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MEH - Spleen White Cells Cytopenia Flashcards

1
Q

What is red pulp vs white pulp in the spleen?

A

Red pulp contains RBC, granulocytes, platelets, plasma - sinuses (engorged with blood) lined by endothelial macrophages and cords (connective tissue)

White pulp - similar structure to lymphoid follicles with especially T and B lymphocytes

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2
Q

What organ does a large spleen put pressure on?

A

Stomach so have to have small meals

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3
Q

Where do white cells and plasma pass through in the spleen?

A

Preferentially white pulp

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4
Q

Where do RBC pass through?

A

Red pulp

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5
Q

What are 4 major roles of the spleen?

A

Sequestration and phagocytosis of old/damaged RBCs - splenic macrophages

Blood pool - release RBC and platelets during bleeding

Extramedullary haemopoiesis - pluripotent stem cells prolif during haem stress or bone marrow failure e.g. myelfibrosis

Immune function - 25% T cells and 15% B cells present in spleen (more in infection)

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6
Q

What is the broad role of red pulp and white pulp?

A

Red - RBC sequestration and phagocytosis

White - Immune response - cell mediated and humeral

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7
Q

Is it ever normal to be able to palpate spleen?

A

No

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8
Q

6 reasons for splenomegaly?

A
  • Back pressure - portal hypertension
  • Overworking red pulp e.g. haemolytic anaemia
  • Overworking white pulp
  • Extramedullary haemopoiesis
  • Infiltrated cancer - leukaemia etc
  • Infiltrated other - gaucheries disease, sarcoidosis
  • Malaria
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9
Q

Via what vessel does blood enter the spleen?

A

Splenic artery

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10
Q

What would you see typically on a blood film of someone with hyposplenism?

A

Howell - Jolly bodies

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11
Q

What are Howell - Jolly bodies and why are they present?

A

Basophilic nucelar remnants (clusters of DNA) in circling erythrocytes. Normally during erythropoiesis erythroblasts expel their nuclei but in some cases a small portion of DNA remains. Such cells would normally be removed by the spleen but presence of these bodies is a good indicator of reduced spleen function

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12
Q

What is leucopenia?

A

Low WBC count

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13
Q

What is low neutrophil blood count?

A

Neutropenia

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14
Q

What is pancytopenia?

A

Low red cells, white cells and platelets

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15
Q

What is leucocytosis?

A

High WBC count

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16
Q

What is high lymphocyte count?

A

Lymphocytosis

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17
Q

What is hyposplenism? What are some causes?

A

Lack of functional spleen

E.g. splenectomy, coeliac, sickle cell

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18
Q

How will Howell Jolly- Bodies look on blood film?

A

Purple dots

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19
Q

Which are the encapsulated bacteria that hyposplenic patients are particularly at risk of infection from?

A

Neisseria meningitidis
Haemophilus influenzae
Step pneumoniae

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20
Q

What are some causes of massive splenomegaly (4)?

A

CML, myelofibrosis, chronic malaria, schistosomiasis

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21
Q

What are some causes of moderate splenomegaly?

A

As above plus lymphoproliferative disorders, myeloproliferative disorders, liver cirrhosis with portal hypertension, infections such as glandular fever caused by EBV

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22
Q

What are some causes of mild splenomegaly?

A

Infection hepatitis, endocarditis, infiltrative disorders such as sarcoidosis, autoimmune diseases such as AIHA

23
Q

How can hypersplenism cause pancytopenia or thrombocytopenia?

A

Because it can pool blood/platelets so removing it from normal circulation

24
Q

What is the risk with playing contact sports with splenomegaly?

