State Educational Establishment of Higher Professional Education Kursk State Medical University Federal Agency of Public Health and

Social Development

CLINICAL IMMUNOLOGY AND ALLERGOLOGY DEPARTMENT

S.M. Yudina, A.V. Arkhipova, T.A. Lykina

GUIDELINES
IN IMMUNOLOGY for the 3-d year students

of the Medical Faculty

KURSK 2010

Authors: Head of the immunology and allergology department professor S.M. Yudina Associated professor A.V. Arkhipova Teacher T.A. Lykina

CONTENTS

Recommended literature 1. Structure and functions of immune system. 2. Antigens and Antibodies. 3. Major Histocompatibility Complex. 4. T-lymphocytes. 5. B-cell immunity. 6. Mononuclear phagocytic system. Antigen-Presenting cells. 7. Mediators of immune system. 8. Adaptive and Innate Immunity. 9. Cytotoxic reactions. 10. Transplantation immunity. 11. Immunology of blood transfusion. 12. Immune system development. 13. Antitumor immunity. 14. The questions for credit-test.

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GENERAL COMMENTS Immunology is associated with many clinical problems. This discipline is a theoretical basis of Medicine. The main purpose of Immunology is to give knowledge in development, individual variability, adaptation to changing function, defensive and pathological mechanisms of the human organism. The aim of the course is teaching the basic principles of theoretical and practical approaches to immunopathologies, clinical thinking development necessary for diagnostics and therapy of immunopathologies.

SUGGESTED READINGS

1. S. M. Yudina, A. V. Arkhipova Immunology. The educational manual for the students on actual questions of theoretical Immunology, Kursk, 2004, 72 pp. ( ) 2. Basic immunology, clinical immunology and allergology. S.M. Yudina, A.V. Arkhipova, T.A. Lykina, T.S. Rusanova. Kursk, 2008, 196 pp. ( ) 3. Hyde, R.M. Immunology, 3-rd ed. New Delhi: B.I. Waverly PVT LTD, 1997 316 pp. 4. Khaitov, R.M. Immunology: textbook. M.- 2008. - 256p.:il ( CD) 5. I. Roitt, J. Brostoff, D. Male. Immunology, St.Louis:Mosby, 1993, 362 pp. 6. Immunology/ D. Male. J. Brostoff, D. Roitt, Canada, 2006, 552 pp. 7. HIV infection and AIDS Ed. L.Deodhar, 2-nd ed. Bombay: VORA Medical Publications, 1996 - 150 pp. 8. Leonard C. Altman. Clinical allergy and immunology, Boston, Massachusetts, 1984, 491 pp. 9. Sharon J. Basic Immunology, Baltimore: Williamse & Wilkins, 1999 303 pp. 10. C. A. Janeway, P. Travers, M. Walport, J.D. Carpa Immunol-

ogy: The Immune system in health and disease, 4-th ed. Churchill Livingstone, 1999 - 635 pp.

Topic: Immune system: structure and functions.

Aim: To study the structure of the immune system at the organ and cellular levels. To be aware of the peculiarities of the immune system functioning. Motivation section. The immune system is one of the main organism systems. The knowledge of its structure and functions is necessary for understanding of the immune mechanism in normal and pathological conditions.

Questions for consideration

1. Definition of the immunology. 2. The main stages of the immunology development. 3. Definition of the immune system. 4. Classification of the immune organs. 5. Peculiarities of the immune system. 6. Functions of the immune system. 7. The structure and functions of the thymus. 8. The functions of the bone marrow. 9. The structure and functions of the spleen. 10. The structure and functions of the lymph node. 11. Peculiarities of the lymphoid tissue. 12. Location of the T- and B-zone in the secondary lymphoid organs. 13. The functions of large granular lymphocytes. 14. The peculiarities of B-system functioning. 15. The cells and the main functions of the phagocytic system. 16. The types of organism reactivity, their characteristics. 17. Explain the phenomena of immunity: immunological memory, tolerance, and autoimmunity.

Task-based activities. Activity A: draw the scheme of lymph node structure.

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Activity B: draw the scheme of hemopoiesis. Activity C: draw the scheme of lymphopoiesis.

Topic: Antigens and Antibodies.

Aim: Study the main properties and biological functions of antibodies, mechanisms of the interaction Ag-Ab and the methods of Antigens and Antibodies identification. Motivation section. The knowledge of the structure, the properties, the functions of Antigens and Antibodies are necessary for understanding of the mechanisms of the immune reactions in normal and pathological conditions.

