What is the Immune System?

The immune system is a network of cells, tissues, and organs that work together to defend the body against attacks by foreign invaders. These are primarily microbestiny organisms such as bacteria, parasites, and fungi that can cause infections. Viruses also cause infections, but are too primitive to be classified as living organisms. The human body provides an ideal environment for many microbes. It is the immune systems job to keep them out or, failing that, to seek out and destroy them. When the immune system hits the wrong target, however, it can unleash a torrent of disorders, including allergic diseases, arthritis, and a form of diabetes. If the immune system is crippled, other kinds of diseases result. The immune system is amazingly complex. It can recognize and remember millions of different enemies, and it can produce secretions (release of fluids) and cells to match up with and wipe out nearly all of them. The immune system is made up of a network of cells, tissues, and organs that work together to protect the body. The cells involved are white blood cells, or leukocytes, which come in two basic types that combine to seek out and destroy disease-causing organisms or substances. Leukocytes are produced or stored in many locations in the body, including the thymus, spleen, and bone marrow. For this reason, they're called the lymphoid organs. There are also clumps of lymphoid tissue throughout the body, primarily as lymph nodes, that house the leukocytes. The leukocytes circulate through the body between the organs and nodes via lymphatic vessels and blood vessels. In this way, the immune system works in a coordinated manner to monitor the body for germs or substances that might cause problems. The two basic types of leukocytes are: 1. phagocytes, cells that chew up invading organisms 2. lymphocytes, cells that allow the body to remember and recognize previous invaders and help the body destroy them A number of different cells are considered phagocytes. The most common type is the neutrophil, which primarily fights bacteria. If doctors are worried about a bacterial infection, they might order a blood test to see if a patient has an increased number of neutrophils triggered by the infection. Other types of phagocytes have their own jobs to make sure that the body responds appropriately to a specific type of invader. The two kinds of lymphocytes are B lymphocytes and T lymphocytes. Lymphocytes start out in the bone marrow and either stay there and mature into B cells, or they leave for the thymus gland, where they mature into T cells. B lymphocytes and T lymphocytes have separate functions: B lymphocytes are like the body's military intelligence system, seeking out their targets and sending defenses to lock onto them. T cells are like the soldiers, destroying the invaders that the intelligence system has identified.

What do T- and B-cells do? T- and B-cells are highly specialised defender cells - different groups of cells are tailored to different germs. When your body is infected with a particular germ, only the T- and B-cells that recognise it will respond. These selected cells then quickly multiply, creating an army of identical cells to fight the infection. Special types of T- and B-cells 'remember' the invader, making you immune to a second attack.

How do you recognize invaders?

Your T- and B-cells recognize invaders by the shape of molecules - antigens - on their surfaces. Your immune system can produce a T- and B-cell to fit every possible shape. However, any Tor B-cell that recognized molecules found on your cells were destroyed while you were growing in the womb, to prevent them from attacking your own body. But you were left with millions of others, one for every foreign antigen you might ever encounter. What is so special about your T-cells?

Having recognized the invader, different types of T-cell then have different jobs to do. Some send chemical instructions (cytokines) to the rest of the immune system. Your body can then produce the most effective weapons against the invaders, which may be bacteria, viruses or parasites. Other types of T-cells recognize and kill virus-infected cells directly. Some help Bcells to make antibodies, which circulate and bind to antigens. (Some T cells are actually called
"killer cells.") T cells also are involved in helping signal other cells (like phagocytes) to do their jobs.

What is so special about your B-cells?

With the help of T-cells, B-cells make special Y-shaped proteins called antibodies. Antibodies stick to antigens on the surface of germs, stopping them in their tracks, creating clumps that alert your body to the presence of intruders. Your body then starts to make toxic substances to fight them. Patrolling defender cells called phagocytes engulf and destroy antibody-covered intruders. Each B cell is programmed to make one specific antibody. For example, one B cell will make an antibody that blocks a virus that causes the common cold, while another produces an antibody that attacks a bacterium that causes pneumonia. When a B cell encounters the kind of antigen that triggers it to become active, it gives rise to many large cells known as plasma cells, which produce antibodies.

Immunoglobulin G, or IgG, is a kind of antibody that works efficiently to coat microbes, speeding their uptake by other cells in the immune system. IgM is very effective at killing bacteria. IgA concentrates in body fluidstears, saliva, and the secretions of the respiratory and digestive tractsguarding the entrances to the body. IgE, whose natural job probably is to protect against parasitic infections, is responsible for the symptoms of allergy. IgD remains attached to B cells and plays a key role in initiating early B cell responses.

