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Immunology and Haematology > Introduction to Haematology > Flashcards

Introduction to Haematology Flashcards

1
Q

What are the components of blood?

A
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2
Q

What is found in the plasma of blood?

A

Clotting or coagulation factors

Albumin

Antibodies

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3
Q

What is found in the ‘buffy coat’ of blood?

A

Platelets

Leukocytes

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4
Q

What are the functions of blood?

A
  • Transport
    • Red cells
      • Gases – oxygen and carbon dioxide
    • Plasma
      • Nutrients
      • Waste
      • Hormones (messages)
  • Maintenance of vascular integrity
    • Platelets and clotting factors
      • Prevention of leaks
    • Anticoagulants and fibrinolytic
      • Prevention of blockages
  • Protection from pathogens
    • Granulocytes/monocytes
      • Phagocytosis and killing
    • Lymphocytes
      • Antigen recognition and antibody formation
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5
Q

What cells allows blood to achieve the function of transport?

A
  • Red cells
    • Gases – oxygen and carbon dioxide
  • Plasma
    • Nutrients
    • Waste
    • Hormones (messages)
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6
Q

What cells allow blood to achieve the function of maintanence of vascular integrity?

A
  • Platelets and clotting factors
    • Prevention of leaks
  • Anticoagulants and fibrinolytic
    • Prevention of blockages
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7
Q

What cells allow blood to achieve the function of protection from pathogens?

A
  • Granulocytes/monocytes
    • Phagocytosis and killing
  • Lymphocytes
    • Antigen recognition and antibody formation
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8
Q

How can haematological abnormalities be classified?

A
  • High levels
    • Increased rate of production
    • Decreased rate of loss
  • Low levels
    • Decreased rate of production
    • Increased rate of loss
  • Altered function
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9
Q

Where does haematopoiesis happen?

A

Bone marrow

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10
Q

What is the formation of blood cellular components called?

A

Haematopoiesis

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11
Q

Describe the process of haematopoiesis?

A
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12
Q

What are myeloid cells?

A

All cells apart from lymphocytes, which are lymphoid cells

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13
Q

What stem cells are found in the bone marrow/blood?

A

Pluripotent haematopoietic stem cell

Mesenchymal stem cells

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14
Q

What do mesenchymal stem cells give rise to?

A
  • Osteoclasts
  • Liver
  • Skin
  • Blood vessels
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15
Q

What are properties of stem cells?

A
  • Totipotent
  • Self-renewal
  • Home to marrow niche
    • CXCR4 (antagonistic plerixafor)
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16
Q

How do stem cells grow?

A

Grow by binary fission and flux through differentiation pathways to amplify numbers:

  • Flux regulated by hormones/growth factors
    • Some used therapeutically (erythropoietin, G-CSF, thrombopoietin agonists)
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17
Q

Where is bone marrow located?

A

Located within bones:

  • In most bones in children, axial in elderly
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18
Q

Describe the structure of bone marrow?

A
  • Stroma and sinusoids
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19
Q

Describe the erythrocyte differentiation anatomy?

A
  • Erythroblast -> reticulocyte -> erythrocyte (red blood cell)
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20
Q

What is the correct name of a red blood cell?

A

Erythrocyte

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21
Q

What hormone governs the development of erythrocytes?

A

Hormone that governs this is erythropoietin:

  • Made by kidney in response to hypoxia
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22
Q

Where is erythropoitin made and in response to what?

A
  • Made by kidney in response to hypoxia
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23
Q

What investigation is used to measure red cell production?

A

Reticulocyte count

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24
Q

What are some pathologies related to red blood cells?

A
  • Polycythaemia
    • Too many red cells
  • Anaemia
    • Too few red cells
    • Aetiology
      • Decreased production: deficiency in haematoinics (iron, folate, B12) or congenital (thalassaemias)
      • Increased loss: bleeding, haemolysis
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25
Q

What is the aetiology of anaemia?

A
  • Decreased production: deficiency in haematoinics (iron, folate, B12) or congenital (thalassaemias)
  • Increased loss: bleeding, haemolysis
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26
Q

What is the medical term for too many red cells?

A

Polycythaemia

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27
Q

How can anaemia be classified?

A
  • Microcytes/macrocytes (big or small cells)
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28
Q

What terms describe big and small red cells?

A
  • Microcytes/macrocytes (big or small cells)
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29
Q

How many red cells can be made per day?

A

Can make about 10g/L/day of red cells

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30
Q

What are platelets released from?

A

Released from megakaryocytes

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31
Q

What is the function of platelets?

A
  • Haemostasis (and immune)
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32
Q

What hormone regulates the production of platelets?

