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Cancer care (Y4) > 10- Haematology (Lymphadenopathy and the spleen)) > Flashcards

10- Haematology (Lymphadenopathy and the spleen)) Flashcards

1
Q

The lymphatic system background

A
  • Series of vessels and nodes that collect and filter excess tissue fluid (lymph), before returning it to venous circulation
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2
Q

Lymph organs

A
  • Spleen
  • Thymus- development and maturation of T lymphocytes
  • Red bone marrow- maturation of immature lymphocytes
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3
Q

Lymph nodes

A

1) Kidney shaped sturctures
2) Filter particles from the blood
3) Immune function
Each node contains:
- T cells, B cells and other immune cells
- They are exposed to fluid as it passes through the node and commence and immune response if they detect the presence of a pathogen

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4
Q

Lymphadenopathy background

A
  • Swelling of lymph nodes
  • When nodes accumulate an excessive amount of lymphocytes they can become swollen
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5
Q

causes of lymphadenopathy

A

Infective
Neoplastic
Others

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6
Q

infective causes of lyphadenopathy

A
  • Infectious mononucleosis
  • HIV, including seroconversion illness
  • eczema with secondary infection
  • rubella
  • toxoplasmosis
  • CMV
  • tuberculosis
  • roseola infantum
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7
Q

Neoplastic causes of lymphadenopathy

A
  • Leukaemia
  • Lymphoma
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8
Q

other causes of lymphadenopathy

A

Others
- Autoimmune conditions: SLE, rheumatoid arthritis
- Graft versus host disease
- Sarcoidosis
- Drugs: phenytoin and to a lesser extent allopurinol, isoniazid

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9
Q

Investigations for lymphadenopathy

A
  • Imaging
    o US
    o CT scan or MRI
  • Lymph node biopsy
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10
Q

the spleen location

A
  • Upper left abdomen
  • Size of clenched fist
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11
Q

Function of the spleen

A

In an adult main function is to filter blood, removing old RBC. Also has a role in cell-mediated and humoral immune responses

  • Red pulp
    –> Recycles RBCs and metabolised Hb
  • White pulp
    –> Antibody synthesis
    –> Removal of opsonised bacteria/blood cells
  • Sequestration and phagocytosis of old/abnormal cells by macrophages
  • Blood pooling -> so platelets and RBCs can be rapidly mobilised during bleeding
  • Extramedullary haemopoiesis -> during haematological stress or if bone marrow fails e.g. myelofibrosis
  • Immunological function
    –> 25% of T cells and 15% of B cells are present in the spleen
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12
Q

Vasculature of the spleen

A
  • Most of its arterial supply from the splenic artery, a vessel which arises from the coeliac trunk
  • Venous drainage through splenic vein
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13
Q

Lymphatics of the spleen

A

Lymphatic vessels of the spleen follow the splenic vessels and drain into the pancreaticosplenic lymph nodes and then the coeliac nodes

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14
Q

Spleen rupture

A
  • Common site of injury
  • Splenic rupture occurs when there is a break in its fibroelastic capsule, disrupting underlying parenchyma
  • Mode of injury
    o Blunt or penetrating trauma
    o Associated with left rib fracture
  • Results in profuse bleeding into the peritoneal cavity because it is highly vascular
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15
Q

management of spleen rupture

A

Splenectomy
- When injury and subsequent haemorrhage are life threatening
- Can be partial or total
- Liver and bone marrow take over some functions of the spleen
- Lifelong antibiotics

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16
Q

Complications of spleen rupture and splenectomy

A
  • Higher risk of encapsulated bacterial infections
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17
Q

Splenomegaly background

A
  • Abnormally large spleen >12cm
  • Usually a result of secondary causes rather than primary disease of the spleen
  • Massive splenomegaly - >20cm
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18
Q

causes of splenomegaly

A

1) Blood cancers
- Leukaemia’s
- Lymphomas

2) Infections (due to increased work of spleen)
- Infectious mononucleosis
- Parasitic infections e.g. malaria
- Bacterial endocarditis
- Viral hepatitis

3) Portal hypertension
- Cirrhosis

4) Less common conditions
* Haemolytic anaemics
* Sickle cell
* Thalassaemia
* Autoimmune
* SLE
* RA
* Metabolic
* Gaucher disease

Causes of massive splenomegaly
- Myelofibrosis
- Chronic myelogenous leukaemia
- Malaria

19
Q

Causes of massive splenomegaly

A

myelofibrosis
CML
malaria
visceral leishmaniasis

20
Q

causes of moderate splenomegaly

A

lymphoproliferative
portal hypertension
thalassaemia

21
Q

causes of mild splenomegaly

A

PRV (polycythaemia vera)
Haemoloytis
Infection
Infiltration
Connective tissue disorders

