2. Autoimmunity 2. Autoimmunity or Autoantibodies or Autoantibodies Inappropriate reaction by the immune system in Inappropriate reaction by the immune system in which antibodies form against self antigens, which antibodies form against self antigens, mistaken as foreign. mistaken as foreign. E.g. E.g. – Tissue injury ( may help the body rid itself of damaged Tissue injury ( may help the body rid itself of damaged or necrotic self component) or necrotic self component)
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– invade and deposit in the capillaries, the– invade and deposit in the capillaries, the
synovium of joints---synovium of joints--- it causes tissue damage viait causes tissue damage via
activation of the complement system.activation of the complement system. Activation of sensitized T lymphocytes Activation of sensitized T lymphocytes: by the: by the
Immunoglobulins and AllergicImmunoglobulins and Allergic
ResponseResponse
AntibodiesAntibodies (IgE, IgD, IgG, IgM, and IgA) react(IgE, IgD, IgG, IgM, and IgA) reactwith specific effector cells and molecules, andwith specific effector cells and molecules, andfunction to protect the bodyfunction to protect the body
IgE antibodiesIgE antibodies are involved in allergic disordersare involved in allergic disorders
IgE moleculesIgE molecules bind to an allergen and triggerbind to an allergen and triggermast cells or basophilsmast cells or basophils
These cells then releaseThese cells then release chemical mediatorschemical mediators suchsuchasas histamine, serotonin, kinins, SRS-A, andhistamine, serotonin, kinins, SRS-A, and
neutrophil factorneutrophil factorThese chemical substances cause the reactionsThese chemical substances cause the reactionsseen in allergic responseseen in allergic response
– Type II Cytolytic or CytotoxicType II Cytolytic or Cytotoxic
HypersensitivityHypersensitivity
The antigen-antibody complex and complementThe antigen-antibody complex and complementattach to a cell – circulating blood cellattach to a cell – circulating blood cell cell lysis.cell lysis.
Type IV Cell Mediated DelayedType IV Cell Mediated DelayedHypersensitivityHypersensitivity
– Sensitized T cells respond to antigens by releasingSensitized T cells respond to antigens by releasinglymphokines, which direct phagocytic cell activity.lymphokines, which direct phagocytic cell activity.
Prevention and Treatment of AnaphylaxisPrevention and Treatment of Anaphylaxis
Screen and prevent:Screen and prevent:
Treat respiratory problems; provide oxygen,Treat respiratory problems; provide oxygen,intubation, and cardiopulmonary resuscitation asintubation, and cardiopulmonary resuscitation as
neededneeded
Epinephrine: 1:1,000Epinephrine: 1:1,000 SQSQ
Auto injection system: EpiPenAuto injection system: EpiPen
May follow with IV epinephrineMay follow with IV epinephrine
The round or disk shaped (discoid) rash of lupus producesThe round or disk shaped (discoid) rash of lupus produces
red, raised patches with scales. The pores (hair follicles)red, raised patches with scales. The pores (hair follicles)
may be plugged. Scarring often occurs in older lesions. Themay be plugged. Scarring often occurs in older lesions. The
majority (approximately 90%) of individuals with discoidmajority (approximately 90%) of individuals with discoid
lupus have only skin involvement as compared to morelupus have only skin involvement as compared to moregeneralized involvement in systemic lupus erythematosisgeneralized involvement in systemic lupus erythematosis
a chronic inflammatory disease of a chronic inflammatory disease of autoimmune origin.autoimmune origin.
presence of presence of autoantibodiesautoantibodies to numerousto numerousnuclear proteins, blood and nerve cells,nuclear proteins, blood and nerve cells,
and blood proteins.and blood proteins.InflammationInflammation – every organ system.– every organ system.
Lesions:Lesions: connective tissue of the vascularconnective tissue of the vascularsystem, the kidney, the dermis, thesystem, the kidney, the dermis, the
serous, synovial membranes.serous, synovial membranes.Long and chronic, with exacerbations,Long and chronic, with exacerbations,
SLE is associated with a geneticSLE is associated with a geneticpredisposition to the disease as wellpredisposition to the disease as wellas a family history autoimmuneas a family history autoimmune
disorders.disorders.
It occurs most commonly in women,It occurs most commonly in women,
especially among those ages 20-30;especially among those ages 20-30;incidence is higher among Africanincidence is higher among AfricanAmericans than whitesAmericans than whites
SLE is characterized by the formation of SLE is characterized by the formation of antibodies (IgE and IgM) against theantibodies (IgE and IgM) against thebody’s nucleic acids, phospholipids, whitebody’s nucleic acids, phospholipids, whiteblood cells, red blood cells, andblood cells, red blood cells, and
coagulation components.coagulation components.
Antigen-antibody complexes against hostAntigen-antibody complexes against hostDNA form and deposit in a variety of DNA form and deposit in a variety of
Neutrophils attempt to phagocytize theNeutrophils attempt to phagocytize theantigen-antibody complexes, but areantigen-antibody complexes, but areineffective.ineffective.
Lysosomal enzymes are released,Lysosomal enzymes are released,further propagating the tissuefurther propagating the tissue
damage.damage.
The glomerular basement membraneThe glomerular basement membraneof the kidneys is particularlyof the kidneys is particularly
susceptible to complex deposition; assusceptible to complex deposition; asa result, there is a high incidence of a result, there is a high incidence of renal failure secondary to SLE.renal failure secondary to SLE.
Deposition of complex also occurs inDeposition of complex also occurs inthe brain, heart lung, GI tractthe brain, heart lung, GI tract,spleen and skin.,spleen and skin.
– Potential for infection d/t poor physical conditionPotential for infection d/t poor physical condition– Grieving d.t chronic nature of SLE and adventGrieving d.t chronic nature of SLE and advent
exacerbationsexacerbations
– Disturbance in self concept: body image d/t butterflyDisturbance in self concept: body image d/t butterfly
rash and alopeciarash and alopecia
– Alt. in tissue perfusion: renal, GI and peripheral d/tAlt. in tissue perfusion: renal, GI and peripheral d/tvasculitis.vasculitis.
autoantibodies and immune complexes fromautoantibodies and immune complexes fromthe blood before organ and tissue damagethe blood before organ and tissue damageoccurs.occurs.
– Use semi-Fowler's or high-Fowler’sUse semi-Fowler's or high-Fowler’spositionposition
– Pulmonary therapy; coughing and deepPulmonary therapy; coughing and deepbreathing; postural drainage;breathing; postural drainage;percussion; and vibrationpercussion; and vibration
– Ensure adequate restEnsure adequate rest
PainPain– Administer medications as prescribedAdminister medications as prescribed
– Provide skin and perianal careProvide skin and perianal care