Immunodeficiency and Immunotherapy (SLS137)

10 credits

Aim of this module

This module will provide the trainee with knowledge and understanding of the causes of immunodeficiency. They will understand the clinical presentation and investigation of a range of immunodeficient conditions and the principles and practice of immunotherapy. They will become familiar with methods and strategies to investigate immunodeficiency and gain experience of the interpretation of patient results in a variety of clinical settings.

  1. Select immunology tests for the diagnosis and management of immunodeficiency and monitoring of immunotherapy.
  2. Perform clinical and laboratory investigation of immunodeficiency.
  3. Interpret and report results of investigation of immunodeficiency in the correct clinical context.
  4. Apply immunotherapeutic strategies for inpatients with a range of primary and secondary immunodeficiencies.
  5. Work in partnership with other clinical specialisms in the investigation of immunodeficiency and immunotherapy.
Number Work-based learning outcome Title Knowledge
1 1

Select the appropriate immunological assay to investigate whether the immune system of the patient is immunocompetent or immunodeficient. To include all of the following:

  • immunoglobulins and subclasses
  • neutrophil function tests
  • lymphocyte function tests
  • specific antibody responses to vaccine antigens
  • complement activity
  • cytokine production
  • molecular assays to define immunodeficiencies.
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2 2

Perform the appropriate investigation of immunodeficiency to include all specified. To include all of the following:

  • immunoglobulins and subclasses
  • neutrophil function tests
  • lymphocyte function tests
  • specific antibody responses to vaccine antigens
  • complement activity
  • cytokine production
  • molecular assays to define immunodeficiencies.
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3 3

Interpret immunological data in the light of clinical details on patients with primary immunodeficiency, including:

  • deficiencies of innate immunity
  • B lymphocyte deficiencies
  • T lymphocyte deficiencies
  • combined T and B cell defects.
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4 3

Interpret immunological data in light of clinical details on patients with secondary immunodeficiency, including all of the following:

  • iatrogenic
  • neoplasia
  • infection.
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5 3

Interpret immunological data in light of clinical details.

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6 4

Apply the appropriate immunotherapeutic strategies/treatment regimens for patients with a range of primary and secondary immunodeficiencies.

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7 3,4

Interpret, assess the effectiveness of and report results from patients receiving a range of immunotherapies, including at least three of the following:

  • antibodies as immunosuppressive agents
  • immunosuppressive drugs
  • physical methods of immunosuppression
  • cytokines and anti-cytokines
  • intravenous immunoglobulins
  • immunisation against infection
  • novel approaches to autoimmunity, i.e. infliximab and rituximab
  • stem cell therapies, specifically for immunodeficiencies.
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8 5

Identify relevant clinical investigations from other disciplines that will impact on the interpretation of the immunological investigation.

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You must complete
2 Case-based discussion(s)
2 of the following DOPS / OCEs
Assessment Title Type
Perform analysis of a patients serum to determine levels of immunoglobulins IgG IgM IgA DOPS
Perform the flow cytometric assay to determine the number of CD4 T cells DOPS
Perform the assay to determine the level of anti tetanus Or anti pneumococcus Or anti Hib IgG antibodies in a patient serum sample DOPS
Perform the assay to determine the C3 and C4 levels in a patient sample DOPS
Perform a lymphocyte proliferation assay DOPS
Perform a neutrophil functional assay DOPS
Perform the C100 or C50 assay to see if the classical pathway of complement is working in a patient DOPS
Perform the AP50 AP100 assay to see if the alternative pathway of complement is working in a patient DOPS
Perform TCR V beta analysis DOPS
Take a history where the patient is suspected of having an immunodeficiency disorder OCE
Describe to a patient with CVID XLA other antibody deficiency why you need to take EDTA blood to examine the B and T cells or measure immunoglboulins OCE
Observe and then report to the clinician on taking blood for immunoglobulin measurement or for B and T cells from a patient OCE
Discuss with a patient undergoing intravenous subcutaneous immunoglobulin therapy about this treatment and how it is helping them OCE
Attend an MDT meeting of clinical immunologists and present the results of patient testing OCE
Attend an outpatient clinic within any discipline gastro rheumatology dermatology renal etc where the patient may have an immunological dysfunction as part of their disease OCE
Obtain a patient history from a normal volunteer or typical patient referred to your service and present the findings to a colleague or peer OCE

