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Test Bank For Clinical Immunology and Serology A Laboratory Perspectiv1
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Test Bank For Clinical Immunology and Serology A Laboratory Perspectiv1
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Test Bank For Clinical Immunology and Serology ALaboratory Perspective, 4th Edition, Christine
Dorresteyn Stevens, Linda E. Miller.
syngeneic graft - ANSWER isograft; identical twins
allograft - ANSWER transplantation of healthy tissue from one person to another
person; also called homograft
same species
xenograft - ANSWER transplantation (dermis only) from a foreign donor (usually a
pig) and transferred to a human; also called heterograft
Direct allorecognition - ANSWER recipient cytotoxic T cells from host bind and
respond directly to foreign (allo) HLA proteins MHC I on graft cells.
CD8
mixed lymphocyte reaction (MLR) - ANSWER in vitro reaction of alloreactive T cells
from one individual against major histocompatibility complex (MHC) antigens on
blood cells from another individual
involves proliferation of and cytokine secretion by both CD4+ and CD8+ T cells
used as a screening test to assess compatibility of potential graft recipient with
potential donor
1. Which of the following responses is the type of allograft rejection associated with
vascular and parenchymal injury with lymphocyte infiltrates ? - ANSWER b . Acute
cellular rejection
8. Which immunosuppressive agent selectively inhibits IL - 2 receptor - mediated
activation of T cells and causes clearance of activated T cells from the circulation ? -
ANSWER d . Daclizumab
Which one of the following donors would be expected to elicit a positive mixed
lymphocyte response in lymphocytes from a patient who has the HLA - DRB1 * 01 :
01 01:03 alleles ? - ANSWER c. DRB1 * 01 : 03 , 01:03
14. Which of the following HLA antigens would be ex pected to elicit an HLA
antibody response in a kidney transplant recipient with the following HLA type : HLA
- A * 01,03 ; B * 07,14 ; C * 01,04N ; DRB1 * 16,07 ? - ANSWER c . HLA - C * 04
Indirect allorecognition - ANSWER Second pathway by which the immune system
recognizes foreign HLA proteins. Uptake processing and presentation of foreign HLA
proteins MHC I OR II by recipient APCs to recipient T cells
CD4
,accelerated rejection - ANSWER Some individuals possess very low levels of donor
- specific antibody in the pretransplant period . In these cases , antibody mediated
rejection may take place over several days involves intravascular thrombosis and
necrosis of donor tissue
acute cellular alloresponse - ANSWER characterized by parenchymal and vascular
injury . Interstitial cellular infiltrates contain a predominance of CD8 + T cells as well
as CD4 T cells and macrophages . CD8 cells likely mediate cytotoxic reactions to
foreign MHC - expressing cells , whereas CD4 cells likely produce cytokines and
induce delayed - type hypersensitivity ( DTH ) reactions
Chronic rejection - ANSWER results from a process of graft arteriosclerosis
characterized by progressive fibrosis and scarring with narrow ing of the vessel
lumen caused by proliferation of smooth mus cle cells . remains the most significant
cause of graft loss after the first year post - transplant because it is not readily
amenable to treatment .
