monoclonals

Your blood is living tissue made up of liquid and solids. The liquid part, called plasma, is made of water, salts and protein. Over half of your blood is plasma. The solid part of your blood contains red blood cells, white blood cells and platelets.

Blood disorders affect one or more parts of the blood and prevent your blood from doing its job. They can be acute or chronic. Many blood disorders are inherited. Other causes include other diseases, side effects of medicines, and a lack of certain nutrients in your diet.

Types of blood disorders include:

• Platelet disorders, excessive clotting, and bleeding problems, which affect how your blood clots
• Anemia, which happens when your blood does not carry enough oxygen to the rest of your body
• Cancers of the blood, such as leukemia and myeloma
• Eosinophilic disorders, which are problems with one type of white blood cell.

Immunotherapy is a cancer treatment that helps your immune system fight cancer. It is a type of biological therapy. Biological therapy uses substances that are made from living organisms, or versions of these substances that are made in a lab.

Doctors don't yet use immunotherapy as often as other cancer treatments, such as surgery, chemotherapy, and radiation therapy. But they do use immunotherapy for some types of cancer, and researchers are doing clinical trials to see whether it also works for other types.

When you have cancer, some of your cells begin to multiply without stopping. They spread into the surrounding tissues. One reason that the cancer cells can keep growing and spreading is that they are able to hide from your immune system. Some immunotherapies can "mark" your cancer cells. This makes it easier for your immune system to find and destroy the cells. It is a type of targeted therapy, which uses drugs or other substances that attack specific cancer cells with less harm to normal cells. Other types of immunotherapies work by boosting your immune system to work better against cancer.

You could get immunotherapy intravenously (by IV), in pills or capsules, or in a cream for your skin. For bladder cancer, they might place it directly into your bladder. You may have treatment every day, week, or month. Some immunotherapies are given in cycles. It depends on your type of cancer, how advanced it is, the type of immunotherapy you get, and how well it is working.

You may have side effects. The most common side effects are skin reactions at the needle site, if you get it by IV. Other side effects may include flu-like symptoms, or rarely, severe reactions.

NIH: National Cancer Institute

Ebola, also known as Ebola virus disease (EVD), is a type of hemorrhagic fever. It is a rare and often deadly disease. It can be caused by several different types of Ebola viruses. There are occasional outbreaks of Ebola, and they mostly occur in Africa.

Researchers believe that the virus first spreads from an infected animal to a human. Ebola can then spread from human to human through direct contact with:

• Blood or body fluids of a person who is sick with or has died from Ebola.
• Objects (such as clothes, bedding, needles, and medical equipment) contaminated with body fluids from a person who is sick with or has died from Ebola.
• Semen (through oral, vaginal, or anal sex) from a man who has recovered from Ebola. The virus can remain in semen and other body fluids, even if the person no longer has symptoms.

When people become infected with Ebola, they do not start developing signs or symptoms right away. They cannot spread Ebola to others until after they develop symptoms.

The symptoms of Ebola may appear anywhere from 2 to 21 days after exposure to the virus. The average is about 8 to 10 days. The symptoms usually include:

• Fever
• Headache
• Joint and muscle aches
• Weakness and fatigue
• Sore throat
• Gastrointestinal symptoms including abdominal (belly) pain, diarrhea, and vomiting
• Loss of appetite
• Unexplained bleeding or bruising

Other symptoms may include a rash, red eyes, and hiccups.

The early symptoms of Ebola are similar to other more common diseases. This makes it difficult to diagnose Ebola in someone who has been infected for only a few days. If a person has the symptoms of Ebola and may have been exposed to the virus, the health care provider can do a blood test for Ebola. It can take a few days after the symptoms start before Ebola shows up in the blood test.

In the United States, there are two approved medicines to treat Ebola that is caused by one specific type of virus (Zaire ebolavirus). These medicines have not been evaluated to treat Ebola caused by other types of Ebola viruses. The medicines are monoclonal antibodies, which are immune system proteins that are created in the lab.

Whether or not there are medicines to treat a case of Ebola, there is supportive care. This type of care can improve the chances of survival, especially when given early. Supportive care includes:

• Giving fluids and electrolytes
• Giving medicines to support blood pressure, reduce vomiting and diarrhea, and to manage fever and pain
• Giving oxygen
• Treating any other complications or infections

People who recover may still have side effects afterwards, such as fatigue, muscle aches, eye and vision problems, and stomach pain.

