Index
Definition:
Immunosuppression, also known as immune suppression or immunocompromise, means the immune system is not functioning correctly.
So, what is the immune system? It is a combination of defenses that our bodies have to fight infections.
Several parts of our body function as soldiers in this fight, particularly the white blood cells in our bloodstream and our spleen and lymph nodes.
When this system is removed, it does not work as it should, and we are more vulnerable to infections.
What does this mean for health?
If your immune system is suppressed, you may be more vulnerable to infections.
You are more likely to need to see a doctor, more likely to need antibiotics, and more likely to be hospitalized for treatment if you develop an infection than someone who is not immunosuppressed.
You are also more vulnerable to certain skin cancers if you are immunosuppressed.
Do I need regular tests?
If you take certain immunosuppressive medications, periodic blood tests will be done to verify that they are not causing more harm than good.
The tests will only be done if you develop a problem. Obtain information on the control of immunosuppressive treatments.
What is the cause of immunosuppression?
- Age, our immune system becomes less effective as we get older.
- In persistent diseases (chronic), immune systems tend to be less effective as certain diseases progress in the long term. Examples include severe chronic kidney disease, chronic liver disease, and diabetes mellitus.
- Medications for diseases caused by the immune system attacking itself (autoimmune conditions). Examples include rheumatoid arthritis and Crohn’s disease.
- Medications in the form of oral steroids for conditions that cause inflammation where treatment is needed to reduce inflammation.
- Medications are taken to prevent rejection in people who have had an organ or bone marrow transplants.
- Treatment of chemotherapy or radiotherapy for cancer.
- Cancers and certain cancers can cause immune suppression, particularly those that involve the blood cells that are so crucial to our immune system.
- Lymphomas, leukemias, and myeloma are cancers that can suppress the immune system.
- Do not have a spleen, either because it has been removed or have a spleen that does not work well. This may occur due to certain conditions, such as sickle cell anemia, thalassemia major or lymphoma, or after radiation therapy.
- HIV and AIDS. The human immunodeficiency virus (HIV) affects the immune system.
- Rare genetic conditions cause loss of immune function, for example, severe combined immunodeficiency syndrome, DiGeorge syndrome, and Wiskott-Aldrich syndrome.
What specific medications cause immunosuppression?
Oral steroids, when used in high doses for long periods, can cause immunosuppression.
The lower doses usually do not cause problems. For an adult, a dose of 40 mg per day of prednisolone for more than a week may cause immunosuppression, but this dose varies for other steroids and children.
Other medicines that suppress the immune system include:
- Azathioprine.
- Micofenolato mofetil.
- Monoclonal antibodies, of which there are many that end in “mab,” such as bevacizumab, rituximab, and trastuzumab.
- Anti-TNF drugs
- Methotrexate
- Ciclosporin.
- Tacrolimus.
- Sirolimus.
- Cyclophosphamide
- Leflunomide.
- These medications are used to treat all types of conditions, some of the most common which include:
- Cancers such as lymphoma or leukemia
- Rheumatoid arthritis
- Crohn’s disease
- Ulcerative colitis
- Organ transplants to prevent rejection.
- Severe psoriasis and psoriatic arthritis.
Extraction of the spleen
The spleen is an integral part of the immune system, but sometimes it must be removed with an operation called a splenectomy.
If you are involved in an accident or have an injury where the spleen is broken, this may need to be done. It may be necessary to remove it to avoid losing significant amounts of blood.
Sometimes it becomes too big and destroys too many blood cells. Examples where this occurs and the spleen may need to be removed include:
- Immune thrombocytopenia
- Hereditary spherocytosis.
- Hereditary elliptocytosis.
- Lymphomas and leukemias.
Complications
Infections can spread particularly fast in people with suppressed immune systems.
A sore throat, for example, is more likely to turn into an infection in the chest. It is more likely to spread an individual infection to the whole body, making you very sick.
People with immunosuppression also seem to be at higher risk for certain types of skin cancer.
This includes squamous cell carcinoma, melanoma, and Kaposi’s sarcoma.
The reason for this is not known with certainty; it may be because the immune system helps destroy skin cells damaged by the sun.
If not eliminated by the immune system, these cells can multiply and cause cancer.
It may also be that viruses (such as human papillomavirus – HPV or herpes virus) involved in some types of cancer are more likely to be present if the immune system is suppressed.
Some immunosuppressive drugs can directly affect skin cells, making them more likely to develop skin cancers.