Questions for consideration

1. Definition of antigen. 2. Properties of antigens. 3. Classification of antigens according to the chemical structure. 4. Classification of antigens according to genetically foreignness. 5. Definition of antigen specificity. 6. Structure of antigens. 7. The role of the antigen determinant. 8. Characteristics of the thymus dependent and thymus independent antigens, their peculiarities. 9. Definition of haptens, their peculiarities. 10. The ways of antigens admittance into the organism. 11. The ways of the antigens elimination. 12. The mechanism of the antigen recognition. 13. Definition of antibodies. 14. Types of immunoglobulin molecules. 15. Light and heavy chains of the immunoglobulins. 16. Structure of the immunoglobulins.
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17. Functions of the variable and constant regions. 18. Definition of domains, their functions. 19. Characteristics of the major antibodies properties. 20. Types of antigen-antibody interaction. 21. Principles of the main methods of antibodies identification.

Task-based activities. Activity A: Draw the scheme of antibody structure. Activity B: Draw the scheme of ELISA.

Practical skills due: 1. A student must be able to determinate the antibodies concentration with Mancini method. 2. A student should learn to detect the level of antigens and antibodies with ELISA.

Topic: Major Histocompatibility Complex.

Aim: To study the structure and functions of MHC-molecules. To know the HLA typing. To be aware of the diseases associated with MHC-complex. Motivation Section: The MHC-complex plays an important role in normal immune response, because antigens are recognized by lymphocytes in conjunction with MHC-molecules. The MHC restriction mediates specific immune response only. The knowledge of the HLA-typing is necessary for understanding of transplantation mechanisms.

Questions for Consideration.

1. Definition of MHC. 2. Definition of HLA. 3. Classification of MHC-antigens.
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4. Genetic organization of the MHC. 5. Polymorphisms of class I and class II loci. 6. Structure of the MHC class I antigens. 7. Cells, expressing the MHC class I antigens. 8. Functions of the class I molecules. 9. Structure of the MHC class II antigens. 10. Cells, expressing the MHC class II molecules. 11. Functions of the class II molecules. 12. Characteristics of the MHC class III. 13. Serologic assays for HLA typing. 14. Mixed lymphocyte reaction for HLA-typing. 15. Uses of HLA- typing. 16. Diseases, associated with MHC-alleles. 17. The role of the MHC antigens in transplantation.

Task-based Activities. Activity A: Draw the scheme of the MHC class II molecules structure. Activity B: Draw the scheme of the mixed lymphocyte reaction.

Practical skills due: A student must be know the indication to HLA- typing.

Topic: T-lymphocytes.
Aim: to study the main stages of the T-lymphocytes development, their receptors and markers, to be aware of the T-cell subsets and their functions, to know the types of the T-cell pathology. Motivation section: T-lymphocytes are the leaders among the immune cells with their quantity and quality characteristics. They take part in all immune reactions, according to their effector function. The studying of T-cell functions
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and peculiarities is necessary for understanding of the immune reactions in normal and pathological states.

Questions for consideration and discussion starters

1. Definition of T-cells. 2. Main stages of T-cell differentiation. 3. Lymphopoiesis in the bone marrow. 4. Regulating factors of cells maturation in bone marrow. 5. Peculiarities of T-cell maturation in the thymus. 6. Definition of double negative stage of thymocytes. 7. Definition of double positive stage of thymocytes. 8. Definition of single-positive cells, their ratio. 9. Regulating factors of thymocyte maturation. 10. Structure of the TRC, their types. 11. Main T-cell markers. 12. Functions of T-cell receptors (CD2, CD3, CD4, CD8). 13. Class II MHC molecules play an important role in thymocyte selection. Explain the reason. 14. Selection mechanisms of T-cells. 15. Disorders of T-cell selection lead to the immune diseases. Explain the reason. 16. Characteristic of T-helper cell. 17. Peculiarities of naive T-helper cell, T-helper-1 and T- helper-2 cells. 18. Lymphokines secreted by T-helper subsets. 19. Peculiarities and functions of cytotoxic T-cells. 20. Peculiarities of cytotoxic T-cells differentiation. 21. Mechanisms of killing by cytotoxic T-cells. 22. Characteristics of the memory T-cells. 23. T-cell immunity pathologies.

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Task based activities Activity A: Draw the scheme of the T-lymphocyte ontogenesis. Activity B: Draw the scheme of the TCR receptor.

