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Y3 immunology and haematology > intro to haematology > Flashcards

intro to haematology Flashcards

1
Q

what is haematology

A

investigation and management of disorders of blood and bone marrow

interactions w/ other organs also

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2
Q

blood components and products

A
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3
Q

functions of blood

A

transport

maintenance of vascular integrity

protection from pathogens

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4
Q

functions of blood - transport

what is transported and where

A

gases (O2, CO2) - red cells

nutrients, waste, messages - plasma

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5
Q

functions of blood - maintenance of vascular integrity

what does it prevent and how

A

prevention of leaks - platelets and clotting factors

prevention of blockages - anticoagulants and fibrinolytics

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6
Q

functions of blood - protection from pathogens

what and how

A

phagocytosis and killing - granulocytes/monocytes

antigen recognition and antibody formation - lymphocytes

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7
Q

pathogenesis of haematological abnormalities

A

high levels

  • increased rate of production
  • decreased rate of loss - very occasionally

low levels

  • decreased rate of production
  • increased rate of loss

altered function

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8
Q

what is haematopoiesis

A

production of all of the cellular components of blood and blood plasma

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9
Q

haematopoiesis in the bone marrow

A
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10
Q

properties of stem cells

A

totipotent - capable of giving rise to any cell type

self-renewal

amplify number by binary fission and flux through differentiation pathways

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11
Q

stem cells and bone marrow

A

home to marrow niche - CXCR4 (antagonist plerixafor)

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12
Q

what regulates the flux of stem cells through differentiation pathways

A

regulated by hormones/growth factors

- some used therapeutically (erythropoietin, G-CSF, thrombopoietin agonists)

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13
Q

what are induced pluripotent stem cells

A

stem cell properties can now be induced in more differentiated cells by getting certain proteins to be expressed

potential for therapeutic value

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14
Q

where is bone marrow located

A

bones - most in children, axial in elderly

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15
Q

appearance of bone marrow

A

stroma - made up of fibroblasts, collagen

sinusoids - blood vessels, as cells differentiate they make their way into the sinusoids

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16
Q

erythroid differentiation

A

erythroblast - reticulocyte - erythrocyte

governed by erythropoietin

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17
Q

what cells are these

A

reticulocytes

still contain RNA

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18
Q

what does reticulocyte count indicate

A

measure of red cell production

usual value = 1%

when red cells are released from marrow they have a reticulocyte appearance for ~24hrs, so if reticulocyte count increases you know blood volume is being replaced for some reason

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19
Q

what is erythropoietin

A

hormone made in kidney in response to hypoxia

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20
Q

what is polycythaemia

A

too many red cells

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21
Q

consequences of anaemia

A

poor gas transfer: SOB, fatigue

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22
Q

what causes anaemia

A

decreased production
- haematinics deficiency (iron, folate, B12)

