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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
Q

Which viral infections exhibit reactive lymphocytosis?

A

Infectious mononucleosis

Cytomegalovirus

Varicella infection

Viral hepatitis

Dengue fever

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26
Q

What does lymphocytosis look like on the blood slide?

A

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.

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27
Q

What is infectious mononucleosis caused by?

A

Epstein-Barr virus (EBV)

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28
Q

Who gets EBV most often?

A

Teenagers and young adults

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29
Q

What are the symptoms of infectious mononucleosis?

A

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]

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30
Q

What does blood film of infectious mononucleosis look like?

A

Virally infected B lymphocytes and activated reactive T lymphocytes

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31
Q

How common is haemolytic anaemia in people with EBV?

A

It is rare and in some cases can cause total bone marrow failure which is extremely rare

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32
Q

What do lymphocytes look like in infectious mononucleosis?

A

Large lymphocytes with round or irregularly shaped nuclei, abundant flowing cytoplasm that is basophilic with a dark staining periphery

33
Q

What are the clinical features of cytomegalovirus?

A

Indistinguishable from EBV

34
Q

What ages is cytomegagalovirus most common in?

A

20 - 50

35
Q

Which cells are infected by cytomegalovirus?

A

Neutrophils

36
Q

Which cells are infected by cytomegalovirus?

A

B Lymphocytes

37
Q

What does blood film show with cytomegalovirus?

A

Reactive T lymphocytes in the blood

38
Q

What is commonly seen in EBV, cytomegalovirus and varicella infections?

A

Thrombocytopenia

39
Q

Which viral infections do we commonly see activated T lymphocytes?

A

EBV, cytomegalovirus, hep A+B and varicella infections

40
Q

What does viral hepatitis cause?

A

Mononucleosis-like syndrome

Also causes reactive lymphocytes

41
Q

What causes Dengue Fever?

A

any one of 4 closely related virus serotypes of the genus flavivirus

42
Q

How is dengue fever transmitted to humans?

A

Aedes aegypti mosquito

43
Q

What are the clinical symptoms of dengue fever?

A

Sudden onset fever

Severe headache

Muscle and Joint pain

Petechial rash on the lower limbs and the chest

mild neutropenia

44
Q

What does blood film look like in dengue fever?

A

Reactive lymphocytes with eccentrically placed nucleus

Basophilic cytoplasm

45
Q

What does blood film of bordatella pertussis look like?

A

leucocytosis (15 - 50 x 10^9/L)

Lymphocytosis

46
Q

How does bordatella pertussis avoid lymphocyte activity?

A

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
Q

What is haemophagocytosis?

A

Macrophages mistake haemopoietic cells and RBCs in the bone marrow for foreign pathogens and “eat them”

48
Q

When do we typically see haemophagocytosis?

A

May be associated with viral infections or with bacterial, fungal, or protozoal infections

49
Q

What are the symptoms of haemophagocytosis?

A

Fever, lethargy, and myalgia

Pancytopenia: severe anemia, leucopenia, thrombocytopenia

50
Q

How is haemophagocytosis mediated?

A

Cytokine mediated

51
Q

What does the bone marrow of someone with haemophagocytosis look like?

A

Increased macrophages

Phagocytosed erythrocytes, leucocytes, and platelets

Variable residual haemopoiesis

52
Q

What are the clinical symptoms of parvovirus B19?

A

Repiratory symptoms

Anaemia

Reticulocytopenia

Giant pronormoblasts with viral inclusions

53
Q

What is a potential complication of parvovirus B19?

A

In patients with sickle-cell disease it can cause bone marrow failure

54
Q

How are people with parvovirus B19 treated?

A

With blood transfusions because controlling the infection is very difficult

55
Q

Do parasitic infections and worms always cause symptoms?

A

No sometimes they can be completely asymptomatic

56
Q

What are some examples of parasitic infections and worms?

A

Malaria

Leishmaniasis

Trypanosomiasis

Filaria

57
Q

What are the symptoms of malaria?

A

Fever

Malaise

Anaemia (haemolytic)

Thrombocytopenia

Increased monocyte count

58
Q

What is the condition caused by malaria called?

A

Blackwater fever (intravascular haemolysis)

59
Q

What species cause malaria?

A

Plasmodium species:

P. falciparum (kills people by damaging brain and severe haemolysis)

P. vivax

P. ovale

P. malariae

60
Q

How does malaria cause anaemia?

A

Through intravascular haemolysis causing splenic pooling and dilution.

61
Q

What are the symptoms of leishmaniasis?

A

Hepatosplenomegaly

Anaemia

BM with macrophages containing intracellular Leishman-Donovan bodies which get released on macrophage death but this can be treated.

62
Q

Where is leishmaniasis located?

A

Africa most commonly

63
Q

What are the symptoms of filariasis?

A

Can be seen in blood but asymptomatic with very little affect on blood count

64
Q

What is bone marrow failure?

A

Inability of bone marrow to produce sufficient blood cells

65
Q

What does bone marrow failure lead to?

A

Pancytopenia

66
Q

What are the clinical features of bone marrow failure?

A

Symptoms and signs of anaemia

Infections

Bruising and bleeding

Symptoms and signs of the underlying cause

67
Q

What causes bone marrow failure?

A

Primary reduction in haemopoietic activity

Bone marrow replacement by malignant cells

Ineffective haemopoiesis

Marrow infiltration

68
Q

What causes primary reduction in haemopoietic activity?

A

Aplastic anaemia

Chemotherapy

Radiotherapy

69
Q

What causes bone marrow replacement by malignant cells?

A

Primary:
Leukaemia

Myeloma

Lymphoma

Secondary:
Metastatic cancer

70
Q

What causes ineffective haemopoiesis?

A

Megaloblastic anaemia

Myelodysplasia

71
Q

What causes marrow infiltration?

A

Marrow fibrosis (myelofibrosis)

Inherited disorders:
Osteopetrosis (thickening of bone);
Gaucher disease

72
Q

What is aplastic anaemia?

A

Pancytopenia due to BM failure. Hypoplastic or aplastic bone marrow

73
Q

What does BM failure look like on Blood Film?

A

Blood film shows no abnormal cells and leucoerythroblastic

74
Q

What does BM failure look like on Full Blood count?

A

Anaemia, leucopenia, thrombocytopenia, Low/absent reticulocytes

75
Q

What does BM failure look like on Bone marrow examination?

A

Bone marrow examination: Used to establish cause and diagnosis

76
Q

What causes aplastic anaemia?

A

Congenital cause: Fanconi anaemia

Acquired:
Idiopathic

Chemotherapy

Chemicals/toxins

Infections

77
Q

SUMMARY

A

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
Q

Can aplastic anaemia be completely idiopathic?

A

Yep (it can also be caused by infection and recover after infection is recovered)

79
Q

How is idiopathic aplastic anaemia treated?

A

Immuno suppression and blood product transfusion

Haemopoietic growth factors (GCSF)

Potential for BM transplantation

IMED2002 (29 decks)

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