Important information

The academic parts of this module will be detailed and communicated to you by your university. Please contact them if you have questions regarding this module and its assessments. The module titles in your MSc may not be exactly identical to the work-based modules shown in the e-portfolio. Your modules will be aligned, however, to ensure that your academic and work-based learning are complimentary.

Learning Outcomes

  1. Discuss the clinical implications of immunodeficiency and the primary and secondary causes of immunodeficiency.
  2. Explain the role of the humoral and cellular components of the immune system in immunodeficiency.
  3. Describe the design, operation and performance of laboratory tests and assays used to investigate and define immunodeficiency.
  4. Explain the principles of immunotherapy.
  5. Describe and monitor the impact of immunotherapeutic treatments.
  6. Discuss and justify appropriate immunotherapeutic strategies/treatment regimens for patients with a range of primary and secondary immunodeficiencies.
  7. Describe the partnership between the clinical immunology laboratory and other clinical specialisms in the investigation of immunodeficiency and immunotherapy and patient care.

Indicative Content

  • Assessing immune function (T lymphocytes; B lymphocytes; phagocytes; complement)
  • Deficiencies of innate immunity (phagocytic cell defects; leukocyte adhesion defects; complement system defects)
  • B lymphocyte deficiencies (X-linked agammaglobulinaemias; selective IgA deficiency; IgG subclass deficiency; common variable immunodeficiency; transient hypogammaglobulinaemia of infancy; selective specific antibody deficiencies)
  • T lymphocyte deficiencies (Di George syndrome; Ommen’s syndrome; bare lymphocyte syndrome; X-linked hyper IgM syndrome; severe T cell deficiencies [X-linked recessive form; adenosine deaminase (ADA) deficiency; purine nucleoside phosphorylase (PNP) deficiency])
  • Combined T and B cell defects
    • Severe combined immunodeficiency (SCID) (autosomal recessive SCID; T cell receptor immunodeficiency; MHC Class II deficiency; IL-2 production defect)
    • Wiskott-Aldrich syndrome
  • Secondary immunodeficiencies (iatrogenic; neoplasia; infection)
  • Cytokine defects
  • Human immunodeficiency virus (HIV) and AIDS
    • Pathogenesis of HIV infection
    • Epidemiology, prevalence and modes of transmission
    • Laboratory abnormalities in HIV infection
    • Management of HIV infection (drug therapies; vaccines)
  • Immunotherapy
    • Antibodies as immunosuppressive agents (plasmapheresis and plasma exchange; monoclonal antibody therapy; generation of antibodies; ‘magic bullet’ therapy)
    • Immunosuppressive drugs (corticosteroids; cyclosporin and tacrolimus; other anti-inflammatory agents)
    • Other immunosuppressive agents (X-irradiation; ultraviolet light)
    • Cytokines and anti-cytokines (interleukin-1; interleukin-2; interferons; tumour necrosis factors [TNF]; Th1/Th2 balance)
    • Immune modulation by intravenous immunoglobulins
    • Immune potentiation (hormones; cytokine therapy; gene therapy)
    • Other uses of monoclonal antibodies
    • Stress and the immune system (psycho-neuro-endocrino-immune pathway)
    • Immunisation against infection (adjuvants; routine immunisations; travel immunisations; passive immunisation; new vaccines)
    • Cancer immunotherapy
    • Novel approaches to autoimmune disease (T cell vaccines; oral tolerance)
    • Other approaches (lymphocyte vaccination; blocking T cell-adenomatous polyposis coli [APC] interactions; gene repair; patient specific amplification of cytotoxic cells; stem cell therapies)