A

Production regulated by thrombopoietin:

  • Produced in liver
  • Regulation by platelet mass feedback
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33
Q

Where is thrombopoietin produced and what provides regulation?

A

Production regulated by thrombopoietin:

  • Produced in liver
  • Regulation by platelet mass feedback
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34
Q

What is the lifespan of a platelet?

A

7 days

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35
Q

What are some pathologies related to platelets?

A
  • Thrombocytosis
    • Too many platelets
    • Aetiology – myeloid malignancies such as Dominic Culligan
  • Thrombocytopenia
    • Too few platelets
    • Aetiology – marrow failure, immune destruction (such as in ITP or Henry Watson)
  • Altered function
    • Aetiology – drugs (aspirin, clopidogrel, abciximab)
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36
Q

What is the medical term for too many platelets?

A

Thrombocytosis

37
Q

Describe the aetiology of thrombocytosis?

A
  • Aetiology – myeloid malignancies such as Dominic Culligan
38
Q

What is the medical term for too few platelets?

A

Thrombocytopenia

39
Q

Describe the aetiology of thrombocytopenia?

A
  • Aetiology – marrow failure, immune destruction (such as in ITP or Henry Watson)
40
Q

Describe the aetiology of altered function of platelets?

A
  • Aetiology – drugs (aspirin, clopidogrel, abciximab)
41
Q

What is the function of neutrophils?

A
  • Ingest and destroy pathogens, especially bacteria and fungi
  • Communicates with other cells
    • Interleukins (between white cells)
    • CSFs (colony stimulating factors) to grow more neutrophils
42
Q

What chemicals do neutrophils use to communicate with other cells?

A
  • Interleukins (between white cells)
  • CSFs (colony stimulating factors) to grow more neutrophils
43
Q

How is neutrophil production regulated?

A

Regulation by immune responses:

  • Macrophages, IL-17
44
Q

What is the lifespan of a neutrophil?

A

Lifespan is 1-2 days

45
Q

Describe the process of neutrohil development?

A
  1. Blast (acute myeloid leukemia is too many of these)
  2. Promyelocyte
  3. Myelocyte
  4. Metamyelocyte
  5. Neutrophil
46
Q

What hormone regulates production of neutrophils?

A

Production regulated by granulocyte-colony stimulating factor (G-CSF):

  • Infection
    • Left shift, toxic granulation
  • Inflammation
    • Such as in MI, postoperative, rheumatoid arthritis
  • G-CSF used therapeutically
    • Neutropenia
    • Mobilisation of stem cells
47
Q

What does G-CSF stand for?

A

Granulocyte-colony stimulating factor

48
Q

What is the medical term for low concentration of neutrophils?

A

Neutropenia

49
Q

Describe the aetiology of neutropenia?

A
  • Decreased production
    • Drugs
    • Marrow failure
  • Increased consumption
    • Sepsis
    • Autoimmune
  • Altered function
    • Such as in chronic granulomatous disease
50
Q

What is the function of monocytes?

A
  • Ingest and destroy pathogens, especially bacteria and fungi
51
Q

What can a subset of monocytes do?

A

Subset of monocytes migrate into tissues and become macrophages or dendritic cells:

  • These pick up antigens and migrate to lymph nodes
52
Q

Macrophages change their name depending on what?

A

What tissue they are in

53
Q

Other than monocytes, what are some other myeloid cells?

A
  • Eosinophils
    • Parasites
    • Allergy
  • Basophils
54
Q

Do lymphocytes mediate adaptive or innate immune system?

A

Mediates adaptive immune system rather than innate:

  • Creation of immunological memory
55
Q

What are lymphocytes unique surface markers?

A

Develop their own surface antigens:

  • CD markers
56
Q

What are some pathologies related to lymphocytes?

A
  • Lymphocytosis
    • Aetiology - infectious mononucleosis, pertussis
  • Lymphopenia
    • Aetiology – usually post-viral, lymphoma
57
Q

What is the medical term for too many lymphocytes?

A

Lymphocytosis

58
Q

Describe the aetiology of lymphocytosis?

A
  • Aetiology - infectious mononucleosis, pertussis
59
Q

What is the medical term for too few lymphocytes?

A

Lymphopenia

60
Q

Describe the aetiology of lymphopenia?

A
  • Aetiology – usually post-viral, lymphoma
61
Q

What are the subtypes of lymphocytes?

A
  • B cells
    • Make antibodies
  • T cells
    • Helper, cytotoxic, regulatory
  • Natural killer (NK) cells
62
Q

Where are lymphocytes produced, and where do they mature?

A

Produced in bone marrow:

  • B cells mature in bone marrow, whereas T cells mature in thymus
63
Q

Where do lymphocytes differentiate into effector cells?

