Cells of the Blood Flashcards
What makes up blood
Plasma
Buffy coat
Red blood cells (50%)
What cells are in the plasma
Clotting factor
Albumin
Antibodies
What cells are in the Buffy coat
Platelet White cells (leucocytes)
What is the function of blood
Transport oxygen and CO2 Transport nutrients, waste and hormones Prevent abnormal bleeding and clots Phagocytosis Antigen recognition and Ab formation
What causes haematological abnormalities
High levels of cells
Low levels of cells
Altered function of cells
What is the process of cell formation
Haematopoiesis
Where do all cells develop from
Pluripotent haematopoetic stem cells in bone marrow
What do lymphocytes form from
Lymphoid progenitor cell
Branch of early
NK cells produced
Develop into T or B cells for immune function
B cells then differentiate into plasma cells which make Ab as part of normal immune
What do the other cells form form
Myeloid progenitor cell
All cells apart from lymphocytes are myeloid cells
How are RBC formed
Erythroblast - contain nucleus
Reticulocyte just before it is released into circulation
Erythrocyte = RBC
What controls formation of RBC
Erythropoietin
Where is erythropoietin produced
Kidney in response to hypoxia so anaemia in CKD
What are platelets produced from
Megakaryocyte
What regulates platelet formation and where is it produced and what is major role and what is the life cycle
Thrombopoietin
Produced in the liver
Important role in blood clotting and haemostasis
After 7-10 days platelets leave blood vessel and enter liver / spleen where they are broken down by macrophages
Where is bone marrow found in children and elderly
Children = mostly all bones Elderly = axial
Where do other cells come from
What cell doesn’t and where does this come from
Myeloblast
EXCEPT mast cells which differentiate from myeloid progenitor themselves
What are neutrophils controlled by
Interluekin
G-CSF’s
What is the function of neutrophils
Ingest and destroy pathogens by phagocytosis
Bacteria and fungi
What are the functions of monocytes
Ingest and destroy pathogens by phagocytosis Release cytokines Activate other cells of immune Differentiate into macrophage in tissue Bacteria and fungi
What do monocytes differentiate into
Macrophages in tissue Kuppfer cells in liver Langerhans in skin Brain migrogilia Dendritic cells - APC that take up antigen and present on cell surface (have both MHC 1 and 2)
What are eosinophils important in and what are they unable to do
When are eosinophils increased
Parasites and allergies
Exocytosis of granules containing cytokines and toxins
Phagocytose (not really)
Increased in
- drug reactions
- allergies / atopy
- parasitic infection
- skin disease
- Chrug Strauss
What other cells are important in dealing with parasites
Mast cells
Basophils
What causes thrombocytosis (neutrophilia as well)
Primary due to overproduction in marrow
- Myeloproliferative = most common (all 4)
- Myeloid malignancy
Secondary Infections Inflammation - IBD/ RA Post surgical / trauma / bleeding Iron deficiency anaemia Malignancy - lung Ca / NHL etc. Previous splenectomy
What causes thrombocytopenia
Bone marrow failure
- Malignancy
- Chemotherapy
- Aplastic anaemia
- Vit b12 / folate deficiency
Increased destruction
- ITP / TTP = severe
- Alcohol
- Drugs
- Hypersplensim
Increased consumption
- DIC / Haemorrhage = severe
- Sepsis
- Pancreatitis
- Pregnancy
Autoimmune
- ITP
- RA
- SLE
- Anti-phospholipid
Not produced
- Hepatic failure
What causes neutrophilia
Primary to overproduction in marrow
- Myeloproliferative
- Myeloid malignancy
Secondary Infection Inflammation / stress - MI / post-op / RA / burns Tissue damage Malignancy Drugs e.g. steroid
What causes neutropenia
Marrow failure Sepsis / Autoimmune = increased consumption Drugs Granulomatous disease Hyeprsplenism - Felty
What causes lymphocytosis (increased lymphocytes)
Leukaemia and lymphoma - particularly CLL
Chronic infection - TB / brucellosis / hepatitis / Pertussis
EBV / HIV
