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IMED2002 > Haematological Response to Infection and Bone Marrow Failure > Flashcards

Haematological Response to Infection and Bone Marrow Failure Flashcards

1
Q

Why is IL-3 so important for production of several different WBCs and platelets?

A

It acts on all cell lineages from the start.

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2
Q

How are megakaryocytes formed?

A

Within cytoplasm you have mitosis occuring within the cytoplasm several times creating exponential growth of nucleus numbers

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3
Q

How do platelets form in the nucleus of megakaryocytes?

A

Platelets are beginning to form when the nucleus is starting to die. When the nucleus dies it is deconstructed into the various components it is made up of

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4
Q

Where are plasma cells most common?

A

Plasma cells are very few in the blood and most frequent at the bone marrow

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5
Q

What are the types of haemotlogical response?

A

Neutrophilia

Lymphocytosis

Reactive bone marrow hyperplasia; aplasia

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6
Q

What do neutrophils do?

A

They are attracted to and move to site of infection they then adhere to foreign particle and encircle the particles and start to form a phagosome and consume the pathogen releaseing the fused primary and secondary granules.

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7
Q

What do neutrophil rleased granules do?

A

The released granules cause destruction of invading organism.

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8
Q

What causes neutrophilia?

A

Infection (bacteria or viruses)

Acute inflammation

Stress

Exertion

Pregnancy

Surgery, trauma

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9
Q

What happens with high neutrophil counts?

A

Increased granulation (toxic environment for bacteria)

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10
Q

What are the common symptoms from bacterial infections?

A

Fever, pain and lethargy

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11
Q

What kind of infections can bacterial infections cause?

A

Localised (in skin, tonsil, bone)

Generalised (Causing hypotension, fluid shifts, and organ failure)

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12
Q

How does the bone marrow respond to bacterial infection?

A

Bone marrow produces more granulocytes (granulocytic hyperplasia)

Blood neutrophilia

Left shift (presence of band forms in neutrophils in blood)

Toxic granulation

Dohle bodies

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13
Q

What signal stimulates pluripotent stem cells to produce more neutrophils?

A

IL-3 and granulocyte colony stimulating factor

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14
Q

How long does granulopoeisis take typically?

A

5 - 7 days (5 under lots of stress)

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15
Q

What happens to neutrophil count immediately after bacterial infection?

A

It drops briefly due to neutrophils moving into the sites of infection

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16
Q

What are the most common neutrophilia causing organisms?

A

Staphylococcus, streptococcus and neisseria

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17
Q

What are Dohle bodies?

A

Blue lines in neutrophils found after long-standing severe bacterial sepsis.

They may be aggregates

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18
Q

What does multi-organ failure look like on blood film?

A

Causes fragmentation haemolysis (schistocytes) with toxic neutrophils and thrombocytopenia.

(might not always look like this so don’t take as fact)

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19
Q

What morphological changes happen in neutrophils in response to bacterial infections?

A

Granulation (toxic granulation)

Dohle bodies

Bacteria

Vacuolation containing bacteria as well as some toxic changes

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20
Q

What is the result of hypercellular bone marrow during bacterial infections?

A

Granulocytic hyperplasia

Increased macrophages with phagocytosed debris

Hypercellular bone marrow trephine and aspirate

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21
Q

What is a good indication of reactive granulocytic hyperplasia?

A

Presence of less white fat blobs in bone marrow

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22
Q

What happens in response to mycobacterium infection?

A

Production of more monocytes

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23
Q

What do monocytes form in the bone marrow in response to mycobacterial infection?

A

Granulomas which have negatively stained rod-like appearace

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24
Q

What are the symptoms of viral infections?

A

Fever, lassitude (lethargy)

Enlarged lymph nodes, liver and spleen

Pharyngitis

Thrombocytopenia (can be a complication of EBV)

