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Sistem Limfatik dan Sistem

Imunitas
Purwo Sri Rejeki

Sistem Limfatik
Sistem Satu Arah:
menuju jantung
Mengembalikan
cairan jaringan
berlebih
Mengembalikan
protein yang bocor
Lymph = cairan
Bila buntu Edema
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Kapiler Limfatik
Punya katup mini cairan masuk
tidak bisa keluar
Menangkap Bakteri dan Virus
dihancurkan
Menyerap protein, elektrolit dan
cairan

Kapiler Limfatik
Tidak didapatkan di tulang, sumsum tulang, gigi dan
SSP
Masuk ke lymphatic collecting vessels

Lymphatic collecting vessels


Mempunyai lapisan seperti pembuluh vaskuler (3 lapis),
tapi tipis dan lentur
Yang superfisial tdp di kulit: bersama vena superfisial
Yang dalam: di badan dan organ visera, berjalan
bersama arteri
Tekanannya sangat rendah
Memberikan gambaran khusus pada lymphangiography
Mengalir ke dalam lymph nodes
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Nodus Limfatik: bean shaped organs


sepanjang lymphatic collecting vessels
Ukiuran: bisa sampai 1 inch
Clusters of both deep and superficial LNs

Lymph Nodes
Superficial groups
-Cervical
-Axillary
-Inguinal
Deep groups
-Tracheobronchial
-Aortic
-Iliac
Drainage
-Superior R 1/4 of body: R
lymphatic duct (green) *
-The rest: thoracic duct *

Fibrous capsule sends in dividing trabeculae


Afferent & efferent lymphatic vessels
Lymph percolates through lymph sinuses
Follicles: masses of lymphoid tissue divided into
outer cortex & inner medulla (details in later slides)

Macrophages on
reticular fibers
consume
pathogens and
foreign particles
Usually
pathogen free
lymph enters
lymph trunks
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Lymphatic Trunks
(Semua berpasangan,
kecuali yang di intestinal
trunk)

Lumbar
Intestinal
Receives fatty
lymph (chyle)
absorbed
through lacteals
in fingerlike villi
of intestines

Bronchomediastinal
Subclavian
Jugular

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20%

Lymph ducts
(variable)
Thoracic duct:
everyone has
* 20% also have
a right
lymphatic duct

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Leukosit ( sel
darah putih )
Sistem Imun Tubuh

Sistem Imun
Mengenali molekul asing yang spesifik
Setiap paparan (patogen yang sama)
meningkatkan efektivitas

Lymphoid organs

Lymph nodes
Spleen
Thymus
Tonsils
Small intestine & appendix aggregated lymphoid
nodules
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Imunologi Dasar
Tergantung kemampuan sistem imun
untukmembedakan antara self dan non-self
molecules
Self molecules: komponen otubuh yang dapat
dibegadakan dari subtans asing oleh sistem imun.
Autoimmunity is an immune reaction against self
molecules (causes various diseases)

Non-self molecules: dikenali sebagai molekul


asing
One class of non-self molecules are called antigens
(short for antibody generators) and are defined as
substances that bind to specific immune receptors and
elicit an immune response
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Jenis Leukosit
Granulosit
Neutrofil 62,0%
Eosinofil 2,3%
Basofil 0,4%

Agranulosit
Monocytes 5,3%
Lymphocytes 30,0%
Jumlah Leukosit 9000 sel / mm3 darah ( liter)
atau 4 11 x 109 / liter

Fungsi
Leukosit
Menahan atau mengeliminasi sel
abnormal, atau benda asing yang
berpotensi merusak.
1. Menahan invasi patogen penyebab penyakit
2. Mengidentifikasi & menghancurkan sel
kanker
3. Membersihkan sampah tubuh
memfagositosis debris/sel-sel mati

