Chapter 28: Lymphocytes, Leukocytes, and Granulocytes Flashcards
What causes leukocytes to demarginize?
epinephrine and cortisol
Which proteins in the endothelium help pull neutrophils out of circulation?
selectin
Which proteins help anchor cells to endothelium?
integrins
I-CAM 1 ?
integrin
Which patients will have higher than normal demargination without infection?
steriod and epinephrine users
most common cause of leukopenia
viral infection (Parvo B19, Hep E, Hep C
drugs that blast bone marrow?
Vinblastine, AZT, Chloramphenicol, Benzene
Which organ can take over erythropoeisis?
spleen
What proteins help neutrophils get through endothelium?
P-CAM
What is leukemoid reaction? When do we see it?
extreme demargination during extreme stress (like burns)
Immature neutrophils with maximal germ-killing ability
bands
What sets leukemia apart from other leukocytosis?
Bands more than 5%
What virus can cause lymphomas?
EBV
most common age for ALL
0-15
What stain for ALL
PAS
What protein do lymphoblasts lose when they mature and which is a marker for ALL?
TdT (terminal deoxythymidine) +
What protein shows a good response to chemotherapy in ALL?
CALLA+ (Common ALL antigen)
Which monoclonal antibody is especially for B cells but shouldn’t be used in children?
Rituximab
What marker is for immature B cells?
CD9 and CD10
What marker is for mature B cells?
CD19, CD20, CD21
What leukemia has Auer rods?
AML
Which leukemia has the worst prognosis and why?
AML because it affects neutrophils, macrophages and monocytes and affects the humoral and cell mediated. The whole immune system is affected.
What does AML stain with?
Sudan black
What is the gene defect in AML?
trans (15,17)
What is normal pt. profile for CML?
30-50 more common in women
What is the normal pt. profile in CLL?
older men
Which gene is responsible for CML?
trans(9,22); Philadelphia chromosome
When do you treat CLL?
When WBC count is more than 100,000, because the cells can clot the blood vessels.
Which meds are used for CML /CLL?
Chlorambucil or “tinibs”
APL Promyeloblast Leukemia most common form
M3
What may happen in Promyeloblast Leukemia
DIC
clues for DIC
high D-dimer and fibrin split products
What is treatment for APL
vitamin A, matures cells and becomes AML, but prolongs life
What is the marker for Hairy Cell Leukemia?
TRAP + (Tartrate Resistant Acid Phosphatase
Which kind of cells do leukemias and lymphomas affect?
B cells
Which lymphoma has Reed-Sternberg cells?
Hodgkins Lymphoma
What is the marker for Hodgkin’s?
CD30, CD15
What is a sign of Hodgkin’s?
painless adenopathy
If pt has multiple painful adenopathy of cerrvical, supraclavicular, epitrochlear and inguinal nodes, what is the next best step in management?
biopsy
How does Non-Hodgkin’s present in the USA?
abdominal mass
How does Non-Hodgkin’s present in developing countries?
jaw mass
Most common Non-Hodgkin’s and its gene defect?
follicular t(14,18) heavy chain (14) and BCL-2 (18)
“starry sky” appearance Non-Hodgkin’s and its gene defect?
Burkitt lymphoma t(8,14) translocation of c-myc (8) and heavy-chain (14)
ABVD lymphoma treatment
Adriamycin, Bleomycin, Vioncristine, Dacarbazine
Which ABVD treatment causes lung fibrosis?
Adriamycin, Bleomycin
Which ABVD treatment causes neuropathy?
Vincristine
Most common cancer that causes myelofibrosis?
ALL, metastasis to bone
presentation of aplastic anemia
fatty infiltration of bone marrow, low ret count
When do you see dacrocytes (tear drop cells)?
myelofibrosis
What kind of stones do people with Polycythemia Rubra Vera get?
Uric acid stones
What lab will be raised in PRV?
LAP
What acid is associated with Gram + bugs?
techoic acid
Which kind of bacteria is more likely to have endotoxin?
gram -
What causes toxic reaction in gram neg. bug?
Lipid A
What is the membrane made of in gram neg. bacteria?
lipopolysaccharides
Which bacteria will get worse after giving antibiotics and before getting better? why?
gram neg. because they release endotoxins
most abundant granulocytes
neutrophils
What kills catalase positive bacteria?
