Ch. 11 Flashcards
Why are more blood cells made?
A need for them
What regulates them
What are colony stimulating factors?
Stimulate cell production
What are the two types of cells a pluripotent stem cell can differentiate into?
lymphoid stem cell
myeloid stem cell
What do our lymphoid stem cells differentiate into ultimately?
NK cells
T cells
B cells (can become plasma cells)
What do our myeloid stem cells differentiate into ultimately?
erythrocyte
megakaryocyte (platelets)
monocyte
Grunulocytes:
neutrophil
basophil
eosinophil
Where are these stem cells found that create the RBCs and WBCs?
Bone marrow
What do neutrophils do?
our primary pathogen fighting cells (first responders)
What do eosinophils do?
help control allergic responses
fight parasites
What do basophils do?
release heparin, histamine, other inflammatory mediators
What are MAST cells?
basophils that are in the tissues
Where do all of our granulocytes originate from?
bone marrow
Where do WBCs like to circulate and hang out?
the lymph tissue
What are our agranulcytes?
monocytes/macrophages
LYMPHOCYTES:
B cells
T cells
NK cells
What do our B cells do?
create antibodies
What do our T cells do?
control the immune response
cell-mediated immunity
What do our NK cells do?
kill antigenic cells
What do our monocytes do?
antigen presenting cells
create inflammatory mediators
How long do monocytes last in our tissues?
months to years
often have specific action
What does it mean that our lymphocytes (B,T,NK) are morphologically indistinguishable?
You cant tell these cells apart under a microscope.
Where do B cells mature?
bone marrow
Where do T cells mature?
the precursor cells leave the bone marrow and travel to the thymus to differentiate.
What are our lymph tissues?
Lymphatic vessels
lymphoid tissue
lymph nodes
thymus
spleen
What are our secondary lymph organs?
spleen
lymph nodes
tonsils
Where is excess fluid that the blood vessel doesnt take back get picked up by?
it enters the lymph vessels and gets transported back to the vena cava
What is the normal size of a lymph node?
1mm - 2cm
What are our lymph nodes shaped like?
oval or bean
Where in the lymph nodes do B and T cells hang out?
the outer cortex
Is the primary follicle of a lymph node immunologically active?
NO NO NO
Is the secondary follicle of a lymph node immunologically active?
YES YES YES
They have the germinal centers
Why is it important to know about mucosa associated lymph tissue?
If you see someone with a viral sore throat and you see red swollen tissue in the back of their throat, this extranodal lymph tissue that is inflammed
What happens to our lymph nodes during infection?
they get enlarged
What is the difference in a swollen lymph node during infections and a swollen lymph node associated with lymphoma?
Infection - the lymph node is tender and enlarged
lymphoma - lymph nodes are NOT tender, but are enlarged
What part of the lymph node causes enlargement?
the secondary follicle, its the part that is actively working making more cells
Do lymph nodes have a blood supply?
YES YES YES
What is a normal WBC count?
4500 - 10500
What is leukopenia?
an absolute decrease in # of WBCs (usually because of neutophils)
What is neutropenia?
a decrease in the # of neutrphils, often the cause of leukopenia
What number is considered neutopenia?
What is agranulocytosis and its lab value?
a neutrophil count of less than 200
What are our non-neoplastic WBC disorders?
leukopenia
neutropenia and agranulocytosis
aplastic anemia (effects all myeloid cells)
infectious mononucleosis (monocyte)
HIV (lymphoid cells)
What are our neoplastic disorders?
lymphoma
leukemia
plasma cell dyscrasia (multiple myeloma)
What are the mechanisms of neutropenia?
reduced or ineffective production of neutrophils:
- overgrowth of neoplastic cells (leukemia, lymphoma) not allowing for proper production
- bone marrow depression (chemotherapy, radiation)
Excessive removal or destruction:
- inflammation and infection
- immunologic destruction (autoimmune)
- cytotoxic drugs (most common cause)
- feltys syndrome
What is feltys syndrome?
the overdestruction of neutrophils in the spleen.
