Allergy and Immunology

HIV

malignancies

primary CNS lymphoma

a/w EBV

CD4 <50

treatment

start HAART therapy

prognosis

improves with inc CD4

radiation thearpy

corticosteroids

Vaccines

MMR

live attenuated

given at age 1 and 4

SE

fever

rash

transient lymphadenopathy

contraindications

anaphylaxis to

MMR

neomycin

gelatin

immunodeficiency

pregnancy

risk of congenital rubella

CD4 < 200

leukemia

no antipyretics (don't prevent fever)

yellow fever

don't give in pt's with egg allergy

Allergy

anaphylaxis

skin and mucous membrane symptoms

resp distress

GI sx

hypotension

treatment

itching

hives

swelling of lips +/- tongue

N/V

Diarrhea

crampy abd pain

may be only sign

IM epi

place pt in supine/semi-recumbent position and elevate LE

fluid resuscitation if hypotension doesn't resolve

IV epi if no response to above

HPV

Females 11-26

inc those with h/o

genital warts

abn cytology

  • papillomavirus DNA test

Males 11-21

Males up to 26 if have sex with men

immunocompromised 11-26

NO PREGGERS

VIRUS

click to edit

causes

genital warts

types 6 and 11

cervical, vulvular, vaginal, penile, and anal cancers

types 16, 18

can be started anytime age 9-26

2 doses if < 15

3 doses if > 15

MC STD

spread by skin-skin contact

does not cause infertility

transfusion reactions

TIMELINE

sec-min

anaphylaxis

1 hr

acute hemolytic

1 - 6 hrs

Febrile nonhemolytic

transfusion-associated circulatory overload (TACO)

transfusion related acute lung injury (TRALI)

transfusion-transmitted bacterial infection (TTBI)

Urticarial

2 d - 10 d

delayed hemolytic

click to edit

most common reaction

due to cytokines released during storage

sxs

fever

chills

malaise w/o hemolysis

treatment

stop infusion

administer antipyretics

use leukoreduced blood in future

premedication doesn't help

prevention

cross-matching

sxs

fever

chills

flank pain

hemoglobinuria

progress to renal failure and DIC

DX

positive direct Ag test (Coombs)

plasma free Hb > 25

UA shows Hguria

indications for specialized RBC txs

irradiated

leukoreduced

washed

BMT recipients

cellular immunodeficiency

bld components donated by 1st/2nd deg relatives

chronically transfused pts

CMV seroneg at-risk pts (AIDS, transplant)

potential transplant recipients

previous febrile nonhemolytic transfusion reaction

IgA def

complement-dependent autoimmune hemolytic anemia

cont allergic rxns w/ red cell transfusion despite antihistamine treatment

DTaP

components

Diphtheria toxoid

Tetanus toxoid

Conjugated Pertusis Ag

schedule

5 doses

2 , 4, 6 mo

15-18 mo

4-6 yrs

contraindications

encephalopathy after previous dose

anaphylaxis

relative CI

extremely high fever (> 105)

seizures following vaccine

ongoing eval for neuro condition

influenza

egg allergy

give if pt can eat eggs or only gets hives

give in medical setting if rxn includes hypotn, resp sx, persistent emesis, or needs emergent intervention

give annually 6 mo+

inactivated IM

egg allergy

immediate type hypersensitivity rxns

tetanus prophylaxis

clean or minor wound + unimmunized, uncertain, or < 3 toixoid doses

clean/minor wound + 3+ toxoid doses

toxoid only (Td/Tdap) if last dose was 10+ yrs ago

toxoid only (Td/Tdap)

dirty/severe wound + unimmunized, uncertain, or <3 doses

dirty or severe wound + 3+ toxoid doses

NO Ig

no Ig

toxoid only (Td/Tdap) if last dose 5+ years ago

Td/Tdap + TIG

give Ig

no Ig