Spleen Flashcards
What is cytopenia?
is a reduction in the number of blood cells.
functions of spleen?
immunlogical> white pulp
1) houses T& B cells
2) helps in initiation of immune responses against circulating antigens and microbes
3) produces antibodies (plasma cells)
4) removal of abnormal macromolecules by splint macrophages
Hemotological>red pulp
1) removes old RBC (by macrophages)
2) retrieval of iron from the RBC (by macrophages)
3) during fetal life (hematopoesis)
4) acts as a resevoir for plateltes
why is the spleen’s capsule very prone to rupture?
bc it is very thin! A SEVERE INFECTION CAN CAUSE IT to RUPTURE, spilling blood into the peritoneal cavity!
what is splenectomy?
Removal of spleen
Location of spleen
L. upper quadrant edge of stomach just beneath the diaphragm
functions of spleen
- blood filter (phagocytosis my macrophages)
- reserve of blood (blood pooling) -immunological function -extra medullary hemoposeis, makes Blood cells (incase Bone marrow fails, it can take over its job)
what is splenomegaly & causes?
Enlargment of spleen
>Overworking red pup
>overworking white pulp
>portal hypertension (back pressure)
>Expands due to infiltration of BAD cells (cancer cells)
>expands to the infiltration of other materials
***UR NOT SUPPOSED TO BE ABLE TO PALPATE THE SPLEEN!
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what is Gauchers disease?
DEFECT in the lysosomal enzyme “beta glucosidase” which is supposed to break down GLUCOCEREBRESIDE (a constitute of web and rbc membranes).
this will cause GLUCOCEREBRESIDE to accumulate in macrophages. these r known as GAUCHER cells. can cause SPLENOMEGALY
what is Hyposplenism & causes?
term used to describe REDUCED function of spleen- -associated w/ high risk of developing sepsis. CAUSES: -underlyign diseases that reduce spleen function (sickle cell, coeliac disease) -SPLENOCTOMY
What could be a good indicator of reduced splenic function? explain why
these r basophilic nuclear remnant (clusters of DNA) in circulating erythroytes
**normally in erythrobpoeis, erythroblasts usually expel their nuclei away and the SPLEEN removes them.
so if spleen isn’t working or u have undergone splenoctamy!>> u get all those DNA clusters floating in the RBC.
if u havent done splenoctamy> it could be due to sickle cell disease or smthn
If patient has spleen removed, what huge risk does he have?
1) bacteria septecemia, bc bacteria in blood is not filtered out and immune response is not properly made! 2) Capsulated bacteria mostly (pneumococcus, Hemophilud influenzae, meningicoccus) bc to remove capsulated bacteria we need the spleen! bc spleen helps with antibodies which can act as opsonins to enhance phagocytosis. 3) congestive spleen >>due to cirrhosis of liver>> vasculature reuined> portsl hypertention> back pressure to spleen> SPLENOMAGLY
if u have ur splenoctamy u r at higher risk of infection, why?
Capsulated bacteria MOSLTY (pneumococcus, Hemophilud influenzae, meningicoccus) bc to remove capsulated bacteria we need the spleen! bc spleen helps with making antibodies which can act as opsonins to enhance phagocytosis.
what is cytopenia?
reduction in # of blood cells.
what is the most abundant type of leuccyte? what colour do they stain? how many lobes do they have? what granules do they contain?
Neutrophils
- Hemotoxylin & eosin (giving it its NEUTRAL COLOUR) hence the name
- 3-5 Lobes
what can cause neutrophillia?
**must know
–bacteria linfection
- acute inflammation
- drugs ex:steroids
- prednosine
- smoking
- acute haemorrhage
- cancer
- myeloproliferative diseases>bone marrow overproducing cells.
What artery supplies the spleen? What does it arise from
Splenic artery, branches off the celiac artery
What is the most common cause of portal hypertension?
Cirrhosis of liver
What is pancytopenia?
Low RBC WBC PLATELETS
Name the following WBC
Neutrophills
monocyte
basophill
lymphocyte
eosonophil
Low red cell count =
Low white blood =
Low neutrophil count =
Low platelet count =
Low red blood cells, white blood cells, and platelets =
Anemia
leucopenia
neutropenia
thrombocytopenia
pancytopenia
-blast> means immature cell
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this is the maturation of neutrohills, which ones should we be able to see in the circulation?
what is the role of C-GSF hormone? (3)
last 2
It controls the prduction of neutrophills, and enhances their chemotaxis and enhances their phagocytosis and killing
in a pateint with severe neutropenia & sepsis after chemotherapy, what can we adminster them?
recombinent manufactured G-CSF
to acclerate their recovery so that they get neutrohills back into their blood quicker
what value of neutrophil count is there in neutropenia?
Neutropenia can arise due to (2)
less than 1.5x 109/ L
1) reduced production
2) increased removal or use
it what situations can neutrophills be overused that it may lead to neutropenia? (3)
describe other 2 causes as well (kharab shakilha inzain)
- could be used up due to sepsis
- their could be immune destruction
- could be pooled in the spleen?
Others: benign ethnic neutropenia
cyclic neutropenia
how can reduced production cause neutropenia? (6)
- folate and B12 deficiency
- bone marrow infiltrated by malignancy and fibrosis
- aplsatic bone marrow (bone marrow empty, it hasnt got the cells to make em)
- radiation to bone marrow!
- Drugs>chemotherapy, antibiotics, antilepileptics, phsucotic drugs, DMARDS
- after viral infection
what type of drugs can lead to neutropenia?
-Drugs > chemotherapy, antibiotics, antilepileptics, phsucotic drugs, DMARDS
what r consequences of neutropenia?
- severe life threatening bacterial infection!
