CBC differential: normal range - WBC
5 - 10 K
CBC differential: normal range - Hgb and Hct
1 to 3 ratio
Hgb: 12 -15
Hct: 36 - 45
CBC differential: normal range - platelets
150K - 450K
leukocytosis
increased WBC (>10K) indication of infection
leukocytopenia
- decreased WBC (< 5K)
- indication of: chemo drugs
- risk of infection
polycythemia vera (PV)
- increased Hgb (> 15)
- risk of stroke, MI
anemia
- decreased Hgb (< 12)
- S/Sx: fatigue, SOB
- indications: bleeding, chemo,
- Tx: transfusion of packed red blood cells (PRBC) for <8 or Hct < 24
thrombocytopenia
- decreased platelets (<150K)
- risk for bleeding
thrombocytosis
- increased platelets (> 450K)
- too many immature platelet cells
- at risk of bleeding
WBC involved in non-specific (innate) immunity
neutrophils
monocytes
first line of innate immunity
skin, physical barrier, mucous membrane
specific immunity: adaptive immunity
cell-mediated immunity
T-lymphocytes
specific immunity: adaptive immunity
humoral immunity
B lymphocytes
monoclonal antibody
antibody for one antigen
Immune system
- antigens
- dendritic cells - antigen presenting cells
- cytokines - activate immune cells
- CD4 T cells (Helper T cells) - Master switch
- CD8 T cells (cytotoxic T cells)
- B cells
CD4 T lymphocytes
- Master Switch for immune system
- Helper T Cells
- Secrete cytokines that activate most other types of immune cells
CD8 T lymphocytes
- cytotoxic - activated by helper CD4 T cells –> destroy target cells
- “cell-mediated immunity”
=> rejection of foreign tissue cells
=> kill other cells that are virus/bacteria infected
=> delayed hypersensitivity reaction
humoral immunity
- Activated B cells => plasma cells + produce millions of antibodies (each is antigen specific)
- Some B cells survive as memory B cells
1st response - slow (7-10 days)
2nd response - much quicker
monoclonal antibodies
- immunoglobulins (Igs)
- play key role in:
= recognition of foreign antigens
= stimulation of immune response to them
Host versus graft disease (HVGD
host’s body rejects graft
Graft versus host disease (GVHD)
graft rejects host’s body
- T lymphocytes of the transplanted tissue attack host tissue
Ex. - bone marrow transplant
4 types of hypersensitivity disorders
Type 1: immediate, IgE mediated (asthma, peanut butter)
Type II: antibodies-mediated cell damage (bad blood transfusion - ATN (acute tubular necrosis)
Type III: immune complex disorders
Type IV: cell-mediated, delayed 24-72 hrs or even years (TB skin test, transplant rejection, contact dermatitis from poison ivy)
Latex allergy
Epoitin Alfa (Epogen, Procrit)
immunostimulant - increases RBC
- by recombinant DNA
Indications:
- anemia of CKD, ESRD
- medication induced anemia = Zidovudine (AZT), cytotoxic drugs, chemo
Route: SQ 1/week
Toxicity: incr risk of stroke, MI
NI: monitor CBC, H and H levels
Drug abuse by professional athletes
Filgrastim (Neupogen)
increases WBC Indications: - chemo pt to reduce risk of infection - pt getting bone marrow transplant - severe chronic neutropenia
SE: bone pain
CBC - monitor WBC
NI: hand washing
- no plants or fresh flowers
- steril technique