increased loss
- bleeding, haemolysis

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23
Q

what can be seen here

what causes it

A

microcytic, hypochromic red cells

iron deficiency

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24
Q

what can be seen here

what causes it

A

macrocytic red cells

e.g. folate deficiency

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25
what can be seen here what causes it
schistocytes (fragmented cells) haemolytic uraemic syndrome
26
what can be seen here what causes it
sickle cells and target cells sickle cell disease
27
how many red cells can we produce daily
~10g/L/day
28
what can be seen here
L: platelets, beginning to clump R: megakaryocyte
29
function of platelets
haemostasis also some immune function
30
what regulates platelet production
thrombopoietin - produced in liver - regulation by platelet mass feedback
31
lifespan of platelets
7 days
32
what is thrombocytosis
too many platelets
33
what is thrombocytopaenia
marrow failure immune destruction (immune thrombocytopaenia purpura)
34
what is the commonest cause of altered platelet function
drugs e.g. aspirin, clopidogrel, abciximab etc
35
neutrophil function
ingest and destroy pathogens esp. bacteria and fungi
36
communication between WBC
interleukins - between WBC CSFs - colony stimulating factors - G-CSF - granulocyte colony stimulating factor
37
what regulates neutrophil production
immune responses and macrophages produced in response to mainly bacterial infections IL-17 stimulates production when bacterial infection is detected
38
neutrophil differentiation
1. blast in bone marrow (many granules of big open nu) - too many in AML 2. promyelocyte - granules begin to form 3. myelocyte 4. metamyelocyte 5. neutrophil
39
when is neutrophilia seen
infection - left shift, toxic granulation inflammation - MI, post-op, RA
40
therapeutic use of G-CSF
neutropenia mobilisation of stem cells
41
what is neutrophilia
increased neutrophil numbers
42
causes of neutrophilia
production regulated by G-CSF
43
what is neutropenia
decreased neutrophil numbers
44
causes of neutropenia
decreased production - drugs, marrow failure increased consumption - sepsis, AI altered function - e.g. chronic granulomatous disease
45
functions of monocytes
ingest and destroy pathogens esp bacteria and fungi subset of monocytes migrate into tissues and become macrophages or dendritic cells - some populations of macrophages self-maintaining
46
macrophages in tissues
47
what types of cells are these
monocytes slight granulation and grey cytoplasm
48
what are eosinophils important for
fighting parasites allergy
49
what type of cells are these
eosinophils
50
what type of cells are these
basophils dark granules
51
what parts of the immune system are lymphocytes involved in
adaptive immune system | - immunological memory
52
surface antigens of lymphocytes
CD markers (cluster of differentiation)
53
what type of cells are these
lymphocytes nucleus and thin rim of cytoplasm
54
what can cause lymphocytosis
infectious mononucleosis pertussis - too many lymphocytes in the blood
55
what causes lymphopaenia
usually post-viral lymphoma
56
subtypes of lymphocytes
B - antibody production T - helper, cytotoxic, regulatory natural killer cells - fight viral infection
57
where are lymphocytes produced and where do they mature
bone marrow B cells - bone marrow T cells - thymus circulate in blood, lymph and LNs
58
what into and where do lymphocytes differentiation
effector cells in 2y lymphoid organs (lymph nodes or mucosal associated lymphoid tissue)
59
adaptive receptor diversity
each naïve T and B cell has a unique surface receptor - T cell - in plasma membrane - B cell - either in plasma membrane or secreted as antibody each receptor has a constant region and a variable region
60
what are antibodies
adaptors between pathogens and clearance systems
61
creation of a receptor chain gene
shuffling of genes that form receptors and recombination within developing lymphocyte variability in this process causes variability of T and B cell receptors combinatorial diversity, junctional diversity
62
where does combinatorial diversity occur
within each chain: V-region combined w/ J- or D- then C-region between chains: each alpha chain pairs with a beta chain, each light chain pairs with a heavy chain
63
where does junctional diversity occur
at join additional nucleotides added
64
mistakes in diversity of T and B cell receptor variability lead to...
cause lymphoid malignancies early B cell maturation, chromosome segments joining and rejoining - acute lymphoblastic leukaemias exit bone marrow, naïve B cells met by macrophages and expand and form immune response - lymphomas become plasma cells, make antibodies, more mistakes in the process - myelomas
65
positive and negative selection in the bone marrow
+ve: if gene rearrangement results in a functional receptor the cell is selected to survive -ve (tolerance): if the receptor recognises 'self' antigens the cell is triggered to die B cells that survive this selection are exported to the periphery
66
classes of HLA
I: internal antigens on all nucleated cells II: displays antigens eaten by professional antigen presenting cells constant within, variation between individuals
67
immune responses against HLA
immune cells read HLA 'barcode' on cells to help identify self vs non-self cells or infected vs non-infected cells immune response is triggered if infected cell is identified
68
RA and impacts on blood
anaemia of chronic disease iron, folate deficiency immune haemolysis - 5% of pts neutrophilia immune thrombocytopaenia cytopenias 2y to medication felty syndrome - splenomegaly and 2y cytopenia
69
systemic diseases and impact on blood
hepatic - anaemia, deficient clotting factors renal - anaemia, HUS CV - anaemia resp - polycythaemia GI - anaemia
70
problems with plasma
too much - paraproteins (early marker of myeloma) too little - clotting factors: haemophilia abnormal function - clotting factors: haemophilia
71
normal FBC
underlined ones are important to know
72
diagnostic tools for blood problems
FBC clotting time for clotting factors and platelets chemical assays marrow aspirate and trephine biopsy LN biopsy or other organ imaging
73
diagnostic tools for blood problems - clotting time
platelet and leucocyte function tests
74
diagnostic tools for blood problems - chemical assays
iron (ferritin - storage molecule for iron) B12 folate
75
haematology treatments
replacement transplantation drugs
76
haematology treatments - replacement
blood haematinics coagulation factors plasma exchange
77
haematology treatments - drugs
``` cytotoxics monoclonal antibodies inhibitors of cellular proliferation immunosuppressants inhibitors of coagulation inhibitors of fibrinolysis ```
78
haematology treatments

Y3 immunology and haematology (20 decks)

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