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MLS Immunology Exam

Term	Definition
The Complement System	A series of 35 proteins that are synthesized by the liver, monocytes, macrophages, and epithelial cells. The main functions of these proteins are to defend the host against infection, clear immune complexes, and join the innate +adaptive immune system
Three Pathways of the Complement System	Classic, Alternative, Mannose-binding Lectin. All three of these converge at the activation of C3.
Mannose binding Lectin Pathway	This pathway does not have C1, but MASP1 and MASP2. Initiated by a certain surface molecule.
Alternative Pathway	This pathway does not have C1, or C4, but Factor B, D and properdin. Initiated by a certain surface molecule.
MAC (Membrane Attack Complex)	This makes an intracellular "hole" for lysis. Includes C6, C7, C8 and C9.
Anaphylatoxins	These fragments of the complement system have a certain function. C3a, C4a, and C5a are all _______. They cause histamine release, smooth muscle contractions and an increase in vascular permeability
Opsonins	These fragments of the complement system have a certain function. C3b, iC3b and C4b are all _________. They bind receptors on phagocytic cells to increase phagocytosis and aid in clearing immune complexes.
Complement Regulators	C1INH controls both classic and MBL pathways. C1INH causes C1r and C1s to dissociate from C1q in classic pathway. C1INH prevents binding of MBL to MASP2 in lectin pathway.
Agglutination and Precipitation	These two immunoassays rely on multiple binding sites of both Ab and Ag. Soluble Ag rxn = ___________ while a particulate antigen rxn = ______________.
Precipitation	Ab and Ag combine to form insoluble lattices. Examples include electrophoresis and nephelometry
Equivalence (Agg. & Precip)	Ag and Ab at which binding sites and epitopes are roughly equal. Has the highest amount of precipitation.
Prozone	Too much Ab - little or no precipitation occurs and thus would test negative for Ab. Must dilute patient sample.
Postzone	Too few Ab - little or no precipitation occurs and thus would test negative for Ab. Must redraw blood to increase titer.
Immunodiffusion / Ouchterlony	A double diffusion gel precipitation. Ab & Ag diffuse through gel. Ab and Ag are in adjacent wells. A precipitin line forms where Ab and Ag are at equivalence. Determines antigenic relatedness of unknown test with known Ag.
Ouchterlony- Identity	Two wells filled with same Ag diffuse to make line of identity.
Ouchterlony- Patrial Identity	Teo wells filled with same Ag but different epitopes.
Ouchterlony- Nonidentity	Two wells filled with different Ag that form a line of _______.
Radial Immunodiffustion	Quantitative immunoprecipitation technique. Different Ag concentrations but constant Ab. Diameter related to concentration of Ag
Nephelometry and Turbidimetry	Optical analysis methods to acquire and analyze Ab/ Ag lattice formations.
Turbidimetry	Initial cloudiness is measured by passing a light through solution. Measures light the gets across solution which is proportional to the concentration of molecules
Nephelometry	Measures light scatter at different angles than incoming light source, Some limitations due to excess in solution
Labels/ Labeled Immunoassays	These are attached to Ab or Ag to increase sensitivity of detection. Includes radio, enzymes , fluorescence, chemiluminsescense
Enzyme Labels	This kind of label requires the addition of a substrate that in turn produces a color change, fluorescens or a flash of light
Heterogenous Assay Labels	Radiolabels, enzymes/substrates, fluorescence (FITC apple green)
Direct vs Indirect Immunoassays	Labeled Ab + Ag or labeled Ag + Ab. VS Unlabeled Ag + unlabeled Ab + labeled antiglobulin
Sandwich (Capture) Immunoassay	Captures Ag between two Ab, one of which is attached to a solid phase and the other is labeled.
Competitive Immunoassay	Small Ag with one epitope. Limited reagent,
Western Blot	Gel electrophoresis separates proteins of pathogens. Separated proteins are transferred to nitrocellulose paper. Nonspecific binding sites blocked by dried milk. Add patient sample containing Ab to paper, add 2nd labeled Ab and substrate.
Direct vs Indirect Fluorescence Assays	Sample fixed to slide conjugate specific to Ab is laid on sample, labeled Ab bind to Ag ex. Flow
Flow Cytometry	Cell measured as they pass through a light source in a fluid stream. Combines immunofluorescent assay with cell sampling and cell optics.
AIDS	Less than 200 CD4 T cells is indicative of what disease?
Hypersensitivity Reaction	A problem in the function of either part of or total function of the immune system, creating partial or total immunodeficiency. Friendly fire from the immune system towards an innocuous Ag. Depends on host response and not nature of Ag.
Allergen	Harmless Ag that stimulates an IgE response
ACID 1- Anaphylaxis 2. Cell Mediated 3. Immune Complex 4. Delayed	What are the four types of hypersensitivity and the acronym used to remember them?