Symptoms of immunosuppression
Most of the time, if you have immunosuppression, you do not know you have it. However, you are likely to have infections more often.
Also, when you get infections, they can be more severe, and you are more likely to have complications.
You can also have unusual or unusual infections. For example, in general, healthy adults usually do not have canker sores in their mouths unless there is a good reason, such as using a steroid inhaler.
However, for people with AIDS, candidiasis is common and may be widespread or severe.
Medicines that can suppress your immune system may give you other side effects. These vary and will be listed in the information they bring the medications.
If you have immunosuppression, the rules of when to see your doctor change. With most minor infections, healthy people are encouraged to take a wait-and-see approach, treat symptoms, and visit the doctor only if they feel unwell or the infection is not resolving.
However, if you have immunosuppression, even a mild infection could quickly become severe. Therefore, it is best to consult a doctor as soon as possible instead of waiting to see how things are going.
Infections detected early can be treated quickly, preventing them from spreading and making you feel bad.
You are more likely to be given an antibiotic for a mild infection compared to someone who is not immunosuppressed, and it may be that, in extreme cases, this will save your life.
Therefore, consult a doctor if you think you might have an infection, such as a sore throat, cough, symptoms of a urinary tract infection, food poisoning, etc.
Seek urgent medical attention if:
- You have a high temperature (fever) above 38 ° C.
- You have chills or tremors.
- In general, you feel wrong with dizziness, drowsiness, or confusion.
- If you have a rash
- The light hurts your eyes.
- If you have seizures.
- If you have an immunosuppressed child, all of the above apply, but also seek urgent medical attention if your child breathes quickly or if they do not eat or drink normally.
- It also monitors your skin; if you develop scaly areas that do not disappear quickly with a good moisturizer, or if you have a new mole or one that has changed, consult your doctor.
- Hopefully, there will not be any skin cancer, but if it is, the sooner it is treated, the better the result will be.
Treatment
Everything depends on the cause. For example:
HIV infection and AIDS are treated with specific anti-HIV drugs. See a separate booklet called HIV and AIDS.
With chemotherapy, many cancers can be treated successfully or at least delay their progression.
Transplants of stem cells (or bone marrow) are used in some situations. The damaged cells are replaced with the normal ones. This is used in some forms of cancer and some conditions of genetic immunosuppression.
The immune suppression caused by the medication should be reversed if the medication is discontinued. If immune suppression is causing harm, sometimes an alternative can be used, or the dose can be reduced.
In other cases, the infection is treated quickly as it occurs while continuing the medication; this depends on the treated condition and for how long the medication is used.
If you had a splenectomy, the effect lasts a lifetime, but there are ways to reduce the risk of infection.
In some conditions, such as genetic disorders of the immune system, injections of antibody proteins can be given to help the body fight infections.
Early treatment of infections is crucial if you are immunosuppressed. You will be treated for the infection. If it is incorrect or does not work, you may need hospitalization.
Do I need any specific treatment to prevent problems if I am immunosuppressed?
If your immune system is suppressed, the important thing is to take measures to avoid infection; this can be done in several ways:
- Complete the general steps to avoid infection. For example, avoid eating foods that put you at risk for food poisoning. Handle raw meat safely. Use general hygiene measures to keep your home clean and free of germs.
- Avoid close contact with people with infectious diseases whenever possible.
- Make sure all routine immunizations are up to date. (Specific recommendations are made for immunosuppressed children with childhood vaccines).
- Additional vaccines for people at higher risk include annual flu and vaccination against pneumonia and herpes zoster.
- Some live vaccines (those that contain live germs) are not given to some people who have a suppressed immune system.
- Some people who have undergone splenectomy and have a particular risk of infection are advised to take a regular antibiotic, such as penicillin, daily.
Travel precautions
As you have a particular risk of infection, it is advisable to plan very carefully to travel. Make all travel vaccines recommended based on the specific location to which you are traveling.
You may be recommended against certain live vaccines depending on the reason for your immunosuppression.
Be careful to travel to countries with a high risk of diseases against which you can not get vaccinated.
Avoid going to places where you would not have access to good vaccines or medical care if you get sick.
Travel with information about your condition and medication in case you need the help of a health professional while you are away from your regular doctor.
Verify that your travel insurance covers you if you get sick. Talk to your doctor and consider taking some “preventative” antibiotics and instructions on when to take them if you are at risk for specific infections.
Take the usual precautions to avoid food poisoning and traveler’s diarrhea if you visit somewhere where this could be a risk.