In the United States, there is one vaccine that has been approved to prevent Ebola caused by one specific type of Ebola virus (Zaire ebolavirus). It may be given to health care providers who will be or may be treating Ebola patients and people who work with live Ebola virus in labs.

If you live in or plan to travel to a region where Ebola virus may be present, you can help protect yourself by avoiding contact with:

• Blood and body fluids of people who are sick
• Semen from a man who has recovered from Ebola, until testing shows that the virus is gone from his semen
• Items that could be contaminated with blood or body fluids from someone who has Ebola
• Bats, forest antelopes, and nonhuman primates (such as monkeys and chimpanzees), including their blood, fluids, or meat

Centers for Disease Control and Prevention

Eosinophilic esophagitis (EoE) is a chronic disease of the esophagus. Your esophagus is the muscular tube that carries food and liquids from your mouth to the stomach. If you have EoE, white blood cells called eosinophils build up in your esophagus. This causes damage and inflammation, which can cause pain, trouble swallowing, and food getting stuck in your throat.

EoE is rare. But because it is a newly recognized disease, it is being diagnosed more often. Some people who think that they have reflux (GERD) may actually have EoE.

Researchers are not certain about the exact cause of EoE. They think that it is an immune system/allergic reaction to foods or to substances in your environment, such as dust mites, animal dander, pollen, and molds. Certain genes may also play a role in EoE.

EoE can affect anyone, but it is more common in people who:

• Are male
• Have other allergic diseases, such as hay fever, eczema, asthma and food allergies
• Have family members with EoE

The most common symptoms of EoE can depend on your age.

In infants and toddlers::

• Feeding problems
• Vomiting
• Poor weight gain and growth
• Reflux that does not get better with medicines

In older children::

• Vomiting
• Abdominal pain
• Trouble swallowing, especially with solid foods
• Reflux that does not get better with medicines
• Poor appetite

In adults::

• Trouble swallowing, especially with solid foods
• Food getting stuck in the esophagus
• Reflux that does not get better with medicines
• Heartburn
• Chest pain

To find out if you have EoE, your doctor will likely:

• Ask about your symptoms and medical history. Since other conditions can have the same symptoms of EoE, it is important for your doctor to take a thorough history.
• Do an upper gastrointestinal (GI) endoscopy. An endoscope is a long, flexible tube with a light and camera at the end of it. Your doctor will run the endoscope down your esophagus and look at it. Some signs that you might have EoE include white spots, rings, narrowing, and inflammation in the esophagus. However, not everyone with EoE has those signs, and sometimes they can be signs of a different esophagus disorder.
• Do a biopsy. During the endoscopy, the doctor will take small tissue samples from your esophagus. The samples will be checked for a high number of eosinophils. This is the only way to make a diagnosis of EoE.
• Do other tests as needed. You may have blood tests to check for other conditions. If you do have EoE, you may have blood or other types of tests to check for specific allergies.

There is no cure for EoE. Treatments can manage your symptoms and prevent further damage. The two main types of treatments are medicines and diet.

Medicines used to treat EoE are:

• Steroids, which can help control inflammation. These are usually topical steroids, which you swallow either from an inhaler or as a liquid. Sometimes doctors prescribe oral steroids (pills) to treat people who have serious swallowing problems or weight loss.
• Acid suppressors such as proton pump inhibitors (PPIs), which may help with reflux symptoms and decrease inflammation.
• Monoclonal antibodies, which can reduce inflammation and may help with swallowing. They can be used in adults and children over age 12.

Dietary changes for EoE include:

• Elimination diet. If you are on an elimination diet, you stop eating and drinking certain foods and beverages for several weeks. If you are feeling better, you add the foods back to your diet one at a time. You have repeat endoscopies to see whether or not you are tolerating those foods. There are different types of elimination diets:
• With one type, you first have an allergy test. Then you stop eating and drinking the foods you are allergic to.
• For another type, you eliminate foods and drinks that commonly cause allergies, such as dairy products, egg, wheat, soy, peanuts, tree nuts and fish/shellfish.
• Elemental diet. With this diet, you stop eating and drinking all proteins. Instead, you drink an amino acid formula. Some people who do not like the taste of the formula use a feeding tube instead. If your symptoms and inflammation go away completely, you may be able to try adding foods back one at a time, to see whether you can tolerate them.