22
Q

Presentation of splenomegaly

A
  • Abdominal pain/ distention
  • Constitutional symptoms: night sweats, fever, weight loss, malaise
  • Abnormal bruising/bleeding
  • Anaemic symptoms
  • Decreased appetite (stomach squishes by spleen)
23
Q

splenomegaly investigations

A
  • Bloods: FBC, blood film, LFTs, UEs, autoimmune screen, CRP, LDH
  • Imaging
    o US
    o CT
    o MRI (blood flow)
24
Q

management of splenomegaly

A

treat underlying causes

1) Avoid source of abdominal injury to prveent rupture

2) Splenectomy
- vaccination
- prophylactic antibiotics

25
Q

summary of splenomegaly

A
26
Q

asplenia

A

absence of spleen due to congenital anomaly or surgical procedure

27
Q

Hyposplenism

A

: reduced or absent function of spleen, impairing capacity to prevent bacterial infections

28
Q

causes of hyposplenism

A

1) Planned, where prophylactic measures can be used to prevent later complications.
2) Traumatic, due to an accident or during surgery.
3) Autosplenectomy, which refers to the physiological loss of spleen function (hyposplenism) - eg, associated with sickle cell anaemia (chronic damage to the spleen results in atrophy), coeliac disease, dermatitis herpetiformis, essential thrombocythaemia and ulcerative colitis.

29
Q

Indication for splenectomy

A
  • Trauma
  • Spontaneous rupture e.g. caused by splenomegaly due to infectious mononucleosis
  • Hypersplenism – immune thrombocytopenia
  • Neoplasia
30
Q

Complication of splenectomy

A
  • Thrombocytosis - increased risk of VTE, but prophylactic aspirin may be given if very high
  • Infection by encapsulated bacteria (NHS)
    o Streptococcus pneumonia
    o Haemophilus influenzae
    o Neisseria meningitis
31
Q

Investigations for hyposplenism

A
  • Blood film: features of hyposplenism include Howell-Jolly bodies, Pappenheimer bodies, target cells and irregular contracted red blood cells
  • Imaging techniques: ultrasound, CT scanning, and MRI scanning.
  • Other investigations, which will depend on the clinical context.
32
Q

Complications of hyposplenism

A
  • Increased risk of NHS encapsulated bacterial infections
  • Increased risk of severe falciparum malaria
33
Q

which immunisations are important for people without a spleen or hyposplenism

A
  • H.influzenae type B
  • Influenza virus
  • Pneumococcal
  • Meningococcal ACWY and B
34
Q

antibiotic prohylaxis in hyposplenism

A

For those at high risk of pneumococcal infections
Types:
- Phenoxypenicillin
- Macrolides

35
Q

Risk factors for high risk hyposplenism

A
  • Age <16 years or >50 years.
  • Poor response to pneumococcal vaccination.
  • Previous invasive pneumococcal illness.
  • Underlying haematological malignancy resulting in splenectomy (increased risk if immunosuppressed).
36
Q

pancytopenia background

A
  • Low levels of RBC, WBC and platelets
    o RBC- oxygen delivery
    o WBC- immune
    o Platelets- haemostasis
  • Increases risk of infection and bleedings
37
Q

Causes of pancytopenia

A

Usually unknown
- Cancer e.g. acute leukaemia’s, chemotherapy or radiation
- Genetic conditions
- Vitamin B12 and folate deficiency
- Autoimmune conditions which attack the bone marrow
- Some medicines e.g. antiseizure, antibiotics

38
Q

presentation of pancyto penia

A
  • Anaemic symptoms
  • low WBC symptoms
  • Thrombocytopenic symptoms
39
Q

Anaemic symptoms

A
  • Weakness
  • Fatigue
  • Rapid heart rate
  • SoB
  • Pale skin
40
Q

Low WBC symptoms

A

Frequent infections

41
Q

Thrombocytopenic symptoms

A
  • Petechiae
  • Bleeding from the gums or nose, blood in faeces or urine, heavy bleeding from cut
  • Heavy menstruation in female
  • Easy bleeding
42
Q

Investigation for pancytopenia

A
  • Bloods
    o Full blood count
    o Blood culture
    o Clotting/coagulation studies
    o Group and cross-match blood
    o U&Es
    o CRP
  • Bone marrow biopsy
43
Q

management of pancytopenia

A

Management
- Treat underlying cause
o E.g. drugs which stimulate bone marrow
o Drugs which suppress immune system attacking bone marrow
- Blood transfusion
o May prevent bleeding or organ damage
o Does not treat pancytopenia
- Stem cell transplant

Cancer care (Y4) (30 decks)

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