What is the most common mechanism of neutropenia?
drugs
What drugs are known to cause neutropenia?
chemotheraputic
antibiotics
What are the signs and symptoms of neutropenia?
those of secondary bacterial or fungal infections
– increased risk; most often respiratory
fever, chills, malaise, fever, weakness, and fatigue
Why is infectious mononucleosis called the kissing disease?
because it is transmitted though the saliva; orally
What virus causes mononucleosis?
epstein-barr virus
What group is mononucleosis most common in?
adolescents and young adults
Is mono as contagious as everyone thinks?
NO NO NO
By age 40, what percentage of people are said to have had EBV (epstein barr virus)?
90%
What family is EBP part of?
herpies
What is the issue with mono?
it is never really gone (still have low grade viral shedding), even when your symptoms go away, so you can asymptomatically spread it without even knowing it
What is the #1 cause of organ transplant rejection?
EBV
What tissue does EBV invade?
oropharyngeal lymphoid tissue
What cells does mono invade?
B cells
What happens to the B cell with EBV?
the B cell may die, which causes a release of more virions
What happens when EBV incorporates itself into the B cells genome?
The cell makes heterophil antibodies (used in the diagnosis of mono with monospot), this process can take up to 2-3 weeks
how long is the incubation period of mono?
4-8 weeks
How does our immune system respond to mono?
it controls viral shedding by limiting the number of infected B cells with our CD8 cytotoxic cells and NK cells
What is the onset of mono?
insidious
What is the prodromal period of mono characterized by?
anorexia (poor appetite), malaise (can last months), chills
What are the symptoms of mono?
fever, severe pharyngitis, LYMPHADENOPATHY (swollen lymph nodes, common, posterior cervical)
Do some cases of mono go undiagnosed? and
Yes, not all have serious symptoms
How long does the acute phase of mono last?
2-3 weeks
How do we differentiate leukemia (and plasma cell dyscrasia) from lymphoma?
leukemia (multiple myeloma) - neoplasms that arise in the bone marrow
lymphoma - neoplasms arise in the lymphoid organs
What is leukemia?
malignant neoplasms of hematopoietic stem cells (bone marrow)
What does leukemia cause?
the creation of abnormal WBCs (can be lymphocytic or myelogenous USUALLY ONLY ONE BLOOD CELL LINE OR THE OTHER)
What is some weird facts about leukemia in children and adults?
leukemia is a leading cause of death in children from ages 1-14 BUT 10 times more adults are diagnosed that children
What do the leukemic cells from leukemia do to our body?
they interfere with the production and maturation of our normal WBCs
they can get into circulation and cross BBB (blood-brain-barrier) CAUSE ORF NEUROLOGIC SYMPTOMS (especially with acute lymphocytic leukemia)
these cells can infiltrate body organs
THESE ARE NOT TRANSFORMED CELLS, THEY ARE CANCER CELLS THAT ARE PRODUCED
Do we know the cause of leukemia?
NO NO NO
Where do we see high incidences of leukemia?
high levels or radiation
exposure to benzene and chemotherapy
genetic predisposition
Event that effect the genes that regulate blood cell development can lead to what?
leukemia
What are the four different types of leukemia and what did she say about each of them?
Acute lymphocytic leukemia (ALL): immature B and T precursors (high risk with down syndrome, radiation)
chronic lymphocytic leukemia (CLL): malignant production of B cells
acute myelocytic leukemia (AML): strongly linked with toxins and congenital disorders (high risk with down syndrome)
chronic myelocytic leukemia (CML): philadelphia chromosome
BOTH MYELOCYTIC HAVE AN OVERPRODUCTION OF ABNORMAL MONOCYTES AND GRANULOCYTES (B,T,NK CELLS GET UNDERPRODUCED BECUASE THEY OF CROWDING)
THE SAME THING HAPPENS JUST OPPOSITE WITH LYMPHOCYTIC LEUKEMIAS
ALSO OUR RBCS AND PLATELETS ARE BEING UNDERPRODUCED WITH ALL TYPES
People with down syndrome are at high risk for what types of leukemia?