Which treatment your doctor suggests depends on different factors, including your age. Some people may use more than one kind of treatment. Researchers are still trying to understand EoE and how best to treat it.

If your treatment is not working well enough and you have narrowing of the esophagus, you may need dilation. This is a procedure to stretch the esophagus. This makes it easier for you to swallow.

Your immune system is a complex network of cells, tissues, and organs. Together they help the body fight infections and other diseases.

When germs such as bacteria or viruses invade your body, they attack and multiply. This is called an infection. The infection causes the disease that makes you sick. Your immune system protects you from the disease by fighting off the germs.

The immune system has many different parts, including:

• Your skin, which can help prevent germs from getting into the body
• Mucous membranes, which are the moist, inner linings of some organs and body cavities. They make mucus and other substances which can trap and fight germs.
• White blood cells, which fight germs
• Organs and tissues of the lymph system, such as the thymus, spleen, tonsils, lymph nodes, lymph vessels, and bone marrow. They produce, store, and carry white blood cells.

Your immune system defends your body against substances it sees as harmful or foreign. These substances are called antigens. They may be germs such as bacteria and viruses. They might be chemicals or toxins. They could also be cells that are damaged from things like cancer or sunburn.

When your immune system recognizes an antigen, it attacks it. This is called an immune response. Part of this response is to make antibodies. Antibodies are proteins that work to attack, weaken, and destroy antigens. Your body also makes other cells to fight the antigen.

Afterwards, your immune system remembers the antigen. If it sees the antigen again, it can recognize it. It will quickly send out the right antibodies, so in most cases, you don't get sick. This protection against a certain disease is called immunity.

There are three different types of immunity:

• Innate immunity is the protection that you are born with. It is your body's first line of defense. It includes barriers such as the skin and mucous membranes. They keep harmful substances from entering the body. It also includes some cells and chemicals which can attack foreign substances.
• Active immunity, also called adaptive immunity, develops when you are infected with or vaccinated against a foreign substance. Active immunity is usually long-lasting. For many diseases, it can last your entire life.
• Passive immunity happens when you receive antibodies to a disease instead of making them through your own immune system. For example, newborn babies have antibodies from their mothers. People can also get passive immunity through blood products that contain antibodies. This kind of immunity gives you protection right away. But it only lasts a few weeks or months.

Sometimes a person may have an immune response even though there is no real threat. This can lead to problems such as allergies, asthma, and autoimmune diseases. If you have an autoimmune disease, your immune system attacks healthy cells in your body by mistake.

Other immune system problems happen when your immune system does not work correctly. These problems include immunodeficiency diseases. If you have an immunodeficiency disease, you get sick more often. Your infections may last longer and can be more serious and harder to treat. They are often genetic disorders.

There are other diseases that can affect your immune system. For example, HIV is a virus that harms your immune system by destroying your white blood cells. If HIV is not treated, it can lead to AIDS (acquired immunodeficiency syndrome). People with AIDS have badly damaged immune systems. They get an increasing number of severe illnesses.

Multiple myeloma is a cancer that begins in plasma cells, a type of white blood cell. These cells are part of your immune system, which helps protect the body from germs and other harmful substances. In time, myeloma cells collect in the bone marrow and in the solid parts of bones.

No one knows the exact causes of multiple myeloma, but it is more common in older people and African Americans. It can run in families. Common symptoms may include:

• Bone pain, often in the back or ribs
• Fractures (broken bones)
• Weakness or fatigue
• Weight loss
• Frequent infections and fevers
• Feeling very thirsty
• Frequent urination

Doctors diagnose multiple myeloma using lab tests, imaging tests, and a bone marrow biopsy. Your treatment depends on how advanced the disease is and whether you have symptoms. If you have no symptoms, you may not need treatment right away. If you have symptoms, you may have chemotherapy, stem cell transplantation, radiation, or targeted therapy. Targeted therapy uses drugs or other substances that attack specific cancer cells with less harm to normal cells.

