Immunity

Afunika Mandevu
Introduction
• Immunity is the condition of being able to resist disease attack.
• It refers to the state in which the body has developed mechanisms to
defend itself against harmful pathogens or foreign substances that
might cause illness
• A pathogen is a microorganism or agent, such as a bacterium, virus,
fungus, or parasite, that causes disease in its host.
• This means any exposure of an organism or conditions that can cause
diseases does not cause diseases
Immune system
• Immune system is the collection of biological structures and process within
an organism that protect against diseases
• It comprises two main components:
 innate immunity, which provides immediate, nonspecific protection. It include
physical barriers, chemical signals, and immune cells like macrophages and
neutrophils. It does not have memory, meaning it reacts the same way to repeated
exposures to the same pathogen.
 adaptive immunity, which delivers a targeted response and immunological memory
it include highly specialized cells like B and T lymphocytes to target particular
antigens. It has memory, enabling a faster and more robust response upon
subsequent exposure to the same pathogen
• This complex system involves organs like the lymph nodes, spleen, and
thymus, as well as cells like white blood cells, antibodies, and signaling
molecules to coordinate its functions.
Cells involved in immune system
• The immune system's cells can be broadly classified into phagocytes
and lymphocytes based on their role
Phagocytes, like neutrophils, macrophages are part of the body’s first line of
defense. They work by engulfing and destroying germs.
lymphocytes include B lymphocytes and T lymphocytes
• B lymphocytes provides immunity by producing antibodies that attack the pathogen.
Antibodies provide immunity by recognizing and binding to specific antigens on
pathogens, neutralizing them, marking them for destruction (Opsonization) , and
creating immune memory for faster responses to future infections
• T lymphocytes has subtypes which include:
 Helper T cells (CD4+ T cells): Assist other immune cells by secreting cytokines which directs
them to engulf or kill cells infected with pathogen.
 Cytotoxic (killer) T cells (CD8+ T cells): Kill infected or cancerous cells by inducing apoptosis
Types of immunity
• Immunity can be classified into natural and artificial immunity, both of
which can be further categorized as active or passive:
1. Natural Immunity comes from within the body itself
Active Natural Immunity: This type of immunity occurs when the body is exposed to
a pathogen, such as through an infection. The immune system responds by
producing antibodies and activating lymphocytes (B and T cells). Some of these
lymphocytes become memory cells, which "remember" the pathogen. This allows
the immune system to mount a faster and stronger response if the same pathogen is
encountered in the future, providing long-term protection. For example, after
recovering from chickenpox, memory cells allow the immune system to recognize
and respond quickly if the virus is encountered again.
Passive Natural Immunity: This occurs when a person receives antibodies from
another individual, typically from the mother to the baby through the placenta or
breast milk. Since the baby’s immune system has not produced its own antibodies, it
does not form memory cells, and this immunity is temporary. The protection lasts
only as long as the transferred antibodies remain in the body.
Types of immunity
2. Artificial Immunity
Active Artificial Immunity: This occurs when a person is exposed to a vaccine
containing a weakened, inactivated, or parts of a pathogen. The immune system
produces antibodies and activates lymphocytes, including memory cells. These
memory cells "remember" the pathogen, allowing the body to mount a rapid
immune response if the pathogen is encountered again in the future. For example,
the measles vaccine stimulates the immune system to produce memory B and T
cells, providing long-term protection against measles.
Passive Artificial Immunity: This involves receiving pre-formed antibodies, often
through an injection of immune globulin or antibody-containing blood products. This
type of immunity does not involve memory cell formation because the person’s
immune system is not actively involved in producing the antibodies. As a result, this
immunity provides immediate but temporary protection, lasting only as long as the
transferred antibodies remain in the body. An example is the administration of rabies
immunoglobulin after potential exposure to rabies.
First line defense and how it works
It helps to prevent pathogens from entering the body and causing
disease.
first-line defense mechanisms in the body include skin, mucus,
hydrochloric acid, tears, cilia, blood clotting, symbiotic defense, and
ear wax
Skin:
The skin is the body’s primary physical barrier against pathogens. It consists
of multiple layers, with the outermost layer being composed of dead skin cells
and keratin, which makes it tough and resistant to damage. The skin prevents
pathogens from entering the body and also secretes oils and sweat that
contain antimicrobial substances to help kill or inhibit the growth of harmful
microbes.
First line defense and how it works
Mucus:
Mucus is produced by mucous membranes lining the respiratory, digestive, and urogenital
tracts. It is a sticky substance that traps pathogens, dust, and other harmful particles. Mucus
also contains enzymes and antimicrobial proteins, such as lysozyme, that can break down
bacterial cell walls. It helps to prevent pathogens from reaching deeper tissues in the body.
Hydrochloric Acid:
The stomach produces hydrochloric acid (HCl), which creates an acidic environment. This low
pH (around 1.5 to 3.5) is harmful to most pathogens, including bacteria and viruses, that may
enter the body through food or drink. The acid kills or neutralizes many of these harmful
microorganisms before they can cause infection or disease.
Tears:
Tears help protect the eyes by washing away debris, dust, and pathogens. They contain
lysozyme, an enzyme that has antibacterial properties and helps break down the cell walls of
bacteria. The continuous production and flushing action of tears keep the eyes clean and free
from infection.
First line defense and how it works
 Cilia:
 Cilia are tiny hair-like structures found in the respiratory tract, particularly in the nose and lungs. These cilia constantly move
