Ebook Medical language for modern health care (4/E): Part 2

LYMPHATIC AND IMMUNE SYSTEMS 
The Language of Immunology

©2014 Nucleus Medical Media

The health professionals involved in the diagnosis and treatment of problems with the
lymphatic and immune systems include:
• Immunologists and allergists, who are physicians who specialize in immune system
disorders, such as allergies, asthma, and immunodeficiency and autoimmune diseases.
• Epidemiologists, who are medical scientists involved in the study of epidemic diseases
and how they are transmitted and controlled.
• Medical or laboratory technicians, who perform testing procedures on blood, body fluids,
and other tissues using microscopes, computers, and other equipment.

398


CHAPTER

12

Chapter Learning Outcomes
The lymphatic and immune systems are the major defenders of the body against disease. The content of this chapter is designed to enable you to: 

LO 12.1 Describe the anatomy and flow of the lymphatic system.
LO 12.2 Relate the structure of the lymph nodes, tissues, and cells to their functions.
LO 12.3 Explain the structure and functions of the lymphatic organs.
LO 12.4 Discuss disorders of the lymphatic system.
LO 12.5 Define the characteristics of the immune system.
LO 12.6 Explain immunity.
LO 12.7 Describe disorders of the immune system and transplantation.

LO 12.8 Discuss HIV and AIDS infections.
LO 12.9 Identify diagnostic and therapeutic procedures and medications used in disorders of the lymphatic and immune systems.
LO 12.A Use the medical terms of immunology to communicate and document in writing accurately and precisely in any health care setting.
LO 12.B Use the medical terms of immunology to communicate verbally with accuracy and precision in any health care setting.
LO 12.C Construct the medical terms of immunology from their word elements.
LO 12.D Deconstruct the medical terms of immunology into their word elements.
LO 12.E Identify health professionals involved in the care of patients with immune disorders.
LO 12.F Use approved abbreviations of terms used in immunology correctly.

Case Report (CR) 12.1
You are
. . . a medical assistant working with Susan Lee, MD, in her primary care clinic at
Fulwood Medical Center.

Your patient is
. . . Ms. Anna Clemons, a 20-year-old waitress, who is a new patient. She has
noticed a lump in her right neck. On questioning, you find that she has lost
about 8 pounds in weight in the past couple of months, has felt tired, and has
had some night sweats.
Her vital signs (VS) are normal. There are two firm, enlarged lymph nodes in her
right neck. Physical examination is otherwise unremarkable, and there is no
evidence of infection in her head, throat, or upper respiratory tract.


Lesson 12.1
LY M P H AT I C A N D I M M U N E S Y S T E M S

Lymphatic System
Lesson Objectives

LO 12.1  Lymphatic System

As part of your defense
mechanisms, the lymphatic
system and its fluid provide
surveillance and protection
against foreign materials.

The body has three lines of defense mechanisms against foreign organisms (pathogens), cells (cancer),
and molecules (pollutants and allergens):
1. Physical mechanisms—the skin and mucous membranes, chemicals in perspiration, saliva and
tears, hairs in the nostrils, cilia and mucus to protect the lungs. These are described in the
individual body system chapters.
2. Cellular mechanisms—based on defensive cells (lymphocytes) that directly attack suspicious cells
such as cancer cells, transplanted tissue cells, or cells infected with viruses or parasites. This is the
basis for the lymphatic system.
3. Humoral defense mechanisms—based on antibodies that are found in body fluids and bind to bacteria,
toxins, and extracellular viruses, tagging them for destruction. This is the basis for the immune system.
The lymphatic system (Figure 12.1) has three components:
1. A network of thin lymphatic capillaries and vessels, similar to blood vessels, that penetrates into
the interstitial spaces of nearly every tissue in the body except cartilage, bone, red bone marrow,
and the central nervous system (CNS).
2. A group of tissues and organs that produce immune cells.
3. Lymph, a clear colorless fluid similar to blood plasma but whose composition varies from place to
place in the body. It flows through the network of lymphatic capillaries and vessels.
The lymphatic system has three functions:
1. To absorb excess interstitial fluid and return it to the bloodstream.
2. To remove foreign chemicals, cells, and debris from the tissues.
3. To absorb dietary lipids from the small intestine (see Chapter 5).
The lymphatic network begins with lymphatic capillaries, which are closed-ended tubes nestled

among blood capillary networks (Figure 12.2). The lymphatic capillaries are designed to let interstitial
fluid enter, and the interstitial fluid becomes lymph. In addition, bacteria, viruses,
cellular debris, and traveling cancer cells can enter the lymphatic capillaries with the
interstitial fluid. The lymphatic capillaries converge to form the larger lymphatic collecting vessels. These resemble small veins and have one-way valves in their lumen.
L. subclavian
They travel alongside veins and arteries.
vein
The larger lymphatic collecting vessels merge into lymphatic trunks that drain
lymph
from a major body region. In turn, these lymphatic trunks merge into two large
Axillary
­lymphatic ducts:
lymph
nodes
1. The right lymphatic duct receives lymph from the right arm, right side of the thorax,
Spleen
and right side of the head and drains into the right subclavian vein (Figure 12.1).

In this lesson, the
information provided will
enable you to use correct
medical terminology to:

12.1.1 Describe the anatomy

and flow of the
lymphatic system.
12.1.2 List the functions of
the lymphatic system.
12.1.3 Identify the major cells

of the lymphatic system
and their functions.
12.1.4 Detail the anatomy and
functions of the lymph
nodes, tonsils, thymus
gland, and spleen.
12.1.5 Explain the effects of
common disorders of
the lymphatic system
on health.
Palatine
tonsil
Submandibular
lymph nodes
Cervical lymph
nodes
R. lymphatic
duct
R. subclavian
vein
Thymus
Lymphatic
vessels
Thoracic
duct

Intestinal
lymph
nodes
Inguinal

lymph
nodes

Blood capillary
Tissue fluid
Tissue cell
Lymphatic
capillary

Bone marrow

Lymphatic
vessels

Lymphatic duct

▲ Figure 12.1  The Lymphatic System.
(R. = right; L. = left)

400

Arteriole

2. T
 he thoracic duct on the left,
the largest lymphatic vessel,
receives lymph from both
sides of the body below the
diaphragm and from the left
arm, left side of the head, and

left thorax. It begins in the
abdomen at the level of the
second lumbar vertebra (L2)
and passes up through the
diaphragm and mediastinum to
empty into the left subclavian
vein (Figure 12.1).

Venule

▲ Figure 12.2  Lymphatic Flow.

CHAPTER 12  Lymphatic and Immune Systems The Language of Immunology


LO 12.1, 12.A 
Word Analysis and Definition
WORD

   S = Suffix   P = Prefix   R = Root    R/CF = Combining Form

PRONUNCIATION

ELEMENTS

DEFINITION

allergen
(Note: The duplicate
letter “g” is deleted to

better form the word.)
allergic
allergy
antibody
antibodies (pl)
humoral

AL-er-jen

S/
R/
R/

-gen to produce
all- different, strange
-erg- work

Substance producing a hypersensitivity
(allergic) reaction

ah-LER-jic
AL-er-jee
AN-tih-body
AN-tih-bod-ees
HYU-mor-al

S/
S/
P/
R/

S/
R/

Pertaining to or suffering from an allergy
Hypersensitivity to a particular allergen
Protein produced in response to an antigen

immune
immunity

im-YUNE
im-YOU-nih-tee

immunology

im-you-NOL-oh-jee

immunologist

im-you-NOL-oh-jist

immunize

IM-you-nize

immunization

im-you-nih-ZAY-shun

immunoglobulin

IM-you-noh-GLOB-you-lin

lymph

LIMF

-ic pertaining to
-ergy process of working
anti- against
-body substance, body
-al pertaining to
humor- fluid
Latin protected from
-ity condition
immun- immune response
-logy study of
immun/o- immune response
-logist one who studies,
 specialist
-ize affect in a specific way
immun- immune response
-ization process of affecting
  in a specific way
-in chemical compound
immun/o- immune response
-globul- protein
Latin clear spring water

lymphatic

lim-FAT-ik

lymphocyte

LIM-foh-site

node
parasite

NOHD
PAR-ah-site

pathogen

PATH-oh-jen

pollutant

poh-LOO-tant

toxin
toxic (adj)