Phagocytes and Their Relatives Phagocytes are large white cells that can swallow and digest microbes and other foreign particles. Monocytes are phagocytes that circulate in the blood. When monocytes migrate into tissues, they develop into macrophages. Specialized types of macrophages can be found in many organs, including the lungs, kidneys, brain, and liver. Macrophages play many roles. As scavengers, they rid the body of worn-out cells and other debris. They display bits of foreign antigen in a way that draws the attention of matching lymphocytes and, in that respect, resemble dendritic cells. And they churn out an amazing

variety of powerful chemical signals, known as monokines, which are vital to the immune response. Granulocytes are another kind of immune cell. They contain granules filled with potent chemicals, which allow the granulocytes to destroy microorganisms. Some of these chemicals, such as histamine, also contribute to inflammation and allergy. One type of granulocyte, the neutrophil, is also a phagocyte. Neutrophils use their prepackaged chemicals to break down the microbes they ingest. Eosinophils and basophils are granulocytes that degranulate by spraying their chemicals onto harmful cells or microbes nearby. Mast cells function much like basophils, except they are not blood cells. Rather, they are found in the lungs, skin, tongue, and linings of the nose and intestinal tract, where they contribute to the symptoms of allergy. Related structures, called blood platelets, are cell fragments. Platelets also contain granules. In addition to promoting blood clotting and wound repair, platelets activate some immune defenses. Dendritic cells are found in the parts of lymphoid organs where T cells also exist. Like macrophages, dendritic cells in lymphoid tissues display antigens to T cells and help stimulate T cells during an immune response. They are called dendritic cells because they have branchlike extensions that can interlace to form a network. WHITE CELL ABNORMALITIES : Since the white cell population includes different types of cells (neutrophils, lymphocytes, monocytes, eosinophils, etc), it is important to identify the affected cell type. To do that, absolute numbers of each cell type need to be calculated. These days, absolute numbers are given in the report. Example: Total WBC count is 26,000. The differential count shows 1% neutrophils and 99% lymphocytes Absolute neutrophil count is 26000 x 1 = 260/mm3 100 Absolute lymphocyte count is 25,740/mm3 Thus, this patient has leukocytosis, lymphocytosis and neutropenia. Increased numbers of various cell types are associated with the following conditions:
Neutrophils: The function of neutrophils is to destroy and ingest bacteria. Neutrophils arrive first at the site of inflammation; therefore their numbers will increase greatly immediately after an injury or during the inflammatory process. Their life span is approximately 10 hours, then a cycle of replenishing neutrophils must occur. Besides during inflammation, neutrophils increase with such conditions as stress, necrosis from burns and heart attack. Normal levels range from 45 percent-74 percent.

Neutrophilia:

-Acute infections -Inflammation -Acute hemorrhage -Acute hemolysis -Chronic granulocytic leukemia -Malignancy -Medications (steroids, lithium)

-Vigorous exercise

Lymphocytes: Lymphocytes fight viral infections; B cells and T cells are two major types. Lymphocytes have a key role in the formation of immunoglobins (humoral immunity) and also provide cellular immunity. Normal levels range from 16 percent-45 percent.

Lymphocytosis:

-Viral infections -Toxoplasmosis -Pertussis -Chronic lymphocytic leukemia

Monocytes: These cells arrive at the site of injury in about five hours or more. The monocytes are phagocytic cells that remove foreign materials such as injured and dead cells, microorganisms and other particles from the site of injury, particularly during viral or bacterial infections. Normal levels, which vary depending on the source, range from 2 percent-8 percent to 4 percent-10 percent.

Monocytosis:

-Infections like TB, Subacute bacterial endocarditis -Malignancy -Inflammatory bowel disease

Eosinophils: These are found in such areas as skin and the airway in addition to the bloodstream. They increase in number during allergic and inflammatory reactions and parasite infections. Normal blood levels range from 0 percent-7 percent.

Eosinophilia:

-Allergic disorders -Parasitic infestations -Malignancy (Hodgkin's disease) -Myeloproliferative disorders

Decrease in various cell types can be associated with the following disorders: Neutropenia:

-Certain bacterial infections like Brucellosis, Typhoid -Viral infections -Medications like chemotherapy, anti-arthritis medications -Aplastic anemia -B12 and Folic acid deficiency -Sequestration due to splenomegaly

Lymphopenia:

-Viral infections (HIV) -Steroids -Radiation, chemotherapy

MANY AFRICAN-AMERICANS NORMALLY HAVE LOW WBC AND LOW NEUTROPHIL COUNT. THIS IS NOT A TRUE DECREASE BUT RESULTS FROM INCREASED MARGINATION BY NEUTROPHILS.