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Y3 HAEMATOLOGY > Haemopoesis and The Lymphoid System > Flashcards

Haemopoesis and The Lymphoid System Flashcards

1
Q

What is the process by which blood cells are produced?

A

Haemopoiesis from pleuripotent stem cells

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2
Q

What is haemopoiesis?

A

Formation of blood cells

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3
Q

What are mature red blood cells called?

A

Erythrocytes

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4
Q

List the main groups of mature white blood cells

A

Granulocytes (neutrophils, basophils, eosinophils)
Monocytes (macrophages)
Lymphocytes (B cells, T cells, NK cells)

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5
Q

State the lifespan for a red blood cell, neutrophil and platelet

A

Red cell: 120 days
Neutrophil: 7-8 hours
Platelet: 7-10 days

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6
Q

What clinical condition would be detected first if bone marrow production was abnormal? What would be next?

A

Neutropaenia followed by a thrombocytopaenia

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7
Q

Outline the progression from precursor to mature neutrophil

A

Myeloblast - promyelocyte - myelocyte - metamyelocyte - neutrophil

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8
Q

What is the immediate red cell precursor called?

A

Reticulocyte

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9
Q

What is a platelet precursor called?

A

Megakaryocyte

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10
Q

What is a nucleated precursor between a blast cell and a neutrophil?

A

Myelocyte

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11
Q

Where do precursor cells of blood cells come from? (what is the precursor of the precursors!)

A

Haemopoietic progenitor cell, derived from stem cells

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12
Q

List, in order, the developmental events in haemopoesis

A 
Self-renewal
Proliferation
Differentiation (commitment to a lineage)
Maturation (acquire function)
Apoptosis
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13
Q

Self-renewal is a property of all haemopoietic cells. True/False?

A

False

Only occurs in stem cells (identical to mature cell); lost in descendants

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14
Q

Which germ cell layer are haemopoietic stem cells derived from?

A

Mesoderm

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15
Q

Circulating haemopoietic progenitors are detectable as early as week _ of life

A

Circulating haemopoietic progenitors are detectable as early as week 5 of life

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16
Q

What is the first site of erythroid activity? When does this activity stop?

A

Yolk sac

Stops by week 10

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17
Q

When does the liver begin erythroid activity?

A

Week 6

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18
Q

When does the spleen begin erythroid activity?

A

Week 12

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19
Q

When does the bone marrow begin erythroid activity?

A

Week 16

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20
Q

Where are the sites of haematopoiesis in the embryo?

A

Yolk sac
Liver
Spleen

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21
Q

Where are the sites of haematopoiesis from birth to maturity?

A

Bone marrow
Liver
Spleen

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22
Q

Where are the sites of haematopoiesis in the adult?

A

Bone marrow of skull, ribs, sternum, pelvis and proximal femur

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23
Q

What is a common site for bone marrow biopsy in the adult?

A

Posterior iliac crest

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24
Q

What is a common site for bone marrow biopsy in the young child?