TOK-sin
TOK-sick

toxicity (contains
two suffixes)

toks-ISS-ih-tee

S/
R/
S/
R/CF
S/
S/
R/
S/
S/
R/CF
R/
S/
R/
S/
R/CF

S/
R/CF
S/
R/
S/
R/
S/

-atic pertaining to
lymph- lymph
-cyte cell
lymph/o- lymph

Latin a knot
Greek a guest
-gen to produce
path/o- disease
-ant pertaining to
pollut- unclean
Greek poison
-ic pertaining to
tox- poison
-ity state, condition

Defense mechanism arising from antibodies in
the blood
Protected from an infectious disease
State of being protected
The science and practice of immunity and
allergy
Medical specialist in immunology
Make resistant to an infectious disease
Administration of an agent to provide immunity
Specific protein evoked by an antigen; all
antibodies are immunoglobulins
A clear fluid collected from tissues and transported by lymph vessels to the venous circulation
Pertaining to lymph or the lymphatic system
Small white blood cell with a nucleus
A circumscribed mass of tissue
An organism that attaches itself to, lives on or
in, and derives its nutrition from another species
A disease-causing microorganism
Substance that makes an environment unclean

or impure
Poisonous substance formed by a cell or organism
Pertaining to a toxin, poisonous
The state of being poisonous

Exercises
A. Build the correct medical terms that match the definitions given. If the term does not have a particular word element, leave it empty.
Fill in the blanks. LO 12.1, 12.D
1. substance that makes the environment unclean or impure:






/
P

/
R/CF

S

2. make resistant to infectious disease:

/
P

/
R/CF

S

3. the basis of humoral defense mechanisms:






/
P

/
R/CF

S

LESSON 12.1  Lymphatic System401


Afferent
lymphatic
vessel

LO 12.2  Lymphatic Nodes, Tissues, and Cells

Capsule
Artery
Vein

Valve

▲ Figure 12.3  Lymph Node.

Keynotes
•Tissues that are the first
line of defense against
pathogens—for example,
the airway passages—have
lymphatic tissue in the
submucous layers to help
protect against invasion.
• T cells (or T lymphocytes)
mature in the thymus and
make up 75% to 85% of the
body’s lymphocytes.
• B cells (or B lymphocytes)
mature in the bone marrow
and make up 15% to 25% of
the body’s lymphocytes.
• Macrophages are produced
and stored in the spleen.

Abbreviations

B cells B lymphocytes
CD cluster of
differentiation
Igimmunoglobulin
T cells T lymphocytes

Lymph Nodes

At irregular intervals, the lymphatic collecting vessels enter into the part of the lymphatic network called lymph nodes (Figure 12.3). There are hundreds of lymph nodes
stationed all over the body. They are especially concentrated in the neck, axilla, and
Efferent
groin. Their functions are to filter impurities from the lymph and alert the immune
lymphatic system to the presence of pathogens.
vessel
The lymph moves slowly through the node (Figure 12.3), which filters the lymph
and removes any foreign matter. On its journey back to the bloodstream, lymph
passes through several nodes and becomes cleansed of most foreign matter.
Macrophages in the lymph nodes ingest and break down the foreign matter and display fragments of it to T cells (see the following section). This alerts the immune system to the presence
of an invader. Lymph leaves the nodes again when it enters into the efferent collecting vessels. All these
lymph vessels move lymph toward the thoracic cavity.

Lymphatic Tissues and Cells
Many organs have a sprinkling of lymphocytes in their connective tissues and mucous membranes,
particularly in passages that open to the exterior—the respiratory, digestive, urinary, and reproductive
tracts—where invaders have access to the body.
In some organs, lymphocytes and other cells form dense clusters called lymphatic follicles. These
are constant features in the tonsils, the adenoids, and the ileum.
Lymphatic tissues are composed of a variety of cells that include:
1. T lymphocytes (T cells). The “T” stands for thymus, where they mature.
T lymphocytes make up 75% to 85% of body lymphocytes. There are several types of T cells:

a. Cytotoxic or “killer” T cells destroy target cells. Their cell membrane holds a coreceptor that
can recognize a specific antigen. Coreceptors are named with the letters “CD” (cluster of
differentiation) followed by a number, for these cells, CD8.
b. Helper T cells contain the CD4 coreceptor and are called CD4 cells. They begin the defensive
response against a specific antigen.
c. Memory T cells arise from cytotoxic T lymphocytes that have previously destroyed a foreign cell. If
they encounter the same antigen, they can now quickly kill it without initiation by a helper T cell.
d. Suppressor T cells suppress activation of the immune system. Failure of these cells to function
properly may result in autoimmune diseases.
2. B lymphocytes (B cells). These cells mature in the bone marrow. B lymphocytes make up 15% to
25% of lymphocytes. They are activated by helper T cells, respond to a specific antigen, and cause
the production of antibodies called immunoglobulins (Ig). The mature B cells are called plasma
cells and secrete large quantities of antibodies that immobilize, neutralize, and prepare the
specific antigen for destruction.
3. Null cells. These are large granular lymphocytes that are natural killer cells but lack the specific
surface markers of the T and B lymphocytes.
4. Macrophages. These cells develop from monocytes (see Chapter 11) that have migrated from blood.
They ingest and destroy tissue debris, bacteria, and other foreign matter (phagocytosis).

402

CHAPTER 12  Lymphatic and Immune Systems The Language of Immunology


LO 12.2, 12.A 
Word Analysis and Definition
WORD

   S = Suffix   P = Prefix   R = Root    R/CF = Combining Form

PRONUNCIATION

ELEMENTS

DEFINITION

coreceptor

koh-ree-SEP-tor

S/
P/
R/

-or a doer
co- with, together
-recept- receive

Cell surface protein to enhance the sensitivity of an antigen
receptor

cytotoxic (adj)

sigh-toh-TOK-sik

S/
R/CF

-toxic able to kill
cyt/o- cell

Agent able to destroy cells

follicle

FOLL-ih-kull

Latin a small sac

Spherical mass of cells containing a cavity, or a small cul-desac such as a hair follicle

macrophage

MAK-roh-fayj

-phag/e to eat
macro- large

Large white blood cell (WBC) that removes bacteria, foreign
particles, and dead cells

null cells

NULL SELLS

null Latin none

Lymphocytes with no surface markers, unlike T cells or B cells

phagocyte

FAG-oh-site

Blood cell that ingests and destroys foreign particles and cells

phagocytize (verb)

FAG-oh-site-ize

phagocytosis
phagocytic (adj)

FAG-oh-sigh-TOH-sis
fag-oh-SIT-ik

-cyte cell
phag/o- to eat
-ize action
-cyt- cell 
-osis condition
-ic pertaining to

plasma cell

PLAZ-mah SELL

plasma Greek
something formed

Cell derived from B lymphocytes and active in formation of

antibodies

R/CF
P/
S/
R/CF
S/
R/
S/
S/

Ingest foreign particles and cells
Process of ingestion and destruction of foreign particles and cells
Pertaining to phagocytes or phagocytosis

Exercises
A. Elements. Knowledge of elements is your best key to understanding medical terminology. Reinforce that knowledge with this exercise. Select the best
choice. LO 12.2, 12.A
1. In the term cytotoxic, one element means
a. to eat

b. able to kill

c. large

b. location

c. size

b. cell

c. mass

b. with

c. under

b. eat

c. produce

b. -ize

c. -ic

2. The prefix in macrophage identifies
a.color
3. The suffix in phagocyte means
a.cyst
4. The prefix co- means
a. next to
5. The suffix -phage means
a.flow
6. This suffix means condition:
a.-osis

LESSON 12.1  Lymphatic System403


LO 12.3  Lymphatic Organs

Diaphragm
(cut)
Spleen
Splenic artery
Pancreas
Kidney
Inferior vena
cava
Aorta

▲ Figure 12.4  Position of Spleen. ©McGraw-Hill
Education/Dennis Strete, photographer

Spleen
The spleen, a highly vascular and spongy organ, is the largest lymphatic organ. It is
located in the left upper quadrant of the abdomen below the diaphragm and lateral to
the kidney (Figure 12.4). It is the only organ the body can live without.
The spleen contains two basic types of tissue:
1. White pulp—which is a part of the immune system that produces T cells, B cells,
and macrophages. The blood passing through the spleen is monitored for antigens.
Antibodies are produced, and the foreign matter is removed.
2. Red pulp—which acts as a reservoir for erythrocytes, platelets, and macrophages
that remove old and defective erythrocytes.
Thus, the functions of the spleen are to:
• Produce T cells, B cells, and macrophages.
• Phagocytize bacteria and other foreign materials.
• Initiate an immune response to produce antibodies when antigens are found in the
blood.
• Phagocytize old, defective erythrocytes and platelets (hemolysis).
• Serve as a reservoir for erythrocytes and platelets.

