General Objectives

The student shall develop the following:

1. An understanding of humoral and cellular immunity and their relative significances to transfusion science theory and practice.

2. An understanding of the characteristics of antigens and antibodies.

3. An understanding of the nature of antigen-antibody reactions.

4. An appreciation of the importance of immunology as a foundation of transfusion medicine theory and practice.

Specific Objectives

The student shall be able to do the following:

1. Define the following immunological terms:

   anamnestic response	epitope
   antibody	hapten
   antigen	monoctonal
   antigenic determinant (site)	opsonin
   aridity	polyclonal
   cross-reactivity	prozone

2. Define the following types of antibodies:

   atypical (irregular); auto; blocking; cold; complete; hetero (xeno); immune; incomplete-isohemagglutin; naturally occurring; regular; warm.

3. Define the following types of antigen-antibody reactions:

   hemagglutination	precipitation
   hemolysis	sensitization
   inhibition or neutralization

4. Briefly explain cellular and humoral immunity under the following headings:

   1. types of cells involved, including T cell subsets.
   2. mechanism of foreign antigen destruction.
   3. cellular co-operation, including role of lymphokines.
   4. role of MHC restriction.

5. Differentiate the terms immune tolerance, immune paralysis and self-tolerance.

6. Define the following types of humoral immunity and give an example of each: active (artificial and natural) and passive (artificial and natural).

7. Describe the physical characteristics of red cell antigens (location, shape, size, numbers, molecular weight).

8. Describe the chemical characteristics of antigens and give an example of each type based on chemistry.

9. Compare and contrast primary and secondary humoral immunity (lag phase, amount of antibody produced, decrease over time, immunoglobulin class)

10. Discuss the factors influencing antibody production under the following headings: antigenicity of antigens, volume of antigenic stimulus, route of antigen administration, possible role of immune response (Ir) genes.

11. List the five classes of immunoglobulins and name their heavy and light chains (including subclasses if appropriate).

12. Discuss the characteristics of IgG, IgM and IgA under the following headings: structure, molecular weight, sedimentation coefficient, ability to cross the placenta, ability to activate complement, normal concentration in serum, presence in secretions, effect of 2-mercaptoethanol and dithiothreitol, effect of papain treatment, location of constant and variable amino acids, fab fragment, fc fragment, location of antigen binding site, location of complement binding site, location of antiglobulin serum binding site, significance of IgG subclass to clinical significance, names and locations of domains.

13. Discuss the factors which affect the first stage of red cell antigen-antibody interaction (sensitization) under the following headings: complementary shape, chemical forces (hydrogen bonds, ionic bonds, hydrophobic bonds, van der Waals forces), Law of Mass Action, antigen/antibody concentration, pH, ionic strength, temperature, time.

14. Discuss the factors which affect the second stage of red cell antigen-antibody interaction (agglutination) under the following headings: number of antigen combining sites on the antibody molecule, antibody size, site of antigen on the cell surface, number of antigenic sites and their distribution on the cell surface, electrical repulsion between red cells suspended in saline, and the effect of proteolytic enzymes and bovine albumin on this repulsion.

15. Discuss complement under the following headings:

    1. chemical composition

    2. role in phagocytosis, cytolysis, chemotaxis

    3. role in in vivo red cell destruction following incompatible blood transfusion (mechanism of intravascular and extravascular hemolysis, blood group systems involved in each)

    4. in vitro significance in transfusion medicine:

       1. if clotted speciments are used, detection of antigen-antibody reactions via hemolysis or the antiglobulin test using polyspecific antiglobulin serum (mechanism, blood group systems involved in each).

       2. importance of using red cells drawn into EDTA for performing DAT when investigating possible cold antibody type AIHA due to autoanti-I.

       3. importance of anti-C3d in polyspecific antiglobulin serum when detecting in vivo red cell coating by complement.

16. classical complement cascade

17. alternative complement (Properdin) pathway (definition, function)

Assessment for Internet-based modules is based on a Pass/Fail status. To receive credit for a module, you must pass each assignment, demonstrate satisfactory performance for participation in the module, and meet module deadlines.

More specifically, assessment is based on these criteria:

• Work of satisfactory quality must be submitted for assignments, with the pass mark set at 70%. Besides evaluation, assignments are meant to enhance learning. If work quality is inadequate, an exercise will be returned as unacceptable with comments and suggestions for improvement. You will then have time to improve and resubmit it by a mutually agreeable due date. If the revised work is acceptable, you will then receive credit for it.

• Participation in class discussions must be of satisfactory quantity and quality. Participating in class discussions is mandatory. This is achieved by exercises that require you to post comments and questions to the class mailing list.

• Assignments must be submitted according to due dates and within the time limit set for the module. Late work will not be accepted unless a delay has been negotiated with the instructor.

Learning Objectives