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MEH > Lecture 5 > Flashcards

Lecture 5 Flashcards

1
Q

What is haemopoiesis?

A

Production of blood cells in bone marrow

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2
Q

Where does haemopoiesis take place in the infant ad adult?

A

Infant throughout skeleton

Adult in pelvis, ribs, vertebrae, skull, sternum

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3
Q

Where are bone marrow biopsies and blood samples commonly taken from?

A

Right side posterior iliac crest of pelvis

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4
Q

Haemopoiesis?

A

Multipotent stem cell goes to common lymphoid progenitor and common myeloid progenitor.

Common lymphoid progenitor becomes T lymphocyte and B lymphocyte

Common myeloid progenitor goes to megakaryocyte, erythrocyte, and myeloblast.

Myeloblast forms the granulocytes which are neutrophils, monocytes, macrophages and eosinophils

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5
Q

What determines what cells stem cells will differentiate into?

A

Exposure to given chemicals such as erythropoietin

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6
Q

Haemopoietic stem cell?

A

Greatest power of self renewal compared to any other cell of body

Can differentiate into a variety of specialised cells

Can mobilise out of bone marrow and into blood

Can undergo apoptosis if required

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7
Q

What is a HPSC transplantation?

A

Haemopoietic stem cell transplant more commonly known as a bone marrow transplant

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8
Q

Where can we get haemopoietic stem cells from?

A

Bone marrow aspiration- done under anaesthetic and rarely performed

GCSF given to patient to mobilise stem cells into peripheral blood. Stem cells removed and blood returned to patient. Cells frozen to be transplanted back later.

Umbilical cord- provide stem cells at time of normal birth delivery

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9
Q

What is leucopharesis?

A

When white blood cells are separated from a blood sample

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10
Q

What is the reticuloendothelial system?

A

Part of the immune system that is made up of a network of tissues that contain phagocytise cells eg microglial in CNS and kupffer cells in the liver.

Main organs are the spleen and liver. Lymph nodes also important

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11
Q

What does the spleen consist of?

A

White pulp- WBCs

Red pulp- red cells

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12
Q

What main artery supplies the spleen?

A

Splenic artery and vein

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13
Q

Functions of spleen in adults?

A

Sequestration and phagocytosis- abnormal or old red cells removed by macrophages

Blood pooling- stores RBCs and platelets if required

Immune function- T cells and B cells

Haemopoietic- if marrow fails or under haematological stress. Results in splenomegaly.

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14
Q

How do you you determine splenomegaly?

A

Start to palpate in the right iliac fossa. It is never normal to feel the spleen below the costal margin.
With splenomegaly you would feel the spleen edge move towards your hand on inspiration

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15
Q

What is the costal margin?

A

Lower edge of chest formed by bottom of the rib cage

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16
Q

What causes splenomegaly?

A

Haemopoiesis

Immune response

Portal hypertension in liver disease

Expanding as cells entering eg cancers

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17
Q

What is sarcoidosis?

A

Abnormal collections of inflammatory cells forming lumps called granulomas

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18
Q

What is hypersplenism?

A

And overactive spleen which removes red blood cells too quickly. Blood can also pool in the spleen which enlarges it.

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19
Q

What is the danger of an enlarged spleen?

A

No longer protected by the rib cage and so can rupture easily

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20
Q

What are two complications associated with splenomegaly?

A

Haematoma- spleen ruptures and bleeds into its surrounding capsule so bleeding is not noticed. Patient becomes hypovolaemic and dies.

Infarction- enlarged spleen compresses blood vessels that supply it

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21
Q

What is hyposplenism?

A

Lack of adequately functioning splenic tissue.

22
Q

Hyposplenism causes?

A

SPLENECTOMY

Sickle cell disease which causes infarcts

Coeliac disease

23
Q

How is hyosplenism diagnosed?

A

Blood sample will show abnormal blood cells that should have been removed. Eg Howell jolly bodies

24
Q

What is extremely important clinically with the spleen?

A

Severely impaired immune function and much increased risk of sepsis especially from encapsulated organisms

Splenectomy= penicillin prophylaxis for remainder of life

25
Q

Red blood cell values?

