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Pediatric Dentistry Prepatory Boards > Immunology - Cancers - Blood Cells > Flashcards

Immunology - Cancers - Blood Cells Flashcards

1
Q

What is a Granulocyte?

“NMEB”

♣️

A

Granulocytes are a category of white blood cells WBC characterized by the presence of GRANULES in their cytoplasm. They are also called POLYMORPHONUCLEAR leukocytes or polymorphonuclear neutrophils (PMN, PML, or PMNL) because of the varying shapes of the nucleus, which is usually lobed into TWO TO FOUR segments. This DISTINGUISHES them from the mononuclear agranulocytes.

♣️

Polymorphonuclear leukocyte often refers specifically to NEUTROPHIL granulocytes,

EOSINOPHILS, BASOPHILS, and MAST cells

“NMEB”

Granulocytes are produced via granulopoiesis in the BONE MARROW

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2
Q

Name the 5 types of LEUKOCYTES? (WBC)

3/2
♣️♣️♣️♦️♦️

A

There are FIVE types of white blood cells.

neutrophils, ♣️
eosinophils, ♣️
basophils, ♣️
and 
lymphocytes, ♦️
monocytes. ♦️

These five types are in two main groups: The Granulocytes and The Mononuclear Cells.

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3
Q

What is a MONOCYTE?

♦️

A

MONOCYTES

WBC

Monocytes are amoeboid in appearance, and have NON-GRANULATED cytoplasm. thus are classified as AGRANULOCYTES.

Monocytes share the PHAGOCYTOSIS function of neutrophils, but are much longer lived as they have an additional role: they PRESENT PIECES of pathogens to T cells so that the pathogens may be recognized again and killed, or so that an antibody response may be mounted

MACROPHAGES
DENDRITIC CELLS

In an adult human, half of the monocytes are stored in the SPLEEN. These change into macrophages after entering into appropriate tissue spaces.

MONOCYTE ➡️ MACROPHAGE in TISSUE

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4
Q

What is an AGRANULOCYTE?

♦️♦️

A

AGRANULOCYTES (nongranulocytes, mononuclear leukocytes)

The TWO TYPES of agranulocytes in the blood circulation are LYMPHOCYTES and MONOCYTES. ♦️♦️

These make up about 35% of the hematologic BLOOD VALUE.

A THIRD TYPE of agranulocyte, the macrophage, is FORMED IN THE TISSUE when monocytes leave the circulation and differentiate into MACROPHAGES.

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5
Q

What is a MAST CELL?

⛵️🔗

A

Granulocyte: (MCHHAA)

A MAST CELL ⛵️ is a migrant cell of connective tissue that contains many GRANULES rich in HISTAMINE and HEPARIN.

Has Histamine receptors which anti-histamine drugs bind 🔗to

Specifically, it is a type of granulocyte derived from the MYLOID STEM cell that is a part of the immune and neuroimmune systems.

Best known for their role in ALLEGY and ANAPHYLAXIS.

Mast cells play an important PROTECTIVE ROLE as well, being intimately involved in wound healing, angiogenesis, immune tolerance, defense against pathogens, and blood–brain barrier function.

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6
Q

How do ANTI-HISTAMINES work?

🔗🔗

A

TWO SUBTYPES: H1 and H2 🔗🔗

H1-antihistamines work by BINDING to histamine H1 RECEPTORS in MAST CELLS, SMOOTH MUSCLE , and ENDOTHELIUM in the body as well as in the tuberomammillary nucleus in the brain.

  • Allergic reactions in the nose
  • Insomnia
  • Vertigo caused by problems with the inner ear

H2-antihistamines BIND to histamine H2 RECEPTORS in the UPPER G.I. TRACT primarily in the STOMACH. Antihistamines that target the histamine H2-receptor are used to treat gastric acid conditions.

  • Peptic ulcers
  • Acid reflux
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7
Q

What is an ANTIGEN 👹

A

ANTIGEN 👹

a TOXIN or other FORIEGN SUBSTANCE which induces an immune response in the body, especially the production of antibodies.

  • Antigens are “targeted” by antibodies.
  • The antigen may originate from within the body (“self-antigen”) AUTOIMMUNE or from the external environment (“non-self”).
  • VACCINES are examples of antigens in an immunogenic form, which are intentionally administered to a recipient to induce the memory function of adaptive immune system
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8
Q

What is a LYSOSOME?

A

LYSOSOME

A membrane-bound organelle found in many animal cells. They are spherical VESICLES that contain HYDROLYTIC ENZYMES that can break down many kinds of biomolecules.

