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Haematology > The Lymphoid System > Flashcards

The Lymphoid System Flashcards

1
Q

What are the steps in the production of lymphoid cells?

A

Haematopoietic stem cells - precursor lymphoid cells - maturation in bone marrow or thymus - secondary lymphoid organs

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2
Q

What cells mature in the bone marrow?

A

B cells

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3
Q

What cells mature in the thymus?

A

T cells

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4
Q

What are the central (primary) lymphoid tissues?

A

Bone marrow and thymus

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5
Q

What are the peripheral (secondary) lymphoid tissues?

A

Lymph nodes, spleen, tonsils, epithelio-lymphoid tissues, bone marrow

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6
Q

What are some functions of the lymphatic system?

A

Returns lymph to circulation = important in fluid homeostasis and preventing oedema
Permits cell traffic, cell trapping and interaction of cells and molecules with cells of the immune system

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7
Q

How are lymph node groups identified?

A

Distinct groups can be palpated = cervical, axillary, inguinal
Major groups can be viewed radiologically (e.g para-aortic)

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8
Q

How is lymph drainage by nodes arranged?

A

Groups of nodes drain particular territories

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9
Q

What are lymph nodes?

A

Small oval bodies up to 2cm in size that are located along the course of lymphatic vessels

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10
Q

What are lymphatic vessels?

A

Blind ending vascular channels that collect fluid from tissues and return to bloodstream

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11
Q

What do lymphatic vessels allow?

A

Passive movement of fluid = valves ensure direction of flow

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12
Q

What drains lymph through the capsule of lymph nodes?

A

Afferent channels = drain through capsule and into peripheral sinus

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13
Q

Where does the efferent vessel of the lymph node drain to?

A

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

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14
Q

Where does lymph drain into the venous system?

A

At the junction of the left or right subclavian and jugular veins

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15
Q

Where do the arterial and venous vessels serving the lymph node enter/exit from?

A

At the hilum

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16
Q

Where is lymph filtered in the lymph node?

A

Filtered within the node parenchyma before returning to the bloodstream = traffic of cells between lymph and node parenchyma

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17
Q

How is the lymphoid system involved in the immune response?

A

Houses cells of innate immune system = traffics APCs to link innate and adaptive systems
Seat of adaptive immune response

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18
Q

What lymphocytes are present in the lymphoid system that serve in the immune response?

A

B cells
T cells = T helper cells, T cytotoxic cells
Natural killer cells

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19
Q

What are some features of the B cells involved in the lymphoid system?

A

Associated with follicles and germinal centres = interfollicular, plasma cells (mainly in medulla)

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20
Q

What immune cells does the lymphoid system conatin?

A

Lymphocytes, macrophages, antigen presenting cells (APCs), dendritic cells, endothelial cells

21
Q

What are some CD numbers associated with B and T cells?

A

CD20 is associated with B cells

CD3 is a T cell marker

22
Q

What are some causes of lymphadenopathy?

A

Local inflammation = infection, vaccination
Systemic inflammation = viral infection, autoimmune
Malignancy = metastatic, leukaemia/lymphoma
Others = sarcoidosis, Castleman’s, IgG4 related

23
Q

How should regional lymphadenopathy be examined for?

A

Examine the territory that drains the particular group of nodes

24
Q

What is associated with some causes of superficial inflammation causing regional lymphadenopathy?

A

Lymphangitis = red lines extending from an inflamed lesion, may be first sign of underlying malignancy

25
Q

What is generalised lymphadenopathy a sign of?

A

A systemic inflammatory process or widespread malignancy = lymphoma/leukaemia are high on differentials (check FBC)

26
Q

What are the different processes that cause lymph nodes to be enlarged?

A

Predominant B cell response = autoimmune, infection
Predominant phagocytic response = draining a tumour site
Predominant T cell response = viral infections, drugs

27
Q

Where is the spleen loacted?

A

High in left upper quadrant of abdomen = usually non-palpable unless substantially enlarged

28
Q

What are the two surfaces of the spleen?

A

Diaphragmatic and visceral

29
Q

What structures is the visceral surface of the spleen in contact with?

A

Left kidney, gastric fundus, tail of pancreas, splenic flexure of colon

30
Q

What is the vasculature of the spleen?

A

Supplied by splenic artery = branch of coeliac axis

Drained by splenic vein = joins with superior mesenteric vein to form portal vein

31
Q

What effect does a disease spleen have on the likelihood of rupture?

A

Diseased spleen is more likely rupture

32
Q

Is the spleen encapsulated?

A

Yes

33
Q

What does the parenchyma of the spleen contain?

A

Red pulp = contains sinusoids and cords

White pulp = contains CD4+ T cells

34
Q

What are some features of splenic sinusoids?

A

Fenestrated with a lining of endothelial cells

Supported by hoops of reticulin

35
Q

What do splenic cords contain?

A

Macrophages and some fibroblasts

Cells in transit = RBC, WBC, PC and some CD8+ T cells

36
Q

What are some of the functions of the spleen?

A

Detects, retains and eliminates unwanted, foreign or damaged red material
Facilitates immune response to blood-borne antigens

37
Q

What does the white pulp of the spleen comprise?

A

Peri-arteriolar lymphoid sheath (PALS) = contains CD4+ T cells and is expanded by lymphoid follicles

38
Q

How does the white pulp of the spleen trigger an immune response?

A

Antigen reaches white pulp via blood and APCs in the white pulp present antigen to immune reactive cells = T and B cell responses can then occur

39
Q

What are some of the features associated with splenomegaly?

A

Dragging sensation in LUQ, discomfort with eating, pain (if ischaemia present), hypersplenism

40
Q

What is the triad of hypersplenism?

A

Splenomegaly, fall in one or more cellular components of blood, correction of cytopenias by splenectomy

41
Q

What are some causes of splenomegaly?

A

Infection = TB, EBV, malaria, typhoid
Congestion and haematological disease
Inflammatory conditions = SLE, rheumatoid
Storage disease = Gaucher’s, Niemann-Pick disease
Others = amyloid, tumours, cysts

42
Q

What are some causes of congestion that lead to splenomegaly?

A

Hepatic cirrhosis, cardiac failure, portal or splenic vein thrombosis

43
Q

What haematological disease cause splenomegaly?

A

Lymphoma and leukaemia, haemolytic anaemia, ITP, myeloproliferative disorders

44
Q

What is hypersplenism associated with?

A

Conditions that cause splenomegaly

45
Q

What is the diagnostic test for hypersplenism?

A

Splenectomy

46
Q

What must be considered in patients with hypersplenism and bone marrow failure?

A

May have to balance productivity of spleen with its role in excessive removal of circulating blood cells

47
Q

What are the causes of hyposplenism?

A

Most commonly due to splenectomy

Others = Coeliac, sickle cell disease, sarcoidosis, iatrogenic

48
Q

What is mostly responsible for the features of hyposplenism?

A

Reduced red pulp function = Howell-Jolly bodies, other red cell abnormalities

49
Q

What can be an additional feature of hyposplenism?

A

Immune deficiency = especially if spleen is removed in childhood

Haematology (24 decks)

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