Muscle and joint pain

Reactive lymphocytosis

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25
Which viral infections exhibit reactive lymphocytosis?
Infectious mononucleosis Cytomegalovirus Varicella infection Viral hepatitis Dengue fever
26
What does lymphocytosis look like on the blood slide?
Change in look from small circular nucleus to cell with long morphology and nucleus. Pale sites present where there are lots of golgi and ER structures. Cytoplasm looks greyish. This greatly resembles monocytes.
27
What is infectious mononucleosis caused by?
Epstein-Barr virus (EBV)
28
Who gets EBV most often?
Teenagers and young adults
29
What are the symptoms of infectious mononucleosis?
Lassitude (lethargy) Fever Pharyngitis Lymphadenopathy Hepatosplenomegaly Thrombocytopaenia is common Haemolytic anaemia (spherocytes (immune mediated)) [this is in rare cases and in some cases total bone marrow failure]
30
What does blood film of infectious mononucleosis look like?
Virally infected B lymphocytes and activated reactive T lymphocytes
31
How common is haemolytic anaemia in people with EBV?
It is rare and in some cases can cause total bone marrow failure which is extremely rare
32
What do lymphocytes look like in infectious mononucleosis?
Large lymphocytes with round or irregularly shaped nuclei, abundant flowing cytoplasm that is basophilic with a dark staining periphery
33
What are the clinical features of cytomegalovirus?
Indistinguishable from EBV
34
What ages is cytomegagalovirus most common in?
20 - 50
35
Which cells are infected by cytomegalovirus?
Neutrophils
36
Which cells are infected by cytomegalovirus?
B Lymphocytes
37
What does blood film show with cytomegalovirus?
Reactive T lymphocytes in the blood
38
What is commonly seen in EBV, cytomegalovirus and varicella infections?
Thrombocytopenia
39
Which viral infections do we commonly see activated T lymphocytes?
EBV, cytomegalovirus, hep A+B and varicella infections
40
What does viral hepatitis cause?
Mononucleosis-like syndrome Also causes reactive lymphocytes
41
What causes Dengue Fever?
any one of 4 closely related virus serotypes of the genus flavivirus
42
How is dengue fever transmitted to humans?
Aedes aegypti mosquito
43
What are the clinical symptoms of dengue fever?
Sudden onset fever Severe headache Muscle and Joint pain Petechial rash on the lower limbs and the chest mild neutropenia
44
What does blood film look like in dengue fever?
Reactive lymphocytes with eccentrically placed nucleus Basophilic cytoplasm
45
What does blood film of bordatella pertussis look like?
leucocytosis (15 - 50 x 10^9/L) Lymphocytosis
46
How does bordatella pertussis avoid lymphocyte activity?
Lymphocytes are mature (but not activated) with nuclear clefts and folds and don't migrate to tissue due to 'lymphocyte promoting factor' produced by B pertussis that inhibits this migration pattern
47
What is haemophagocytosis?
Macrophages mistake haemopoietic cells and RBCs in the bone marrow for foreign pathogens and "eat them"
48
When do we typically see haemophagocytosis?
May be associated with viral infections or with bacterial, fungal, or protozoal infections
49
What are the symptoms of haemophagocytosis?
Fever, lethargy, and myalgia Pancytopenia: severe anemia, leucopenia, thrombocytopenia
50
How is haemophagocytosis mediated?
Cytokine mediated
51
What does the bone marrow of someone with haemophagocytosis look like?
Increased macrophages Phagocytosed erythrocytes, leucocytes, and platelets Variable residual haemopoiesis
52
What are the clinical symptoms of parvovirus B19?
Repiratory symptoms Anaemia Reticulocytopenia Giant pronormoblasts with viral inclusions
53
What is a potential complication of parvovirus B19?
In patients with sickle-cell disease it can cause bone marrow failure
54
How are people with parvovirus B19 treated?
With blood transfusions because controlling the infection is very difficult
55
Do parasitic infections and worms always cause symptoms?
No sometimes they can be completely asymptomatic
56
What are some examples of parasitic infections and worms?
Malaria Leishmaniasis Trypanosomiasis Filaria
57
What are the symptoms of malaria?
Fever Malaise Anaemia (haemolytic) Thrombocytopenia Increased monocyte count
58
What is the condition caused by malaria called?
Blackwater fever (intravascular haemolysis)
59
What species cause malaria?
Plasmodium species: P. falciparum (kills people by damaging brain and severe haemolysis) P. vivax P. ovale P. malariae
60
How does malaria cause anaemia?
Through intravascular haemolysis causing splenic pooling and dilution.
61
What are the symptoms of leishmaniasis?
Hepatosplenomegaly Anaemia BM with macrophages containing intracellular Leishman-Donovan bodies which get released on macrophage death but this can be treated.
62
Where is leishmaniasis located?
Africa most commonly
63
What are the symptoms of filariasis?
Can be seen in blood but asymptomatic with very little affect on blood count
64
What is bone marrow failure?
Inability of bone marrow to produce sufficient blood cells
65
What does bone marrow failure lead to?
Pancytopenia
66
What are the clinical features of bone marrow failure?
Symptoms and signs of anaemia Infections Bruising and bleeding Symptoms and signs of the underlying cause
67
What causes bone marrow failure?
Primary reduction in haemopoietic activity Bone marrow replacement by malignant cells Ineffective haemopoiesis Marrow infiltration
68
What causes primary reduction in haemopoietic activity?
Aplastic anaemia Chemotherapy Radiotherapy
69
What causes bone marrow replacement by malignant cells?
Primary: Leukaemia Myeloma Lymphoma Secondary: Metastatic cancer
70
What causes ineffective haemopoiesis?
Megaloblastic anaemia Myelodysplasia
71
What causes marrow infiltration?
Marrow fibrosis (myelofibrosis) Inherited disorders: Osteopetrosis (thickening of bone); Gaucher disease
72
What is aplastic anaemia?
Pancytopenia due to BM failure. Hypoplastic or aplastic bone marrow
73
What does BM failure look like on Blood Film?
Blood film shows no abnormal cells and leucoerythroblastic
74
What does BM failure look like on Full Blood count?
Anaemia, leucopenia, thrombocytopenia, Low/absent reticulocytes
75
What does BM failure look like on Bone marrow examination?
Bone marrow examination: Used to establish cause and diagnosis
76
What causes aplastic anaemia?
Congenital cause: Fanconi anaemia Acquired: Idiopathic Chemotherapy Chemicals/toxins Infections
77
SUMMARY
Describe how the bone marrow and blood respond to bacterial and viral infections. • Specific leucocytes due to their function • Numerical and morphological changes in blood cells • Bone marrow response • Appropriate and inappropriate responses • Bone marrow failure
78
Can aplastic anaemia be completely idiopathic?
Yep (it can also be caused by infection and recover after infection is recovered)
79
How is idiopathic aplastic anaemia treated?
Immuno suppression and blood product transfusion Haemopoietic growth factors (GCSF) Potential for BM transplantation

IMED2002 (29 decks)

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