Vesicles are small spheres of fluid surrounded by a lipid bilayer membrane, and they have roles in transporting molecules within the cell.

There are 50 to 1,000 lysosomes per mammalian cell.

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9
Q

What is the ATOPIC TRIAD?

A

ATOPIC TRIAD 80%

Asthma
Eczema
Allergies

“AAE…”

It’s called the atopic triad because they so often occur together. Up to 80% of children with ECZEMA also have asthma or allergies to pollen, dust mites, pet dander, mold, or certain foods.

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10
Q

What is the normal range for Total Leukocyte Count? (TLC or WBC)

⚪️⚪️⚪️

💰

A

⚪️⚪️4000-11,000 mm3 ⚪️⚪️

Leukopenia < 4000-11,000 > Leukocytosis

Normal PEDIATRIC ranges may go higher

  • The NUMBER of leukocytes in the blood is often an INDICATOR OF DISEASE, and thus the white blood cell count is an important subset of the complete blood count.
  • White blood cells make up approximately 1% 💰of the TOTAL BLOOD VOLUME in a healthy ADULT, making them substantially less numerous than the red blood cells at 40% to 45%.
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11
Q

Where does Leukemia begin?

A

Leukemia begins in the BONE MARROW, which is where new blood cells are made. The symptoms of leukemia are often caused by problems in the bone marrow.

As LEUKEMIA CELLS build up in the marrow, they can CROWD OUT the NORMAL BLOOD CELLS. As a result, a child may not have enough normal red blood cells, white blood cells, and blood platelets. These SHORTAGES show up on blood tests, but they can also cause symptoms. The leukemia cells might also invade other areas of the body, which can also cause symptoms.

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12
Q

Acute Lymphocytic Leukemia (ALL) prevalences?

A

ACUTE LYMPHOCYTIC LEUKEMIA:

-MOST common cancer in CHILDREN 0-14 years old (26% of all cancers for age group)

  • 80% of Leukemia cases in Children
  • 56% of Leukemia cases in Adolescents

PEAK incidence: 2-4 years old.

Substantially higher in WHITE children.

5 year survival rate: 90%

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13
Q

Acute Lymphocytic Leukemia (ALL) pathology?

A

The cancerous cell in ALL is the LYMPHOBLAST. Normal lymphoblasts develop into mature, infection-fighting B-cells or T-cells, also called lymphocytes.

ALL emerges when a single lymphoblast gains many MUTATIONS TO GENES that affect blood cell development and proliferation. In childhood ALL, this process BEGINS AT CONCEPTION with the inheritance of some of these genes.

A BONE MARROW BIOPSY provides conclusive proof of ALL, typically with >20% of all cells being leukemic LYMPHOBLASTS.

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14
Q

What is HCT?

Why is it important to Pediatric Dentists?

A

HTC

Hematopoietic Cell Transplant

The American Academy of Pediatric Dentistry (AAPD) recognizes that the pediatric dental professional plays an important role in the diagnosis, prevention, stabilization, and treatment of oral and dental problems that can COMPROMISE the child’s quality of life before, during, and after immuno-suppressive therapy which lowers the body’s normal immune response. This can be deliberate as in lowering the immune response to PREVENT the REJECTION of an organ or hematopoietic cell TRANSPLANT (HCT)

Patients with a compromised immune system may not be able to tolerate a transient BACTEREMIA following invasive dental procedures.

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15
Q

Hematological considerations for ANC, Antibiotics, and Dental Treatment.

⚪️⚪️

A

ABSOLUTE NEUTROPHIL COUNT (ANC)

— >2,000 ⚪️⚪️ per cubic millimeters (/mm3): NO need for antibiotic prophylaxis

— 1000 to 2000/mm3: Use clinical judgment based on the patient’s health status and planned procedures. If infection is present or unclear, more aggressive antibiotic therapy may be indicated and should be discussed with the medical team

— <1,000/mm3: defer elective dental care.

In dental emergency cases, discuss antibiotic coverage (antibiotic prophylaxis versus antibiotic coverage for a period of time) with medical team before proceeding with treatment. The patient may need hospitalization for dental management

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16
Q

Hematological considerations for Platelet Count, Transfusions, and Dental Treatment.

👨‍🎤 “the 1975”

A

PLATELET COUNT

— >75,000/mm3: no additional support needed; 👨‍🎤

— 40,000 to 75,000/mm3: platelet transfusions may be considered pre- and 24 hours post-operatively. Localized procedures to manage prolonged bleeding may include sutures, hemostatic agents, pressure packs, and/ or gelatin foams; and

— <40,000/mm3: defer care.

