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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
Q

List the main bony sites of haemopoiesis post-natally

A

Tibia and femur
Vertebra
Sternum
Ribs

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26
Q

List the anatomical compartments of bone marrow seen under the microscope

A

Cellular haemopoietic cells
Cellular non-haemopoietic cells (adipocytes, fibroblasts, osteoclasts, osteoblasts)
CT matrix
Vascular elements

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27
Q

Osteoblasts form/resorb bone and osteoclasts form/resorb bone

A

Osteoblasts form bone and osteoclasts resorb bone

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28
Q

Outline the vasculature of the bone marrow

A

Nutrient artery and periosteal network

Arterioles drain into venous sinuses which drain into larger central sinuses

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29
Q

Describe the structure of a bone marrow sinus

A

Endothelial cells with tight junctions
Surrounded by a discontinuous basement membrane
Adventitial cells dispersed around endothelial cells

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30
Q

How do mature blood cells leave endothelial cells of a bone marrow sinus to enter the circulation?

A

They pass through openings known as fenestrations

31
Q

What part of long bones - epiphysis, metaphysis or diaphysis - involves the most haemopoiesis?

A

Metaphysis

32
Q

What is “red” and “yellow” marrow?

A

Red marrow: haemopoietically active
Yellow marrow: fatty and inactive
With age, yellow marrow replaces red marrow

33
Q

What is a normal myeloid: erythroid ratio?

A

Relationship between neutrophils and precursors to nucleated red cell precursors
Usually 1.5:1 (always more myeloid)

34
Q

Give an example of when the myeloid: erythroid ratio can be distorted

A

In haemolysis as compensation for breakdown of red blood cells (surge in erythroid activity)

35
Q

List factors affecting regulation of haemopoeisis

A

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
Q

What is a ‘niche’?

A

An area occupied by haemopoeitic stem cells where signals for expansion, differentiation or dormancy are optimal

37
Q

What regulates neutrophil maturation?

A

Granulocyte-colony stimulating factor (G-CSF)

38
Q

What regulates platelet maturation?

A

Thrombopoetin regulates growth of megakaryocytes from precursors

39
Q

How is haemopoiesis assessed in mature cells?

A

Blood count
Cell indices
Morphology (blood film)
Bone marrow examination

40
Q

What specialist tests can be done to analyse haemopoietic precursor cells, which are morphologically indistinguishable?

A

Immunophenotyping
Cytochemistry
Clonogenic assay
Animal modelling

41
Q

What is immunophenotyping?

A

Identify pattern of antigen expression unique to cell lineage by using antibodies (in combination) specific to different antigens

42
Q

Where are haemopoietic stem cells of lymphoid cells located?

A

Liver in foetus

Bone marrow post-natally

43
Q

Where are precursor lymphoid cells located?

A 
Bone marrow (B-cells)
Thymus (T-cells)
44
Q

List the main primary lymphoid tissues

A

Bone marrow

Thymus

45
Q

List the main peripheral (secondary) lymphoid tissues

A

Spleen
Lymph nodes
Tonsils (Waldeyer’s ring)
Epithelio-lymphoid tissues

46
Q

What are the functions of the lymphatic system?

A

Return lymph (tissue fluid) to circulation in homeostasis from particular territories
Prevent accumulation of fluid in tissues (oedema)
Filter lymph of toxins

47
Q

Lymph node groups can always be palpated. True/ False?

A

False

Internal groups can be viewed radiologically e.g. paraaortic nodes

48
Q

Describe the structure of a lymph node from entry of lymph to exit from the node

A

Afferent channels drain lymph through capsule into peripheral sinus
Lymph filters through the node
Efferent vessels exit from hilum

49
Q

Where does lymph travel after leaving the lymph node?

A

Cisterna chyli or thoracic duct
Left or right subclavian vein
Left or right jugular vein

50
Q

Where are lymph nodes found?

A

Along course of lymphatic vessels closely associated with blood vessels

51
Q

What is the function of the lymphoid system?

A

Defence system housing cells of innate immune system and is the seat of the adaptive immune response

52
Q

List cells found within the lymphoid system

A 
B cells
T cells
NK cells
Macrophages
Antigen presenting cells
Dendritic cells
Endothelial cells
53
Q

Where are B cell lymphoid follicles located in the lymph node?

A

The outer layer, the cortex

54
Q

Where are T cell lymphoid follicles located in the lymph node?

A

The middle layer, the paracortex

55
Q

List differential diagnoses of lymphadenopathy

A 
Local inflammation (infection, vaccination)
System inflammation (viral infection, AI or CTD)
Malignancy (haematological, metastatic)
Others (sarcoidosis)
56
Q

What are the two types of lymphadenopathy?

A 
Regional lymphadenopathy (in one region)
Generalised lymphadenopathy (two or more regions)
57
Q

Regional lymphadenopathy is suggestive of…

A

Reactive infection or localised inflammation

could still be metastatic malignancy!

58
Q

Generalised lymphadenopathy is suggestive of…

A 
Viral infection
Systemic inflammatory process (CTD, sarcoidosis, RA)
Widespread malignancy (lymphoma, leukaemia)
59
Q

List differentials of a predominant B cell response in a lymph node

A

AI disease

Infection

60
Q

List differentials of a predominant phagocytic response in a lymph node

A

Drain tumour size

61
Q

List differentials of a predominant T cell response in a lymph node

A

Viral infection

Drugs e.g. phenytoin

62
Q

Name the two surfaces of the spleen

A 
Diaphragmatic surface (smooth and convex)
Visceral surface (irregular, concave, has impressions)
63
Q

Outline the arterial supply and venous drainage of the spleen

A 
Splenic artery (branch of coeliac axis)
Splenic vein (drains into SM vein, then portal vein)
64
Q

What is the function of the spleen?

A

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
Q

Spleen contains both red and white pulp. Describe the contents of red pulp

A

Sinusoids lined by endothelial cells (clear aged red blood cells)
Cords containing macrophages and fibroblasts (devour red blood cells not cleared by sinusoids)

66
Q

Spleen contains both red and white pulp. Describe the contents of white pulp

A

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
Q

List clinical features of splenic enlargement

A

Dragging sensation in LUQ
Discomfort with eating
Pain if infarction
Hypersplenism

68
Q

List the triad of features of hypersplenism

A

Splenomegaly
Fall in one or more cellular components of blood
Correction of cytopaenia by splenectomy

69
Q

List causes of splenomegaly

A

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
Q

What clinical situations would make you suspicious of hypersplenism?

A

Conditions associated with splenomegaly

Post-splenectomy

71
Q

List causes of hyposplenism

A 
Splenectomy most commonly
Coeliac disease
Sickle cell disease
Sarcoidosis
Immune deficiency (child splenectomy)
72
Q

Hyposplenism is usually caused by reduced red/white pulp function.

A

Reduced red pulp function

73
Q

What is the name for a basophil breakdown remnant found in red blood cells, which is diagnostic of hyposplenism?

A

Howell Jolly body

Dense purple spot inside a RBC

74
Q

What does a plasma cell look like on film?

A

Fried egg nucleus off to one side

Y3 HAEMATOLOGY (16 decks)

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