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Clinical Immunology and Haematology > Normal Haematopoiesis > Flashcards

Normal Haematopoiesis Flashcards

1
Q

What are the sites of haematopoiesis in humans?

A

Yolk sac
Liver and spleen
Bone marrow (in adults this is the central skeleton, proximal ends of femur).

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2
Q

What part of the bone marrow creates red blood cells

A

Red bone marrow

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3
Q

When do we find stem cells?

A

Bone marrow

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4
Q

what can stem cells develop into?

A

Red cells
White cells
Platelets

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5
Q

Multipotent haematopoitic stem cells can differentiate into what 2 types of cells?

A

Common myeloid progenitor and common lymphiod progenitor

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6
Q

What cells can the common myeloid progenitor differentaite into?

A

Erythrocytes, mast cells, myeloblasts, megokaryocytes

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7
Q

What can myeloblasts divide into?

A

Basophil, neutrophil, eosinophil, monocyte.

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8
Q

Where do macrophages come from?

A

Monocytes

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9
Q

What can lymphoid progenitors divide into?

A

Natural killer cells and small lymphocytes

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10
Q

What are the subcategories of small lymphocytes?

A

T-lymphocytes and B lymphocytes

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11
Q

Where do plasma cells develop from?

A

B lymphocytes

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12
Q

What can totipotent stem cells give rise to?

A

Intraembryonic and extraembryonic structures

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13
Q

Are stem cells capable of self renewal?

A

Yes

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14
Q

How do stem cells become self renewal?

A

They give rise to two daughter cells, one will stay as a stem cell the other will differentiation intp a specialised cells

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15
Q

How would you diagnose abnormalities in the blood?

A

Bone marrow examinations

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16
Q

Do blood cells become more or less identifiable as they develop?

A

More

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17
Q

Why dont red blood cells have nuclei?

A

They need more room to carry haemoglobin and oxygen around the body

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18
Q

Do HSC’s create niches and if so why?

A

Yes because they need to survive, it also helps them differentiate

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19
Q

How do cells make a niche?

A

Through extrinsic and intrinsic signalling pathways

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20
Q

Examples of the extrinsic signalling used to make a niche (what do growth factors help with?)

A

Growth factors which help cell survival, proliferation, differentiation, maturation and activation

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21
Q

Examples of the extrinsic signalling used to make a niche (what do adhesion molecules help with?)

A

Interactions with the extracellular matrix.

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22
Q

What are examples of intrinsic signalling to help with differentiation?

A

transcription factors

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23
Q

Growth factors can help create specifical lineages, for example what growth factor regulates erythropoiesis?

A

Renal erythropoietin which is stimulated by tissue oxygen

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24
Q

What growth factors encourage white cell growth (myelopoiesis) for granulocytes, macrophages and eosinophils?