In dental emergency cases, contact the patient’s physician to discuss supportive measures (e.g., platelet transfusions, bleeding control, hospital admission and care) before proceeding. In addition, localized procedures (e.g., microfibrillar collagen, topical thrombin) and additional medications as recommended by the hematologist/oncologist (e.g., aminocaproic acid, tranexamic acid) may help control bleeding.

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17
Q

Orthodontic appliances and space maintainer consideration in immunocompromised patients

A
  • Poorly-fitting appliances can abrade oral mucosa and INCREASE ⬆️ the risk of MICROBIAL INVASION into deeper tissues.
  • Appliances should be removed if the patient has poor oral hygiene and/or the treatment protocol or HCT conditioning regimen carries a risk for the development of moderate to severe MUCOSITIS.
  • Consider removing orthodontic bands or adjusting prosthesis if a patient is expected to receive CYCLOSPORINE or other drugs known to cause GINGIVAL HYPERPLASIA. If band removal is not possible, vinyl mouth guards or orthodontic wax should be used to decrease tissue trauma.
  • Orthodontic care may start or resume after completion of all therapy and after at least a TWO-YEAR disease-free survival when the risk of relapse is decreased and the patient is no longer using immunosuppressive drugs
18
Q

What is Mucositis?

A

MUCOSITIS?

  • Mucositis is the PAINFUL INFLAMMATION and ULCERATION of the MUCOUS MEMBRANES lining the digestive tract, usually as an adverse effect of CHEMOTHERAPY and RADIOTHERAPY treatment for cancer.
  • Mucositis can occur anywhere along the gastrointestinal (GI) tract, but oral mucositis refers to the particular inflammation and ulceration that occurs in the mouth. ORAL mucositis is a COMMON and often debilitating complication of cancer treatment.
  • Oral mucositis usually begins SEVEN to TEN days AFTER INITIATION of HCT conditioning, and symptoms continue approximately TWO WEEKS AFTER the END of conditioning.
19
Q

What is the normal value range for Platelets?

👨‍🎤👨‍🎤

A

A NORMAL PLATELET count ranges from 150,000 👨‍🎤👨‍🎤 to 450,000 platelets per microliter of blood/mm3

Having more than 450,000 platelets is a condition called THROMBOCYTOSIS.

having less than 150,000 is known as THROMBOCYTOPENIA.

20
Q

What is the difference between primary and secondary immunodeficiency?

A

PRIMARY immunodeficiencies are the result of GENETIC DEFECTS:

SECONDARY immunodeficiencies are caused by ENVIRONMENTAL factors, such as HIV/AIDS or malnutrition:

21
Q

What is the concern of BPA? Where is/has it been found in Dental products?

A

It can IMITATE the body’s HORMONES, and it can INTERFERE with the production, secretion, transport, action, function, and elimination of natural hormones. BPA can behave in a similar way to ESTROGEN and other hormones in the human body .

BPA is a precursor to the resin monomer Bis-GMA.

Bis-GMA (bisphenol A-glycidyl methacrylate) is a resin commonly used in dental COMPOSITE, dental SEALANTS, and dental CEMENT.

Dental sealants and fillings **don’t contain BPA, but many of them contain compounds that turn into BPA on contact with saliva.

22
Q

What is Agammaglobinemia?

A

AGAMMAGLOBINEMIA

lack of gamma-globulin in the blood PLASMA, causing IMMUNE DEFICIENCY.

It is caused by a GENE DEFECT-TYROSINE KINASE (Btk) that blocks the growth of normal, mature immune cells called B LYMPHOCYTES.

Often times, X-LINKED

The most common treatment for XLA is an intravenous infusion of immunoglobulin (IVIg, human IgG antibodies) every week, for life.

23
Q

What is Hyper IGM syndrome?

A

Hyper IgM syndromes

X-Linked, AR

a group of PRIMARY IMMUNE DEFICIENCY disorders characterized by defective CD40 signaling; via B cells affecting class switch recombination (CSR) and somatic hypermutation.

Immunoglobulin (Ig) class switch recombination deficiencies are characterized by ELEVATED SERUM ⬆️ Immunoglobulin M ⬆️ (IgM) levels and a considerable DEFICIENCY in Immunoglobulins ⬇️ G (IgG), A (IgA) and E (IgE). As a consequence, people with HIGM have decreased concentrations of serum IgG and IgA and normal or elevated IgM, leading to increased susceptibility to infections

24
Q

Sickle Cell Anemia

🌙

A

SICKLE CELL ANEMIA 🌙

It is both “Sickle” shaped and “Cyclical”

autosomal RECESSIVE inheritance.

