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Haematology > The Lymphoid System > Flashcards

The Lymphoid System Flashcards

1
Q

Where does B cell maturation occur?

A

Bone marrow

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2
Q

Where does T cell maturation occur?

A

Thymus

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3
Q

What are the primary lymphoid tissues?

A

Bone marrow

Thymus

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4
Q

What are the secondary lymphoid tissues?

A 
Lymph nodes
Spleen 
Tonsils (waldeyer's ring) 
Epithelio-lymphoid tissues
Bone marrow
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5
Q

What is the function of the lymph system?

A

Fluid haemostasis
Prevents excessive accumulation of fluid in tissues
Permits cell traffic and trapping
Allows for interaction of cells and molecules with immune cells

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6
Q

What are lymph nodes?

A

Small oval bodies, up to 2.5cm in size

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7
Q

What is located along the course of lymphatic vessels?

A

Blind ending vascular channels that collect fluid from tissues and return it to the blood stream
Passive movement of fluid
Valves ensure direction of flow

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8
Q

What is the role of afferent channels in lymph nodes?

A

Drain lymph through capsule into the peripheral sinus

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9
Q

Where will lymph drain to from the lymph nodes?

A

Cisterna chyli/ thoracic duct
Left jugular, subclavian or bronchomediastinal trunks
Right jugular, subclavian or bronchomediastinal trunks

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10
Q

How will lymph go from the lymphatic system to the venous system?

A

Thoracic angle; junction of L/R subclavian and jugular veins

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11
Q

Where do arterial and venous vessels that serve the node enter/exit?

A

Hilum

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12
Q

What is lymph filtered through before it returns to the blood stream?

A

Lymph node parenchyma

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13
Q

How does the lymphoid system act as a defensie system?

A

House cells of innate immune system
Traffic of APCs links innate and adaptive immune responses
Allows for specificity, inducibility, memory and an enhanced secondary reaction

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14
Q

Where can B cells be found in the lymphatic system?

A

Follicles and germinal centers
Interfollicular
Plasma cells in the medulla of lymph nodes

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15
Q

What cell populations are found in lymph nodes?

A 
B cells
T cells 
NK cells
Macrophages 
Dendritic cells 
Endothelial cells
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16
Q

What is CD20 a marker of?

A

B cells

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17
Q

What is CD3 a marker of?

A

T cells

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18
Q

What can cause local lymphadenopathy?

A

Infection; TB, toxoplasma
Vaccination
Dermatopathic

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19
Q

What is dermatopathic lymphadenopathy?

A

A distinctive reaction pattern in lymph nodes characterized by paracortical hyperplasia composed of dendritic cells, Langerhans cells, macrophages containing melanin pigment, and T-cells

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20
Q

What can cause systemic lymphadenoapthy?

A 
Infection; viral 
Autoimmune 
Sarcoidosis 
IgG4 related disease 
Castelmans disease
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21
Q

What can cause malignant lymphadenopathy?

A

Haem; lymphoma/ leukaemia

Metastatic

22
Q

What is sarcoidosis?

A

Granulomatous disease

Can mask malignancy in a lymph node

23
Q

What is lymphangitis?

A

Superficial infection that tracts in lymph system

24
Q

What can superficial lymphadenopathy be the first sign of?

A

Malignancy

25
Q

What does generalised lymphadenopathy suggest?

A

Systemic inflammation or widespread malignancy

26
Q

If you suspect lymphoma/ leukaemia due to generalised lymphadenopathy, what should you do?

A

Check the FBC

27
Q

How can you differentiate a lymph node enlargement from a reactive process and a neoplastic process?

A

Reactive; different patterns
Neoplastic; filtration function hampered
Primary
Look at B cell response and T cell response separately

28
Q

What does a predominant B cell response in lymph node enlargement suggest?

A

Autoimmune conditions

Infections

29
Q

What does a predominant phagocytic response in a lymph node enlargement suggest?

A

Drainage of tumour site

30
Q

What does a predominantly T cell response in a lymph node enlargement suggest?

A

Viral infection

Drugs; phenytoin

31
Q

Where is the spleen located?

A

Left upper quadrant
Diaphragmatic surface
Visceral surface; left kidney, gastric fundus, tail of pancreas, splenic flexure of colon

32
Q

What supplies the spleen?

A 
Splenic artery (branch of coeliac axis) 
Draine by splenic vein (joins with SMV to form portal vein)
33
Q

Is the spleen encapsulated?

A

Yes

34
Q

What is contained within the spleen parenchyma?

A

Red pulp

White pulp

35
Q

What does red pulp contain?

A

Sinusoids and cords

36
Q

Describe the sinusoids in the spleen

A

Fenestrated
Lined by endothelial cells
Supported by hoops of reticulin

37
Q

What do the cords of the spleen contain?

A

Macrophages
Fibroblasts
Cells in transit; RBC, WBC, PC, CD8+ T cells

38
Q

What is the function of the spleen?

A

Filter for blood
Detects, retains and eliminates unwanted foreign or damaged material
Facilitates immune responses to blood borne antigens

39
Q

What does the white pulp of the spleen contain?

A

Periarteriolar lymphoid sheath (PALS) = CD4+ T cells

Expanded by lymphoid follicles in reactive changes

40
Q

How do antigens reach the white pulp of the spleen?

A

Blood
APCs in white pulp will present antigen to immune reactive cells
when stimulated by antigen, T c and B cells respond

41
Q

What are the symptoms of splenic enelargement?

A

Dragging sensation in LUQ
Discomfort with eating (pressure on gastric fundus)
Pain if infarction
Hypersplenism

42
Q

What is the triad of hypersplenism?

A

Splenomegaly
Fall in one of more cellular components of blood
Correction of cytopenias by splenomegaly

43
Q

What infections can cause splenomegaly?

A 
EBV
Malaria 
TB
Typhoid
Brucellosis
Leishmaniasis
Trypanosomiasis
44
Q

What diseases can result in congestion and subsequent splenomegaly?

A

Portal:
Hepatic cirrhosis
Portal/ splenic vein thrombosis
Cardiac failure

45
Q

What haem disorders can result in splenomegaly?

A 
Lymphoma 
Leukaemia
Haemolytic anaemia 
ITP 
Myeloproliferative disorders
46
Q

What inflammatory conditions can result in splenomegaly?

A

RA

SLE

47
Q

What storage diseases can result in splenomegaly?

A

Gaucher’s

Niemann-Pick disease

48
Q

Broadly, what can cause splenomegaly?

A 
Infection 
Congestion 
Haem diseases 
Inflammatory conditions 
Storage disease 
Amyloid 
Tumours 
Cysts
49
Q

What can cause hypersplenism?

A

Associated with splenomegaly

Key diagnostic feature of hypersplenism if splenectomy

50
Q

What can cause hyposplenism?

A 
Splenectomy
Coeliac disease 
Sickle cell 
Sarcoid 
Iatrogenic
51
Q

What causes the symptoms seen in hyposplenism?

A

RED pulp dysfunction; howell jolly bodies

Haematology (31 decks)

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