Type 1 Hypersensitivity- Anaphylaxis	Immediate, IgE mediated, localized or systemic. Reaction is a result of release of mediators from mast cells and basophils, only activated at second exposure. Ag stimulates Ab IR by activating CD4. Ex. Allergic Rhinitis and certain foods. Causes uticaria.
Sensitization	Previously exposed to an Ag, have developed an immune response
Type 2 Hypersensitivity- Cell/Surface Bound Ab	mediated by IgG and IgM. Cellular destruction as a result of Ab/complement mediated lysis, opsonization and cytotoxicity. Results in tissue destruction. Ex. Hemolytic Anemia
Type 3 Hypersensitivity- Immune Complex Mediated	Inflammatory response via complement system responds directly to Ag itself. Complexes precipitate into tissue. Ex. SLE, RA
Type 4 Hypersensitivity- Delayed	Mediated by CD4 and CD8 cells that release cytokines and recruits inflammatory cells at exposure site. Results in localized tissue damage, contact dermatitis. Ex. Poison ivy/oak and nickel.
Autoimmunity	Affects females more than males, HLA and MHC thought to be influential. Includes molecular mimicry.
SLE	Titers greater than or equal to 80 indicate ______.
Staining patterns in nuclei	Homogenous - SLE Speckled - MCTD, Sjorgen's, SLE, Scleroderma Nucleolar - SLE, Scleroderma Centromere - CREST
Liver	This organ has metabolic functions as well as storage, immune and endocrine.
Metabolic Functions of Liver	Breaks down carbs, amino acids, lipids, hemoglobin. Breaks down ammonia to urea and removes toxins
Synthetic Functions of Liver	Makes plasma proteins (albumin), lipids, triglycerids, fatty acids, coag proteins and RBCs in infants
Storage Function of Liver	Vitamins, minerals and carbs in the form of glycogen
Immune Functions of Liver	Mononuclear phagocytic system, removal of immune complexed from circulation
ALT, AST, ALP, bilirubin, PT/INR	Increases with decreased liver function or biliary obstruction.
Cirrhosis	Fibrous tissue that forms due to damage to liver structure and impaired function
Cholestatis	Suppression of flow and or synthesis of bile due to impaired liver function related to hepatobiliary system or obstruction
5 Causes of Hepatits	Primary viral, secondary viral (CMV, EBC, Herpes), bacterial, drug/toxins (ethanol) , parasites
HAV Serological Tests	HAVT Ab, HAVIgM Ab, HAVIgG Ab, NO AG TESTS
HBV Serological Tests	HBsAg, HBsAb, HBeAg, HBeAb, HbcT and HBcIgM - NO AG for C!!
HCV Serological Tests	HCV Ab, HC RNA Qualitative, HC RNA Quantitative, HC Genotyping - NO AG
HDV Serological tests	HDAg, HDAb
HEV Serological Tests	HEAb - NO AG
Spirochetes	A group of motile, anaerobic, gram negative bacteria with axial flagella. Examples include syphilis, Lyme disease and leptospirosis.
Lyme Disease	This disease is spread by deer ticks and is due to the presence of Borrelia burgdorferi. A bullseye rash (erythema chronicum migrans) may appear 3-30 days post infection. Tested with IFA, ELISA and confirmed with Western Blot. Tests look for Ab, NOT Ag.
Treponema Pallidum; mostly transmitted sexually	What is the bacteria responsible for syphilis and how is it transmitted?
When is syphilis considered primary? What are the symptoms?	10-90 days; Chancres at transmission site and swollen lymph nodes
When is syphilis considered secondary? What are the symptoms?	2-8 weeks; rash and lesions occur as well as warts and flu like symptoms. This stage is most contagious.
When is syphilis considered latent? What are the symptoms?	5-20 years, but can be earlier; usually asymptomatic
When is syphilis considered tertiary? What are the symptoms?	as early as 1 year; issues with CNS and cardiac system, formation of granulomas
Syphilis Testing	Detects organism directly, treponemal and non-treponema, IFA, ELISA, PCR, Multiplex Flow Assay (Bioplex), VDRL (venereal disease research lab, requires CSF), RDR, TPPA
Non-treponemal syph screenings	Bioplex, RPR (Rapid Plasma Reagin which is a flocculation test), VDRL
HIV	An incurable virus that attacks the immune system. Detected by low # of CD4 cells. Belongs to Lentivirus family and has 2 types, oral and genital.
Structure of HIV	This organism has 2 copies of RNA, proviral DNA and 3 structural genes
3 Structural Genes of HIV	Gag- capsid, matrix, nucleocapsid Pol- integrase, reverse transcriptase, protease Env- gp120 and gp41 which bind to cells for infection
Viral IgG	develops 1-2 weeks after primary infection, peaks at 4-8 weeks and remains detectable throughout life
Viral IgM	found within first few weeks of infection, becomes undetectable after a few months, A fourfold raise in titer indicates active infection

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