Non Neoplastic D/O & Spleen Flashcards
1
Q
WBCs (leukocytes) originate from what stem cell?
A
pluripotent stem cell
2
Q
a pluripotent stem cell divides into what two types of stem cells?
A
myeloid and lymphoid
3
Q
what three cell types are made from lymphoid stem cells?
A
all progenitors
NK
T cell
B cell
4
Q
T cell progenitor goes where in the body?
A
thymus (forms a T cell)
5
Q
B cell progenitor forms into a ______ cell and then a _______ cell
A
progenitor to B cell to plasma cell
6
Q
myeloid stem cell divides into what four stem cells?
A
monocyte, granulocyte, megakaryocyte and erythrocyte
7
Q
a monocyte turns into a __________ and then a _________
A
monocyte to monoblast to monocyte
8
Q
what are the three types of granulocytes?
A
neutrophils, eosinophils, and basophils
9
Q
a megakaryocyte turns into a __________, which turns into __________
A
megakaryocyte and then platelets
10
Q
an erythrocyte turns into a _________ and then turns into a ____________
A
erythrocyte to reticulocyte to an erythrocyte
11
Q
what are the agranulocytes?
A
monocytes and lymphocytes
12
Q
when is a monocyte called a macrophage?
A
once it goes into the tissues
13
Q
“Blasts” represent what?
A
committed cells (i.e. lymphoblast will become a lymphocyte)
14
Q
“Pro” and “Meta” represent what?
A
further differentiation
15
Q
lymphoid stem cell leads to development of what type of cells?
A
lymphocytes
16
Q
most WBC are found where?
A
the tissues (connective or lymphatic)
17
Q
which two types of cells circulate?
A
monocytes and granulocytes
18
Q
_________ migrate between circulation and lymphatic system
A
lymphocytes
19
Q
T cells become what two types of cells?
A
CD4 (helper)
CD8 (cytotoxic)
20
Q
B cells become what type of cells?
A
antibody-producing plasma cells
21
Q
NK lack what?
A
immunologic specificity
22
Q
T cells initiate what type of immunity? B cells? what do both of these cells require?
A
T cells: cell mediated
B cells: antibody mediated
**both cells require exposure to antigen (priming)- NK cells don’t
23
Q
what two organs are part of the lymphatic system?
A
spleen and thymus
24
Q
what is special about lymphoid tissues? where are they normally located>
A
they lack an external capsule
located near systems with external openings (put lymph near where pathogens can get into the body)
25
what are four lymphoid tissues?
MALT
Waldeyer's ring
peyer's patches
appendix
26
what is waldeyer's ring?
ring of lymphoid tissue that surrounds the larynx
27
Lymph nodes: concentrated in what three places?
neck, axilla, groin
28
lymph nodes are __________ with inner __________
encapsulated with inner trabeculae (divides lymph nodes into areas)
29
outer cortex of lymph node contains?
B cell rich follicles in (germinal center is a secondary follicle and indicates active proliferation)
30
inner cortex (paracortex) of lymph node contains?
mostly T cells
31
lymph enters via _________ lymphatics and converge to _________ lymphatic in medulla
afferent; efferent
32
what is lymphadenitis?
inflammation within a lymph node
33
what does lymphadenopathy mean?
enlarged node
34
acute generally reactive hyperplasia: does what to the node? what two types can it be?
stretches the node (painful)
localized (bacterial infection in one body area, which is drained by that node) vs generalized (systemic viral infection)
35
Mesenteric adenitis: what type of infection? often confused for what? occurs in what part of the body?