in a coordinated way to push mucus (which traps pathogens and particles) up and out of the respiratory system. This is
known as the mucociliary escalator. When mucus is moved out of the respiratory tract, it helps expel trapped pathogens and
prevents them from reaching the lungs or causing infection.
 Blood Clotting:
 When a blood vessel is injured, the body responds by forming a clot to prevent excessive blood loss and protect against
infection. This process involves the aggregation of platelets and the activation of clotting factors, leading to the formation of
fibrin, which creates a mesh that seals the wound. The clot prevents pathogens from entering the body through the injured
site, providing an essential physical barrier.
 Symbiotic Defense (Normal Flora):
 The human body is home to trillions of beneficial microorganisms, such as bacteria and fungi, collectively known as the
normal flora. These organisms live on the skin, in the gut, and other mucosal surfaces. They provide a form of defense by
outcompeting harmful pathogens for nutrients and space. This competitive exclusion prevents pathogens from establishing
infections. In addition, some beneficial bacteria produce substances that inhibit the growth of harmful microbes.
 Ear Wax:
 Ear wax, or cerumen, is produced in the ear canal and serves as a protective barrier against foreign particles, dust, and
pathogens. It traps debris and helps to prevent infection in the ear canal. Ear wax also has antibacterial properties, which
help to protect the ear from infections caused by bacteria or fungi.
Vaccination
• Vaccine is the biological preparation that is introduced into the body
of an animal to increase its ability to produce antibodies against a
particular disease causing organism
• Vaccination controls diseases such as measles, polio, diphtheria,
tetanus, whooping cough (pertussis), hepatitis B, hepatitis A, human
papillomavirus (HPV), influenza (flu), rotavirus, chickenpox (varicella),
mumps, pneumococcal disease, Haemophilus influenzae type b (Hib),
rubella, yellow fever, typhoid fever, and tuberculosis (TB
How vaccination works
• Vaccination works by introducing antigens, which are harmless parts
of a pathogen, such as weakened or inactivated forms or specific
proteins, to trigger an immune response. The immune system
recognizes these antigens as foreign and activates B cells to produce
antibodies and T cells to destroy infected cells. This process also
generates memory cells (memory B and T cells), which "remember"
the pathogen. If the person encounters the pathogen again, the
immune system can quickly recognize and respond to it, leading to a
faster and stronger defense that prevents illness or reduces its
severity.
Importance of vaccination
• It helps to Prevent Disease: Vaccines protect individuals from
potentially serious or life-threatening diseases, such as polio, measles,
and influenza.
• It provide herd Immunity: When a large proportion of the population
is vaccinated, the spread of the disease is reduced, protecting those
who cannot be vaccinated, such as individuals with compromised
immune systems
• It enables children and young people to grow strong and healthy
Immunity and HIV
• How HIV weakens immune system
HIV weakens the immune system by targeting and infecting CD4+ T cells,
which are crucial for coordinating the body's immune response. As HIV
replicates within these cells, it leads to their destruction, resulting in a decline
in CD4+ T cell numbers. This decline impairs the immune system's ability to
activate other immune cells, leaving the body more susceptible to infections
and diseases. Over time, the loss of CD4+ T cells can progress to AIDS, the
final stage of HIV infection, where the immune system becomes significantly
compromised.
Effects of HIV on helper T lymphocytes and
killer T lymphocytes
• Effects of HIV on Helper T Lymphocytes (CD4+ T cells): HIV primarily targets and
infects helper T lymphocytes, or CD4+ T cells, which are crucial for activating and
coordinating immune responses. As the virus replicates within these cells, they
are destroyed, leading to a progressive decline in their numbers. This weakens
the immune system’s ability to coordinate the defense against infections and
pathogens, making the body more vulnerable to opportunistic infections and
diseases. Over time, if untreated, this depletion of helper T cells can lead to the
progression of HIV to AIDS.
• Effects of HIV on Killer T Lymphocytes (CD8+ T cells): HIV also affects killer T
lymphocytes, or CD8+ T cells, which are responsible for recognizing and
destroying infected or cancerous cells. While HIV does not directly infect CD8+ T
cells, the depletion of helper T cells impairs the activation and functioning of
killer T cells. As a result, the body’s ability to effectively target and eliminate
infected or abnormal cells diminishes, further compromising immune defense.
This dysfunction in killer T cells contributes to the increased susceptibility to
infections and cancers in people with HIV.
role of lymphatic system HIV immune
response
• The lymphatic system is essential for the immune response to HIV, as
it houses key immune cells like CD4+ T cells, which are targeted by
the virus. When HIV enters the body, it infects lymphoid tissues, such
as lymph nodes, where it replicates and weakens the immune system
by depleting CD4+ T cells. This impairs the immune response, as CD4+
T cells are crucial for coordinating the activation of other immune
cells like CD8+ T cells and B cells. Over time, the ongoing infection and
chronic inflammation in the lymphatic system contribute to immune
dysfunction and the progression of HIV to AIDS.
Organ transplant is the moving of an organ
from one body to replace a damaged or
absent organ
Examples of organs that can be transplanted
include the heart, kidneys, liver, cornea of
the eye and skin
Most common transplanted organ is kidney
followed by heart then the heart
ABO blood system
• There are more than 20 different blood group systems in
humans
• The most important blood group systems are ABO and Rhesus
• People are divided into “blood groups” depending on the
antigens that are present on their red cells.
• Related antigens form a “blood group system”.
• An example of a blood group is “A”.
• An example of a blood group system is the “ABO system”.
ABO blood system
In the ABO blood group system there are:

