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2 MEH > 5 Haemopoiesis, the Spleen and Bone Marrow > Flashcards

5 Haemopoiesis, the Spleen and Bone Marrow Flashcards

1
Q

Where does bone marrow become more limited to in adults?

A

Pelvis, sternum, skull, ribs, vertebrae

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2
Q

What cell types can haematopoietic stem cells develop into? (4)

A
  1. Erythroid
  2. Megakaryocyte/Platelet/Thrombocyte
  3. Granulocytes
  4. Lymphocytes
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3
Q

What are 4 properties/characteristics of the HPSC (haemopoietic stem cell)?

A
  1. Has greatest power of self renewal in adult
  2. Can differentiate into lots of different cells
  3. Mobilises out of bone marrow
  4. Can undergo apoptosis
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4
Q

What are the sources of haemopoietic stem cells if needed in a clinical scenario?

A
  1. Bone marrow aspiration
  2. Stem cells- mobilised by GCSF- collected by leucopharesis in peripheral blood
  3. Umbilical cord stem cells
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5
Q

Name the system which removes and controls blood cells.

A

Reticuloendothelial system (RES)

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6
Q

How does the reticuloendothelial system work?

A
  • =Network of cells and tissues- contain phagocytic cells: monocytes, macrophages, kupffer cells, microglial cells (CNS)
    • Identifies and mounts appropriate immune response
    • Dispose of blood cells

Kupffer cell= specialised macrophage

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7
Q

What are the main organs of the Reticuloendothelial system?

A
  1. Spleen
  2. Liver
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8
Q

What are the 2 types of tissue found in the spleen?

A
  1. Red Pulp: sinuses lined with endothelial macrophages and chords
  2. White Pulp: structure=similar to lymphoid follicle
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9
Q

Where does blood enter the spleen?

A

Splenic artery

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10
Q

Which tissue tissue in the spleen do each of the following preferentially pass through?:

White cells

Plasma

RBCs

A
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11
Q

State 4 functions of the spleen (in adults).

A
  1. Sequestration and phagocytosis- removal of old/abnormal red cells - macrophages
  2. Blood pooling - so platelets and RBCs= rapidly mobilised during bleeding
  3. Extramedullary haemopoiesis- pluripotent stem cells
  4. Immunological function- 25% T cells and 15% B cells produced in spleen
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12
Q

What does in mean if you can palpate the spleen below the costal margin?

A

Spleen=enlarged

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13
Q

How can you measure the sze of the spleen?

A
  1. Palpate in right iliac fossa- spleen with move towards hand on inspiration
  2. Feel for splenic notch
  3. Measure CM from costal margin in mid-clavicular line
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14
Q

State some possible causes of splenomegaly?

A
  1. Back pressure- portal hypertension in liver disease
  2. Overworking red and white pulp
  3. Increase in extramedullary haemopoiesis
  4. Infiltrated by cells- eg cancer cells (leukaemia)
  5. Infiltrated material eg Gaucher’s disease, sarcoidosis
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15
Q

What are the 3 categories of Splenomegaly?

A
  1. Massive- chronic myeloid leukaemia, malaria
  2. Moderate- chronic myeloid leukaemia, malaria, lymphoma, liver cirrhosis
  3. Mild- chronic myeloid leukaemia, malaria, lymphoma, liver cirrhosis, hepatitis, autoimmune diseases
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16
Q

What is Hypersplenism?

A

Low blood count due to pooling of blood in spleen

(Removing too many red blood cells)

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17
Q

What is there an increased risk of if the spleen is enlarged?

A

Rupture (no longer protected by ribcage)–> haematoma

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18
Q

What is hyposplenism?

A

Lack of functioning splenic tissue

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19
Q

What causes hyposplenism?

A
  • Splenectomy
  • Sickle cell disease
  • Multiple infarcts then fibrosis
  • Caeliac disease
20
Q

How might hyposplenism be detected?

A

Howell Jolly Bodies shown on blood film

21
Q

If a patient has hyposplenism, what is the patient at greater risk of?

A
  • Overwhelming sepsis
  • Especially from Encapsulated Organisms
    • ​Pneumococcus
    • Haemophilus influenzae
    • Meningococcus
22
Q

Name 4 functions of a Red Blood Cell.

A
  1. Oxygen delivery
  2. Maintain haemoglobin in ferrous (reduced) state
  3. Maintain osmotic equilibrium
  4. Generate energy
23
Q

What condition can develop as a result of changes in the red blood cell membrane?

A

Red cell survival reduces (broken down more easily)

Can develop Haemolytic anaemia

24
Q

In 5 steps, describe how the body responds if a patient becomes anaemic.