Yersinia enterocolitica infection
often confused for appendicitis
occurs in small bowel mesentery
36
cause of chronic lymphadenitis? may require what test?
has many causes
| may require biopsy (acute usually doesn't require one)
37
disease states that can cause lymphadenitis (12)
1) . metastatic CA
2) . lymphoma
3) . Mono
4) . RA
5) . syphilis
6) . AIDS related complex
7) . lupus
8) . toxoplasmosis
9) . whipple's dz
10) . phenytoin
11) . vaccine reactions
12) . dermatopathic lymphadenitis
38
what is the most common cause of lymphadenitis?
dermatopathic: nodes that drain inflamed skin
39
total WBC normal range
4,000-11,000/ul
40
_______ WBC count is more informative than _________
absolute count > percentages
41
normal neutrophil count
1800-6500/ul
42
few eosinophil count
100/ul
43
few basophil count
300/ul
44
normal monocyte count
100-600/ul
45
normal lymphocyte count
1200-3400/ul
46
normal CD4 count
> or equal to 1000/ul (KNOW in respect to AIDS*)
47
leukocytosis means?
WBC> 12,000
48
leukopenia means?
any low total WBC (not helpful)
49
severe and life threatening levels of low absolute neutrophil count
severe: <500
| life threatening: <100
50
low absolute neutrophil count is also called?
agranulocytosis
51
what are the three main causes of neutropenia?
1) . suppression of granulopoiesis
2) .destruction or sequestration of neutrophils
3) . drugs
52
things that cause suppression of granulopoiesis (4)
bone marrow failure, chemo, radiation, bad stuff in the marrow (fibrosis)
53
two things that cause destruction or sequestration of neutrophils?
overwhelming infection, hypersplenism
54
drugs that can cause neutropenia (4)
carbamazepine, clozapine, PTU/methimazole, ticlopidine
55
what is agranulocytosis?
severe neutropenia (ANC< 500)
56
what are two types of ulcers that can provide a portal to the blood stream (and therefore lead to agranulocytosis)?
oral ulcers w pseudomembranes or cecal ulcers (typhlitis- inflammation of cecum)
57
what is the usual cause of agranulocytosis? death occurs how quickly?
usual cause is meds; death occurs within days
58
what are three dreadful complications of agranulocytosis?
bacterial sepsis, deep candidiasis, and deep aspergillosis
59
treat agranulocytosis with what two things?
antimicrobials and hematopoietic growth factors
60
what four disease states can cause lymphocytopenia?
HIV
protein/calorie malnutrition
Cushing's
stress
61
which is less common: lymphocytopenia or agranulocytosis?
lymphocytopenia
62
what does multi system organ failure induce?
lymphocytic apoptosis
63
systemic viral infections does what to T cells?
drive them into lymph nodes
64
what is leukocytosis? what are the two main types of causes?
elevated WBC count; neoplastic and non neoplastic
65
what is important about marginated neutrophils?
half of the circulating neutrophils are stuck along BV walls; certain conditions will cause them to de-marginate and will result in a higher WBC lab count but not a changed # in the body
66
what are some things that can cause granulocytosis?
1) . pyogenic bacterial infection
2) . burns
3) . tissue necrosis (remember MI)
4) . late pregnancy
5) . stress/pain/exercise (demarginates)
6) . glucocorticoid therapy
7) . "left shift"
67
what is a left shift?
means that there is a severe infection in which bone marrow is producing WBCs and releasing them into the blood before they are fully mature
68
what is a leukemoid reaction?
an increase in the white blood cell count usually due to infection or another disease (can mimic leukemia)
69
which type of patients usually get a leukemoid reaction? WBC levels are what?
super sick septic patients
| WBC > 100K
70
what are four manual differentials results of a leukemoid reaction?
1) . toxic granulation
2) . vacuolization- creation of compartments within the cell
3) . low to normal absolute basophil count
4) . high leukocyte alkaline phosphatase
71
why is a manual differential lab run?
The manual differential white blood cell count is performed to determine the relative number of each type of white blood cell present in the blood
72
what is eosinophilia? what are the morning and pm values?
elevated eosinophil count
am: >350/ul
pm: >650/ul
73
cause of eosinophilia in healthy patients?
no cause usually found
74
what type of immune response is eosinophilia?
type 1
75
what is the most common type of eosinophilia?
chronic eosinophilic leukemia
76
eosinophilia can be caused by what two things?
parasitic infection and drug allergy
77
what are two conditions that you can see basophilia in?
chronic myelogenous leukemia and polycythemia vera
78
is monocytosis diagnostic?