A

Risk of rupture if below rib cage

25
What are some complications of splenomegaly?
Infarction - e.g. sickle cell | Haematoma - can cause anaemia and hypertension in spleen
26
What is increased lobes on neutrophil indicative of (e.g. 3-5 lobes)?
Vit B12 deficiency
27
How long do neutrophils live for?
1-4 days
28
What hormone controls neutrophil maturation/production? What 4 roles does the hormone have?
G-CSF Increased production of neutrophils Decreased time to release of mature cells from BM Enhances chemotaxis Enhances phagocytosis and killing of pathogens
29
What are two reasons for immature release of neutrophils e.g. meyeloblast/promyelocyte/myelocyte/metamyelocyte
Haem cancer Sepsis
30
What treatment can you give to enhance a patients neutrophils e.g. post chemo neutropenia
Recombinant CSF
31
What are 10 important causes of neutrophilia
1) Drugs e.g. steroids 2) Acute haemorrhage 3) Myeloproliferative diseases 4) Tissue damage 5) Smoking 6) Infection 7) Cancer 8) Cytokines G-CSF 9) Metabolic/endocrine disorders 10) Acute inflammation
32
What is the diagnostic level of neutrophils for neutropenia?
<1.5 x 10^9/L | <0.5 is servere
33
What causes neutropenia?
Decreased production | Increased breakdown or use
34
What reasons for decreased production of WBC are there?
1) B12/folate deficiency 2) Infiltration by malignancy or fibrosis 3) Aplastic anaemia 4) Radiation 5) Drugs - chemo etc 6) Viral infection - v common 7) Congenital disorders
35
What are three causes of increased neutrophil removal or use?
Immune destruction Sepsis Splenic pooling
36
What are two others causes of neutropenia?
Benign ethnic neutropenia in afro carribbevn Cyclic neutropenia
37
What are 3 complications of neutropenia?
Severe life threatening bacterial infection Severe life threatening fungal infection Mucosal ulceration - painful mouth ulcers
38
What do monocyte lysosomes contain?
Lysozyme, complement, interleukins, arachidonic acid (conditionally essential fatty acid), CSF
39
What is increased monocytes called?
Monocytosis
40
When might you see monocytosis (4)?
Chronic inflam conditions - Rheumatoid, SLE, Crohns, Ulcerative colitis Chronic infection e.g. TB Carcinoma Myeloproliferative disorders/leukaemias
41
How long are eosinophils in circulation? What is their life span
3-5 hours | Lifespan 8-10 days
42
What do their granules contain?
Arginine Phospholipid Enzymes
43
What can eosinophils phagocytose?
Antigen-antibody complex
44
When might you see eosinophilia?
Allergic diseases - hay fever, asthma, eczema, aspergillosis Drug hypersensitivity Parasitic infections Hodgkins lymphoma, acute myeloid leukaemia, acute lymphoblastic leukaemia, myeloproliferative conditions, eosinophilic leukaemia, idiopathic hypereosinophilic syndrome
45
How common are basophils?
Least common
46
What are they active for?
Allergic reactions and inflammatory conditions
47
What do their granules contain?
Histamine Heparin Hyaluronic acid Serotonin
48
When might you see basophilia?
Reactive - Immediate hypersensitivity reactions UC RA Myeloproliferative disorders CML etc
49
When might you see lymphocytosis?
``` Viral infections Bacterial infections Post splenectomy MI/Cardiac arrest (stress related) Smoking ``` Lymphoproliferative e.g. CLL (B cells), other lymphomas/leukaemias
50
What can cause pancytopenia?
Most common is reduced production | Also splenic pooling
51
How can reduced production of all blood cells occur?
``` B12 folate deficiency - if advanced Malignancy in bone marrow Marrow fibrosis Idiopathic immune aplastic anaemia Radiation Drugs - chemo Viruses - EBC, viral hepatitis, HIV, CMV Congenital bone marrow failure Fanconi's Anaemia, Dyskeratosis congenita ```
52
What non haem malignancy can cause pancytopenia?
Prostate Breast Lung
53
What are symptoms of pancytopenia?
Anaemia symptoms Thrombocytopenia symptoms (bleeding bruising) Neutropenia symptoms - fever infection ulcers Symptoms of underlying cause
54
What can you do to increase all cells?
GCSF mobilised stem cells from donor - stem cell transplant

ESA2 (37 decks)

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