Both acute leukemias
People with the philadelphia chromosome are at a high risk for what type of leukemia?
Chronic myelocytic leukemia
People who have been exposed to radiation are at a high risk for what type of leukemia?
acute lymphocytic leukemia
What are some clinical characteristic of the acute leukemias and the life expectancy?
rapid onset (sudden stormy)
rapid progression
life expectancy =
What are some clinical characteristics of the chronic leukemias and the life expectancy?
Insidious onset
prolonged clinical course
cells are a little more mature (differentiated) so can perform some function
tend to delay seeking of care
life expectancy > 5 years
What are the most curable human tumors?
lymphomas
What do the hodgkin and non-hodgkin lymphomas have in common?
both are solid tumors
both derive from neoplastic lymph tissue and their precursors
How would you describe the tumors of non-hodgkins lymphoma?
heterogenous (many different) groups of solid tumors composed of neoplastic lymphoid cells
How many times more does non-hodgkins occur that hodgkins?
3X
What causes non-hodgkins lymphoma?
we dont really know
could be VIRUSES:
- -EBV *****
- Human T-lyphotropic virus type I (HTLV-1)
could be BACTERIAL:
— H. pylori
What cells can non-hodgkins originate in?
B cells or T cells (80-85% ARE OF B CELL ORIGIN)
What are the different types of B cell lymphomas?
- -follicular
- -diffuse large B cell (account for 50% of all non-hodgkins lymphomas) good remission rate
- -burkitts (90% cure rate)
- -mantle cell
- -marginal zone
What are the clinical manifestations of non-H lymphoma?
painless, superficial lymphadenopathy in teh neck, groin, or underarm MOST FREQUENT
unexplained fever night sweats constant fatigue unexplained weight loss itchy skin reddened patches on the skin
What is special about how diffuse large B cell lymphoma spreads through the lymph vessels?
It doesn’t spread from one lymph node to the next in sequential order of the drainage flow, IT CAN SKIP NODES AND SHOW UP AT OTHERS, this is called non-contiguous spread.
also has a more frequent involvement of the GI tract, liver, testes and bone marrow
How do we diagnose non-hodgkins lymphoma?
lymph node biopsy
What happens during hodgkins lymphoma?
malignant B cells are invading lymphoid tissue, causing painless lymphadenopathy
What is asymptom that is weirdly specific to hodgkins lymphoma?
Pain involved with the lymph nodes that ONLY occurs when consuming ALCOHOL
What is the most common age group for hodgkins lymphoma?
young adults (18-24)
average age at onset 32
median age of onset is the 20s
What are the common sites of lymphadenopathy for hodgkins lymphoma?
cervical
axial
inguinal chains
Is hodgkins lymphoma curable in most cases?
YES YES YES
What are reed-sternberg cells?
these are large distinctive tumor cells that have to be present in order to have a definitive diagnosis for hodgkins lymphoma.
What causes hodgkins lymphoma?
We dont know
Where do 1/3 of hodking lymphomas travel to?
spleen
Does hodgkins lymphoma have contiguous spread?
YES YES YES
What is multiple myeloma?
PLASMA CELL MALIGNANCY
abnormal B cells (plasma cells) produce abnormal antibodies, and also cause the proliferation of osteoclasts (break down the bone)
Can multiple myeloma cause tumors?
YES YES YES
What happens with the production of abnormal antibodies?
immune depression
proteins increase blood viscosity
infiltrate organs almost every one
What does the proliferation of osteoclasts cause?
breakdown of bone
easy bone fractures
hypercalcemia
bone pain
kidney stones
renal disease
many people put this off as arthritis pain
What is the normal prognosis of multiple myeloma?
very very poor
it invades almost every organ in the body
very hard to treat
What else does multiple myeloma suppress?
hematopoiesis (RBC production)
causes anemia
Does multiple myeloma cause electrolyte imbalances eventually?
YES YES YES
Which type of lymphoma has a better prognosis?
HODGKINS LYMPHOMA