Two Antigens (Ag)

A antigens
B antigens
These are located on the surface of the RBC
membrane

Two corresponding
Antibodies (Ab)
Anti-A
Anti-B
(These form naturally in first 4-6 months of a
baby’s life and are present in the plasma.)
• Antigens and corresponding Antibodies interact (Example: A antigen
and Anti-A)
• This interaction of antigen on red blood cell and its corresponding
antibody cause agglutination
• Agglutination is the clumping together of red blood cells
• Anti-A will agglutinate red cells with A antigens on them.
• Anti-B will agglutinate red cells with B antigens on them

• These reactions will determine the blood group

Rh blood group system
• RhD is the most important antigen, followed by C, c, E, e
• If RhD positive are often called Rh positive.

• RhD is the most immunogenic antigen [very good at stimulating the

production of anti-D].
• About 85% of the population has this antigen on the red blood cell
This is the reason why blood is described as either positive (+) or negative (-)
in addition to the blood type e.g. A+ or A-
A- means has antigen A and lack RhD factor
A+ means it has antigen a and has RhD factor
• An Rh Positive person has got D antigen on the red cells and
• will seldom make anti-D

• In an Rh Negative person – NO D antigen is present on the red cells

and NO anti-D is present naturally
Anti-D is only produced in response to an exposure to Rh Positive red cells
This could be -
 Through pregnancy / childbirth / miscarriage
 Through blood transfusion

• Anti-D is a major cause of haemolytic transfusion reactions [HTR]