Practical skills due: A student must be able to count the quantity of T-cells through light microscope.

Topic: B-cell immunity.

Aim: to study the stages of B-cell differentiation, markers and the functions of B-lymphocytes, to know pathology in B-cell immunity. Motivation section: B-lymphocytes take the special place in immune system, forming the humoral immunity. Their normal functioning gives the antiinfective protection from the childhood to the old years. The disorders of B-cells immunity play the leading role in pathogenesis of autoimmune, allergic diseases. Lymphocytes assays have wide application for diagnostic pathological conditions.

Questions for considerations

1. Definition of B-cells. 2. Main stages of B-cell differentiation. 3. Characteristics of surface immunoglobulin receptor. 4. Main markers of B-cells. 5. Mechanisms of B-cell tolerance development. 6. Definition of apoptosis. 7. Factors of B-cell activation. 8. Peculiarities and functions of B-1 cells. 9. Peculiarities and functions of B-2 cells. 10. Characteristics of plasma cells.
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11. Characteristics of IgA and its types. 12. Characteristics of IgG. 13. Characteristics of IgM. 14. Characteristics of IgD, IgE. 15. Definition of isotypes, allotypes, idiotypes. 16. B-cell immunity pathologies. 17. Main methods of lymphocyte identification. 18. Functional assays for lymphocytes. 19. Clinical application of lymphocyte assays.

Task-based activities. Activity A: Draw the scheme of the B-lymphocytes ontogenesis. Activity B: Draw the scheme of the B-lymphocyte activation. Activity C: Draw the scheme of immune fluorescence analysis.

Practical skills due: A student must be able to count the quantity of B-cells through light microscope.

Topic: Mononuclear phagocytic system. Antigenpresenting cells.

Aim: to study the accessory cells, their main biological functions, and properties; the stages of phagocytosis, to know killing mechanisms of macrophages and methods of their functional activity estimation; to be aware of the antigen presenting cells and their properties. Motivation section. Macrophages and antigenpresenting cells play important role in immune response. The knowledge of its phenotype and functions is necessary for understanding of intercellular interactions in immune and inflammatory responses.

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Questions for consideration.

1. Definition of mononuclear phagocytic system. 2. Characteristics of monocytes. 3. Macrophage ontogenesis. 4. Factors, which can influence on the differentiation of myeloid stem cells. 5. Characteristics of tissue macrophages. 6. Macrophage activators. 7. Characteristics of activated macrophages. 8. Macrophage receptors. 9. Properties of macrophages. 10. Stages of phagocytosis, their characteristics 11. Classification of macrophages cytotoxicity. 12. Characteristics of Oxygen dependent killing mechanism, mediators. 13. Characteristics of Oxygen independent killing mechanism, mediators. 14. Main biological substances, secreted with macrophages. 15. Main types of antigenpresenting cells. 16. Definition of antigen processing. 17. The mechanisms of antigen presentation. 18. The role of MHC class I and II molecules in antigen presentation. 19. Definition of polymorphonuclear leucocytes (PNL). 20. Characteristics of PNL. 21. Methods of monocyte identification. 22. Methods of functional activities estimation.

Task based Activities: Activity A. Draw the scheme of phagocytosis. Activity B. Draw the scheme of antigen processing.

Practical skills due: A student must be able to count the phagocytises using light microscope.
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A student must be able to count the Formosanpositive cells using light microscope.

Topic: Mediators of the immune system.

Aim: To study the main cytokines, their functions, properties, sources of production. To know their roles in immune and inflammatory responses. To be aware of the clinical application of cytokines. Motivation section. Mediators of the immune system play an important role in immune response regulation, use for treatment of infections and tumour diseases, regulate healing of any type of the wounds. The knowledge of cytokine functions is necessary for understanding of immune and inflammatory responses in normal and pathological conditions.

Questions for consideration and discussion starters

1. Definition of cytokines. 2. Classification of cytokines. 3. Properties of cytokines, their characteristics. 4. Functions of cytokines. 5. Actions of cytokines. 6. IL-1: sources of production, inhibitors. 7. Effects of IL-1 on immune cell functions. 8. Effects of IL-1 on non-immune cell functions. 9. IL-2: cells of production, inhibitors, functions. 10. Signals to secretion of IL-2. 11. Characteristics of IL-3. 12. Main functions and properties of IL-4. 13. Biological effects of IL-5. 14. IL-6: sources of secretion, its main functions. 15. Main effects of IL-7.
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16. Characteristics of IL-8. 17. IL-1, IL-6, TNF- and other are called the cytokines, promoting inflammatory processes. Explain the reasons. 18. IL-4, IL-10, IL-13 and other are called antiinflammatory cytokines. Explain their action. 19. TNF: cells of production, effects on immune and non-immune cells. 20. TNF- is called cachexin. Explain the reason. 21. Characteristics of interferon family, types, functions. 22. Mechanism of cytokine interaction with cells. 23. Inhibitors of cytokine production. 24. Cytokines assays in blood and biological fluids. Clinical application. 25. Use of cytokine drugs in clinical practice.

