MEH: The Spleen, White Cells, Cytopenia

Question 1

Describe the function of the spleen in adults.

Answer 1

• Removal of old/abnormal RBC
• Blood pooling (platelets and RBC can be rapidly mobilised during bleeding)
• Extramudullary haemopoiesis (pluripotent stem cells proliferate during haematological stress or bone marrow failure)
• Immunological functions

Question 2

Give some causes for splenomegaly.

Answer 2

• Back pressure in portal system
• Over working red/white pulp
• Expansion due to cells infiltrating that shouldn’t be there (i.e. Cancer cells)
• Expansion due to flirtation of other material (i.e. In sarcoidosis)

Question 3

What conditions can cause massive splenomegaly?

Answer 3

• Chronic myeloid leukaemia
• Chronic malaria
• Myelofibrosis

Question 4

What conditions can cause moderate splenomegaly?

Answer 4

• Liver cirrhosis

- Glandular fever

Question 5

What conditions can cause mild splenomegaly?

Answer 5

• Endocarditis

- Sarcoidosis

Question 6

What is hyposplenism?

Answer 6

Lack of functioning spleen tissue.

Question 7

Name 3 causes of hyposplenism.

Answer 7

• Splenectomy
• Sickle cell disease
• Coeliac disease

Question 8

How does a blood film appear under a microscope with a patient how have hyposplenism?

Answer 8

Howell jolly bodies (DNA remnants)

Question 9

What is the clinical importance of a diagnosis of hyposplenism?

Answer 9

Patients are at risk of overwhelming sepsis, partially from encapsulated organisms.

For this reason they often have to take preventative antibiotics.

Question 10

Define cytopenia.

Answer 10

The reduction in the number of blood cells.

Question 11

List different types of cytopenia.

Answer 11

• Anaemia
• Leucopenia
• Neutropenia
• Thrombocytopenia
• Pancytopenia (low RBC, WBC, platelets)

Question 12

Name some causes of neutrophilia.

Answer 12

• Acute inflammation/ haemorrhage
• Tissue damage
• Drugs e.g. Steroids
• Cytokines: G-CSF
• Cancer
• Smoking

Question 13

Name some causes of neutropenia.

Answer 13

• B12/folate deficiency
• Infiltration of bone marrow by malignancy or fibrosis
• Empty bone marrow
• Viral infection
• Congenital disorders

Question 14

What is the clinical importance of a diagnosis of neutropenia?

Answer 14

Neutropenia sepsis is a medical emergency and patient have to put on IV antibiotics immediately.

Question 15

Describe the common causes of eosinophilia.

Answer 15

• Allergic reactions
• Parasite infection
• Hodgkin lymphoma

Question 16

Describe the common causes of lympocytosis.

Answer 16

• Viral infections
• Bacterial infections
• Post splenectomy
• Smoking