NO never
79
what four disease states could you see monocytosis in?
RA, TB, Crohn's, deep fungal infections
80
adult lymphocytosis range?
4,000-10,000/ul
81
what are two disease states that can cause lymphocytosis?
stress- "transient stress lymphocytosis"
| Mono- atypical lymphocytes
82
Mono mostly results from exposure to what virus? how is it spread?
Epstein-barr virus (85%); spread by contact with infected oral secretions
83
mono virus infects what cells? what happens to these cells?
B cells; infected B cells are immortalized and eventually bear viral antigens...they stimulate heterophil antibody production
84
what's the incubation period for mono?
long- months
85
what does the mono spot test detect?
heterophil antibodies produced by EBV infected B cells
86
what does the immune system produce in response to mono?
T cell hyperplasia in lymphoid organs and lymphocytosis
87
what's the atypical circulating lymphocyte % that is found in mono?
at least 20%
88
what two ways are mono infected B cells eventually eliminated?
cell mediated and humoral mechanisms
89
mono signs/symptoms (8)
1) . fever
2) . fatigue
3) . malaise
4) . pharyngitis (maybe palatal petechiae)
5) . generalized lymphadenopathy (check behind ears)
6) . impressive splenomegaly
7) . mild hepatitis
90
mono rarely infiltrates the ____
CNS
91
problem with monospot test?
often negative for weeks into illness and often never positive in kids
92
monospot only binds _______ RBCs
bovine
93
what is IgG anti-EBV capsid useful at detecting?
past or present EBV infection (higher titers indicate present infection)
94
what is IgM anti-EBV capsid useful at detecting?
present infection in children
95
what are three "minor mysteries" with mono?
1) . half get positive cold agglutinins & hemolytic anemia
2) . mild thrombocytopenia
3) . morbilliform (measles-like rash): those who are tx with ampicillin/amoxicillin
96
treatment for mono?
supportive: rest, fluids, pain meds
| no contact sports if splenomegaly
97
EBV strongly linked to what type of lymphoma?
burkitt's
98
healthy spleen weighs how many grams? how big does it need to be to be palpable?
50-250 g (over 800g before palpable)
99
what two cell centers are in the spleen? macrophages in there remove? what does it do to platelets?
T and B cell centers
| macrophages remove outdated RBC; sequesters platelets
100
do you biopsy the spleen?
almost never due to potential of rupture
101
4 main infections causing splenomegaly?
malaria, mono, bacterial endocarditis, most other bad infections
102
two types of WBC disorders that can cause splenomegaly
chronic myelogenous leukemia and hairy cell leukemia
103
what are four congestion issues that can cause splenomegaly?
cirrhosis, R sided heart failure, splenic vein thrombosis, red cell sludge- sicklers
104
four cases of over destruction of RBC that causes splenomegaly?
Hereditary spherocytosis
Hemoglobinopathies
Immune hemolytic anemia
Immune thrombocytopenic purpura
105
3 immunoreactive conditions that can cause splenomegaly
Systemic lupus erythematosus
Rheumatoid arthritis
Transplant rejection
106
4 storage diseases that can cause splenomegaly
Gaucher's
Niemann-Pick's
Hunter's
Hurler's
107
enlarged spleen destroys what in blood?
formed elements of blood
108
accessory spleens are how common?
about 25%
109
what can splenosis result from?
spillage of pulp with splenic rupture
110
how does a septic spleen feel?
abnormally soft "tomato paste"
111
infarcts in the spleen are _______. three things that can cause splenic infarct
common; atheroembolization (splenic artery), sickle cell, mitral valve endocarditis
112
spleen is a common metastasis site of what two types of CA?
leukemias and lymphomas
113
what is the most frequently injured organ in blunt abd trauma?
spleen (even CPR)