Inflammation - RA
What causes lymphopenia
Bone marrow failure Autoimmune HIV Drugs Post viral Transplant GVHD Post chemo / RT Steroids
How does RA affect the blood
Anaemia Iron / folate deficiency Immune haemolysis Neutropenia Immune thrombocytopenia Cytopenia due to Rx Felty syndrome - HSM, neutropenia, RA
What is the ranges of Hg in M
<70 and >70
135-170
116-156
What is the ranges of Hg in F
<70 and >70
120-160
108-143
What should RBC be
4-5 x10^12
What should platelets be
150-400
What should WBC be
4-10
What should neutrophils be
1.5-7
What should lymphocytes be
1.5-4
What should monocytes be
0.2-0.8
What should eosinophils be
0.1-0.5
What should basophils be
0.01-0.1
What are the main haematological tests
FBC Blood film Bleeding time Reticulocyte count Chemical assay - iron, B12, folate Marrow aspirate LN biopsy Imaging
How do you treat haematological problems
Blood transfusion Haematinics - iron / b12 / folate Coagulation factor Plasma exchange Transplant - stem cell / bone marrow Cytotoxic drugs Immunosupression Inhibitors of coagulation / fibrinolysis
What is the spleen
Acts as a blood filter
Red pulp where RBC go to mature
White pulp for immune function
What does hypersplenism cause
Pancytopenia (lower number of all cells)
What does hyposplenism cause
Infection with encapsulated bacteria
Red cell changes - Howel Jolly
Requires immunisation and Az
What are causes of splenomegaly (enlargement of spleen)
Infections
Leukaemia + lymphoma
Myeloproliferative disorder
Portal hypertension 2 to cirrhosis
Haemolytic disorders
Autoimmune - SLE / Felty / RA / sarcoid/. amyloid
Storage pool disorder - Hauchers / Niemann-Pick
What haemolytic disorders cause splenomegaly
Congenital anaemia's - Heriditary spherocytosis - Thalassaemia - Sickle cell Megaloblastic anaemia Haemolytic anaemia - often warm AB Autoimmune
What infections cause splenomegaly
Acute - EBV / CMV
Chronic bacteria - TB / brucella
Parasitic - malaria / schistosomiasis
What disorders cause massive splenomegaly
Myelofibrosis CML Malaria Gaucher Visceral leishmaniasis
What does target cell on blood film suggest
Sickle cell Thalasseamia Iron deficiency anaemia Hyposplenism / post-splenectomy Liver disease
What does tear drop poikilocytes
Myelofibrosis
What does spherocytes suggest
Hereditary spherocytosis
Autoimune haemolytic anaemia
What does basophilic stippling suggest
Lead poison
Thalassemia
Sideroblastic anaemia
Myelodysplasia
What do Howell-Jolly bodies suggest
Hyposplenism
Severe anaemia
What do Heinz bodies suggest
G6PD deficinecy
Thalassemia
What do schistocytes ‘helmet cell’ suggest
Intravascular haemolysis HUS DIC TTP Mechanical heart valve
What do pencil poikilocytes suggest
Iron deficiency anaemia
What do Burr cells suggest
Uraemia
Pyruvate kinase deficiency
What do hypersegmented neutrophils suggest
Megaloblastic anaemia - b12 / folate
Look at differentiation from multi potential stem cell
OK - immunological notes
Reed Sternberg
Hodkin’s lymphoma
Smudge
CLL
Also spear
Rouleux
MM
Auer rods
AML
What do you get after splenectomy
Immunisation - 2 weeks before or 2 weeks after - Pneumococcal every 5 years - H.influeza - Meningococcal A+C - Annual infleunza Life long Ax - penicillin or amoxicillin
Indications for splenectomy
Trauma Spontaneous rupture - EBV Hypersplenism - Hereditary spherocytosis - Autoimmune haemolytic (warm) Malignancy Cyst / abscess
What causes hyposplenism
Splenectomy Sickle cell Coeliac Graves SLE Amyloid
What do sideroblasts suggest
Myelodysplastic syndrome
What organisms common post splenectomy
Pneumoccocus
H.influenza
Meningococcal
Complications post splenectomy
Haemorrhage
Infections
Thrombocytosis - give aspirin
Pancreatic fistula
What changes to RBC
Howel Jolly
Target cells
Can WBC be normal in infection
Yes cause recruited but also used up
What happens if bone marrow destroyed
Extra-medullatry sites take over
e.g spleen for RBC production
Can result in RBC looking different and splenomegaly
Starry sky
Burkitt lymphoma