Tonsils
The tonsils (see Chapter 13) are two masses of lymphatic tissue located at the entrance
to the oropharynx, where they entrap inhaled and ingested pathogens. Adenoids are
similar tissue on the posterior wall of the nasopharynx (see Chapter 13). The tonsils and
adenoids form lymphocytes and antibodies, trap bacteria and viruses, and drain them
into the tonsillar lymph nodes for elimination. They can become infected themselves.

Thymus Gland
The thymus gland has both endocrine (see Chapter 17) and lymphatic functions. T cells develop and
mature in it and are released into the bloodstream. The thymus is largest in infancy and childhood
(Figure 12.5a and b) and reaches its maximum size at puberty. It then regresses into a small structure in
the adult (Figure 12.5 (b)) and is eventually replaced by fibrous and adipose tissue.

Trachea
Thyroid

Thymus

Trachea
Thyroid

Lungs

Thymus
Lung
Heart

Heart

Diaphragm

Diaphragm
Liver

Liver

▲ Figure 12.5(a)  Large Thymus in an Infant.
404

▲ Figure 12.5(b)  Adult Thymus.

CHAPTER 12  Lymphatic and Immune Systems The Language of Immunology


LO 12.3, 12.A 
Word Analysis and Definition
WORD

   S = Suffix   P = Prefix   R = Root    R/CF = Combining Form

PRONUNCIATION

adenoid

ADD-eh-noyd

spleen

SPLEEN

splenectomy
(Note: The “ee” in
spleen becomes “e” for
easier pronunciation.)
splenomegaly

spleh-NEK-toh-mee

tonsil

TON-sill

tonsillectomy

ton-sih-LEK-toh-mee

tonsillitis

ton-sih-LIE-tis

spleh-noh-MEG-ah-lee

ELEMENTS
S/
R/

S/
R/
S/

R/CF

S/
R/
S/

DEFINITION

-oid resemble
aden- gland

Single mass of lymphoid tissue in the midline at
the back of the throat

Greek spleen

Vascular, lymphatic organ in the left upper
quadrant of the abdomen
Surgical removal of the spleen

-ectomy surgical excision
splen- spleen
-megaly enlargement
splen/o- spleen

Enlarged spleen

Latin tonsil

Mass of lymphoid tissue on either side of the

throat at the back of the tongue
Surgical removal of the tonsils

-ectomy surgical excision
tonsill- tonsil
-itis inflammation

Inflammation of the tonsils

Exercises
A. Identify the correct answer that contains all the lymphatic organs. Select the best choice. LO 12.3, 12.A
1. Which of the following is a list of only lymphatic organs?
a. liver, spleen, thyroid gland
b. spleen, lungs, kidney
c. tonsils, spleen, parathyroid gland
d. thymus gland, spleen, lymph vessels and nodes
e. gallbladder, spleen, thyroid gland
B. The spleen is a very important organ in the body. Select T if the statement is True. Select F if the statement is False.  LO 12.3
1.
The spleen is a highly vascular and spongy organ.

T

F

2.
The spleen is the largest of the lymphatic organs.

T

F

3.
The spleen is located in the right upper quadrant of the body.

T

F

4.
The spleen contains white pulp and red pulp.

T

F

5.
The spleen serves as a reservoir for RBCs and platelets.

T

F

C. This exercise describes the “where” of lymphatic tissue—you need to supply the term that is the “what.” “What am I?” Identify
the correct medical term for each of the following questions. LO 12.3, 12.A
1. I am located below the diaphragm and lateral to the kidney. 
2. I am located at the entrance to the oropharynx, where I trap pathogens. 
3. I am located on the posterior wall of the nasopharynx. 
4. I am located in the chest cavity. 

LESSON 12.1  Lymphatic System405


Case Report (CR) 12.1 (continued)
Ms. Clemons has cancerous nodes in her neck. They were not caused by metastatic cancer but by a
cancer of the lymph nodes called Hodgkin lymphoma.

LO 12.4  Disorders of the Lymphatic System

▲ Figure 12.6  Hodgkin Lymphoma.

The lymphatic tissues in Hodgkin disease
contain specific cells called
Reed-Sternberg cells that are not found
in any other cancerous lymphomas or
cancers. ©James Cavallini/Photo Researchers, Inc.

Physicians routinely palpate accessible lymph nodes in the neck (cervical nodes), axillae
(axillary nodes), and groin (inguinal nodes) for enlargement and tenderness. Their presence indicates disease in the tissues drained by the lymph nodes. Cancerous lymph nodes
are enlarged, firm, and usually painless.
Infections in the lymph nodes cause them to be swollen and tender to the touch, a
condition called lymphadenitis. All lymph node enlargements are collectively called
lymphadenopathy. When lymph nodes are removed, it is called lymphadenectomy.
Lymphoma is a malignant neoplasm of the lymphatic organs, usually the lymph nodes.
The disorder usually presents as an enlarged, nontender lymph node, often in the neck or
axilla.
Lymphomas are grouped into two categories:

1. Hodgkin lymphoma—characterized by the presence of abnormal, cancerous B cells
called Reed-Sternberg cells. These are large cells with two nuclei resembling the eyes

of an owl (Figure 12.6). The cancer spreads in an orderly manner to adjoining lymph
nodes. This enables the disease to be staged, depending on how far it has spread.
Diagnostic procedures include biopsy of an enlarged node to look for Reed-Sternberg
cells, x-rays, computed tomography (CT) and magnetic resonance imaging (MRI) scans,
lymphangiogram, and bone marrow biopsy. Treatment options include radiation, chemotherapy,
and an autologous bone marrow transplant.
2. Non-Hodgkin lymphomas—occur much more frequently than Hodgkin lymphoma. They include
some 30 different disease entities in 10 different subtypes. Treatment depends on the rate of
growth of the disease and varies from careful observation to chemotherapy and radiation to bone
marrow transplantation.

▲ Figure 12.7  Tonsillitis.

Open mouth and throat
of a 15-year-old girl with
inflamed tonsils. They are
flecked with infected white
patches due to tonsillitis,
an infection usually caused
by streptococci bacteria.
©Dr. P. Marazzi/Science Photo
Library, Photo Researchers, Inc.

Tonsillitis, inflammation of the tonsils and adenoids, occurs mostly in the first years of life. The
infection can be viral or bacterial (usually streptococcal). It produces enlarged, tender lymph nodes
under the jaw (Figure 12.7). A rapid strep test can determine if Streptococcus is the cause, in which case
a full course of antibiotics is indicated. The infection can be recurrent, and tonsillectomy is sometimes
performed.
Splenomegaly, an enlarged spleen, is not a disease in itself but the result of an underlying disorder.
However, when the spleen enlarges, it traps and removes an excessive number of blood cells and platelets (hypersplenism) and reduces the number of blood cells and platelets in the bloodstream.

The potential causes of splenomegaly are numerous and include infections such as infectious
mononucleosis, lymphomas, anemias such as sickle cell anemia, and storage diseases such as Gaucher
disease.
Diagnosis and treatment focus on the underlying cause. Occasionally, splenectomy is necessary.
Ruptured spleen is a common complication from car accidents or other trauma when the abdomen
and rib cage are damaged. Intra-abdominal bleeding from the ruptured spleen can be extensive, with a
dramatic fall in blood pressure (BP), and is a surgical emergency requiring splenectomy. After splenectomy, patients are very susceptible to infection but function very well.
Lymphedema is localized, nonpitting fluid retention caused by a compromised lymphatic system,
often after surgery or radiation therapy. It also can be primary, where the cause is unknown.