Task based activities. Activity A: Draw the scheme of hemopoiesis regulating with cytokines. Activity B: Explain the scheme, which you have drawn.

Practical skills due A student should learn to determine the cytokine concentration in serum using ELISA.

Topic: Adaptive and Innate Immunity.

Aim: To study mechanisms of non-specific and specific immunity. To know the peculiarities of the immune response to thymusdependent and thymusindependent antigens. To be aware of the antibody production dynamics in the primary and secondary immunity. Motivation section: Immune response occupies the most important place in the field of theoretical immunology. Normal immune response provides the

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protection of the organism of all foreign agents. The disturbance of it is the reason of different diseases (infections, tumours, allergy, autoimmune diseases).

Questions for Consideration:

1. Definition of innate immunity. 2. Definition of adaptive immunity. 3. Classification of the protecting constitutional factors. 4. Characteristics of mechanical factors. 5. Chemical factors of protection. 6. Phagocytosis, its stages. 7. Peculiarities of cellular mechanisms in innate immunity. 8. Characteristics of non-specific humoral factors. 9. Peculiarities of adaptive immunity. 10. Classification of the specific immune response. 11. Phases of humoral immune response. 12. Characteristics of the primary immune response. 13. Peculiarities of the secondary immune response. 14. Dynamics of antibody production in immune response. 15. Characteristics of antigen presentation. 16. Phenomenon of double recognition. 17. Signals of T helper cell activation. 18. Factors of B-cell activation. 19. Peculiarities of cell mediated immunity. 20. Definition of the immunological memory. 21. Characteristics of the thymus-independent immune response, its peculiarities. 22. Regulation of the immune response. 23. Definition of anti-idiotype antibodies. 24. Pathologies associated with disorders of the immune response regulation.
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Task-Based Activities Activity A: Draw the scheme of the cell-mediated immunity. Activity B: Draw the scheme of the thymus dependent humoral immunity. Activity C: Draw the scheme of antibodies production in primary and secondary immune response. Activity D: Draw the scheme of the cytokine regulation of the immune response.

Topic: Cytotoxic reactions.

Aim: To study mechanisms of cytotoxic reactions. To know the peculiarities of different types of the cytotoxic reactions, to study the peculiarities and functions of NK-cells. Motivation section: The main mechanism of antigen elimination is release most by the cytotoxic reactions. The knowledge of these mechanisms plays an important role for understanding of pathogenesis of many diseases (autoimmune, allergic).

Questions for consideration and discussion starters

1. Definition of cytotoxicity. 2. Classification of cytotoxic reactions 3. Cells, participating in cytotoxic reactions. 4. Conditions necessary for cellular lysis. 5. Peculiarities of T-killers. 6. Properties of NK-cells. 7. Mechanisms of killing by NK-cells. 8. Characteristics of lymphokine-activated killer cells. 9. Peculiarities Killer cells. 10. Cytotoxicity by macrophages: classification, mediators.
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11. Characteristics of Oxygen-dependent and Oxygen-independent killing mechanism, mediators. 12. Characteristics of antibody-dependent cellular cytotoxicity. 13. Characteristics of the main components of complement. 14. Main pathways of C3 activation. 15. Biological effects of complement activation. 16. Formation of membrane attack complex. 17. Cell lysis by complement. 18. The pathogenesis of many diseases is associated with cytotoxic reactions. Enumerate the diseases and explain, why?

Task based activities. Activity A: Draw the scheme of complement activation. Activity B: Draw the scheme of antibody-dependent cellular cytotoxicity.

Topic: Transplantation immunity.

Aim: To study the different mechanisms of transplantation. Should be capable select the donor and the recipient. Motivation section: Transplantation is an important clinical procedure, is used to replace tissues and organs that have failed. Knowledge of transplantation antigens and immune mechanisms allow to prevent Host versus graft reaction (HVGR) and Graft versus host reaction (GVHR).

