Immunology - Cancers - Blood Cells Flashcards
What is a Granulocyte?
“NMEB”
♣️
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
Name the 5 types of LEUKOCYTES? (WBC)
3/2
♣️♣️♣️♦️♦️
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.
What is a MONOCYTE?
♦️
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
What is an AGRANULOCYTE?
♦️♦️
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.
What is a MAST CELL?
⛵️🔗
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.
How do ANTI-HISTAMINES work?
🔗🔗
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
What is an ANTIGEN 👹
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
What is a LYSOSOME?
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.
What is the ATOPIC TRIAD?
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.
What is the normal range for Total Leukocyte Count? (TLC or WBC)
⚪️⚪️⚪️
💰
⚪️⚪️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%.
Where does Leukemia begin?
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.
Acute Lymphocytic Leukemia (ALL) prevalences?
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%
Acute Lymphocytic Leukemia (ALL) pathology?
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.
What is HCT?
Why is it important to Pediatric Dentists?
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.
Hematological considerations for ANC, Antibiotics, and Dental Treatment.
⚪️⚪️
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
Hematological considerations for Platelet Count, Transfusions, and Dental Treatment.
👨🎤 “the 1975”
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.
Orthodontic appliances and space maintainer consideration in immunocompromised patients
- 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
What is Mucositis?
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.
What is the normal value range for Platelets?
👨🎤👨🎤
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.
What is the difference between primary and secondary immunodeficiency?
PRIMARY immunodeficiencies are the result of GENETIC DEFECTS:
SECONDARY immunodeficiencies are caused by ENVIRONMENTAL factors, such as HIV/AIDS or malnutrition:
What is the concern of BPA? Where is/has it been found in Dental products?
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.
What is Agammaglobinemia?
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.
What is Hyper IGM syndrome?
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
Sickle Cell Anemia
🌙
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.