NIH: National Cancer Institute

Myasthenia gravis, sometimes called MG, is a chronic (long-lasting) disease that causes weakness in your voluntary muscles. The voluntary muscles are the ones that you can control. They include the muscles you use for:

• Eye and eyelid movement
• Facial expressions
• Chewing
• Talking
• Swallowing
• Breathing
• Moving your arms and legs

You can also have weakness in other muscles. This weakness gets worse with activity, and better with rest.

Myasthenia gravis is a type of autoimmune disease. In autoimmune diseases, your immune system attacks the healthy cells of your organs and tissues by mistake.

Myasthenia gravis is caused by an error in how nerve signals are sent to muscles. These signals get blocked at the nerve-muscle junction. This junction is the place where the nerve endings connect with the muscles they control.

Normally, this is how the signals work:

• The signals travel down a nerve that controls movement in the muscle
• The nerve endings release a substance called acetylcholine
• Acetylcholine binds to the muscle tissue at the nerve-muscle junction
• This causes the muscle to contract (move)

But in someone with myasthenia gravis, the body's own immune system makes antibodies that block the binding of acetylcholine to the muscle. This makes the muscles weaker.

The thymus gland, which is part of your immune system, may play a role in myasthenia gravis. Normally, your thymus gland is active and growing when you are a child. It makes white blood cells to fight infections. At puberty, it starts getting smaller and is replaced by fat. It is usually small by the time you are an adult. But in many adults with myasthenia gravis, the thymus gland stays large. And some people with myasthenia gravis can get thymomas, which are tumors of the thymus. The are usually benign (not cancer), but they can sometimes become cancerous.

Although myasthenia gravis can affect people of any age, it is most common in young adult women (under age 40) and older men (over age 60). It is usually not inherited (passed down in families).

Myasthenia gravis normally does not affect infants. But it's possible for pregnant people who have myasthenia gravis to pass the antibodies to their unborn babies. The baby can then be born with neonatal myasthenia. This condition is usually temporary, and the symptoms typically go away within two to three months after birth.

The symptoms of myasthenia gravis will depend on which muscles are affected. The symptoms often include:

• Weakness of the eye muscles
• Drooping of one or both eyelids
• Blurred or double vision
• Changes in facial expressions
• Trouble swallowing
• Shortness of breath
• Speech problems
• Weakness in the arms, hands, fingers, legs, and neck

Different people have different levels of muscle weakness. And the weakness can vary from day to day. Some days it might be mild, and other days it might be worse. Physical activity often makes the muscle weakness worse.

Some people with myasthenia gravis can get severe weakness that affects the muscles that control breathing. This is called a myasthenic crisis, and it is a life-threatening emergency.

There are many other conditions that can cause muscle weakness, so myasthenia gravis can be hard to diagnose. To find out if you have myasthenia gravis, your health care provider:

• Will ask about your medical history and symptoms
• Will do a physical exam, including a neurological exam
• Will likely order tests for myasthenia gravis, including:
  • Blood tests
  • Imaging tests
  • Electromyography (EMG) and nerve conduction studies

There is no cure for myasthenia gravis, but treatments that can improve muscle weakness and help with symptoms. They include:

• Anticholinesterase medicines, which can improve nerve-to-muscle messages and make muscles stronger.
• Immunosuppressive medicines, which are medicines that decrease your body's immune system responses. They can lower your body's production of abnormal antibodies.
• Monoclonal antibodies, which can also help decrease your body's immune system responses.
• Plasmapheresis (plasma exchange) and intravenous immunoglobulin, which are procedures to remove abnormal antibodies from your blood. They are usually used in severe cases. They can help with symptoms for a few weeks or months.
• Thymectomy, surgery to remove the thymus gland. It can reduce the symptoms of myasthenia gravis, possibly by rebalancing the immune system.

Lifestyle changes may be helpful for some people. The changes could include regular gentle exercise, getting enough rest, and eating healthy foods.

Some people with myasthenia gravis go into remission. This means that they do not have symptoms. The remission is usually temporary, but sometimes it can be permanent.

NIH: National Institute of Neurological Disorders and Stroke

Sarcoidosis is a condition in which groups of cells in your immune system form small, red, and swollen (inflamed) lumps. These lumps are called granulomas. They can form in any organ in the body. But they most commonly affect the lungs and lymph nodes in the chest. Over time, sarcoidosis can cause permanent scarring of organs.