406

CHAPTER 12  Lymphatic and Immune Systems The Language of Immunology


LO 12.4, 12.A 
Word Analysis and Definition
WORD
Hodgkin lymphoma

   S = Suffix   P = Prefix   R = Root    R/CF = Combining Form

PRONUNCIATION

ELEMENTS

HOJ-kin lim-FOH-muh

DEFINITION

S/
R/

Thomas Hodgkin, 1798–
1866, British physician
-oma tumor, mass
lymph- lymph

Disease marked by chronic enlargement of
lymph nodes spreading to other nodes in an
orderly way

S/
P/
R/

-ism condition, process
hyper- excessive
-splen- spleen

Condition in which the spleen removes blood
components at an excessive rate

S/
R/
S/
S/
R/CF

-ectomy surgical excision

lymphaden- lymph node
-itis inflammation
-pathy disease
lymphaden/o lymph node

Surgical excision of a lymph node

S/
R/CF

-gram recording
lymphangi/o- lymphatic
 vessels

Radiographic images of lymph vessels and
nodes following injection of contrast material

hypersplenism (Note
the one “e.”)

high-per-SPLEN-izm

lymphadenectomy

lim-FAD-eh-NEK-toh-mee

lymphadenitis
lymphadenopathy

lim-FAD-eh-NIE-tis

lim-FAD-eh-NOP-ah-thee

lymphangiogram

lim-FAN-jee-oh-gram

lymphedema

LIMF-eh-DEE-mah

R/
R/

lymph- lymph
-edema edema

Tissue swelling due to lymphatic obstruction

lymphoma

lim-FOH-mah

S/
R/

-oma tumor
lymph- lymph

Any neoplasm of lymphatic tissue

splenectomy
(Note: The “ee” in
spleen becomes “e” for
easier pronunciation.)
splenomegaly

sple-NEK-toh-mee

S/
R/

-ectomy surgical excision
splen- spleen

Surgical removal of the spleen

sple-noh-MEG-ah-lee

S/
R/CF

-megaly enlargement
splen/o- spleen

Enlarged spleen

tonsillectomy

ton-sih-LEK-toh-mee
ton-sih-LIE-tis

-ectomy surgical excision
tonsill- tonsil
-itis inflammation

Surgical removal of the tonsils

tonsillitis

S/
R/
S/

Inflammation of a lymph node
Any disease process affecting a lymph node

Inflammation of the tonsils

Exercises
A. Deconstruct medical terms into their elements. Deconstruct each term using the slashed lines. LO 12.4, 12.A, 12.D
1. splenectomy:


/
R

2. tonsillitis:


/

R

3. lymphadenitis:


S
/

R

4. hypersplenism:


S

S
/

P

/
R

S

B. Use the terms related to disorders of the lymphatic system above that is described by each statement.  LO 12.4, 12.A
1. Write the term that means tumor of lymphatic tissue: 
2. Write the term that means removal of the tonsils: 
3. The term that means tissue swelling that occurs as a result of obstructed lymphatics: 
4. The term that means inflammation of a lymph node: 

LESSON 12.1  Lymphatic System407


Lesson 12.2
LY M P H AT I C A N D I M M U N E S Y S T E M S

Immune System
Lesson Objectives
The study of the
immune system is called
immunology. The medical
specialist involved in the
study and research of the
immune system and in
treating disorders of the
immune system is called
an immunologist. The
information in this lesson
will enable you to use correct
medical terminology to:

12.1.1 Define the immune

system and its
specific reactions to
stimulation.
12.1.2 Contrast cellular and
humoral immunity.
12.1.3 Describe the life

histories of B cells and
T cells.
12.1.4 Explain the structure
and actions of
antibodies.
12.1.5 Discuss some common
disorders of the
immune system,
including human
immunodeficiency virus
(HIV) and acquired
immune deficiency
syndrome (AIDS).

Keynotes
• The immune system is
not an organ system but a
group of specialized cells.
• Receptors on the surface of
T cells and B cells recognize
specific nonself (foreign)
antigens.
• Antigens are molecules that
trigger an immune response.
Each antigen has a unique
structure that is recognized
by the immune system.
•Haptens are small,
foreign molecules that
attach themselves to

host molecules to form
large, unique complexes
that the immune system
can recognize as foreign.
Haptens are found in
cosmetics, detergents,
industrial chemicals, poison
ivy, and animal dander.

408

Case Report (CR) 12.2
You are

. . . a laboratory technician working the night shift at Fulwood Medical Center.

Your patient is
. . . Mr. Michael Cowan, a 40-year-old homeless man and drug addict, who has presented to the
Emergency Department with a high fever for which no cause is obvious on clinical examination.
You are called to the Emergency Room to take blood from Mr. Cowan. You have inserted the needle into
an antecubital vein, and he starts jerking his arm around and trying to get off the gurney. In the struggle,
the needle comes out of the vein and pricks your hand through your glove.
As you immediately flush and clean the wound, report the incident, seek immediate medical attention,
and go through your initial medical evaluation, it is essential that you have knowledge about your
immune system and its response to the potential infection. Then you can make informed decisions about
your treatment and future employment.

LO 12.5  The Immune System
The immune system is a group of specialized cells in different parts of the body that recognize foreign
substances and neutralize them. It is the third line of defense listed at the beginning of this chapter.

When the immune system is functioning correctly, it protects the body against bacteria, viruses, cancer
cells, and foreign substances. When the immune system is weak, it allows pathogens (including the
viruses that cause common colds and “flu”) and cancer cells to successfully invade the body.
Three characteristics distinguish immunity from the first two lines of defense:
1. Specificity. The immune response is directed against a particular pathogen. Immunity to one
pathogen does not confer immunity to others. Specificity has one disadvantage. If a virus or a
bacterium changes a component of its genetic code, it will lead to a change in the structure and/or
physiology of the microorganism, which then is no longer recognized by the immune system. This
mutation occurs, for example, in bacteria in response to antibiotics and in HIV’s response to antiHIV drugs (development of resistance).
2. Memory. When exposure to the same identical pathogen occurs again, the immune system
recognizes the pathogen and has its responses ready to act quickly.
3. Discrimination. The immune system learns to recognize agents (antigens) that represent “self”
and agents that are “nonself” (foreign). Most of this recognition is developed prior to birth. A
variety of disorders occur when this discrimination breaks down. They are known as autoimmune
disorders.

CHAPTER 12  Lymphatic and Immune Systems The Language of Immunology


LO 12.5, 12.A 
Word Analysis and Definition
WORD

   S = Suffix   P = Prefix   R = Root    R/CF = Combining Form

PRONUNCIATION

ELEMENTS

DEFINITION

antigen

AN-tih-jen

P/
R/

anti- against
-gen produce, create

Substance capable of triggering an immune response

autoimmune

aw-toh-im-YUNE

P/
R/

auto- self, same
-immune immune response

Immune reaction directed against a person’s own tissue

discrimination

DIS-krim-ih-NAY-shun

S/

P/
R/

-ation process
dis- away from, apart
-crimin- distinguish

Ability to distinguish between different things

hapten

HAP-ten

Greek to fasten or bind

Small molecule that has to bind to a larger molecule to
form an antigen

mutate
mutation

MYU-tayt
myu-TAY-shun

To make a change in the chemistry of a gene
Change in the chemistry of a gene

R/

Latin to change

-ion action, condition,
 process
mutat- change

S/
R/
S/

-ance state of, condition
resist- to withstand
-ant pertaining to

Ability of an organism to withstand the effects of an
antagonistic agent
Able to resist

S/
R/
S/

-ic pertaining to
specif- species
-ity condition, state

Relating to a particular entity

resistance

ree-ZIS-tants

resistant

ree-ZIS-tant

specific

speh-SIF-ik

specificity (Note:
two suffixes)

spes-ih-FIS-ih-tee

S/

State of having a fixed relation to a particular entity

Exercises
A. Build your knowledge of elements and their meaning by matching the element in the left column with the definition in the
right column.  LO 12.5
      1. crimina.species
_____2. ityb. away from
_____3. specifc.distinguish
_____4. antid.process
_____5. dise. pertaining to
_____6. ationf. condition, state
_____7. icg. produce, create
_____8. genh.against
B. Analyze Case Report 12.2, then answer the following questions.  LO 12.5, 12.A
1. What is the purpose of flushing the wound?

a. Hydrate the skin

c. Remove pathogens from the wound

b. Replace any lost blood

d. Water is a natural antibiotic

2. Mr. Cowan’s high fever is most likely due to:
a. an infection

b.heatstroke

c. an allergic reaction

d. cardiac arrest

3. If you have been exposed to a pathogen, your body will react to it by creating:
a.haptens

b.erythrocytes

c.mutations

d.antibodies

LESSON 12.2  Immune System409


Abbreviations

IgA
IgD
IgE
IgG
IgM

immunoglobulin A
immunoglobulin D
immunoglobulin E
immunoglobulin G
immunoglobulin M

Keynotes
• The immune system is
thought to be able to
produce some 2 million
different antibodies.
• Antibodies do not actively
destroy an antigen. They
render it harmless and
mark it for destruction by
phagocytes.
• Antibodies can be
produced naturally in
response to an antigen
or artificially in response
to immunizations and
vaccines.