A

Differentiate into effector cells in secondary lymphoid organs:

  • Lymph nodes
  • Mucosal associated lymphoid tissue
64
Q

Each naive T and B cell has unique what?

A

Unique surface receptor

65
Q

Describe the structure of immunoglobulins?

66
Q

T cell receptors are made out of what?

A

T cell receptor are made of alpha chain and beta chain

67
Q

What do antibodies perform?

A

Antibodies are adaptors between pathogens and clearance systems:

  • Perform opsonisation (makes target prone to destruction by other cells)
68
Q

What is opsonisation?

A
  • Perform opsonisation (makes target prone to destruction by other cells)
69
Q

What are the different kinds of antibodies?

A
  • IgG
  • IgE
  • IgD
  • IgM
  • IgA
70
Q

What does the creation of the receptor gene allow for?

A

Creation of receptor chain gene:

  • Allows for enormous variability
71
Q

What are different ways that allow receptor diversity to be achieved?

A
  • Combinatorial diversity – within each chain
    • V-region combined with J- or D- then C region
  • Junctional diversity
    • At join, additional nucleotides added for further diversity
  • Combinatorial diversity – between chains
    • Each alpha chain pairs with a beta chain
    • Each light chain pairs with a heavy chain
72
Q

What is a consequence of the genetic processes allow for huge receptor diversity?

A

A consequence is mistakes cause lymphoid malignancies

73
Q

Describe B cell maturation?

74
Q

Where does positive and negative selection of B cells occur?

A

Positive and negative selection occurs in the bone marrow:

  • Positive selection
    • If gene rearrangement results in a functional receptor the cell is selected to survive
  • Negative selection
    • If receptor recognises ‘self’ antigens the cell is triggered to die
75
Q

What does HLA stand for?

A

Human leucocyte antigen

76
Q

What is HLA?

A

Molecules that grab antigens in body and take to B or T cells

77
Q

What are the different classes of HLA?

A
  • Class I
    • Displays internal antigens on all nucleated cells
  • Class II
    • Displays antigens eaten by professional antigen presenting cells
78
Q

What are some pathologies related to plasma?

A
  • Too much
    • Paraproteins
  • Too little
    • Clotting factors – haemophilia
  • Altered function
    • Clotting factors - haemophilia
79
Q

What are examples of systemic disease that affect the blood?

A
  • Rheumatoid arthritis
  • Anaemia of chronic disease
  • Iron deficiency
  • Folate deficiency
  • Immune haemolysis
  • Neutrophilia
  • Immune thrombocytopenia
  • Cytopenias secondary to medication
  • Felty syndrome

Other examples:

  • Hepatic
    • Anaemia, deficiency clotting factors
  • Renal
    • Anaemia, haemolytic uraemic syndrome
  • Cardiovascular
    • Anaemia
  • Respiratory
    • Polycythaemia
  • Gastrointestinal disease
    • Anaemia
80
Q

What are some diagnostic tools for haematological conditions?

A
  • Full blood count
  • Clotting factors
    • Clotting times for clotting factors and platelets (platelet and leucocyte function tests)
  • Chemical assays
    • Iron (ferritin)
    • B12
    • Folate
  • Biopsy
    • Marrow aspirate and trephine biopsy
    • Lymph node biopsy
  • Imaging
    • CT angiogram
    • Plain film
    • CT scan
81
Q

What chemical assays are often used in haematology?

A
  • Iron (ferritin)
  • B12
  • Folate
82
Q

What biopsys are often done in haematology?

A
  • Marrow aspirate and trephine biopsy
  • Lymph node biopsy
83
Q

What does a FBC measure?

84
Q

In a FBC, what are the normal ranges for:

  • haemoglobin
  • RBC
  • platelets
  • WBC
  • neutrophils
  • lymphocytes
  • monocytes
  • eosinophils
  • basophils
85
Q

What are different kinds of haematological treatments?

A
  • Replacements
    • Blood
    • Haematinics
    • Coagulation factor
    • Plasma exchange
  • Transplantation
  • Drugs
    • Cytotoxics
    • Monoclonal antibodies
    • Inhibitors of cellular proliferation
    • Immunosuppressants
    • Inhibitors of coagulation
    • Inhibitors of fibrinolysis
86
Q

What are some drugs often used in haematology?

A
  • Cytotoxics
  • Monoclonal antibodies
  • Inhibitors of cellular proliferation
  • Immunosuppressants
  • Inhibitors of coagulation
  • Inhibitors of fibrinolysis
87
Q

What are some replacement therapies often used in haematology?

A
  • Blood
  • Haematinics
  • Coagulation factor
  • Plasma exchange

Immunology and Haematology (23 decks)

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