If only ONE PARENT passes the usickle cell gene to the child, that child will have the sickle cell TRAIT.

caused by the substitution of a SINGLE acidic AMINO ACID, ßGlu6 to VAL. As the structure shows, this amino acid position is on the SURFACE of the protein

Hemoglobin (HbA) is composed of four protein chains and four small non-protein molecules, called HEME, that carries oxygen from the lungs to the rest of the body. … Oxygen can’t get into the HbS fibers as well, so each red blood cell CARRIES LESS OXYGEN than one with normal Hb.

When sickle hemoglobin gives up its oxygen to the tissues, it sticks together to form LONG RODS inside the red blood cells making these cells RIGID and sickle-shaped. Normal red blood cells can bend and flex easily.

Sickle cells BREAK apart EASILY and die, leaving you without enough red blood cells. Red blood cells usually live for about 120 days before they need to be replaced. But sickle cells usually die in 10 to 20 DAYS, leaving a SHORTAGE of RBC’s (anemia).

The sickle-shaped cells can also STICK to VESSEL walls, causing a BLOCKAGE that slows or stops the FLOW of BLOOD. When this happens, OXYGEN can’t reach nearby tissues.
The lack of oxygen can cause attacks of sudden, severe pain, called PAIN CRISIS. These attacks can occur without warning.

25
Q

Normal Hemoglobin values

vs

Anemia Hemoglobin values

A

NORMAL

The normal range for hemoglobin is:

Men: 13.5 to 17.5 grams per deciliter.

Women: 12.0 to 15.5 grams per deciliter.

ANEMIA

red blood cell count or the hemoglobin is less than normal.

Men: < 13.5 gram/100 ml and

Women: < 12.0 gram/100 ml.

26
Q

What does polymerize mean?

Where do we see it in RBC?

A

POLYMERIZE

  • to COMBINE or cause to combine to form a polymer
  • seen in SICKLE CELL ANEMIA as DEOXYGENATED HEMOGLOBIN in rbcs can bond to each otherl

Large fibrous AGGREGATES of Hb form, thousands of Hb molecules in length, that DISTORT the red blood cell into a SICKLE shape.

Thus, the SYMPTOMS of sickle cell anemia are due to the aggregate of Hb that forms in the red blood cells.

27
Q

Naso-Pharyngeal Cancer

A

NPC occurs in children and adults.

The first peak occurs in late adolescence/early adulthood (ages 15–24 years), followed by a second peak later in life (ages 65–79 years).

It is a SQUAMOUS cell CARCINOMA of an undifferentiated type.

SWELLING of LYMPH NODES in the NECK is the initial presentation in many people, and the diagnosis of NPC is often made by lymph node biopsy. (Trimus, Otitis Media, Paresis, Palsy)

The viral influence is associated with infection with EPSTEIN-BARR virus. (in NPC type 2 and 3, has revealed that EBV can infect epithelial cells and is associated with their transformation.)

It is sometimes referred to as CANTONESE cancer (廣東癌) because it occurs in about 25 cases per 100,000 people in this region, 25 times higher than the rest of the world.

28
Q

What does the internalized normalized ratio (INR) measure?

A

PROTHROMBIN TIME

This blood test looks to see how well your blood clots.

EXTRINSIC Clotting Function

Extrinsic pathway and common pathway of coagulation.

Used to monitor how well the blood-thinning medication (anticoagulant) warfarin (Coumadin®) is working to prevent blood clots.

29
Q

What does The partial thromboplastin time (PTT) measure?

Normal range

A

known as the INTRINSIC PATHWAY and common pathway of coagulation.

Normal results are typically 25 to 35 SECONDS

A blood test that characterizes coagulation of the blood.
also used to monitor the treatment effect of HEPARIN, a widely prescribed drug that reduces blood’s tendency to clot.

Prolonged APTT may indicate:

  1. use of HEPARIN
  2. antiphospholipid antibody (especially lupus anticoagulant, which paradoxically increases propensity to thrombosis)
  3. Coagulation factor deficiency (e.g., HEMOPHILIA )
  4. Sepsis — coagulation factor consumption
  5. presence of antibodies against coagulation factors (factor inhibitors)
30
Q

How and where is Iron (Fe2) transported in the bloodstream?

A

Transported in the circulation by TRANSFERRIN

“transFErrin”

From LIVER to BONE MARROW

developing RBCs absorb amino acid and FE2 from bloodstream and synthesize new Hb molecules

31
Q

What are the 2 classes of HEMOLYTIC Anemia’s

🌙 🦋

A

HEMOLYSIS:
-Rupture of RBC’s in the bloodstream

HEMOGLOBINURIA:
-when abnormally large numbers of RBC’s real down in the bloodstream and URINE turns RED or BROWN.