A

Granulocytes = G-CSF
Macrophages - M-CSF
Eosinophils - IL-5

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25
What growth factor encourages platelet differentiation (thrombopoiesis) and is part fo the feedback method to control platelet count?
Thrombopoietin from the liver
26
What does the normal peripheral blood (full blood count) tell you?
Gives you different values of peripheral blood. This includes, haemoglobin, RBC, Haematocrit (amount of blood which is actually cells), MCV, reticulocyte (immature cells), neutrophils, lymphocytes, eosinophils, monocytes, basophils and platelets
27
What conditions could arise from having too many of a type of cells?
Erythrocytosis - too many red cells Leucocytosis - too many white cells Thrombocytosis - too many platelets All end in cytosis
28
What conditions could arise from having too little of a type of cells?
Anaemia - too little red blood cells Leucopenia - too little white blood cells Thrombocytopenia - too little platelets Pancytopenia - too little of everything All end in cytopenia (apart from anaemia)
29
Can cytosis and cytopenias be caused by malignancys and non-malignant diseases?
yes
30
Why is pancytopenia common in malignant disease?
The malignancy invades the entirety of the bone marrow pushing all the blood cells into the peripheral blood
31
What are myeloproliferative disorders?
These are too many cells caused by a malignancy
32
What can cause benign erythrocytosis?
Smoking, alcohol, altitude, lung disease
33
What can cause benign leucocytosis?
Infection, inflammation
34
What can cause benign thrombocytosis?
Iron deficiency, infection
35
What are some ways to can get cytopenias?
This is a failure of production which can be inhertied or acquired, general or specific, primary (primary bone marrow disorder) or secondary (e.g infection is worse, sepsis).
36
what causes cytopenias?
Excessive loss or consumption of cells. For example a massive bleed or a an autoimmune consumption (the body is attacking its own cells).
37
Does anaemia cause less oxygen to be in the body?
Yes
38
Symptoms of anaemia?
Lethargy, breathlessness, chest pain, headache, dizziness, pallor.
39
Can some people function with very low haemoglobin levels?
Yes if it happens slowly their body can adjust.
40
What type of leucopenia are doctors most worried about and is most common?
Neutropenia (neutrophils are too low)
41
What are symptoms of leucopenia?
Recurrant bacterial skin infections, mouth ulcers, overwhelming sepsis and more unusual infections.
42
What are symptoms of thrombocytopenia?
Bruising, gum bleeding, nose bleeds, petechiae (rash), rash as back of mouth (normally due to a brain bleed) and prolonged bleeding from cuts.
43
What are erythrocytes main function?
carry oxygen around the body
44
Do RBC's have osmotic equilibrium and flexable membranes?
yes
45
What blood cells survive the longest in the blood?
red blood cells (3 months)
46
How is haemoglobin made up?
Has 4 globin chains (in adults this is HbA alpha 2 and beta 2) (infants this is alpha 2 and gamma 2 chains). These are linked to 4 haem moieties - iron and protoporphyrin which can bind to oxygen
47
What can cause anaemia?
Blood loss
48
What types of illnesses can cause anaemia through reducing RBC production?
Iron deficiency (most common) , B12/folate deficiency, malignancy and thalassaemia ()
49
How does an iron deficiency cause anaemia
Haem needs iron to bind oxygen and when there is less iron in the body there is less haem.
50
How does B12 and folate deficiency cause Anaemia?
These are needed for DNA synthesis and lack of this means RBC's cannot be produced
51
What are haemotinics?
Iron, B12 and folate as these are the most common causes of anaemia
52
What is thalassaemia?
Inherited defects of haemoglobin synthesis
53
What diseases cause anaemia through increased RBC production?
Haemolysis (e.g. autoimmune diseases) and sickle cell disease.
54
What causes iron deficiency?
- Chronic blood loss such as menstruation or gastrointenstinal bleeding (common in older people as it is more common for them to get bowel cancer than younger people) - Diet (vegetarian, vegan, toddlers) - Malabsorption (coeliac disease, gastric surgery) - Increased requirements (pregnancy, growth).
55
Can you spot iron deficiency anaemia?
Yes - cells will be paler and smaller, there is also pencil cells which is common in iron deficiency anaemia.
56
What causes Megaloblastic anaemia?
Defective DNA synthesis causing the RBC's being produced to grow significantly larger and not divide.
57
What is the most common cause of megaloblastic anaemia?
B12/ folate dificiency which would then need to be tested for and replaced.
58
Megaloblastic anaemia - Macrocytic anaemia (increased MCV) shows you what on the blood film?
Oval macrocytes, neutropenia with hypersegmented neutrophils, thrombocytopenia (low platelet levels), Reduced reticulocytes (young cells) and large red cells
59
What causes a folate deficiency?
- Dietary sources usually include green vegtables and therefore inadequate intake (e.g. vegans), - malabsorption (e.g. coeliac disease), excess consumption (pregnancy) - drugs (e.g. anticonvulsants).
60
What causes vitamin B12 deficiency?
- B12 is found in meat, dairy and fish and therefore not eating enough could give you the deficiency (e.g. vegans) - Autoimmune diseases such as pernicious anaemia (B12 needs factors to be absorbed - these factors come from the pernicous cells in the stomach and pernicious anaemia is when the pernicious cells are reduced). - Malabsorption (e.g. gastric or ileal surgery - comes from the pernicious cell idea (these are lost in surgery)).
61
What is Haemolytic anaemia
When red cells are destroyed and can be either inherited or acquired
62
What are biochemical sign of haemolytic anaemia?
Spherocytes or fragments, anaemia and reticulocytosis, raised bilirubin and LDH.
63
What can hereditary haemolytic anaemia cause?
Membrane and cytoskeleton defects (spherocytosis, elliptocytosis) Issues with enzymes (Defective RBC metabolism (G6PD, pyruvate kinase deficiency)) Haemoglobin (Haemoglobinopathies (sickle cells, thalassemia))
64
What would you see on a blood film of hereditary spherocytosis
More spherical red blood cells, paler red blood cells.
65
What causes autoimmune haemolysis (AIHA)?
Antibody starts to be produced in the body against the bodies RBC.
66
What tests would you use and expected results when suspecting AIHA?
Direct coombs/antiglobulin test which would test positive. This tests to see if RBC's are coated in immunoblobin or complement in vivo after spinning and washing the blood.
67
Where are Haemoglobinopathies more common in and why?
Africe, asia and the mediterranean as they have a selective advantage over malaria (someone with this cannot get malaria) and this is why it is more passed on through generations.
68
What is thalassemia?
Reduced rate of synthesis of normal globin chain and haemolysis
69
What is sickle cell disease?
When abnormal haemoglobin is synthesised which causes haemolysis and vaso-occlusive complications.
70
What would you see on a blood film showing thalassemia?
Red cells are smaller and paler (similar to iron deficiency but more pronounced and iron will be normal).
71
What would you see on a blood film for sickle cell disease?
All blood cells are sickle cells.

Clinical Immunology and Haematology (25 decks)

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