A
  1. Cells in kidney- detect reduced pO2
  2. Increased erythropoietin production
  3. (erythropoietin) Stimulates maturation of RBCs
  4. Increase:
    1. RBCs
    2. Haemoglobin
    3. O2 delievered
  5. Eventually- erythropoietin production falls- feedback loop
25
Q

What is cytopenia?

A

Reduction in number of RBCs

26
Q

What type of blood cell is reduced in number for each of the following conditions?:

  • Anaemia
  • Leucopenia
  • Neutropenia
  • Thrombocytopenia
  • Pancytopenia
A
  • Anaemia: RBC/Haemoglobin
  • Leucopenia: Low WBC
  • Neutropenia: Low neutrophil
  • Thrombocytopenia: Low platelet
  • Pancytopenia: All
27
Q

What has occured in a patient with each of the following conditions?

  • Erythrocytosis
  • Leucocytosis
  • Neutrophilia
  • Lymphocytosis
  • Thrombocytosis
A

Increase in circulating:

  • Erythrocytosis-RBCs
  • Leucocytosis-WBCs
  • Neutrophilia-Neutrophils
  • Lymphocytosis- Lymphocytes
  • Thrombocytosis- Platelets
28
Q

What is a neutrophil?

A
  1. First responder phagocyte
  2. Most common WBC

Circulate in bloodstream- live 1-4 days

29
Q

How is neutrophil maturation controlled?

A
  • Hormone: G-CSF
30
Q

Why might G-CSF be administered clinically?(2)

A
  1. Severe neutropenia
  2. Sepsis after chemotherapy
31
Q

What are some possible causes of neutrophilia? (increased circulating neutrophils)

A
  1. Infection
  2. Cancer
  3. Tissue damage
  4. Acute inflammation
  5. Drugs eg steroids
  6. Acute haemorrhage
  7. Myeloproliferative disease
32
Q

What are possible causes of neutropenia due to increased use/removal of neutrophils?

A
  1. Immune destruction
  2. Sepsis
  3. Splenic pooling
33
Q

Apart from reduced production and increased removal of neutrophils, what are the other (2) causes of neutropenia?

A
  • Benign, ethnic neutropenia
  • Cyclic neutropenia (autosomal dominant disorder)
34
Q

What are some possible causes of neutropenia due to a reduced production of neutrophils?

A
  1. B12/folate deficiency
  2. Infiltration of bone marrow by fibrosis/malignancy
  3. Aplastic anaemia- empty bone marrow
  4. Radiation
  5. Drugs
  6. Viral infection
  7. Congenital disorders
35
Q

Describe 2 complication of Neutropenia?

A
  1. Mucosal ulceration eg in mouth
  2. Neutropenic sepsis (life threatening)= medical emergency. IV antibiotics given immediately
36
Q

What do monocytes develop into?

A

Macrophages (once migrated to tissues)

37
Q

What may cause monocytosis?

A
  1. Carcinoma
  2. Chronic infection
  3. Chronic inflammatory conditions eg ulcerative collitis
38
Q

What’s the lifespan of an eosinophil?

A

8-12 days

39
Q

What is the function of eosinophils?

A

Mediate:

allergic response

hypersensitivity reactions

Migrate–> epithelial surfaces

40
Q

What do the granules in an eosinophil contain?

A

Arginine, phospholipid, enzymes

41
Q

Name some conditions which eosinophilia is commonly due to:

A
  1. Allergic diseases:
    1. Asthma
    2. Eczema
    3. Hay fever
  2. Drug hypersensitivity:
    1. Penicillin
  3. Parasitic infection: Round worm, flukes
42
Q

Name some conditions which eosinophilia is rarely due to?

A
  • Hodgkin lymphoma
  • Acute myeloid leukaemia
43
Q

What are basophils?

A

Least common but LARGEST blood cell

Granules contain:

  • Histamine
  • Heparin
  • Hyaluronic acid
  • Seratonin
44
Q

What may cause Basophilia?

A
  • Immediate hypersensitivity reactions
  • Ulcerative collitis
  • Chronic myeloid leukaemia
45
Q

What types of cells do lymphocytes differentiate into?

A
46
Q

What are some possible causes of lymphocytosis?

A

Reactive:

  • Viral infections
  • Stress related : MI/Cardiac arrest
  • Post splenectomy (No where for lymphocytes to rest)
  • Smoking

Lymphoproliferative (malignant):

  • Lymphoma (cells spill out of infiltrated bone marrow)
  • T-cell leukaemia

2 MEH (18 decks)

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