LO 12.6  Immunity

Immunity is classified biologically into two types, though both mechanisms often respond to the same
antigen:
1. Cellular (cell-mediated) immunity is a direct form of defense based on the actions of lymphocytes
to attack foreign and diseased cells and destroy them.
The many different types of T cells, B cells, and macrophages described in the previous lesson of
this chapter are involved in this style of attack.
2. Humoral (antibody-mediated) immunity is an indirect form of attack that employs antibodies
produced by plasma cells, which have been developed from B cells. The antibodies bind to an
antigen and thus tag them for destruction.
These antibodies are called immunoglobulins (Igs), defensive gamma globulins in the blood plasma
and body secretions. There are five classes of antibodies (immunoglobulins):
•IgG makes up about 80% of the antibodies. It is found in plasma and tissue fluids. It crosses the

placenta to give the fetus some immunity.

•IgA makes up about 13% of the antibodies. It is found in exocrine secretions such as breast milk,

tears, saliva, nasal secretions, intestinal juices, bile, and urine.
•IgM makes up about 6% of antibodies. It develops in response to antigens in food or bacteria.
•IgD is found on the surface of B cells and acts as a receptor for antigens.
•IgE is found in exocrine secretions along with IgA and also in the serum.

Once released by plasma cells, the antibodies function in several ways to make antigens harmless,
including:
•Neutralization. An antibody binds to the antigen and masks it.
•Agglutination. An antibody binds to two or more bacteria to prevent them from spreading

through the tissues.
•Precipitation. Antibodies create an antigen-antibody complex that is too heavy to stay in
solution. The complex precipitates (drops out of solution) and can be ingested and destroyed by

phagocytes.
•Complement fixation. The complement system is a group of 20 or more proteins continually
present in blood plasma; IgG and IgM bind to foreign cells, initiating the binding of complement
to the cell and leading to its destruction. Complement fixation is the major defense mechanism
against bacteria and mismatched blood cells.
Based on the production or acquisition of antibodies, four classes of immunity can be described:
1. Natural active immunity—the production of your own antibodies as a result of normal maturation,
pregnancy, or an infection.
2. Artificial active immunity—the production of your own antibodies as a result of vaccination or
immunization. A vaccine consists of either killed or attenuated (weakened) pathogens (antigens).
3. Natural passive immunity—a temporary immunity that results from acquiring antibodies from
another individual. This occurs for the fetus through the placenta (IgG) or for the infant through
breast milk (IgA).
4. Artificial passive immunity—a temporary immunity that results from the injection of an immune
serum from another individual or an animal. Immune serum is used to treat snakebite, tetanus,
and rabies.

Definition of Terms
• Immunity is protection from an infectious disease. If you are immune to a disease, you can be

exposed to it without becoming infected.

• A vaccine is a product that stimulates a person’s immune system to produce immunity to a specific

disease, protecting that person from that disease. Vaccines are administered through needle
injections, by mouth, or by nasal spray.
• Vaccination is the act of introducing a vaccine into the body to produce immunity to a specific disease.
• Immunization is the process by which a person becomes protected against a disease through
vaccination. This term is often used interchangeably with vaccination or inoculation.
These definitions are provided by the U.S. Centers for Disease Control and Protection.

410

CHAPTER 12  Lymphatic and Immune Systems The Language of Immunology


LO 12.6, 12.A 
Word Analysis and Definition

   S = Suffix   P = Prefix   R = Root    R/CF = Combining Form

WORD

PRONUNCIATION

ELEMENTS

agglutination

ah-glue-tih-NAY-shun

S/
R/

agglutinate (verb)

ah-GLUE-tin-ate

attenuate

ah-TEN-you-ate

attenuated (adj)

ah-TEN-you-ay-ted

complement

KOM-pleh-ment

humoral immunity

HYU-mor-al
im-YOU-nih-tee

immune serum (also
called antiserum)

im-YUNE SEER-um

vaccine
vaccinate (verb)

vak-SEEN
VAK-sin-ate

vaccination

vak-sih-NAY-shun

DEFINITION
Process by which cells or other particles adhere
to each other to form clumps

S/

-ation process
agglutin- sticking together,
 clumping
-ate composed of, pertaining to

S/
R/
S/

-ate composed of, pertaining to
attenu- to weaken
-ated process

Weaken the ability of an organism to produce
disease
Weakened

Latin that which completes

Group of proteins in serum that finish off the
work of antibodies to destroy bacteria and other
cells

-al pertaining to

humor- fluid
-ity condition
immun- immune response

Defense mechanism arising from antibodies in
the blood

immune Latin protected from
serum Latin whey

Serum taken from another human or animal that
has antibodies to a disease

Latin relating to a cow
-ate composed of, pertaining to
vaccin- giving a vaccine
-ation process

Preparation to generate active immunity
To administer a vaccine

S/
R/
S/
R/

S/
R/
S/

Stick together to form clumps

Administration of a vaccine

Exercises
A. Identify the meanings of the word elements. Knowing the meanings of the word elements will help you to define medical terms.
Select the answer that correctly completes each statement. LO 12.5, 12.6
1. The root attenu- means:
a.clumping

b.inject

c.fluid

d.weaken

b.process

c. condition

d. pertaining to

2. The suffix -ity means:
a.source

B. Relate the name of the four classes of immunity to how it creates an immunity. Select the answer that correctly completes each
statement. LO 12.6
1. If the source of the immunity originates with an injection or a fluid that is inhaled or swallowed, then it is termed to be:
a.natural

b.artificial

2. If the person creates his or her antibodies after exposure, then the immunity is termed:
a.active

b.passive

3. If the source of the immunity originates within a person’s own body or from a mother to her baby, then the immunity is termed:
a.natural

b.artificial

4. If a person is given antibodies, then the immunity is termed:
a.active

b.passive

LESSON 12.2  Immune System411


LO 12.7  Disorders of the Immune System
Hypersensitivity is an excessive immune response to an antigen that would normally be
tolerated. Hypersensitivity includes:
• Allergies, which are reactions to environmental antigens such as pollens, molds, and
dusts; to foods such as peanuts, shellfish, and eggs; to plants such as poison ivy; to
sunlight (Figure 12.8); and to drugs such as penicillin, as well as asthmatic reactions to
inhaled antigens (see following text).
• Abnormal reactions to your own tissues (autoimmune disorders).
• Reactions to tissues transplanted from another person (alloimmune disorders).
In most allergic (hypersensitivity) reactions, allergens (antigens) bind to IgE on the

▲ Figure 12.8  Sun Allergy. ©BSIP/Photo
membranes of basophils and mast cells (see Chapter 11) and, within seconds of exposure,
Researchers, Inc.
stimulate the cells to produce histamine. This triggers vasodilation, increased capillary
permeability, and smooth muscle spasms. The symptoms produced by these changes include edema;
mucus hypersecretion and congestion; watery eyes; hives (urticaria); and sometimes cramps, diarrhea,
and vomiting.
Keynote
Anaphylaxis is an acute, immediate, and severe allergic reaction. It can be relieved by antihistamines.
Anaphylactic shock is more severe and is characterized by dyspnea due to bronchiole constriction,
• Because of the use of
circulatory
shock, and sometimes death. It is a life-threatening medical emergency and requires immeimmunosuppressive
diate
epinephrine
and circulatory support.
drugs, 75% of all solidAsthma is triggered by allergens (as listed earlier) and by air pollutants, drugs, and emotions. These
organ transplants will
be newly affected
all stimulate plasma cells to secrete IgE, which binds to cells in the respiratory mucosa and releases a
with cytomegalovirus
mixture of histamine and interleukins. Within minutes, the bronchioles constrict spasmodically (bron(CMV) following organ
chospasm), leading to the wheezing and coughing of asthma.
transplantation.
Autoimmune disorders are an overvigorous response of the immune system in which the immune
system fails to distinguish self-antigens from foreign antigens. These self-antigens produce autoantibodies that attack the body’s own tissues. This type of response occurs, for example, in lupus erythematosus, type 1 diabetes, multiple sclerosis, rheumatoid arthritis, and psoriasis.
Immunodeficiency disorders are a deficient response of the immune system in which it fails to
Abbreviation
respond vigorously enough. They are in three categories:
CMVcytomegalovirus

1. Congenital (inborn)—caused by a genetic abnormality that is often sex-linked, with boys affected
more often than girls. An example from among the 20 or more congenital immunodeficiency
diseases is inherited combined immunodeficiency disease, in which there is an absence of both T
cells and B cells. Affected children are very susceptible to opportunistic infections and must live in
protective sterile enclosures.
2. Immunosuppression—a common side effect of corticosteroids in treatment to prevent transplant
rejection and in chemotherapy treatment for cancer. These drugs reduce the numbers of all
lymphocytes, making it possible for opportunistic infections to invade the body.
3. Acquired immunodeficiency—a result of diseases such as acquired immunodeficiency syndrome
(AIDS) that involve a severely depressed immune system from infection with the human
immunodeficiency virus (HIV).