A

Femur

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25
List the main bony sites of haemopoiesis post-natally
Tibia and femur Vertebra Sternum Ribs
26
List the anatomical compartments of bone marrow seen under the microscope
Cellular haemopoietic cells Cellular non-haemopoietic cells (adipocytes, fibroblasts, osteoclasts, osteoblasts) CT matrix Vascular elements
27
Osteoblasts form/resorb bone and osteoclasts form/resorb bone
Osteoblasts form bone and osteoclasts resorb bone
28
Outline the vasculature of the bone marrow
Nutrient artery and periosteal network | Arterioles drain into venous sinuses which drain into larger central sinuses
29
Describe the structure of a bone marrow sinus
Endothelial cells with tight junctions Surrounded by a discontinuous basement membrane Adventitial cells dispersed around endothelial cells
30
How do mature blood cells leave endothelial cells of a bone marrow sinus to enter the circulation?
They pass through openings known as fenestrations
31
What part of long bones - epiphysis, metaphysis or diaphysis - involves the most haemopoiesis?
Metaphysis
32
What is "red" and "yellow" marrow?
Red marrow: haemopoietically active Yellow marrow: fatty and inactive With age, yellow marrow replaces red marrow
33
What is a normal myeloid: erythroid ratio?
Relationship between neutrophils and precursors to nucleated red cell precursors Usually 1.5:1 (always more myeloid)
34
Give an example of when the myeloid: erythroid ratio can be distorted
In haemolysis as compensation for breakdown of red blood cells (surge in erythroid activity)
35
List factors affecting regulation of haemopoeisis
Intrinsic properties of cells (stem cells vs precursors vs mature cells) Signals from immediate surroundings and periphery (microenvironmental factors) Specific anatomical area for optimal developmental signals
36
What is a 'niche'?
An area occupied by haemopoeitic stem cells where signals for expansion, differentiation or dormancy are optimal
37
What regulates neutrophil maturation?
Granulocyte-colony stimulating factor (G-CSF)
38
What regulates platelet maturation?
Thrombopoetin regulates growth of megakaryocytes from precursors
39
How is haemopoiesis assessed in mature cells?
Blood count Cell indices Morphology (blood film) Bone marrow examination
40
What specialist tests can be done to analyse haemopoietic precursor cells, which are morphologically indistinguishable?
Immunophenotyping Cytochemistry Clonogenic assay Animal modelling
41
What is immunophenotyping?
Identify pattern of antigen expression unique to cell lineage by using antibodies (in combination) specific to different antigens
42
Where are haemopoietic stem cells of lymphoid cells located?
Liver in foetus | Bone marrow post-natally
43
Where are precursor lymphoid cells located?
``` Bone marrow (B-cells) Thymus (T-cells) ```
44
List the main primary lymphoid tissues
Bone marrow | Thymus
45
List the main peripheral (secondary) lymphoid tissues
Spleen Lymph nodes Tonsils (Waldeyer's ring) Epithelio-lymphoid tissues
46
What are the functions of the lymphatic system?
Return lymph (tissue fluid) to circulation in homeostasis from particular territories Prevent accumulation of fluid in tissues (oedema) Filter lymph of toxins
47
Lymph node groups can always be palpated. True/ False?
False | Internal groups can be viewed radiologically e.g. paraaortic nodes
48
Describe the structure of a lymph node from entry of lymph to exit from the node
Afferent channels drain lymph through capsule into peripheral sinus Lymph filters through the node Efferent vessels exit from hilum
49
Where does lymph travel after leaving the lymph node?
Cisterna chyli or thoracic duct Left or right subclavian vein Left or right jugular vein
50
Where are lymph nodes found?
Along course of lymphatic vessels closely associated with blood vessels
51
What is the function of the lymphoid system?
Defence system housing cells of innate immune system and is the seat of the adaptive immune response
52
List cells found within the lymphoid system
``` B cells T cells NK cells Macrophages Antigen presenting cells Dendritic cells Endothelial cells ```
53
Where are B cell lymphoid follicles located in the lymph node?
The outer layer, the cortex
54
Where are T cell lymphoid follicles located in the lymph node?
The middle layer, the paracortex
55
List differential diagnoses of lymphadenopathy
``` Local inflammation (infection, vaccination) System inflammation (viral infection, AI or CTD) Malignancy (haematological, metastatic) Others (sarcoidosis) ```
56
What are the two types of lymphadenopathy?
``` Regional lymphadenopathy (in one region) Generalised lymphadenopathy (two or more regions) ```
57
Regional lymphadenopathy is suggestive of...
Reactive infection or localised inflammation | could still be metastatic malignancy!
58
Generalised lymphadenopathy is suggestive of...
``` Viral infection Systemic inflammatory process (CTD, sarcoidosis, RA) Widespread malignancy (lymphoma, leukaemia) ```
59
List differentials of a predominant B cell response in a lymph node
AI disease | Infection
60
List differentials of a predominant phagocytic response in a lymph node
Drain tumour size
61
List differentials of a predominant T cell response in a lymph node
Viral infection | Drugs e.g. phenytoin
62
Name the two surfaces of the spleen
``` Diaphragmatic surface (smooth and convex) Visceral surface (irregular, concave, has impressions) ```
63
Outline the arterial supply and venous drainage of the spleen
``` Splenic artery (branch of coeliac axis) Splenic vein (drains into SM vein, then portal vein) ```
64
What is the function of the spleen?
Encapsulated organ acting as a filter for blood to remove unwanted, foreign or damaged material and facilitates an immune response to blood-borne antigens
65
Spleen contains both red and white pulp. Describe the contents of red pulp
Sinusoids lined by endothelial cells (clear aged red blood cells) Cords containing macrophages and fibroblasts (devour red blood cells not cleared by sinusoids)
66
Spleen contains both red and white pulp. Describe the contents of white pulp
Peri-arteriolar lymphoid sheath containing CD4 T cells Expanded by lymphoid follicles (contain B cells) APCs present antigen in white pulp to immune cells
67
List clinical features of splenic enlargement
Dragging sensation in LUQ Discomfort with eating Pain if infarction Hypersplenism
68
List the triad of features of hypersplenism
Splenomegaly Fall in one or more cellular components of blood Correction of cytopaenia by splenectomy
69
List causes of splenomegaly
Infection (EBV, malaria, TB) Congestion (portal cirrhosis, thrombosis) Haem disease (lymphoma/leukaemia, haem anaemia) Inflam conditions (rheumatoid arthritis, SLE) Storage disease (gauchers, Neeiman-Pick) Miscellaneous (amyloid, tumours, cysts)
70
What clinical situations would make you suspicious of hypersplenism?
Conditions associated with splenomegaly | Post-splenectomy
71
List causes of hyposplenism
``` Splenectomy most commonly Coeliac disease Sickle cell disease Sarcoidosis Immune deficiency (child splenectomy) ```
72
Hyposplenism is usually caused by reduced red/white pulp function.
Reduced red pulp function
73
What is the name for a basophil breakdown remnant found in red blood cells, which is diagnostic of hyposplenism?
Howell Jolly body | Dense purple spot inside a RBC
74
What does a plasma cell look like on film?
Fried egg nucleus off to one side

Y3 HAEMATOLOGY (16 decks)

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