Sistem Imun Tubuh

Non Spesifik

Granulosit
Monosit-makrofag

Spesifik

Limfosit B
Limfosit T

Sistem Imun Non Spesifik


a. Fisik / Mekanik

Kulit, selaput lendir, silia, batuk, bersin

b. Biokimia

Asam lambung, lisosim, lactoferin, spermin

c. Humoral

Komplemen

Interferon

C-reaktive protein (CRP)

d. Selular

Fagosit

Natural killer cell

Sifat Pertahanan Netrofil dan Monosit Makrofag


a) Marginasi (menepi)
b) Diapedesis (menembus dinding pori-pori)
c) Ameboid motion (bergerak seperti amoeba)
d) Chemotaxis (bergerak mendekati sumber bahan kimia)
Kelompok Chemokines, yaitu :
* Complement system
* Leukotrien
* Polipeptida, hasil dari limfosit, mast cell dan basofil
Efektif : radius 100 daerah radang
e) Fagositosis (= endositosis)
Selektif dan bersyarat
* permukaan partikel harus kasar
* tidak dilapisi protein
* dapat : Opsonisasi

Gambar sifat leukosit:


1. Marginasi
2. Diapedesis
3. Amoeboid Motion
4. Chemotaxis

Tjitra Wardani , dr., MS


Bag. I Faal F.K. Unair

Fagositosis
Netrofil

Makrofag

Melekat pada reseptor partikel


Pseudopani
a
Menyatu
Vesikel fagosit
( fagosome)

Llsosom

Pembunuh bakteri (secara oksidatif)

Berisi :

= Pengoksidir :

Enzim proteolitik
Lipase

hypochlorite

Lisosim

Superoxide radikal (O2)


Hidrogenperoxida (H2O2)

Myeloperoksidase (mpo)

Hidroxyl radikal

(OH)

H2O2 + C1
Diproduksi oleh :
Membran fagosom
Peroxisome

Keradangan
trauma

panas

bakteri

bahan kimia

kerusakan jaringan

Memproduksi
- Histamine
- Bradikinine
- Serotonine
- Prostaglandin
- Hasil suatu sistem komplemen
- Hasil reaksi sistem koagulasi darah
- Lymphokines

terjadi perubahan jaringan

Perubahan jaringan keradangan


1. Vasodilatasi pembuluh darah lokal
2. Permeabilitas kapiler meningkat
3. Penjendalan cairan interstitial
4. Migrasi granulosit dan monosit
5. Pembengkakan sel jaringan

tanda tanda kardinal keradangan yaitu Dolor (nyeri), Calor (panas),


Rubor (kemerahan), Tumor (bengkak) dan Functio laesa (gangguan
fungsi)

Respon Netrofil Makrofag terhadap keradangan


The first line
of defense
I

The second line


of defense
Aksi fagositos

II

Mobil makrofag
(dilepas)

Inflamasi
mokrofag

dang
a
r
k
u
Prod

Monosit

Neutrofilia
M
15.000-25.000/1
em
br
an
Ka
pi
le
r
Marginasi
Diapedesis
kemotaksis
The third line
Of defense

Granulakosit
Monosit

The fourth line


of defense
IV

Blood

III

3 4 hr
Prod : 50 x N
Bone Marrow
Stem cells

Eosinofil
- 1 3 % sel darah putih
- Fagosit lemah
- Mencegah infeksi tertentu
- Jumlah eosinofil meningkat pada

infeksi parasit

reaksi alergi

enzim hidrolitik (lisosim)

chemotactic factor

oksigen reaktif

untuk detoksifikasi

major basic protein (MBP)


untuk membunuh larva

dan menghancurkan alergen

Basofil
- 0,5 % sel darah putih
- Serupa dengan mast cell (sel besar dalam kapiler-kapiler)
- Mengeluarkan :
Heparin
Histamin
Bradikinin
Serotonin
Slow reacting substance (SRS
Enzym lisosim

dikeluarkan
selama terjadi
keradangan

Sistem Imun
Spesifik
ACQUIRED IMMUNITY

Humoral Immunity

Cell-mediated Immunity

B-cell immunity

T-cell immunity

Antibodi

Activated Lymphocytes

Antigen
Adalah bahan yang mampu bereaksi dengan antibodi yang
diproduksi atas rangsangan imunogen
Imunogen
Adalah setiap bahan yang dapat menimbulkan respons imun
spesifik baik respons seluler maupun humoral
(protein besar dengan BM 100.000)
Hapten determinan antigen dengan BM kecil
Untuk menjadi antigen harus terikat oleh molekul besar
(carrier)
Antibodi
Adalah imunoglobulin (Ig) yang merupakan gol. Protein yang
dibentuk oleh sel plasma, yang berasal dari proliferasi
sel B akibat adanya kontak dengan antigen.

Lymphocytes
the primary cells of the lymphoid system
Respond to:
Invading organisms
Abnormal body cells, such as virus-infected
cells or cancer cells
Foreign proteins such as the toxins released
by some bacteria

Types of lymphocytes
T cells (thymus-dependent)
B cells (bone marrow-derived)
NK cells (natural killer)

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T Cells
80% of circulating lymphocytes
Some of the types:
Cytotoxic T cells: attack foreign cells or body
cells infected by viruses (cell-mediated
immunity)
Regulatory T cells: Helper T cells and
suppressor T cells (control activation and
activity of B cells)
Memory T cells: produced by the division of
activated T cells following exposure to a
particular antigen (remain on reserve, to be
reactivated following later exposure to the
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same antigen)

B Cells
10-15% of circulating lymphocytes
Can differentiate into plasmocytes (plasma cells)
when stimulated by exposure to an antigen
Plasma cells produce antibodies: soluble proteins
which react with antigens, also known as
immunoglobulins (Igs)
Humoral immunity, or antibody-mediated
immunity
Memory B cells: produced by the division of
activated B cells following exposure to a particular
antigen (remain on reserve, to be reactivated
following later exposure to the same antigen)
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NK Cells
5-10% of circulating lymphocytes
Attack foreign cells, normal cels infected
with viruses, cancer cells that appear in
normal tissues
Known as immunologic surveillance

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Antigen
Kontak I
Dihancurkan sel imun
Terbentuk klon limfosit
Sel memori
Antigen

Kontak II
Proliferasi klon limfosit

Respons sekunder spesifik


(lebih cepat dan intensif)

Humoral vs Cell mediated


Cell-mediated immunity - direct attack by activated
T cells (react with foreign antigens on the surface of
other host cells)
Antibody-mediated (humoral) immunity attack
by circulating antibodies, also called immunoglobins
(Igs), released by the plasma cells derived from
activated B cells
humor from old-fashioned word for stuff in the blood,
like good humors and bad humors

These two systems interact with each other


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Gambar: Cell-mediated immunity dan Humoral immunity

Respon Imun Humoral

RECOGNITION
PHASE

ACTIVATION
PHASE

EFFECTOR

Gambar Imonuglobulin

ANTIBODI
Ig G (75%), Ig A, Ig M, Ig E, Ig D
Mekanisme Kerja

Direct attack

Activation of the Complement System


(C1-9, B, D)

agglutination

opsonization & phagocytosis

precipitation

lysis

neutralization

agglutination

lysis

neutralization
Chemotaxis
Activation of mast cell-basophils
Inflamatory effects

Respons Imun Seluler


Merupakan fungsi limfosit T

T-helper

T-sitotoksik

Thd antigen yang terdpt pd


permukaan makrofag

Antigen pada antigen dalam makrofag

Menginduksi limfosit
Produksi : limfokin

Langsung
Menghasilkan :

Menghancurkan
Mikroorganisme/antigen

Mencegah penyebaran
Mikroorganisme

interferon

Prinsip Imunisasi
Immunisasi (Imunitas spesifik)

Alamiah

Buatan

Pasif
Antibodi
(mel plasenta,
kolostrum )

Aktif
Infeksi: virus, bakteri

Pasif
Antitoksin
Antibodi

Aktif
Toksoid
vaksinasi

Ab

B Lymphocytes

The receptor for antigens is an antibody on B cell


surface
B lymphocytes can respond to millions of foreign antigens
This capability exists before exposure to any antigens
Each lineage of B cell expresses a different antibody, so the complete set of
B cell antigen receptors represent all the antibodies that the body can
manufacture

A B cell identifies pathogens when antibodies on its surface bind to a


specific foreign antigen
This antigen/antibody complex is taken up by the B cell and processed
by proteolysis into peptides (small pieces)
As the activated B cell then begins to divide (clonal expansion), its
offspring secrete millions of copies of the antibody that recognizes this
antigen
These antibodies circulate in blood plasma and lymph, bind to
pathogens expressing the antigen and mark them for destruction by
complement activation or for uptake and destruction by phagocytes
Antibodies can also neutralize challenges directly, by binding to
bacterial toxins or by interfering with the receptors that viruses and
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bacteria use to infect cells

The needs

To be able to attack cells


which have been infected
T cells target alien cells they
reject transplanted organs,
destroy our own cells that have
been infected, and kill some
cancer cells: these are all treated
as foreign because they have
altered (antigenic) proteins on
their surfaces

To be able to take care of small


extracellular antigens such as
bacteria which multiply outside
cells, the toxins they make, etc.
Antibodies made by plasma cells
(differentiated B lymphocytes)
bind to antigens on bacteria,
marking them for destruction by
macrophages
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Development of lymphocytes
Originate in bone marrow from lymphoid stem cells
B cells stay in bone marrow, hence B cells
T cells mature in thymus, hence T cells
These divide rapidly into families
Each has surface receptors
able to recognize one
unique type of antigen=
immunocompetence

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Lymphoid Organs

Lymph nodes
Spleen
Thymus
Tonsils
Small intestine &
appendix aggregated
lymphoid nodules
46

Lymphoid Tissue
Specialized connective
tissue with vast quantities
of lymphocytes
Lymphocytes become
activated
Memory
Macrophages & dentritic
cells also
Clusters of lymphoid
nodules or follicles
47

Thymus
Prominent in newborns, almost
disappears by old age
Function: T lymphocyte maturation
(immunocompetence)
Has no follicles because no B cells

48

Lymph Nodes
Lymphatic and immune systems intersect
Masses of lymphoid tissue between lymph
sinuses (see next slide)
Some of antigens leak out of lymph into
lymphoid tissue
Antigens destroyed and B and T
lymphocytes are activated: memory
(aiding long-term immunity)
49

Follicles: masses of lymphoid tissue divided into


outer cortex & inner medulla
All follicles and most B cells: outer cortex
Deeper cortex: T cells, especially helper T cells
Medullary cords: T & B lymphocytes and plasma
cells

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51

lymphangiogram

52

Spleen
Largest lymphoid tissue; is in LUQ posterior to stomach
Functions

Removal of blood-borne antigens: white pulp


Removal & destruction of aged or defective blood cells: red pulp
Stores platelets
In fetus: site of hematopoiesis

Susceptible to injury; splenectomy increases risk of bacterial


infection

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Spleen

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Tonsils
Simplest
lymphoid
tissue:
swellings of
mucosa, form
a circle

Crypts get
infected in
childhood

Palatine (usual
tonsillitis)
Lingual
(tongue)
*
Pharyngeal
(adenoids)
Tubal
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Parts of the intestine are so densely packed


with MALT (mucosa-associated lymphoid tissue)
that they are considered lymphoid organs
Aggregated lymphoid
nodules (Peyers
Patches)
About 40 follicles, 1 cm
wide
Distal small intestine
(ileum)

Appendix
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