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

2. 2 Genetics Basic Principles of Genetics  Genes  Chromosomes  DNA  RNA  Protein synthesis  Mitosis  Meiosis Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

3. 3 Genetics Inheritance Patterns Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

4. 4 Genetics Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Fig. 14-1. Examples of family pedigrees. More detailed family pedigrees are shown in eFig. 14-2 available on the Evolve website for this chapter.

5. 5 Genetics Human Genome Project Genetic Testing Gene Therapy Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

6. 6 Nursing Management: Genetics Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Fig. 14-2. Punnett squares illustrate inheritance possibilities. A, If the mother and father are both carriers for cystic fibrosis, there is a 25% chance that offspring will have cystic fibrosis. B, If the mother 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 female offspring will be a carrier. C, If the mother has a normal genotype and the father has Huntington’s disease, there is a 50% chance that offspring will have the disease.

7. 7 Stem Cells Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

8. 8 Normal Immune Response Types of Immunity Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

9. 9 Normal Immune Response Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Table 14-4. Types of Acquired Specific Immunity.

10. 10 Normal Immune Response Types of Immunity, continued  Active acquired immunity  Passive acquired immunity Antigens Lymphoid Organs Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

11. 11 Normal Immune Response Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Fig. 14-3. Organs of the immune system.

12. 12 Normal Immune Response Cells Involved in Immune Response  Mononuclear phagocytes Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

13. 13 Normal Immune Response Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Fig. 14-4. The immune response to a virus. A, A virus invades the body through a break in the skin or another portal of entry. The virus must make its way inside a cell in order to replicate itself. B, A macrophage recognizes the antigens on the surface of the virus. The macrophage digests the virus and displays pieces of the virus (antigens) on its surface. C, A T helper cell recognizes the antigen displayed 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 provide communication among the cells. D, IL-2 instructs other T helper cells and T cytotoxic cells to proliferate (multiply). T helper cells release cytokines, causing B cells to multiply and produce antibodies. E, T cytotoxic cells and natural killer cells destroy infected body cells. F, The antibodies bind to the virus and mark it for macrophage destruction. G, Memory B and T cells remain behind to respond quickly if the same virus attacks again.

14. 14 Normal Immune Response Cells Involved in Immune Response, continued  Lymphocytes Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

15. 15 Normal Immune Response Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Fig. 14-5. Relationships and functions of macrophages, B lymphocytes, and T lymphocytes in an immune response.

16. 16 Normal Immune Response Cells Involved in Immune Response, continued  Lymphocytes B lymphocytes T lymphocytes T cytotoxic cells T helper cells Natural killer cells  Dendritic cells Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

17. 17 Normal Immune Response Cytokines Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

18. 18 Normal Immune Response Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 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.

19. 19 Normal Immune Response Comparison of Humoral and Cell- Mediated Immunity  Humoral immunity Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

20. 20 Normal Immune Response Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 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.

21. 21 Normal Immune Response Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Table 14-6. Types and Functions of Cytokines*.

22. 22 Normal Immune Response Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Table 14-8. Comparison of Humoral Immunity and Cell-Mediated Immunity.

23. 23 Normal Immune Response Comparison of Humoral and Cell- Mediated Immunity, continued  Cell-mediated immunity Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

24. 24 Gerontologic Considerations Effects of Aging on Immune System Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

25. 25 Gerontologic Considerations Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Table 14-9. Gerontologic Differences in Assessment.

26. 26 Altered Immune Response Hypersensitivity Reactions  Type I: IgE-mediated reactions Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

27. 27 Altered Immune Response Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Fig. 14-8. Steps in a type I allergic reaction.

28. 28 Altered Immune Response Hypersensitivity Reactions  Type I: IgE-mediated reactions, continued Anaphylaxis Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

29. 29 Altered Immune Response Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Fig. 14-9. Clinical manifestations of a systemic anaphylactic reaction.

30. 30 Altered Immune Response Hypersensitivity Reactions  Type I: IgE-mediated reactions, continued Atopic reactions Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

31. 31 Altered Immune Response Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Fig. 14-10. Atopic dermatitis of the lower leg.

32. 32 Altered Immune Response Hypersensitivity Reactions, continued  Type II: Cytotoxic and cytolytic reactions Hemolytic transfusion reactions Goodpasture syndrome Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

33. 33 Altered Immune Response Hypersensitivity Reactions, continued  Type III: Immune-complex reactions  Type IV: Delayed hypersensitivity reactions Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

34. 34 Altered Immune Response Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Fig. 14-11. Contact dermatitis to rubber.

35. 35 Altered Immune Response Hypersensitivity Reactions  Type IV: Delayed hypersensitivity reactions, continued Contact dermatitis Microbial hypersensitivity reactions Transplant rejection Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

36. 36 Allergic Disorders Assessment Diagnostic Studies  Skin tests Procedure Results Precautions Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

37. 37 Allergic Disorders Collaborative Care  Anaphylaxis  Chronic allergies Allergen recognition and control Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

38. 38 Allergic Disorders Collaborative Care, continued  Drug therapy Antihistamines Sympathomimetic/decongestant drugs Corticosteroids Antipruritic drugs Mast cell–stabilizing drugs Leukotriene receptor antagonists Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

39. 39 Allergic Disorders Collaborative Care, continued  Immunotherapy Mechanism of action Method of administration Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

40. 40 Nursing Management: Immunotherapy Latex Allergies  Types of latex allergies  Latex food syndrome Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

41. 41 Nursing and Collaborative Management: Latex Allergies Multiple Chemical Sensitivities Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

42. 42 Nursing and Collaborative Management: Latex Allergies Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Table 14-15. Guidelines for Preventing Allergic Latex Reactions.

43. 43 Autoimmunity Autoimmune Diseases Apheresis  Plasmapheresis Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

44. 44 Immunodeficiency Disorders Primary Immunodeficiency Disorders Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

45. 45 Immunodeficiency Disorders Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Table 14-17. Primary Immunodeficiency Disorders.

46. 46 Immunodeficiency Disorders Secondary Immunodeficiency Disorders Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

47. 47 Human Leukocyte Antigen System Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. 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 P 1 and P 2 and the haplotypes of the mother are labeled M 1 and M 2. Each child inherits two haplotypes, one from each parent. C, Therefore only four combinations—P1M 1, P1M 2, P2M 1, and P2M 2 —are possible, and 25% of the offspring will have identical HLA haplotypes.

48. 48 Human Leukocyte Antigen System Human Leukocyte Antigen and Disease Associations Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

49. 49 Organ Transplantation Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Fig. 14-13. Tissues and organs that can be transplanted.

50. 50 Organ Transplantation Tissue Typing  HLA typing  Panel of reactive antibodies  Crossmatch Transplant Rejection  Hyperacute rejection  Acute rejection Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

51. 51 Organ Transplantation Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Fig. 14-14. Mechanism of action of T cytotoxic lymphocyte activation and attack of transplanted tissue. 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.

52. 52 Organ Transplantation Transplant Rejection, continued  Chronic rejection Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

53. 53 Organ Transplantation Immunosuppressive Therapy Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

54. 54 Organ Transplantation Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Fig. 14-15. Sites of action for immunosuppressive agents.

55. 55 Organ Transplantation 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.

56. 56 Graft-Versus-Host Disease Copyright © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier Inc.