Questions for Consideration:

1. Definition of transplantation immunity. 2. Development of transplantation in history. 3. Classification of grafts types. 4. Definition of Autograft. 5. Definition of Isograft.
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6. Definition of Allograft. 7. Definition of Xenograft. 8. Classification of transplantation antigens. 9. The characteristic of transplantation antigens. 10. Stages of immune response in Grafts rejection. 11. Types of Grafts rejection, their characteristic. 12. Classification of Allograft Rejection. 13. Types of Host versus graft reaction (HVGR). 14. Cause and characteristic of Hyperacute rejection HVGR. 15. Characteristic and mechanisms of Acute rejection HVGR. 16. Characteristic and mechanisms of Chronic rejection HVGR. 17. Cause and characteristic of Graft versus host reaction. 18. Prevention of graft rejection. 19. Principles of donor and recipient selection. 20. Main principles of immunosuppressive therapy.

Task-based activities. Activity A: Draw the scheme of the Acute rejection HVGR. Activity B: Draw the scheme of the Graft versus host reaction.

Practical skills due A student should know the principles of donor and the recipient selection. A student should know the principles of graft rejection prevention.

Topic: Immunology of blood transfusion.

Aim: To study the different immune mechanisms of blood transfusion. Should be capable select the donor and the recipient for blood transfusion.

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Motivation section: Blood transfusion is an important clinical procedure for any doctor. Knowledge of blood antigens and immune mechanisms allows to prevent blood transfusion reactions and hemolytic disease of the newborn.

Questions for Consideration:

1. Development of blood transfusion in history. 2. Characteristic of ABO blood group system. 3. Characteristic of A blood group types. 4. Characteristic of Rhesus (Rh) system. 5. Classification and characteristic of blood transfusion sources. 6. Indications for blood transfusion. 7. Classification of blood transfusion complications. 8. Characteristic of specific complications during blood transfusion. 9. Characteristic of nonspecific complications during blood transfusion. 10. Prevention of blood transfusion reactions. 11. Permitted variants of blood transfusion. 12. Immune mechanisms of transfusion reactions. 13. Cause and characteristic of acute hemolytic reaction. 14. Cause and characteristic of Rh conflict. 15. Cause and characteristic of hemolytic disease of the newborn. 16. Cause and characteristic of Rh conflict of the newborn. 17. Principles of Rh incompatibility treatment.

Task-based activities. Activity A: Write the table of permitted variants of blood transfusion. Activity B: Draw the scheme of the Rh conflict of the newborn.

Practical skills due A student should be able to detect the patients blood group. A student should know the principles of donor and the recipient selection.
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A student should know the principles of blood transfusion reactions prevention.

Topic: Immune system development.

Aim: To study the development of the immune system in ontogenesis. Motivation section: development of the immune system depends of different factors. Knowledge of critical period of babys Immune system development and changes in old immune system is necessary for correct evaluation in different types of pathological conditions.

Questions for consideration and discussion starters

1. Characterize the immune system development in embryogenesis. 2. The peculiarities of T-system development. 3. The peculiarities of B-cell development. 4. Enumerate critical period of babys immune system development. 5. Definition of passive immunity. 6. Preventive mechanisms for babys protection from developing diseases and infections. 7. Characterize 1st critical period. 8. Characterize 2nd critical period. 9. Characterize 3rd critical period. 10. Characterize 4th critical period. 11. Characterize 5th critical period. 12. Enumerate peculiarities of babys immune system development. 13. Definition of old age. 14. Enumerate and characterize immune theories of old age. 15. Name normal changes in immune system that occurs in elderly. 16. Enumerate and explain pathologies in elderly.

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Task-based activities. Activity A: umbilical blood of newborn contains Ig M to cytomegalovirus. Explain, what does it mean? Activity B: umbilical blood of newborn contains Ig G to herpes virus. Explain, what does it mean?

Topic: Antitumor immunity.

Aim: To study the different immune mechanisms in tumors, meaning of immune methods in early diagnostics of cancer. Motivation section: Knowledge of antitumor immune mechanisms is necessary for early diagnostics and effective immunotherapy of cancer.

