Haemopoiesis and The Lymphoid System

Question 1

what is the name for when there is too many blood cells

Answer 1

Myeloproliferative disorders

Question 2

what is the progression from premature cell to neutrophil

Answer 2

myeloblast&raquo_space; promyelocyte&raquo_space; myelocyte&raquo_space; metamyelocyte&raquo_space; neutrophil

Question 3

what is the precursor cell of platelets

Answer 3

megakayocyte

- polyploid [can undergo division w/out cytoplasm dividing]

Question 4

what is meant by “blasts”

Answer 4

primitive nucleated precursor cell

Question 5

what are haemopoietic cells derived from

Answer 5

mesoderm

Question 6

where is the first site of erythroid activity

Answer 6

yolk sac

- stops by week 10

Question 7

where are the other sites of erythroid activity

Answer 7

Liver starts by week 6

Spleen by week 12 (small contribution in humans)

Bone marrow by week 16

Question 8

after age 20, where are the main sites of haemopoiesis

Answer 8

axial skeleton

- skull, ribs, sternum, vertebra

Question 9

what are the bone forming cells and what are the bone break down cells

Answer 9

bone forming = osteoblasts

bone break down = osteoclasts

Question 10

how does blood enter the bone

Answer 10

arteries feed into sinusoids

Question 11

what are sinusoids

Answer 11

flatten capillaries with holes between epithelial cells which all regulation of which cells get in and out the blood vessels

Question 12

why are sinusoids important

Answer 12

Formed blood cells can pass through gaps in endothelial cells to enter circulation

Question 13

what is the relationship between megakaryocytes and sinusoids

Answer 13

extend long branching processes called proplatelets into the sinusoidal blood vessels
- blood sheers off platelets and they enter the blood stream

Question 14

what is red and yellow marrow

Answer 14

red = haemopoietically active

yellow = fatty inactive

Question 15

what is the composition in marrow as we get older

Answer 15

red marrow replaced by yellow marrow

Question 16

what is meant by the myeloid:erythroid ratio

Answer 16

relationship of neutrophils and precursors to proportion of nucleated red cell precursors

Question 17

what is neutrophil maturation regulated by

Answer 17

G-CSF (granulocyte-colony stimulating factor)

Question 18

what regulates growth and development of megakaryocytes from precursors

Answer 18

Thrombopoietin

Question 19

what is important for cytokine growth

Answer 19

stem cell factor

Question 20

what is important for stem cell development

Answer 20

CXCL12

Question 21

what investigation is the study of antigen expression using specific antibodies

Answer 21

immunophenotyping

[using flow-cytometry]

Question 22

what is the functions of the lymphatic system

Answer 22

Return lymph to the circulation

Filter lymph before return to the circulation

Question 23

what is lymph nodes ensures unidirectional flow

Answer 23

valves

Question 24

what cells are seen in lymph nodes

Answer 24

Lymphocytes
- B cells, T cells [helper or cytotoxic] and NK cells

Mononuclear phagocytes (macrophages), APC, and dendritic cells.

Endothelial cells

Question 25

what is a marker for a B-cell

Answer 25

CD20

Question 26

what is a T-cell marker

Answer 26

CD3

Question 27

what are causes of lymphadenopathy

Answer 27

local inflammation systemic inflammation [infection, autoimmune, CTD] malignancy

Question 28

what could a lymphadenopathy of predominant B-cells mean

Answer 28

autoimmune conditions | infections

Question 29

what could a lymphadenopathy of predominant phagocytic response mean

Answer 29

draining a tumour site

Question 30

what could a lymphadenopathy of predominant T cell mean

Answer 30

Viral infections | Drugs e.g. Phenytoin

Question 31

what is a malignant lymphadenopathy called

Answer 31

lymphoma

Question 32

what is the blood supply of the spleen

Answer 32

splenic artery | - branch of coeliac axis

Question 33

what is the venous drainage of the spleen

Answer 33

splenic vein | - w/ SMV forms portal vein

Question 34

what does the parenchyma of the spleen include

Answer 34

red pulp and white pulp

Question 35

what does the red pulp in the spleen contain

Answer 35

sinusoids - lined by endothelial cells with gaps and cords - contain macrophages, some fibroblasts

Question 36

what does the white pulp do in the spleen

Answer 36

comprises the peri-arteriolar lymphoid sheath (PALS). | - CD4+ lymphoid cells

Question 37

how does PALS work

Answer 37

Antigen reaches white pulp via the blood. APCs in the white pulp present antigen to immune reactive cells When stimulated by antigen, T and B cell responses may occur

Question 38

what is features of splenic enlargement

Answer 38

Dragging sensation in LUQ Discomfort with eating Pain if infarction Hypersplenism

Question 39

what is the triad of hypersplenism

Answer 39

1. splenomegaly 2. fall in one or more cellular components of blood 3. correction of cytopenias by splenectomy

Question 40

what can cause hyposplenism

Answer 40

splenectomy coeliac disease sickle cell disease sarcoidosis

Question 41

what are features of hyposplenism

Answer 41

Howell-Jolly bodies

Question 42

what do people need to be immunised against if the spleen is taken out

Answer 42

pneumococcal s

Question 43

what is lymphoma

Answer 43

malignant lymphocytes that accumulate in the lymph node

Question 44

what are the subdivisions of lymphomas

Answer 44

Hodgkin Lymphoma | Non-Hodgkin Lymphoma

Question 45

what are symptoms of a lymphoma

Answer 45

painless, non-tender, rubbery/soft, asymmetrical lump - NOT TETHERED ``` fever night sweats weight loss itch w/out rash alcohol induced pain fatigue ```

Question 46

how would a viral lymphadenopathy present

Answer 46

tender, hard and smooth lymph node

Question 47

how would a bacterial lymphadenopathy present

Answer 47

tender, hard, and smooth lymph node | skin inflammed

Question 48

how would a metastatic lymphadenopathy present

Answer 48

non-tender, hard lymph node with a irregular surface TETHERED

Question 49

how is a lymphadenopathy investigated

Answer 49

FNA or core biopsy

Question 50

after a lymphoma has been confirmed, what Ix can be done to help subclassify

Answer 50

immunohistochemistry

Question 51

what are the 4 subtypes of Hodgkin's disease that can be differentiated from histology

Answer 51

Nodular Sclerosis Lymphocyte rich Mixed cellularity Lymphocyte depleted

Question 52

what cell type is associated with Hodgkin's disease

Answer 52

Reed Sternberg cells

Question 53

what immunomarker is positive in follicular Non-Hodgkin's lymphoma

Answer 53

CD20

Question 54

what immunomarkers are positive in Reed Sternberg cells

Answer 54

CD30 and CD15

Question 55

what are the two types of NHL

Answer 55

T cell NHL (10%) B cell NHL (90%)

Question 56

what is a B cell NHL furthered divided into

Answer 56

Low grade B cell High grade B cell

Question 57

how is lymphoma staged

Answer 57

1 = one group of glands above diaphragm 2 = more than one group of glands EITHER above OR below diaphragm 3 = both above and below diaphragm 4 = extra nodal disease