JAUNDICE:
-A yellow tint to the skin or eyes caused by an EXCESS of BILIRUBIN, a substance created when red blood cells break down

  1. CONGENITAL Hemolytic Anemias
    - Sickle Cell 🌙
    - Thalassemia (Alpha and Beta)
    - Heredity Spherocytosis
  2. ACQUIRED (autoimmune and infections)
    - Systemic Lupus 🦋
    - Rheumatoid Arthritis
    - Ulcerative Colitis
  • CMV
  • EBV
  • Hepatitis
32
Q

What are common signs of Bleeding Disorder / Anemia?

Mouth 👄 / Skin

4 each

GUAC 🥑JEPP 🔶

A

MOUTH 👄 “GUAC”🥑

  • Ulcers
  • Glossitis
  • Angular Stomatitis
  • Candida

SKIN “Jepp”

  • Jaundice 🔶
  • Excessive Bruising
  • Pallor
  • Purpuric/Petechial rash
33
Q

Red Blood Cells

Stimulated by which organ?
Growth?
Development?
Lifespan?

A

RBC production is STIMULATED by ERYTHROPOIETIN in KIDNEY.

Process of formation to maturity: 7 DAYS

Rate: 2 MILLION cells/sec

Lifespan: 120 days

As RBC ages, PLASMA MEMBRANE undergoes changes increasing SUSCEPTIBILITY to PHAGOCYTOSIS. (ERYPTOSIS)

Rate of Eryptosis = rate of Erythropoiesis

RETICULOENDOTHELIAL (RES) system

  • responsible for removing old or defective RBC
  • SPLEEN, LIVER, BONE MARROW
34
Q

Cyclic Neutropenia

“Blackjack” ♣️🔘 🧬 🦷

A

IMMUNITY DISORDER

Defect in STEM CELL regulation by mutation in neutrophil ♣️ elastase gene 🧬

PMN counts fluctuate from normal (1.5 - 8 mm3) to <500 on @ 21 DAY CYCLE.

Neutropenia lasting 1 week

🦷 Findings:

  • localized / generalized early onset periodontitis
  • Recession/Ulceration/Desquamation
  • Infections of Skin/Mucous Membrane

** Most commonly, neutropenia is caused by CHEMOTHERAPY for cancer. In fact, around half of cancer patients undergoing chemotherapy will experience some level of neutropenia.**

35
Q

Wilson Disease

🥃🔴 🔶

A

A rare inherited (AR) disorder that causes COPPER 🥃 to ACCUMULATE in your liver, brain and other vital organs.

Most people are diagnosed between the ages of 5 and 35

🔴 Blood problems. These might include destruction of red blood cells (hemolysis) leading to ANEMIA and JAUNDICE.🔶

Untreated, Wilson’s disease can be FATAL

36
Q

Dental 🦷 considerations for IMMUNODEFICIENCY

A
  • CBC and White Cell Differential and Platelets prior to any INVASIVE dental procedure
  • patient may present with PREMATURE loss of primary and permanent TEETH due to progressive PERIODONTAL disease.
  • consider EXTRACTION of pulpally-involved teeth to avoid septicemia
  • ANTIBIOTICS other than pencillin due to chronic use and penicillin resistant organisms
  • Chlorohexidine .12% mouthwashes
37
Q

What is Leukocyte Adhesion Deficiency?

A

Blood Disorder

Caused by DEFICIENCY of adhesive GLYCOPROTEINS on the surfaces of white blood cells (WBCs);

It is a COMBINED (B CELL) and cellular (T CELL) immunodeficiency disorder.

Adhesion molecules deficiency results in abnormal INFLAMMATORY response and eventually RECURRENT BACTERIAL infections.

🦷
Generalized Periodontitis in primary and permanent dentition

TX: SCT

38
Q

The Childhood Cancer with the greatest survival rate is?

A

ALL ~ 90%

39
Q

What is the most common TUMOR at age 1

A

NEUROBLASTOMA

A cancer that is commonly found in the ADRENAL GLANDS.

Neuroblastoma is a cancer often found in the small glands on top of the kidneys (adrenal glands). It can develop in the belly, chest, neck, pelvis, and bones. Children ages five or younger are most commonly affected.

40
Q

Most common oral opportunistic infection in immunocompromised patients?

A

FUNGAL

Pediatric Dentistry Prepatory Boards (39 decks)

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