LO 12.7  Immunology of Transplantation
The success of any organ transplantation is based on control of the recipient’s immune system to prevent rejection of the allograft, tissue from another individual of the same species.
Transplant immunity is designed to cause rejection, and both cellular and humoral defense mechanisms are involved. To try to prevent this, the recipient and donor must match at both the human
lymphocyte antigen (HLA) and blood group system (ABO) (see Chapter 11) types. A combination of
immunosuppressive drugs is used to control graft rejection, but the drugs have adverse side effects on
the recipient. One combination is corticosteroids with cyclosporine or FK506. Other drugs are in clinical trials.

412

CHAPTER 12  Lymphatic and Immune Systems The Language of Immunology


LO 12.7, 12.A 
Word Analysis and Definition
WORD

   S = Suffix   P = Prefix   R = Root    R/CF = Combining Form

PRONUNCIATION

allogen

AL-oh-jen

allogenic (adj)
allograft

al-oh-JEN-ik
AL-oh-graft

alloimmune

ELEMENTS

DEFINITION

P/
R/
S/
R/

allo- strange, different
-gen producing
-ic pertaining to
-graft tissue for transplant

Antigen from someone else in the same species

AL-oh-im-YUNE

P/
R/

allo- strange, different
-immune immune response

Reaction directed against foreign tissue

anaphylaxis

AN-ah-fih-LAK-sis
AN-ah-fih-LAK-tik

ana- away from
-phylaxis protection
-tic pertaining to
-phylac- protect

Immediate severe allergic response

anaphylactic (adj)

P/
R/
S/
R/

histamine

HISS-tah-meen

antihistamine

an-tee-HISS-tah-meen

S/
R/
P/

-amine nitrogen containing
hist- derived from histidine
anti- against

Compound liberated in tissues as a result of injury
or an allergic response
Drug used to treat allergic symptoms because of
its action antagonistic to histamine

hypersensitivity

HIGH-per-sen-sihTIV-ih-tee

S/
P/
R/

-ity condition
hyper- excessive

-sensitiv- feeling

Exaggerated abnormal reaction to an allergen

immunodeficiency

IM-you-noh-deeFISH-en-see

S/
R/CF
R/

-ency quality
immun/o- immune response
-defici- failure

Failure of the immune system

immunosuppression

IM-you-noh-suhPRESH-un

S/
R/CF
R/

-ion process
immun/o- immune response
-suppress- pressed under

Suppression of the immune response by an outside agent, such as a drug

transplant

TRANZ-plant

transplantation

TRANZ-plan-TAY-shun

trans- across
-plant plant
-ation process, action

The tissue or organ used, or the act of transferring
tissue from one person to another
The moving of tissue or an organ from one person
or place to another

urticaria

ur-tih-KARE-ee-ah

Latin nettle

Rash of itchy wheals (hives)

P/
R/
S/

Pertaining to allogen
Tissue graft from another person or cadaver

Pertaining to anaphylaxis

Exercises
A. Build more medical vocabulary for immunology. Complete the construction of the medical term by using the following elements to
fill in the blanks. LO 12.7, 12.C
hyperdefici phylaxis auto suppress graft
ion

anti sensitiv transallo

gen

1. Exaggerated, abnormal reaction to an antigen

     /     /ity

2. Suppression of the immune response caused by an outside agent

immuno/     /     

3. Immediate, severe, allergic response

ana/     

4. Skin from another person or cadaver

allo/     

5. Failure of the immune system

immuno/     /ency

6. Transferring tissue or an organ from one person to another

     /plant

7. Antigen from someone else in the same species

allo/     

8. Reaction against foreign tissue

     /immune

9. Drug used to treat allergic symptoms

     /histamine

LESSON 12.2  Immune System413


Case Report (CR) 12.3
You are

. . . a medical assistant working with Henry Vandenberg, MD, in the AIDS Clinic at Fulwood Medical Center.

Your patient is
. . . Mr. Eugene Holman, a 40-year-old male who is known to be HIV-positive (HIV+) and has been
receiving treatment with efavirenz, zidovudine, and lamivudine.
In the past couple of months, Mr. Holman has not been taking his medication regularly. In the previous
week, he has noticed a progressive shortness of breath and a nonproductive cough. Vital signs are
T 102°, P 120, R 32, BP 110/60. He is anxious and dyspneic but not cyanotic. His breath sounds are clear,
with no rales or rhonchi heard. You have called Dr. Vandenberg to see him.
Mr. Holman’s chest x-ray shows bilateral, diffuse, fluffy infiltrates spreading out from the hila. Bronchial
lavage with laboratory examination shows Pneumocystis jiroveci. His CD4 count is 140. Mr. Holman has
developed an opportunistic infection, which is probably due to Pneumocystis jiroveci.

LO 12.8  HIV and AIDS

Human immunodeficiency virus (HIV) is one of a group of viruses known as retroviruses.
Like other viruses, it can replicate only inside a living host cell; HIV invades helper T (CD4)
cells and cells in the upper respiratory tract and CNS. Inside the cell, the virus generates
new deoxyribonucleic acid (DNA) and can stay dormant in the cell for months or years.
When it is activated, the new viruses emerge from the dying host cell and attack more CD4
cells. This dormant phase (incubation) can range from a few months to 12 years.
The CD4 cells are the central coordinators for the immune response. As the virus destroys
more and more cells, the CD4 count falls, and antibodies cannot be produced. Symptoms
appear, including chills, fever, night sweats, fatigue, weight loss, and lymphadenitis.
When CD4 cells are very low, opportunistic infections by bacteria, viruses, and fungi can
▲ Figure 12.9  Lesions of Kaposi
occur. These infections include toxoplasmosis, pneumocystis, tuberculosis, herpes simplex,
Sarcoma. ©SPL/Photo Researchers, Inc.
cytomegalovirus, and candidiasis. If human immunodeficiency virus (HIV) invades the
brain, it causes dementia. Cancers also can invade, and a form of malignancy called Kaposi
sarcoma (Figure 12.9) is often seen in association with autoimmune deficiency syndrome (AIDS).
HIV is found in blood, semen, vaginal secretions, saliva, tears, and the breast milk of infected mothers.

The most common means of transmission of HIV are:
Sexual
intercourse (vaginal, oral, anal).
•
• Sharing of needles for drug use.
• Contaminated blood products. (All donated blood is now tested for HIV.)
• Transplacental (from an infected mother to her fetus).
The virus survives poorly outside the
human body. It is destroyed by laundering,
dishwashing, chlorination, disinfectants,
alcohol, and germicidal skin cleansers.
In the United States, the number of new
HIV diagnoses declined about 19% from
2005 to 2014, but diagnoses have increased
among certain groups and in certain
geographical regions so new infections
continue to occur (Figure 12.10). 

Black MSM
White MSM
Hispanic/Latino MSM
Black heterosexual women
Black heterosexual men
Hispanic/Latina
heterosexual women
White heterosexual women

Men
Women
0

2,000

4,000

6,000

8,000

10,000

12,000

▲ Figure 12.10  HIV Diagnoses. New HIV diagnoses in the United States for the mostaffected subpopulations, 2015. (MSM, men who have sex with men.)

