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MEH A > Session 6 Lecture 1 > Flashcards

Session 6 Lecture 1 Flashcards

1
Q

Where is the spleen located?

A

Left upper quadrant of the abdomen

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2
Q

What does the spleen consist of?

A

Red pulp and white pulp

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3
Q

What is red pulp?

A

Sinuses lined by endothelial macrophages and cords

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4
Q

What is white pulp?

A

Similar structure to lymphoid follicles

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5
Q

What is the main role of the spleen?

A

To filter the blood

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6
Q

Describe the blood supply to the spleen?

A

Blood enters the spleen via the splenic artery

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7
Q

What passes through the white pulp?

A

White cells and plasma preferentially pass through white pulp

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8
Q

What passes through the red pulp?

A

Res cells preferentially pass through the red pulp

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9
Q

What is the function of the red pulp?

A

Removes old red cells and metabolises the haemoglobin

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10
Q

What is the function of the white pulp?

A

Synthesises antibodies and removed antibody-coated bacteria and blood cells

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11
Q

What are the different function of the spleen?

A

Sequestration and phagocytosis
Blood pooling
Extramedullary haemopoiesis
Immunological function

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12
Q

Describe the sequestration and phagocytic function of the spleen?

A

Old/abnormal red cell are removed by macrophages

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13
Q

Describe the blood pooling function of the spleen?

A

Platelets and red cell can be rapidly mobilised during bleeding

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14
Q

What is the extra-medullary haemopoiesis function of the spleen?

A

Pluripotent stem cells proliferate during haematological stress of if marrow fails

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15
Q

What is the immunological function of the spleen?

A

25% of T cells and 15% of B cells are present in the spleen

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16
Q

What is splenomegaly?

A

Enlargement of spleen

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17
Q

What is splenomegaly typically associated with?

A

Increased workload eg haemolytic anaemia

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18
Q

What is haemolytic anaemia?

A

An increased number of defective red cells are removed form the circulation

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19
Q

Is it ever normal to feel the spleen?

A

No

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20
Q

Why would the spleen grow?

A

Haemolytic anaemia
Portal hypertension (back pressure)
Infiltration by leukaemia/lymphoma
Accumulation of waste products of metabolism

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21
Q

What are the different types of splenomegaly?

A

Massive, moderate, mild

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22
Q

What can occur due to pooling of the blood in an enlarged spleen?

A

Pancytpenia or thrombocytopenia

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23
Q

What is hypersplenism?

A

This is overactivity of the spleen.

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24
Q

What are you at risk of if you have splenomegaly?

A

Risk of rupture because the spleen will not longer be protected by the rib cage. Can lead to haemorrhage

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25
Q

What is hyposplenism?

A

Describes reduced splenic function

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26
Q

What are you at risk of if you have hyposplenism?

A

Risk of overwhelming sepsis

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27
Q

What are the causes of hyposplenism?

A

Underlying diseases which destroy spleen tissue such as sickle-cell disease and sickle cell disease. Spelectomy

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28
Q

Why might someone have a splenectomy?

A

Splenic rupture from trauma or because of tumour.

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29
Q

What will a blood film from someone with hyposplenism present as?

A

Howell jolly bodies

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30
Q

What are Howell-jolly bodies?

A

Basophilic nuclear remnants (clusters of DNA) in circulating erythrocytes.

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31
Q

How do you get Howell-jolly bodies ?

A

Normally erythrocytes expel their nuclei but in some cases small portions of DNA remain. Normally these cells would be removed by the spleen.

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32
Q

Define cytopenia

A

Describes a reduction in the number of blood cells

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33
Q

What is anaemia?

A

Low red cell count

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34
Q

What is low white blood count?

A

Leucopenia

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35
Q

What is low neutrophil count?

A

Neutropenia

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36
Q

What is low platelet count?

A

Thrombocytopenia

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37
Q

What is low red cell, white cell and platelet?

A

Pancytopenia

38
Q

How is an increase in number of blood cells denoted?

A

Suffix cytosis or philia

39
Q

What is a high red cell count?

A

Erythrocytosis

40
Q

What is a high white cell count?

A

Leucocytosis

41
Q

What is a high neutrophil count?

A

Neutrophilia

42
Q

What is a high lymphocyte count?

A

Lymphocytosis

43
Q

What is a high platelet count?

A

Thrombocytosis

44
Q

What are the most abundant type of leukocyte?

A

Neutrophils

45
Q

What colour do neutrophils stain?

A

Pink

46
Q

What does a neutrophil look like on a blood film?

A

Stains pink with H&E

Lobed nucleus 2-5 lobes

47
Q

What is neutrophil function controlled by?

A

Granulocyte-colony stimulating factor (G-CSF)

48
Q

What does G-CSF do?

A

Increases the production of neutrophils in the bone marrow and decreases their maturation time. Enhances chemotaxis and phagocytosis

49
Q

What is neutrophillia?

A

High number of neutrophils in the blood

50
Q

How can you get neutrophilia?

A

Results from bacterial infection, acute inflammation, drugs, smoking or acute haemorrhage

51
Q

What is neutropenia?