Acute graft - versus - host disease ( GVHD) - ANSWER occurs during the first 100
days postinfusion and manifests in the skin , gas trointestinal tract , and liver
mismatched allogeneic stem cell transplantation
acute rejection ( AR ) - ANSWER rejection can be mediated by a cellular
alloresponse or by donor - specific antibody ( also known as antibody mediated
response ; AMR )
Immunosuppressive agents - ANSWER list of agents employed to suppress
antigraft immune re sponses in solid - organ and HSC transplantation
induction and maintenance of immune suppression and treatment of rejection
Immunosuppressive agents used in transplantation - ANSWER Corticosteroids
Antimetabolites mycophenolate mofetil azathioprine
Calcineurin inhibitors Cyclosporing FK - 506 (tacrolimus) block T cell signal
transduction
Monoclonal antibodies basiliximab and daclizumab (anti CD25 il2 receptor)
Polyclonal antibodies anti T cell thymoglobulin ATGAM
HLA matching - ANSWER specialized testing to aid in the selection of the most
appropriate donors for patients needing transplantation
HLA typing - ANSWER the HLA antigens or genes in a transplant candidate or
donor . typing phenotypic or genotypic identification
HLA phenotype - ANSWER Determined by complement dependent cytotoxicity CDC
test
,Panels of antisera or monoclonal antibodies that define individual or groups of
immunologically related HLA antigens are incubated with lymphocytes from the
person to be HLA typed in separate wells of a microtiter plate . Each well of the plate
contains a different antibody
HLA genotype - ANSWER identified by determining which primers resulted in
amplification
PCR SSP
PCR SSOP
SBT
crossmatch test - ANSWER Antibodies to HLA antigens can be detected in
candidates and recipients of solid - organ transplants by performance of a
HLA antibody screen - ANSWER If detected the HLA specificity of the antibodies is
then determined so that donors possessing those HLA antigens can be eliminated
from consideration for donation to that patient . Patients are tested monthly for the
presence of HLA antibodies while they are waiting for an organ offer
percent panel reactive antibody ( % PRA ) - ANSWER the proportion of lymphocytes
in the panel that are killed by the patient's serum is referred to as the
Hyperacute graft rejection - ANSWER Minutes to hours
Preformed antibodies to ABO , HLA , and certain endothelial antigens bind to donor
vascular endothelium , activating complement and clotting factors . This leads to
thrombus formation , ischemia , and necrosis of transplanted tissue
Accelerated Graft Rejection - ANSWER Days
Same as for hyperacute rejection
Acute graft rejection - ANSWER Days to months
Cell - mediated response to foreign MHC - expressing cells . CD4 + T cells produce
cytokines and induce delayed type hypersensitivity . CD8 + T cells mediate cytotoxic
reactions . Antibodies produced against HLA antigens bind to vessel walls , activate
complement , and induce transmural necrosis and inflammation .
Chronic graft rejection - ANSWER 1 year or more
Delayed type hypersensitivity response , and possibly antibodies , to foreign HLA
antigens on graft . Graft arteriosclerosis and smooth muscle proliferation occur ,
resulting in fibrosis , scarring , and narrowing of vessel lumen .
graft-versus-host disease (GVHD) - ANSWER 100+ days
T cells in HSC , lung , or liver transplants react against foreign HLA proteins in the
recipient's cells , causing massive cytokine release , inflammation , and tissue
destruction in various locations throughout the body
, Which of the following is an example of a tumor specific antigen ? - ANSWER a .
BCR / ABL fusion protein
Both AFP and hCG exhibit serum elevations in in - ANSWER b. ovarian germ cell
carcinoma
All of the following are recommended for cancer screening in the groups indicated
except - ANSWER a . CA 125 / women of reproductive age .
The best use of serum tumor markers is considered to be in - ANSWER c .
monitoring patients undergoing cancer treatment
Which of the following markers could be elevated in nonmalignant liver disease ? -
ANSWER d . All of the above
A woman with breast cancer is treated with a mono clonal antibody to HER2 . This is
an example of - ANSWER c . passive immunotherapy
Multiple myeloma symptoms and lab findings - ANSWER Thrombocytopenia
Bone pain
RBC rouleaux
Decrease in normal immunoglobulins
Hyperviscosity
15% light chain deposition or amyloidosis
Monoclonal Gammopathy of Undetermined Significance (MGUS) - ANSWER 3.5%
> 50 years
Monoclonal immunoglobulin with no symptoms of organ damage or multiple
myeloma symptoms
The International Myeloma Working Group ( IMWG ) has identified three criteria that
define the presence of MGUS : - ANSWER ( 1 ) a serum monoclonal protein
concentration of less than 3 g / dL ; ( 2 ) a plasma cell count of lower than 10 % of
the total cells in the bone marrow ; and ( 3 ) the absence of signs or symptoms asso
ciated with multiple myeloma , known as the CRAB features ( increased serum
calcium , renal failure , anemia , lytic bone lesions )
Patients with multiple myeloma typically have - ANSWER excess plasma cells in the
bone marrow , a monoclonal immunoglobulin component in the plasma or urine , and
lytic bone lesions . The plasma cells infil trating the bone marrow may be
morphologically normal or may show atypical or bizarre cytological features
Malignant plasma cells phenotypically express - ANSWER CD38 , CD56 , and
CD138 . Approximately 20 % of myeloma cells express CD20 plasma cells ,
Bence Jones proteins . - ANSWER monoclonal light chains can be found in the
blood , but are rapidly excreted in the urine
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