414

CHAPTER 12  Lymphatic and Immune Systems The Language of Immunology


LO 12.8, 12.A 
Word Analysis and Definition
WORD

   S = Suffix   P = Prefix   R = Root    R/CF = Combining Form

PRONUNCIATION

ELEMENTS

DEFINITION

dormant

DOR-mant

S/
R/

-ant forming
dorm- sleep

Inactive

incubation

in-kyu-BAY-shun

S/
R/

-ation process
incub- sit on, hatch

Process to develop an infection

opportunistic

OP-or-tyu-NIS-tik

S/
S/
R/

-ic pertaining to
-ist- agent
opportun- take advantage of

An organism or a disease in a host with lowered
resistance

retrovirus

REH-troh-VIE-rus

P/
R/

retro- backward
-virus poison

Virus that replicates in a host cell by converting its
ribonucleic acid (RNA) core into deoxyribonucleic acid
(DNA)

sarcoma

sar-KOH-mah
ka-POH-see
sar-KOH-mah

-oma tumor, mass
sarc- flesh
Moritz Kaposi, 1837–1902,
Hungarian dermatologist

A malignant tumor originating in connective tissue

Kaposi sarcoma

S/
R/

virus

VIE-rus

Latin poison

viral (adj)

VIE-ral

Group of infectious agents that require living cells for
growth and reproduction
Pertaining to or caused by a virus

S/
R/

-al pertaining to
vir- virus

A malignancy often seen in AIDS patients

Exercises
A. Analyze Case Report 12.3 and then answer the following questions. Select the answer that correctly completes each statement. LO 12.8
1. Mr. Holman developed an opportunistic infection because:
a. the pathogen is potent

c. he forgets to take his medication

b. he is homeless

d. his immune system is compromised

2. The diagnostic test that determined the reason for the infection was:
a. breath sounds

b. bronchial lavage

c. CD4 count

d. chest x-ray

B. Identify the meaning of the word elements. Given the term, identify the correct definition of the indicated word element. LO 12.8
1. In the term viral, the root means:
a. pertaining to

b.cancer

c.process

d.virus

c.tumor

d.inflammation

c. pertaining to 

d.sleep

2. In the term sarcoma, the root means:
a.cancer

b.flesh

3. In the term dormant, the suffix means:
a.forming

b. take advantage

LESSON 12.2  Immune System415


Lesson 12.3
LY M P H AT I C A N D I M M U N E S Y S T E M S

Procedures and Pharmacology

Lesson Objectives
Immunoassays rely on the
ability of an antibody to
recognize and bind to a
specific antigen and produce
a measurable response. In
some cases they can use
an antigen to detect for
the presence of antibodies,
and again produce a
measurable response. A wide
range of medical tests are
immunoassays: 

12.3.1 Identify

immunodiagnostic
tests that involve an
antigen-antibody
reaction.
12.3.2 Define the mechanism
of agglutination tests.
12.3.3 Recognize diagnostic
tests used for allergies.

LO 12.9  Diagnostic Procedures 
Immunodiagnostics uses an antigen-antibody reaction as a diagnostic tool; an antigen is used to detect
antibodies to a pathogen; an antibody is used to detect an antigen of a pathogen in a patient’s specimen. Very small amounts of biochemical substances can be detected when antibodies specific for a
desired antigen are conjugated with a radiolabel, fluorescent label, or a color-forming enzyme and used
as a “probe” to detect it. 

Applications include pregnancy testing, dipsticks, and enzyme-linked immunosorbent assay
(ELISA). ELISA uses antibodies and enzymes linked to color-changing dyes to detect specific antibodies and chemicals. ELISA is used to diagnose HIV, West Nile virus, malaria, tuberculosis, and rotavirus
in feces, as well as in drug screening. 
In agglutination tests, a particle such as a latex bead or a bacterium is coupled to a reagent antigen
or antibody and the resulting particle complex is mixed with the specimen (e.g., serum or CSF). If the
target antibody or antigen is present in the specimen, it attaches to the particle complex and produces
agglutination. 
A complement fixation test measures the amount of an antibody in the serum or CSF to viral and
fungal infections such as coccidioidomycosis. 
Diagnostic tests for allergies include:
• nasal smears to check the amount of eosinophils in the nose. 
• skin tests to measure the level of IgE antibodies in response to allergens that are injected under

the skin or applied with a small scratch. A reaction appears as a small red area.

• blood tests measure IgE antibodies to specific allergens in the blood. A radioallergosorbent test

(RAST) uses a radioimmunoassay to detect the specific IgE antibodies, but is now little used.

• Challenge testing is performed by an allergist, who administers a very small amount of an allergen

orally or by inhalation and monitors its effect. 

High blood levels of IgA are found in multiple myeloma, autoimmune diseases such as rheumatoid
arthritis and systemic lupus erythematosus (see Chapter 15), and cirrhosis of the liver (see Chapter 5).
Low levels of IgA occur in some types of leukemia (see Chapter 11) and in nephrotic syndrome (see
Chapter 6). 
High blood levels of IgG can indicate a chronic infection, such as HIV and in chronic hepatitis and
multiple sclerosis. Low levels are found in some types of leukemia and in nephrotic syndrome. 
High blood levels of IgE are also found in patients with parasitic infections.

416

CHAPTER 12  Lymphatic and Immune Systems The Language of Immunology


LO 12.9  Word Analysis and Definition
WORD

PRONUNCIATION

   S = Suffix   P = Prefix   R = Root    R/CF = Combining Form
ELEMENTS

DEFINITION

bacterium
bacteria (pl)

bak-TEER-ee-um
bak-TEER-ee-ah

Greek a staff

A unicellular microorganism that multiplies by cell division

complex

KOM-pleks 

Latin woven together

A stable combination of two or more compounds in the
body

conjugate

KON-joo-gate

To join together, usually in pairs.

P/
R/

-ate composed of,
  pertaining to
con- together
jug- yoke

S/

immunoassay

IM-you-no-ASS-ay

R/CF
R/

immun/o- immune
-assay evaluate

Biochemical test that uses the reaction of an antibody to its
antigen to measure the amount of a substance in a liquid

immunodiagnostics

IM-you-no-die-ag-

S/
R/CF
R/

-ics pertaining to
immun/o- immune
-diagnost- decision

A diagnostic process using antigen-antibody reactions

radioallergosorbent

RAY-dee-oh-ahLUR-go-SOAR-bent
RAY-dee-oh-im-you-noASS-ay

-ent end result
radi/o- radiation
-allerg/o- allergy
-sorb- suck in
-immun/o immune
-assay evaluate

A radioimmunoassay to detect IgE-bound allergens
responsible for tissue hypersensitivity

radioimmunoassay

S/
R/CF
R/CF
R/
R/CF
R/

NOSS-tiks

Immunoassay of a substance that has been radioactively
labeled

Exercises
A. Immunoglobulin (Ig) levels are used to support the diagnosis of lymphatic system disorders. Match the Ig levels in the first column
with the condition it is associated with in the second column. LO 12.9
      1. increased IgE antibodiesa. HIV infection
      2. increased IgG antibodiesb.leukemia
      3. decreased IgG antibodiesc. parasitic infections
B. Choose the correct test used in the diagnosis of conditions caused by immune system disorders.  LO 12.9, 12.F
1. The test used to detect the presence of HIV infection:
a.ELISA

b. RAST

c. challenge testing

d. Ig levels

c. challenge testing

d. agglutination testing

2. Patient inhales allergens to see if they cause an allergic reaction:
a. skin test

b. blood test

3. Measures the amount of antibody present in cerebrospinal fluid or serum:
a.RAST

b. complement fixation test

c.ELISA

d. challenge testing

LESSON 12.3  Procedures and Pharmacology417


LO 12.9  Therapeutic Procedures and
Drugs for the Immune System
Immunotherapy, also called biologic therapy, is designed to boost the body’s natural defenses against
cancer by using substances either made in the laboratory or made by the body to enhance or restore
immune system function. This form of therapy can stop or slow the growth of cancer cells, and stop
cancer from metastasizing.

The types of immunotherapy include:
• Monoclonal antibodies, made in the laboratory, can attach to cancer cells to flag them so that
macrophages in the body’s immune system can recognize and destroy them. Two pathways
inside cells that cancers use to evade the immune system have been identified and named PD-1/
PD-L1 and CTLA-4. These pathways can be blocked with antibodies called immune checkpoint
inhibitors to allow the body’s immune system to respond to the cancer. Immune checkpoint
inhibitors ipilimumab (Yervoy), nivolumab (Opdivo), and pembrolizumab (Keytruda) have been
shown to improve overall patient survival in advanced melanoma.
• Interferons are a nonspecific immunotherapy mostly given at the same time as other cancer
treatments such as chemotherapy or radiation therapy. An interferon called interferon alpha made
in a laboratory is the most common type of interferon used in cancer treatment.
• Interleukins are also a nonspecific immunotherapy used to treat kidney and skin cancers,
including melanoma.
Human immunoglobulins are given by injection to confer passive (temporary) immunity that provides immediate protection lasting several weeks. There are two types:
• Human normal immunoglobulin (HNIG) made from the plasma of about 1,000 unselected donors
to provide antibodies against hepatitis A, rubella, measles, and other viruses found in the general
population.
• Hyperimmune specific immunoglobulins are made from selected donors and provide antibodies
individually against hepatitis B, varicella zoster, rabies, tetanus, and cytomegalovirus.