and haemolytic disease of the new born [HDN]
Blood Transfusion
• A blood donor is a person who voluntarily goes to a hospital or a
health Centre to give blood
• Blood is taken from the donor and kept in a bag containing the
anticlotting substance called heparin
• A blood recipient is a person who is receiving donated blood
• Blood transfusion is the process of putting donated blood into the
recipient
Situation that require blood transfusion
• Severe Anemia: Blood transfusion is necessary when hemoglobin
levels drop dangerously low, often due to chronic conditions like
sickle cell disease or significant blood loss. Transfused blood helps
restore oxygen-carrying capacity, alleviating symptoms such as
fatigue and shortness of breath. This treatment stabilizes the patient
while addressing the underlying cause of anemia
• Trauma or Major Surgery: In cases of severe injuries or surgical
procedures, substantial blood loss can occur, necessitating
transfusion to maintain blood volume and pressure. Restoring blood
levels prevents hypovolemic shock and ensures oxygen delivery to
vital organs. Packed red blood cells, platelets, or plasma may be
used depending on the type of blood loss.
Situation that require blood transfusion
• Cancer and Chemotherapy: Patients with certain cancers, such as
leukemia, or those undergoing chemotherapy often experience bone
marrow suppression, leading to low blood cell counts. Blood
transfusion replenishes red cells, platelets, or plasma to manage
anemia, bleeding risks, or clotting disorders. This supportive
treatment improves quality of life and ensures patients can tolerate
further therapies.
• Childbirth Complications: Postpartum hemorrhage (PPH) is a
leading cause of maternal mortality, where excessive blood loss
occurs during or after delivery. Blood transfusion is life-saving in
such cases, replenishing lost volume and stabilizing the mother.
Immediate intervention with matched blood products is critical for
recovery and preventing long-term complications.
Situation that require blood transfusion
• Inherited Blood Disorders: Conditions like thalassemia and
sickle cell anemia require regular blood transfusions to manage
chronic anemia and complications. Transfusions supply healthy
red blood cells, improving oxygen delivery and reducing
symptoms like fatigue and pain. For these patients, ongoing
transfusion therapy is essential for maintaining normal
physiological function.
Importance of blood groups and cross-
matching

Ideally, a patient should get blood of his or her OWN

ABO blood group
A should get A
B should get B
AB should get AB
O should get O
Note that every blood group is of EQUAL importance!!

Slide 27
• In reality some flexibility is allowed
Group A May be transfused with A or O
Group B may be transfused with B or O
Group AB may be transfused with AB, A, B, O
Group O may be transfused with O
• People with blood Group O can donate to all blood groups and are called
UNIVERSAL DONORS
This is because they do not have an antigen on their red blood cells to stimulate
production of antibody in recipient's immune response to cause agglutination
• People with blood group AB can receive blood from all blood groups and
are called UNIVERSAL RECIPIENTS
This is because they can not produce antibodies against any antigen in their
immune response to cause agglutination
Factors to be considered before a blood
transfusion
• ABO Blood Group Compatibility
The ABO blood group system is critical in transfusion compatibility. It includes
four main blood groups: A, B, AB, and O, based on the presence of antigens
on red blood cells:
Group A: A antigens and anti-B antibodies.
Group B: B antigens and anti-A antibodies.
Group AB: Both A and B antigens, no antibodies (universal recipient).
Group O: No antigens, both anti-A and anti-B antibodies (universal donor for red cells).
Mismatched transfusions can cause hemolytic reactions, leading to severe
complications or death.
Cross-matching and blood typing are performed to ensure donor and
recipient compatibility.
Factors to be considered before a blood
transfusion
 Human Immunodeficiency Virus (HIV)
HIV, which causes AIDS, can be transmitted via infected blood.
All donated blood must be tested for HIV using methods such as ELISA, PCR, or rapid
antibody/antigen tests.
Screening aims to prevent the transmission of the virus through transfusion
transfusion of infected blood can transmit the virus; only HIV-negative blood is
allowed.
 Hepatitis (B and C)
Hepatitis B and C are viral infections that affect the liver and can be transmitted
through infected blood.
Testing for Hepatitis B surface antigen (HBsAg) and anti-HCV antibodies is
mandatory.
Nucleic Acid Testing (NAT) enhances detection and reduces the risk of transmission.
infected blood can transmit these life-threatening liver diseases; hepatitis-free blood
is required
Factors to be considered before a blood
transfusion
 Syphilis
 Syphilis, a sexually transmitted infection caused by Treponema pallidum, can be transmitted through blood transfusion.
 Screening involves detecting antibodies against the pathogen using tests like Rapid Plasma Reagin (RPR) or Treponema-
specific tests.
 Donated blood showing positive results is typically discarded.
 blood from syphilis-positive donors is prohibited to avoid transmission.
 Anemia
 Anemia refers to a deficiency of red blood cells or hemoglobin, leading to reduced oxygen transport.
 Blood transfusion for anemia is indicated only when necessary, such as in severe cases of iron-deficiency anemia, hemolytic
anemia, or aplastic anemia.
 The type and volume of blood to be transfused depend on the cause and severity of the anemia.
 A person who is anaemic (who has anaemia) should not donate blood
 Malaria
 Malaria, caused by Plasmodium species, can be transmitted through transfusion of infected blood.
 Screening for malaria is especially crucial in endemic areas.
 Techniques like microscopy, rapid diagnostic tests (RDTs), or PCR are used to detect the parasite.
 blood from donors with a history of malaria or infection is excluded to avoid transfusion-transmitted malaria