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Part I: Development, Structure and Function 1

Preface 3

1.Overview of the Immune, Blood and Lymphatic Systems 3

The players-an overview of the cell lines 3

Acknowledgements 5

2.Organization of the Lymphoid System 7

Primary Iymphoid organs 7

Dedication 8

Secondary Iymphoid organs 9

3.Concepts of Immunity 15

Innate and adaptive immunity 15

The innate immune system 16

Recognition molecules:The B cell 22

Recognition molecules:The T cell 26

Generation of antigen receptor diversity 30

Humoral immunity 33

Cell-mediated immunity 35

The complemnt system 38

4.The Immune System in disease 43

Response to tissue damage 43

Hypersensitivity mechanisms 49

Immune response to pathogens 51

Autoimmunity and immune disease 53

Immunization 55

Transplantation 58

Structure and function of erythrocytes 61

5.Red Blood Cells and haemoglobin 61

Erythropoiesis 63

Iron and haem metabolism 65

Haemoglobin 68

The red cell cytoskeleton 72

Metabolism of red cells 73

6.Haemostasis 77

Platelets and blood coagulation 77

The coagulation cascade 80

Normal serum proteins 85

7.Serum Proteins 85

Acute phase proteins 87

8.Serology and Blood Transfusion 89

Red cell antigens 89

Blood transfusion 91

Part II: clinical Assessment 93

9.Taking a History 95

Structure of a history 95

Common presenting complaints 97

10.Clinical Examination 101

11.Further Investigations 105

Haematological investigations 105

Investigation of immune Function 110

Part III: Basic Pathology 119

12.Disorders of Immunity 121

Autoimmune disease 121

Diseases of immune deficiency 124

Amyloidosis 130

Leukopenia 133

13.Disorders of White Cells, Lymph Nodes and the Spleen 133

Reactive proliferation of white cells 134

Neoplastic proliferation of white cells 134

Disorders of the spleen 143

14.Disorders of Red Cells 145

Anaemia due to blood loss 145

Anaemia due to red cell destruction (haemolytic anaemias) 146

Anaemia due to impaired red cell production 152

Bleeding disorders:platelets 155

15.Disorders of Red Cells 155

Bleeding disorders:clotting factor abnormalities 158

Thrombosis 159

Part IV: Self-assessment 161

Multipe-choice questions 163

Short-answer questions 168

Essay questions 169

MCQ answers 170

SAQ answers 171

Index 175