Immunosuppressant Drugs
Immunosuppressant drugs inhibit or prevent activity of the immune system and are used to prevent
the rejection of transplanted organs and tissues, treat autoimmune diseases, and help control longterm allergic asthma. There are four main types of immunosuppressant drugs:
• Glucocorticoids, which suppress cell-mediated immunity and protect through T-cells and
macrophages, and by stimulating cells to secrete cytokines.
• Cytostatics, which inhibit cell division. Cyclophosphamide (Cytoxan), a nitrogen mustard
alkylating agent, is probably the most potent immunosuppressant. Methotrexate, an
antimetabolite, interferes with the synthesis of nucleic acids and is used in the treatment of
autoimmune diseases. Azathioprine (Imuran) is the main immunosuppressive cytotoxic substance
and is used to control transplant rejection reactions.

• Antibodies can be used as quick immunosuppressive therapy and are described above in sections
on monoclonal antibodies and immunoglobulins.
• Calcineurin is a phosphatase that stimulates the growth and differentiation of T cells. Calcineurin
inhibitors such as ciclosporin (Sandimmune), tacrolimus (Prograf), and sirolimus (Rapamune) are
used in the prevention and treatment of transplant rejection reactions.
Alcohol, marijuana, and illicit drugs have been shown to depress the immune system.

418

CHAPTER 12  Lymphatic and Immune Systems The Language of Immunology


LO 12.9  Word Analysis and Definition
WORD

PRONUNCIATION

alkylation

al-kih-LAY-shun

antimetabolite 

AN-tih-meh-TAB- oh-lite

biologic

BI-oh-LOJ-ik

calcineurin

kal-see-NYUR-in

cytokine

SIGH-toh-kine

cytostatic

SIGH-toh-STAT-ik

cytotoxic
immunoglobulin

SIGH-toh-TOK-sik
IM-you-noh-GLOB-you-lin

immunotherapy

IM-you-noh-THAIR-ah-pee

inhibitor

in-HIB-ih-tor

interferon

in-ter-FEER-on

interleukin

IN-ter-LOO-kin

monoclonal

MON-oh-KLOH-nal

   S = Suffix   P = Prefix   R = Root    R/CF = Combining Form
ELEMENTS

S/
R/
S/
P/
R/
S/
R/CF
R/
S/
R/CF
R/
S/
R/CF
S/
R/CF
R/
S/
S/
R/CF
R/

R/
R/CF
S/
R/
S/
P/
R/
S/
P/
R/
S/
P/
R/

-ation process
alkyl- alkali
-ite resembling
anti- against
-metabol- change
-ic pertaining to
bio- life
-log- study of
-in chemical
calc/i calcium
-neur- nerve
-kine movement
cyt/o- cell
-ic pertaining to
cyt/o cell
-stat- stop

-toxic able to kill
-in chemical
immun/o immune response
-globul- protein
immun/o immune response
-therapy treatment
-or that which does
inhibit- restrain
-on on
inter- between
-fer- to strike
-in chemical
inter- between
leuk- white
-al pertaining to
mono- one
-clon- cutting used for
 propagation

DEFINITION
Introduction of a side chain into a compound
A substance that antagonizes another substance
Pertaining to the study of life and living organisms
A chemical that stimulates the growth and
differentiation of T-cells
A hormone-like protein that regulates the intensity
of an immune response
Inhibiting cell division
Destructive to cells
Specific protein (antibody) generated by an antigen

Treatment to boost immune system function
An agent that restrains a chemical action
A small protein produced by T-cells in response to
infection
A group of cytokines synthesized by white blood cells
Derived in the laboratory from a protein from a
single colony of cells

Exercises
A. Identify the action of the drug based on a word element that it contains. Being able to pick out and define word elements can help you
determine the meaning of the word. Select the answer that correctly completes each statement. LO 12.9
1. A medication that would provide antibodies to persons to prevent viral infections:
a.cytostatic

b. glucocorticoid

c. human normal immunoglobulin

d. monoclonal antibodies

c.interleukin

d. interferon

2. A medication that would inhibit cell division:
a.cytostatic

b.calcineurin

B. Categorize medications of immunotherapy. Match the medication in the first column with the disorder it is used to treat in the second column. LO 12.9

      1.interleukina. treat kidney and skin cancers
      2.interferonsb. flag cancer cells for macrophages
      3. monoclonal antibodiesc. given alongside chemotherapy and radiation therapy
C. Categorize immunosuppressant drugs. Match the medication in the first column with the disorder it is used to treat in the second column. LO 12.9
      1.methotrexatea. interferes with nucleic acids as a means to treat autoimmune diseases
      2. tacrolimus (Prograf)b. inhibits cell division
      3.glucocorticoidc. suppresses cell-mediated immunity
      4. cyclophosphamide (Cytoxan)d. prevents and treats transplant rejection reactions

LESSON 12.3  Procedures and Pharmacology419


Chapter 12 Review
©2014 Nucleus Medical Media

Lymphatic and Immune Systems
Challenge Your Knowledge
A. Latin and Greek elements cannot be deconstructed into prefix, root, or suffix. You must know them for what they are. Test your
knowledge of these elements with this exercise. Match the meaning in the left column with the correct medical term in the right
column. (LO 12.1, 12.D)




1. Protected froma.conjugate

2. That which completesb.hapten





3.Nonec.lymph





4. To fasten or bindd.assay





5. To joine.mutate





6. A knotf.complement

7. To changeg.edema





8. To evaluateh.immune





9.Swellingi.null





10. Clear fluidj.node

420

CHAPTER 12 REVIEW  Lymphatic and Immune Systems


B. Language of immunology. Challenge your knowledge of the immune system and employ the language of immunology to answer the
following questions. Choose the correct answer. (LO 12.1, 12.3, 12.4, 12.7, 12.A)
1.
Choose the correct pair of spellings:

5.
Ingestion and destruction of tissue debris and bacteria is called

a.
tonseltonselectomy

a.
lymphadenitis

b.
tonsiltonsillectomy

b.
phagocytosis

c.
tonssiltonsilectomy

c.
lymphadenopathy

d.
tonsilltonsilectomy

d.
agglutination

e.
tonnsiltonsillectomy

e.
osmosis

2.
This triggers vasodilation in an allergic response:
a.
interferon
b.
complement fixation
c.
histamine
d.
hormones
e.
antihistamine
3.
The largest lymphatic vessel is the
a.
thoracic duct
b.
lymph node
c.
spleen
d.
lymphatic duct
e.
aorta
4.
Kaposi sarcoma is a form of
a.

lymphadenitis
b.
malignancy
c.
lymphadenopathy
d.
lung cancer
e.
lymphoma

6.
A life-threatening medical emergency that cannot be
relieved by antihistamines is
a.
asthma
b.
Kaposi sarcoma
c.
anaphylactic shock
d.
urticaria
e.
lymphadenitis
7.
An allergic reaction is one of
a.
hypoglycemia
b.
hypersensitivity
c.

hypotension
d.
hyperglycemia
e.
hypertension
8.
White pulp and red pulp can be found in the
a.
lymph nodes
b.
spleen
c.
lymph vessels
d.
kidney
e.
thymus



CHAPTER 12 REVIEW  Lymphatic and Immune Systems

421


Chapter 12 Review
©2014 Nucleus Medical Media

Lymphatic and Immune Systems
C. Language of immunology. Challenge your knowledge of the immune system and employ the language of immunology to answer the

following questions. Circle the correct choice. (LO 12.4, 12.7, 12.9)
1.
Which disease is likely to cause enlarged lymph nodes
under the jaw?
a.
tonsillitis

a.
organ transplant
b.
anaphylactic shock

b.
lymphoma

c.
retrovirus

c.
hypersplenism

d.
opportunistic infection

d.
asthma

e.
viral load count

e.
urticaria
2.
Abnormal, cancerous B cells are known as
a.
macrophages

d. killer cells

b.
osteoblasts

e. phagocytes

c.
Reed-Sternberg cells
3.
Lymph nodes accessible for palpation are in the
a.
neck

4.
Immunosuppressive drugs are given after

5.
Serum used to treat a snake bite is an example of
a.
natural active immunity
b.
artificial active immunity

c.
natural passive immunity
d.
artificial passive immunity

d. all of these

b.
axillae. only A and C
c.
groin
D. Correct spelling of medical terms is always important. Listed below are two examples of medical terms for which a variation of the term is
not always spelled the same as the original term. Fill in the blanks with the correctly spelled medical terms. (LO 12.1, 12.4, 12.9, 12.A)
Example 1:
Lymphatic organ in LUQ of abdomen

1. 

Excision/removal of this organ

2. 

Enlargement of this organ due to an underlying disorder

3. 

Example 2:
Lymphoid tissue on either side of the throat

4. 

Inflammation of this tissue

5. 

Removal of this tissue

6. 

422

CHAPTER 12 REVIEW  Lymphatic and Immune Systems