Your immune system creates inflammation to help defend you against germs and sickness. But in sarcoidosis, inflammation goes off track. It causes the cells in your immune system to form granulomas. Studies suggest that this inflammation might be triggered by infections and certain substances in the environment such as insecticides and mold. And your genes may affect how your immune system reacts to a trigger.

Anyone can develop sarcoidosis, but you are more likely to have it if you:

• Are older, especially if you are over age 55
• Live or work near insecticides, mold, or other substances that may cause inflammation
• Have a close relative who has sarcoidosis
• Take certain medicines, such as some types of HIV medicines and monoclonal antibodies
• Are of African or Scandinavian descent
• Are female

Many people who have sarcoidosis have no symptoms, or they may feel unwell but without any obvious symptoms. If you have symptoms, you may have some general symptoms. And you may have other symptoms, which will depend upon which part of the body is affected.

The general symptoms can include:

• Fatigue
• Weight loss
• Swollen lymph nodes
• Depression
• Fever
• Night sweats (heavy sweating during sleep)

The symptoms of sarcoidosis in the lungs can include:

• Wheezing
• Cough
• Shortness of breath
• Chest pain

The symptoms of sarcoidosis in other parts of the body can include:

• Larger than normal liver or spleen
• Jaundice, which can make your eyes or skin yellow
• Nervous system problems, such as:
  • Headache
  • Dizziness
  • Vision problems
  • Seizures
  • Numbness or tingling
• Heart palpitations or an irregular heartbeat (arrhythmia)
• Pain and swelling in the joints
• Skin problems such as rashes and growths under the skin

There is also a set of symptoms that are called Lofgren's syndrome. Some people have Lofgren's syndrome when they first develop sarcoidosis. It usually goes away completely within 2 years. The symptoms of Lofgren's syndrome may include:

• Swollen lymph nodes in your chest, neck, chin, armpits, or groin.
• A rash of small, itchy, or painful bumps called erythema nodosum. The rash is most often on your head, neck, or legs.
• Blurred vision, eye pain or redness, light sensitivity, or watery eyes.
• Joint pain, stiffness, or swelling.
• Fever.

If untreated, or if the treatment does not work, sarcoidosis can cause serious health problems called complications. Possible complications include:

• Lung problems
• Heart problems
• Hormone problems
• Brain, nerve, or muscle problems
• Kidney problems
• Severe organ damage

There is no single test that can diagnose sarcoidosis, and its symptoms can be similar to the symptoms of many other conditions. That makes it hard to diagnose. To find out if you have sarcoidosis, your health care provider:

• Will ask about your medical history, including your symptoms, lifestyle, and any other health conditions you may have.
• Will do a physical exam, which may include:
  • Checking your temperature
  • Checking to see if your lymph nodes, spleen, or liver are swollen
  • Listening to your chest with a stethoscope as you breathe in and out
  • Looking for rashes or sores on your body, such as scalp and lower legs
• Will likely order various tests, such as:
  • Chest x-rays
  • A biopsy of the skin, lymph nodes, lungs, or other affected organs
  • Blood tests to check your blood counts, hormone levels, and how well your kidneys are working
  • Other imaging tests

If you are diagnosed with sarcoidosis, your provider may order other tests to look at how sarcoidosis is affecting the body.

There is no cure for sarcoidosis. The goal of treatment for sarcoidosis is remission, which means you still have the condition, but it does not cause you problems.

You may not need treatment, and sometimes the condition goes away on its own. If you do need treatment, which treatment(s) you get will depend on your symptoms, which organs are affected, and whether those organs are working well. You may be given medicines to:

• Lower inflammation
• Treat an overactive immune response
• Treat joint pain
• Treat skin problems

If you have complications from sarcoidosis, you may need other treatments, such as other medicines, surgery, oxygen therapy, pulmonary rehabilitation, or an implanted cardiac pacemaker or defibrillator.

Whether or not you have symptoms from sarcoidosis, it's important to get regular follow-up care from your provider, make healthy lifestyle changes, and contact your provider if you have any new symptoms.

NIH: National Heart, Lung, and Blood Institute