A

See lecture

26
Q

RBC functions?

A

Carry oxygen

Carry haemoglobin

Maintain osmotic equilibrium

27
Q

Haemoglobin structure?

A

Two pairs of globin chains each with its own ahem group.

T state and R state

28
Q

What is haemolytic anaemia?

A

Anaemia due to the abnormal breakdown of RBCs

29
Q

How does the body react to haemolytic anaemia?

A

Less RBCs results in less oxygen.
This is detected by the interstitial peritubular cells of the kidney.
Cause increased erythropoietin synthesis. RBC count increases and through a feedback loop erythropoietin production falls

30
Q

Haemoglobin catabolism complications?

A

Excess of RBC destruction results in increased bilirubin production which can lead to jaundice particularly if the liver is overwhelmed

31
Q

What is cytopenia?

A

Low blood cell count

32
Q

What is anaemia?
leucopenia?
Neutropenia?
Thrombocytopenia?

A

Low red cell count
Low white blood cell count
Low neutrophil count
Low platelet count

33
Q

What is the term for having low RBCs, WBCs and platelets?

A

Pancytopenia

34
Q 
High RBSs?
High WBCs
High neutrophils
High platelets 
High lymphocytes
A

Polycythaemia or erythrocytosis

Leucocytosis

Neutrophilia

Thrombocytosis

Lymphocytosis

35
Q

How do neutrophils find pathogens?

A

Through chemotaxis

36
Q

What is a neutrophil?

A

First responder of innate immune system. Lives for 1-4 days in blood and then tissue. Commonest white cell and a phagocyte

37
Q

What hormone stimulates neutrophil production?

A

Granulocyte colony stimulating factor (G-CSF)

Enhances chemotaxis and phagocytosis of neutrophils

38
Q

What do we do in the case of neutropenia and sepsis after chemo?

A

Administer recombinant g-csf. Works better than antibiotics

39
Q

What causes neutrophilia?

A 
Tissue damage
Smoking 
Cancer 
Haemorrhage 
Myeloproliferative disease 
Acute inflammation
40
Q

What causes neutropenia?

A

Decreased production or increased removal or use eg sepsis or enlarged spleen with blood pooling.

Neutrophil count is also race dependent

41
Q

What causes reduced neutrophil production?

A 
B12 or folate deficiency 
Congenital defect 
Defect in bone marrow 
Viral infection 
Drugs eg chemotherapy which poison marrow 
Radiation
Aplastic anaemia- empty marrow 
Infiltration of marrow by malignancy or fibrosis
42
Q

Consequences of neutropenia?

A

Bacterial and fungal infections which can be life threatening

Neutropenia sepsis is a medical emergency. IV antibiotics to be given within an hour

43
Q

Monocytes?

A

First responders

Antigen presenting cells for activating adaptive immune system

Become macrophages once migrated into tissue

Phagocytosis and pinocytosis

44
Q

Monocytosis cause?

A

Myeloproliferative disorders

Leukaemia

Carcinoma

Chronic infection

45
Q

Eosinophils?

A

3-8 hours in circulation and then last 8-12 days

Deal with parasites and immune responses eg asthma

Can cause hypersensitivity reactions in asthma, certain drugs etc

46
Q

Basophils?

A

Least common but largest

Granules contain histamine

Active in allergic reactions and inflammatory conditions

Increased in rheumatoid arthritis and hypersensitivity reactions and myeloproliferative disorders

47
Q

What is a myeloproliferative disorder?

A

Increased production of white blood cell

48
Q

Lymphocytes?

A

B cells- produce antibodies

T cells- kill directly and stimulate other immune cells

Natural killer cells which undertake cell mediated cytotoxicity

49
Q

What is cell mediated cytotoxicity?

A

When a cell such as a natural killer cell loses a target cell whose membrane antigens have been bound by a particular antibody

50
Q

What is lymphoma?

A

Cancer of lymphocytes

51
Q

What can cause lymphocytosis?

A

Reactive

Viral infections
Bacterial infections
Post splenectomy (no place for storage)
Smoking

Lymphoproliferative

Leukaemia
Lymphoma

MEH (17 decks)

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