Questions for consideration and discussion starters

1. Explain the presence of antitumor immune mechanisms in health body. 2. Enumerate effector mechanisms in tumor immunity. 3. Explain the role of NK cells in antitumor immunity. 4. Explain the increasing of tumor in elderly. 5. Classification of tumor-specific antigens. 6. Characterize virus-induced antigens; 7. Characterize chemical carcinogens (mutagens); 8. Characterize oncofetal (carcinoembryonic) antigens; 9. Characterize antigens of different organs. 10. Characterize tumor evasion of the Immune system. 11. Characterize tumor cell. 12. Enumerate modern methods of diagnostics in tumor. 13. Enumerate immune disorders during oncological process. 14. Enumerate main principles of treatment of cancer. 15. Characterize immunotherapy in oncological process.
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16. Explain principles of cell therapy. 17. Explain the advantage of immunotherapy by monoclonal antibodies to tumor antigens.

Task-based activities. Activity A: Draw the scheme of antitumor immunity. Activity B: Write the immunogramm in patient with cancer.

Practical skills due A student should know main principles of immune diagnostics and immunotherapy of cancer.

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The Questions for credit-test.

1. Definition of the immune system. 2. Classification, structure and peculiarities of the immune organs (thymus, bone marrow, spleen, lymph node). 3. Functions of the immune system. 4. Peculiarities of the lymphoid tissue. 5. Definition and classification of antigen. 6. Properties, structure of antigens and haptens. 7. The mechanism of the antigen recognition. 8. Definition of antibodies. 9. Types of immunoglobulin molecules. Their characteristics. 10. Structure of the immunoglobulins, functions of the variable and constant regions. 11. Definition of isotypes, allotypes, idiotypes. 12. Characteristics of the major antibodies properties. 13. Definition of MHC. 14. Classification of MHC-antigens. 15. Genetic organization of the MHC. Polymorphisms of class I and class II loci. 16. Structure and functions of the MHC antigens class I and class II. 17. Serologic assays for HLA typing. 18. Uses of HLA- typing. 19. Diseases, associated with MHC-alleles. 20. The role of the MHC antigens in transplantation. 21. The characteristics of T-cells: ontogenesis, markers, the functions, identification. 22. The characteristics of B-cells: ontogenesis, markers, the functions, identification. 23. The characteristics of antigen-presenting cells (APCs ): types of APCs, markers, the functions in immunity.
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24. The characteristics of the most importent cytokines, IL-1, IL-2, IL-3, TNF-, IL-4, IL-5, IL-6, IL-8 (cell sources, main cell targets, main actions). 25. The characteristics of the interferons (cell sources, main cell targets, main actions). 26. Definition of innate and adaptive immunity. 27. Classification and characteristics of the protecting constitutional factors. 28. Peculiarities of adaptive immunity. 29. Phases of humoral immune response. 30. Characteristics of the primary and secondary immune response. 31. Dynamics of antibody production in immune response. 32. Peculiarities of cell mediated immunity. 33. Definition of the immunological memory. 34. Characteristics of the thymus-independent immune response, its peculiarities. 35. Classification of cytotoxic reactions. 36. Properties of NK-cells and killer cells. 37. Cytotoxicity by macrophages: classification, mediators. 38. Characteristics of antibody-dependent cellular cytotoxicity. 39. Characteristics of the main components of complement. 40. Main pathways of C3 activation and biological effects of complement activation. 41. B-cell immunity pathologies. 42. Pathologies of T-cell immunity. 43. Definition of transplantation immunity. 44. Classification and characteristic of grafts types. 45. Classification and characteristic of transplantation antigens. 46. Types of grafts rejection, there characteristic. 47. Classification of allograft rejection, there characteristic. 48. Reason and characteristic of graft versus host reaction.
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49. Prevention of graft rejection. 50. Characteristic of ABO blood group system. 51. Characteristic of Rhesus (Rh) system. 52. Classification and characteristic of blood transfusions sources. 53. Indications for blood transfusion. 54. Classification of blood transfusion complications. 55. Prevention of blood transfusion reactions. 56. Permitted variants of blood transfusion. 57. Principles of Rh incompatibility treatment. 58. The immune system development in embryogenesis. 59. Characteristic of critical period of babys Immune system development. 60. Definition of passive immunity. 61. Preventive mechanisms for babys protection from developing diseases and infections. 62. Peculiarities of babys Immune system development. 63. Characteristic of immune theories of old age. 64. Normal changes in immune system that occurs in elderly. 65. Pathologies in elderly. 66. Effector mechanisms in tumor immunity. 67. Classification and characteristic of tumor-specific antigens. 68. Tumor evasion of the Immune system. 69. Characteristic of tumor cell. 70. Immune disorders in tumor. 71. Modern methods of immunotherapy in tumor.

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