A

Low number of neutrophils in the blood

52
Q

How can you get neutropenia?

A

Can result in life threatening bacterial or fungal infection. Inc removal due to immune destruction or splenic pooling

53
Q

What is neutropenic sepsis?

A

Often in patients with cancer who have received chemotherapy. Life threatening medical emergency

54
Q

How would you treat a patient who had sever neutropenia?

A

Administer recombinant manufactured GCSF- this helps the bone marrow recover

55
Q

What are the causes of neutropenia?

A

Reduced production or increased removal/use

56
Q

Why might you get reduced production of neutrophils?

A 
B12/folate deficiency 
Infiltration of bone marrow 
Asplastic anaemia 
Radiation 
Drugs
Viral infection 
Congenital disorders
57
Q

What are the consequences of neutropenia?

A

Sever life threatening bacterial infection, fungal infection and painful mouth ulcers

58
Q

What are the largest leukocyte in the body?

A

Monocytes

59
Q

What happens to monocytes once they have been made?

A

They circulate in the blood for 1-3 days before moving into tissues and differentiating into tissue resident macrophages or dendritic cells.

60
Q

What happens to about half of the monocyte population?

A

Stored as a reserve in the red pulp of the spleen

61
Q

What are the main function of monocytes, macrophages and dendritic cells?

A

Phagocytosis, antigen presentation and cytokines production

62
Q

When are monocytes released?

A

In response to inflammation and antigenic stimuli

63
Q

What is monocytosis?

A

Increase in a number of monocytes

64
Q

When does monocytosis often occur?

A

During chronic inflammatory conditions eg rheumatoid arthritis, crohns, UC. Also myoproliferative, malignancies, leukaemia

65
Q

How can you identify an eosinophil on a blood film?

A

Bilobed nucelus and stain red with H&E.

66
Q

What is the function of eosinophils?

A

Important in the immune response to multicellular parasite such as helminths.

67
Q

How do eosinophils work?

A

Release their granular contents which constrains enzymes such as elastase, ROS and leukotrienes and cytokines. These aid destruction and subsequent phagocytosis

68
Q

What is eosinophilia?

A

Abnormally high eosinophil count.

69
Q

What are the non haematological causes of eosinophilia?

A

Allergic disease - asthma, eczema
Drug hypersensitivity
Parasitic infection
Skin diseases

70
Q

What are the haemotological causes of eosinophilia?

A

Hodgkin lymphoma, acute lymphoblastic leukaemia, acute myeloid leukaemia, myeloproliferative conditions, eosinophilia leukaemia

71
Q

Is eosinophilia itself a disorder?

A

No it is a sign of an underlying disease

72
Q

What are basophils?

A

Least numerous leukocyte

73
Q

What do basophils look like on a blood film?

A

Contain large cytoplasmic granules which may obscure the cell nucleus.

74
Q

What do the granules n basophils contain?

A

Vasodilator histamine and heparin. They are released following the binding of IgE to surface receptors.

75
Q

When are basophils important?

A

They play an important role in both parasitic and allergic reactions.

76
Q

What causes basophilia?

A

Inflammatory conditions such as UC and rheumatoid arthritis and also sensitivity reactions to drugs, foods or inhalants etc.

77
Q

What are the different types of lymphocytes?

A

B cells, T cells and natural killer cells.

78
Q

What is the function of natural killer cells?

A

Cell mediated cytotoxic innate immunity

79
Q

What is the function of T cells?

A

They facilitate cell-mediated adaptive immunity

80
Q

What is the function of B cells?

A

Facilitate humoral antibody driven adaptive immunity

81
Q

What is lypmphocytosis?

A

Increase in the number of lymphocytes in the blood

82
Q

What causes lymphocytosis?

A

Common feature of infection. In elderly people - it is associated with lymphoproliferative malignancies including.

83
Q

What is pancytpenia?

A

Describes the condition where there is a reduction in the number of erythrocytes, leukocytes and platelets

84
Q

What can cause pancytopenia?

A

Reduced production or increased removal

85
Q

Why might you get reduced production of blood cells?

A 
B12/folate deficiency 
Malignancy or fibrosis
Idiopathic immune aplastic anaemia
Drugs
Viruses 
Congenital bone marrow failure
86
Q

Why might you get increased removal of blood cells?

A

Hypersplenism
Irradiation
Drug insult
Acute viral infection

87
Q

What are some symptoms of pancytopenia?

A

You basically get all the symptoms of anaemia, thrombocytopenia, neutropenia

88
Q

What are the main symptoms of anaemia?

A

Fatigue, dizziness, chest pain, shortness of breast

89
Q

What are the main symptoms of thrombocytopenia?

A

Bleeding, bruising etc

90
Q

What are the symptoms of neutropenia?

A

Infection, ulcers and fevers

91
Q

What is asplastic anaemia?

A

Pancytopenia with a hypocellular bone marrow in the absence of an abnormal infiltrate and with no increase in reticulin (fibrosis)

MEH A (19 decks)

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