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Haematology > lymphoid System > Flashcards

lymphoid System Flashcards

1
Q

origin of lymphoid cells?

A

haemopoietic stem cells > precursor lymphoid cells > either become T cells in thymus or B cells in bone marrow > secondary lymphoid organs

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2
Q

what are the 2 primary lymphoid tissues?

A

bone marrow

thymus

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3
Q

what the 5 peripheral (secondary) lymphoid tissues?

A 
lymph nodes
spleen
tonsils (waldeyers ring)
epithelia-lymphoid tissues
bone marrow
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4
Q

2 main roles of lymphatic system?

A

filtration of circulatory fluids

location for cells of the immune system (lymphoid and accessory)

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5
Q

importance of lymphatic system in circulation?

A

returns lymph to the circulation

important in fluid homeostasis and prevents excessive accumulation of fluid in tissues causing oedema

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6
Q

what does the lymphatic system permit?

A

cell traffic
cell trapping
interacting of cells and molecules with cells of the immune system (protective function)

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7
Q

main palpable lymph node groups?

A

cervical nodes
axillary nodes
inguinal nodes

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8
Q

non-palpable lymph node groups?

A

mediastinal

para-aortic

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9
Q

normal lymph node size?

A

up to 2.5cm

oval shaped

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10
Q

where are lymph nodes found?

A

located along course of lymphatic vessels

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11
Q

general structure and function of lymph nodes?

A

blind-ended vascular channels that collect fluid from tissues and return to blood stream
allow passive movement of fluid
have valves which ensure direction of flow

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12
Q

describe the movement of fluid in a lymph node

A

afferent channels bring fluid in through the capsule and into the peripheral sinus of the node
lymph filters through the node then leaves via efferent vessel in the hilum

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13
Q

where does lymph fluid go after leaving node?

A

cisterna chyli/thoracic duct
or
left jugular/subclavian/bronchomediastinal trunks
or
right “”
then goes to venous system at junction of left or right subclavian and jugular veins

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14
Q

where do arterial and venous vessels serving the node enter/exit the node?

A

hilum

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15
Q

how is lymph filtered in the node?

A

within the parenchyma
traffic of cells between lymph and the parenchyma
interactions between cells in the node and cells/substances contained within the lymph fluid

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16
Q

how does the lymphoid system act as defence system?

A

houses cells of innate immune system

traffic of antigen presenting cells (APCs) links innate and adaptive immune response

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17
Q

features of adaptive immune response?

A

specific
inducible
has memory
enhanced secondary reaction

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18
Q

what cell populations are found within lymph nodes?

A 
lymphocytes
macrophages
antigen presenting cells
dendritic cells
endothelial cells
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19
Q

markers of B cell and T cell populations in lymph nodes?

A

B cells = CD20

T cells = CD3

20
Q

how can lymph node enlargement be described in clinic?

A

localised or wide-spread and generalised

peripheral or central (internal)

21
Q

types of lymphadenopathy?

A 
local inflammation (infection, vaccination)
systemic inflammation (infection, autoimmune)
malignancy (haem - lymphoma/leukaemia or metastatic)
others (sarcoidosis, IgG4 disease etc)
22
Q

what is sarcoidosis?

A

generalised granulomatous condition with a wide differential

23
Q

why are sarcoid like reactions a problem in lymphadenopathy?

A

may mask a malignancy

24
Q

what is lymphangitis?

A

regional lymphadenopathy where there is inflammation of the lymphatic drainage system from a region to the node
(seen as red lines extending from an inflamed region)

25
Q

superficial regional lymphadenopathy may be the first sign of what?

A

underlying malignancy

26
Q

what does generalised lymphadenopathy suggest?

A

systemic inflammatory process or widespread malignancy (lymphoma/leukaemia)

27
Q

what do you look for in lymph node enlargement?

A

evidence of underlying pathology (draining sites)
reactive processes (B/T cell response have different patterns on microscopy)
evidence of neoplastic disorders

28
Q

how do you assess reactive processes in enlarged lymph node?

A

stimulate immune reaction in node
mainly B cell response = autoimmune condition or infection
mainly phagocyte response = draining tumour site
mainly T cell response = viral infection or drugs (phenytoin)

29
Q

normal size and position of spleen?

A

usually in LUQ
normally 150-200g
shouldn’t be palpable

30
Q

what are the 2 key aspects of the spleen?

A 
diaphragmatic surface
visceral surface (facing left kidney, gastric fundus, tail of pancreas and splenic flexure)
31
Q

blood supply and drainage spleen?

A

splenic artery

drained via splenic vein (combines with superior mesenteric vein to form portal vein)

32
Q

general structure of spleen?

A

encapsulated organ filled with parenchyma made of red pulp and white pulp

33
Q

what is contained within red pulp?

A

sinusoids and cords

34
Q

what are sinusoids?

A

components of red pulp which are fenestrated, lined by endothelium and supported by hoops of reticulin

35
Q

what are cords?

A

components of red pulp which contain macrophages, some fibroblasts and cells in transit (RBCs, WBCs, PCs and some CD8 T cells)

36
Q

function of spleen?

A

acts as a filter for blood
detects, retains and eliminates unwanted foreign/damaged material
also facilitates immune response to blood borne antigens

37
Q

describe circulation in the spleen

A

blood enters via trabecular artery > continues in central artery > branches off via radial arterioles to perilymphoid sinuses > some continues up central artery and smaller branches then sheathed capillaries > splenic cords > venous sinuses > trabecular vein

38
Q

components of white pulp in the spleen?

A

peri-arteriolar lymphoid sheath (PALS)

CD4 lymphoid cells

39
Q

how does white pulp change?

A

expanded by lymphoid follicles (may show reactive changes as in lymph node)

40
Q

how does antigen reach white pulp? what happens next?

A

via the blood
APCs in the white pulp then present antigen to immune reactive cells (B/T cells)
B and T cells responses then occur once stimulated by antigen

41
Q

what spleen problems can be seen in clinic?

A

splenomegaly

splenic atrophy

42
Q

features of splenomegaly?

A

dragging sensation in LUQ
discomfort when eating
pain if infarcted
hypersplenism

43
Q

features of hypersplenism?

A

triad of

  • splenomegaly
  • fall in 1+ cellular components of blood
  • correction of cytopenias by splenoectomy
44
Q

what can cause splenomegaly?

A 
infection
congestion (portal)
haematological diseases
inflammatory conditions (RA, SLE etc)
storage diseases
miscellaneous (amyloid, tumours, cysts)
45
Q

most common cause of hypospplenism?

A

splenectomy

other causes include coeliac, sickle cell, sarcoidosis, iatrogenic etc

46
Q

features of hyposplenism?

A

due to reduced red pulp function

  • Howell-jolly bodies
  • red cell abnormalities
  • need for immunisation and prophylaxis
  • may have immune deficiency

Haematology (26 decks)

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