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
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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
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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