combinations—P1M1, P1M2, P2M1, and P2M2—are possible, and 25% of the offspring will have identical HLA haplotypes.

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•Human Leukocyte Antigen and Disease Associations


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Organ TransplantationOrgan Transplantation


Fig. 14-13. Tissues and organs that can be transplanted.

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•Tissue Typing HLA typing Panel of reactive antibodies Crossmatch

•Transplant Rejection Hyperacute rejection Acute rejection


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Fig. 14-14. Mechanism of action of T cytotoxic lymphocyte activation and attack of transplantedtissue. The transplanted organ (e.g., kidney) is recognized as foreign and activates the immune system. T helper cells are activated to produce interleukin-2 (IL-2), and T cytotoxic lymphocytes are sensitized. After the T cytotoxic cells proliferate, they attack the transplanted organ.

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•Transplant Rejection, continued Chronic rejection


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• Immunosuppressive Therapy


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Fig. 14-15. Sites of action for immunosuppressive agents.

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• Immunosuppressive Therapy, continued Calcineurin inhibitors Sirolimus Mycophenolate mofetil Polyclonal antibodies

(antithymocyte globulin and antilymphocyte globulin)

Monoclonal antibodies Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

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Graft-Versus-Host DiseaseGraft-Versus-Host Disease


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Genetics, Altered Immune Responses, and Transplantation Chapter 14 Overview Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc