4.2 Review of Anatomy and Physiology of the Immune System
Anatomy of the Lymphatic and Immune Systems
The lymphatic system is the system of vessels, cells, and organs that transports fluid called lymph to the bloodstream and also filters pathogens from the blood. The immune system is the complex collection of cells and organs that destroys or neutralizes pathogens that would otherwise cause infection, disease, or death. The lymphatic system, for most people, is associated with the immune system to such a degree that the two systems are virtually indistinguishable.
Lymph Vessels
Lymph capillaries are interlaced in interstitial space, the space between individual cells in the tissues. Interstitial fluid enters the lymphatic capillaries and becomes lymph. Lymph is a clear-to-white fluid that transports immune system cells, as well as dietary lipids and fat-soluble vitamins absorbed in the small intestine called chyle. See Figure 4.1[1] for an image of lymph capillaries.
Lymph capillaries empty into larger lymphatic vessels that become larger and larger until they ultimately empty into the left and right subclavian veins in the neck. This is where lymph enters the bloodstream.
Lymph Nodes
Immune system cells use lymphatic vessels to not only make their way from interstitial space into the circulation, but also use lymph nodes as major staging areas for the development of critical immune responses. A lymph node is one of the small, bean-shaped organs located throughout the lymphatic system. Lymph nodes store immune system cells that help the body fight infection and also filter the lymph fluid to remove foreign material such as bacteria and cancer cells.
Lymph travels through the lymph nodes near the groin, armpits, neck, chest, and abdomen. Humans have about 500–600 lymph nodes throughout the body. See Figure 4.2[2] for an illustration of lymph vessels and nodes.
A major distinction between the lymphatic and cardiovascular systems is that lymph is not actively pumped by the heart but is forced through the vessels by the contraction of skeletal muscles during body movements and breathing. One-way valves in lymphatic vessels keep the lymph moving toward the heart. When the lymphatic system is damaged in some way, such as by being blocked by cancer cells or destroyed by injury, lymph “backs up” from the lymph vessels into interstitial spaces. This inappropriate accumulation of fluid is referred to as lymphedema. Lymphedema can also occur after lymph nodes are removed as part of cancer treatment. See Figure 4.3[3] for an image of lymphedema.
Figure 4.3 Lymphedema (https://commons.wikimedia.org/wiki/File:Lymphedema_limbs.JPG)
Primary Lymphoid Organs: Bone Marrow and Thymus
The primary lymphoid organs are the bone marrow and thymus gland. The lymphoid organs are where lymphocytes mature, proliferate, and are selected to attack pathogens.
A lymphocyte is a type of white blood cell that fights infection. There are two main types of lymphocytes: B cells and T cells. B cells produce antibodies that are used to attack invading bacteria, viruses, and toxins. T cells destroy the body’s own cells that have been taken over by viruses or become cancerous.[4] Recall that all blood cells, including lymphocytes, are formed in the bone marrow. The B cell undergoes nearly all of its development in the bone marrow, whereas the immature T cell, called a thymocyte, leaves the bone marrow and matures in the thymus gland. The thymus gland is an organ found in the space between the sternum and the aorta of the heart.
Secondary Lymphoid Organs
Lymphocytes develop and mature in the primary lymphoid organs, but they mount immune responses from the secondary lymphoid organs. Secondary lymphoid organs include the lymph nodes, spleen, and tonsils.
Spleen
The spleen is sometimes called the “filter of the blood.” The spleen stores and filters red blood cells and also functions as the location of immune responses to blood-borne pathogens. Therefore, clients who have had a splenectomy are at increased risk for infection.
Tonsils
The tonsils are lymphoid nodules located along the inner surface of the pharynx and are important in developing immunity to oral pathogens. The tonsil located at the back of the throat, the pharyngeal tonsil, is sometimes referred to as the adenoid when swollen. See Figure 4.4[5] for an illustration of the tonsils. Such swelling is an indication of an active immune response to infection.
View a supplementary YouTube video[6] from Crash Course on the lymphatic system: Lymphatic System: Crash Course Anatomy & Physiology #44
The Immune Response
There are two basic processes the body uses to defend against pathogens (i.e., microorganisms that cause infection). These processes are referred to as the innate immune response and the adaptive immune response.
Innate Immune Response
The innate immune response defends the body against pathogens in a nonspecific manner. It is called “innate” because it is present from the moment we are born. The innate immune response includes physical barriers and internal defenses.
Physical Barriers
Physical barriers are the body’s basic defenses against infection. They include skin and mucous membranes, as well as mucus and enzymes that physically destroy and/or remove pathogens and debris from areas of the body where they might cause harm or infection.
Internal Defenses
Internal defenses include phagocytosis, the inflammatory response, and fever.[7]
Phagocytosis
Phagocytosis refers to the process of specific white blood cells engulfing and destroying pathogens (i.e., “eating” them). Phagocytes include neutrophils and macrophages. Neutrophils are the most abundant type of white blood cells. They are the first to arrive during the innate immune response. After destroying a pathogen, neutrophils self-destruct and become pus. Macrophages are created from monocytes, a type of white blood cell. Each macrophage can destroy multiple pathogens, and they also clean up the destroyed neutrophils.[8] See Figure 4.5[9] for an image of phagocytosis.
Inflammatory Response
Inflammation is characterized by heat, redness, pain, and swelling. Although inflammation is often perceived as a negative consequence of injury or disease, it is an important process that recruits immune defenses to eliminate pathogens, remove damaged and dead cells, and initiate repair mechanisms.
During the inflammatory response, the damaged cells release chemicals including histamine, bradykinin, and prostaglandins. These chemicals cause redness, heat, and increased permeability of blood vessels, so fluid leaks into tissues, causing swelling. These chemicals also attract phagocytes and lymphocytes. See Figure 4.6[10] from Crash Course on nonspecific innate immunity: Immune System, Part 1: Crash Course Anatomy & Physiology #45