NADPH
Which disease is NADPH defective because of superoxide dismutase deficiency?
CGD (X-linked)
What causes an abscess?
free radicals
Abscesses day 1 to 3
Staph aureus
Abscesses day 3 to 7
Strep pyogenes
Abscesses after day 7
anaerobes
Management of abscess
cut and drain
What kind of infection is malodorous and produces gas?
anaerobes
What is the marker for monocytes in circulation?
CD4
What is marker for macrophages in tissue?
CD14 mediated by interferon gamma
Which infections cause monocytosis?
Salmonella, TB, EBV/CMV, Listeria, Syphilis (STELS)
macrophage in brain
microglia
macrophage in lung
type 1 pneumocytes
mactrophage in liver
Kupffer cells
macrophage in spleen
RES (reticuloendothelial system)
macrophage in lymph nodes
dendritic cells
macrophage in bone
osteoclasts
macrophage in kidneys
mesangial cells
macrophage in skin
Langerhan’s
macrophage in Peyer’s patches
M cells
macrophage in blood
monocytes
macrophage in connective tissue
epithelioid cells, giant cells, histiocytes
What infections have high mast cell and eosinophil counts?
- Allergies 2. parasites
How do T cells initiate class switching?
bind to B cells by CD40 Ligand
Which interleukin causes class switching and is produced by T cells?
IL-4
What do mast cells release and what is the effect?
Histamine, venodilation, vasodilation, BP drop, bronchoconstriction, and sometimes anaphylactic shock
What is SRS-A released by mast cells?
Slow reacting substance of anaphylaxis, a leukotreine that is the most severe bronchoconstrictor and vasoconstrictor (4-8 hours later)
What do eosinophils release to regulate mast cells?
histaminase (breaks down histamine); arylsulfatase (breaks down SRS-A), Heparin (breaks clots when venodilating and vasodilating)
What medicine is a mast cell stabilizer?
steroids
What are antihistamines?
H1 blockers, block muscarinic receptors, dries out secretions
MC 1st generation antihistamine
Diphenhydramine “Benadryl”
What are H2 blockers used for
ulcers
third gen antihistamine?
Loratadine (Claritin) Cetirizine (Zyrtec) Fexofenadine (Allegra)
Eosinophilia NAACP
Neoplasia, Allergies/Asthma, Addison’s, Collagen Vascular dis., Parasites
best drug for allergies
steroids
oral steroid
prednisone
IV steroid
methylprednisone
topical steroid
hydrocortisone
drug of choice for eczema
topical hydrocortisone
steroid to replace cortisol
hydrocortisone
steroid to replace aldosterone
fludricortisone
If an adult suddenly develops hives but never had allergies, what should you suspect?
lymphoma
The only reversible obstructive lung disease
asthma
markers for T cells
CD3, CD4,, CD8
Where T cells mature?
thymus
After maturation where do T cells hang out?
paracortical areas of LN
T cell lymphomas?
Mycosis fungoides/ Sezary syndrome
What Interleukin is produced by macrophage? What does it do?
IL-1 produces fever, recruits T helper cells
Which cells make other interleukins?
T-cells
What do T cells use to make interleukins?
calcineurin
Which meds block calcineurin?
cyclosporine, tacrilimus (used in transplants)
What does IL 2 do?
recruits everybody
What monoclonal antibody is used against IL2
daclizumab (in transplants to prevent rejection)
What does IL-3 do?
B cell proliferation
what is the second messenger for IL-3 and why?
tyrosine kinase because it is a growth factor
What does IL-4 do?
controls class switching IgM to IgE and differation of B cells
Which med blocks IL-4?
Dupilumab
What does IL-5 do?
class switching to IgA only
Which drug blocks IL-5 and which disease is it used for?
Mepolizumab used in atopic dermatitis
What does IL-6 do?
controls acute phase reactants CRP and ESR
What are potent chemotactant factors for neutrophils?
IL-8 and LTB-4
Which three factors suppress cell mediated inflammation?
IL-10, TGFBeta, CTLA4
What does IL-12 do?
Enhances cell mediated; suppress humoral response