- Severe life threatening fungal infection
- mucosal ulceration ex:mouth ulcers
clinical fact: Neutropenic sepsis is a medical emergency. Intravenous antibiotics must be given immediately
Key clinical fact: Neutropenic sepsis is a medical emergency. Intravenous antibiotics must be given immediately
describe what u see in this image,
we breath in fungal spores all the time,
If ur neutropenic, u have no neutrophills to kill em off>> and u develop Aspergilloma in the lungs!
u can bleed into that!
what WBC is this? what is its function? (4)
Response to inflammation and antigenic stimuli
Migrate to tissues – become macrophages
lysosomes contain lysozyme, complement, IL, arachidonc acid, CSF
phagocytosis, pinocytosis
what r causes of monocytosis?
- carinoma
- chronic infection
- Myeloproliferative disorders
- chronic inflmaations (chrons, UC, RA)
what wbc cell is this? how long does it stay in the circulation? what is its life span?
functions?
Eosinophil
3-8 hrs in circulation
lifespan 8-12 days
deals w/ parasites
Mediator of allergic response
Migrate to epithelial surfaces
Granules contain arginine, phospholipid, enzymes
Phagocytosis of antigen - antibody complexes
Mediate hypersensitivity reactions eg: to drugs, in asthma, skin inflammation
if someone has a drug reaction? they’ll have a high_______ count
(name the wbc)
eosoniphils!
label the blood constituents! with % amounts
Plasma> contains clotting factors
Serum> blood plasma w/ out clotting factors (preferrred for checking blood groups)
if someone comes in with eosinophilia, what type of history qs should u ask?
- allergic diseases? asthma? eczema? hay fever?
- has she had a drug reaction?
if that true YAS, if not…
- look at her skin
- has she been travelling?
- any tropical sites u went to? parasitic infection (tape worms, round worms)
what do the granules of basophills contain?
(3 h’s)
Dense granules: >> -histimine, heparin, hyaluronic acid, seratonin
what r lymphocytes? what r causes of lymphocytosis?
- b cells
- t cells
- NK cells
- viral & bacterial infections
- post splenoctemy
- smoking
- stress related> MI/cardiac arrest
Lymphoproliferative ie malignant
- Chronic Lymphocytic Leukaemia (B cells)
- T- or NK- cell leukaemia
- Lymphoma (cells ‘spill’ out of infiltrated bone marrow)
Monocytes, macrophages and dendritic cells serve three main functions:
(APC)
- antigen presentation
- phagocytosis
- cytokine production
what 2 things can cause pancytopenia?
- increased production
- increased removal
Pancytopenia with a hypocellular bone marrow in anscence of abnormal filtrate and no fibrosis is known as _________
Aplastic anemia
(the bone marrow is such a fake “plastic” its got no cells in em!)
this is an image of the bone marrow, describe the finding and the disorder related
Aplastic Anemia >
Bone marrow has more fat cells and very few lymphocytes!
“empty bone marrow”
what is the haemopoietic stem cell? HPSC
where do we get them from? (2)
greatest power of self renewal,
it can differentiate into a variety of specialised cells, can undergo apoptosis
- aspiration of bone marrow> not done anymore
- we give hormone C-GSF, to push these stem cells out into the peripheral blood & we collect them.
what structure has a very RICH source of stem cells?
umbilicus
during delivery we had a ‘cord back’ where we take stem cells from the umbilicus
Describe th evalues u’d see for each!
Lymphocytosis >
Basophilia >
Eosinophilia >
Neutropenia >
Lymphocytosis = more > 4 x 109/L
Basophilia= > 1010
Eosinophilia =4.5×108/L
Neutropenia = <1.5 x 109/L
what is sarcoidosis?
symptoms?
Sarcoidosis is a rare condition that causes small patches of red and swollen tissue, called granulomas, to develop in the organs of the body. It usually affects the lungs and skin.
- tender, red bumps on the skin
- shortness of breath
- persistent cough
Splenomegaly can be caused by infiltration of stuff & cells that shouldnt be there!
give exmaples! and conditions
- cancer cells Eg: chronic lymphocytic leukemia CLL ( expanded white pulp nodules)
- sarcoidosis (granulomas)
- TB
stages of Splenomegaly
Massive – chronic myeloid leukaemia, myelofibrosis, chronic malaria, Schistosomiasis
Moderate – As above, PLUS lymphoproliferative disorders, myeloproliferative disorders, liver
cirrhosis with portal hypertension, infections such as Glandular Fever caused by Epstein Barr virus
Mild – As above, also infections such as infectious hepatitis, endocarditis; infiltrative disorders such as sarcoidosis; autoimmune diseases such as AIHA, ITP, SLE
- when ur spleen is enlarged,(splenomagaly) more of the blood will spend its time in the enlarged spleen, therfore u get this dilutional effect and u may get either Pancytopenia or thrombocytopenia .*
- we call this situtation …*
Hypersplenism!
where spleen is large and is overdoing its normal job!
increased in function basically
what protects the spleen for getting damaged?
the presence if the rib cage!
what is this ?
howell jolly bodies!
**normally in erythropoiesis, erythroblasts usually expel their nuclei away and the SPLEEN removes them. so if spleen isn’t working, u get those DNA clusters floating in the RBC. (look like very tiny scattered dots in blood film)
Hypochromia define
RBC paler than normal due to reduction in haemoglobin
Leucocytes can be broadly classified either by their (2)
structure (granulocytes and agranulocytes)
or
by their cell lineage (myeloid cells and lymphoid cells
bone marrow can be classifies as either
hypocellular or hypercellular,
which defines how much cells r in the bone marrow
give a condition where we would see a hypercellular bone marrow
heridterary spherocytosis
