The Spleen And White Cells

Question 1

What is red pulp in the spleen?

Answer 1

• sinuses linked with macrophages and cords

- The red cells move through it and old ones are recognised and phagocytosed

Question 2

What is white pulp in the spleen?

Answer 2

• Similar to lymphoid follicles
• Many leukocytes and macrophages present
• plasma passes through and if checked for bacteria ect

Question 3

What are the 4 key functions of the spleen?

Answer 3

• sequstration and phagocytosis of old RBCs
• Blood pooling (platelets and RBCs and then be mobilised when bleeding)
• Haematopoesis (if haematological stress/ bone marrow fails it has stem cells that can take over)
• immunological function (25% of t cells and 15% of white cells are here)

Question 4

How can a spleen be palpated?

Answer 4

can never normally be felt
start palpation from right fossa or a large one might be missed
Measure its size from costal margin in mid clavicular line and downwards

Question 5

What processes can cause splenomegaly?

Answer 5

• back pressure (portal hypertension in liver disease)
• overworking red or white pulp (haemolytic anaemias)
• if it starts haematopoesis
• cancers
• infiltration by other materials (gauchers or sarcoidosis)

Question 6

What can cause a massive splenomegaly?

Answer 6

• chronic myeloid leukaemia
• myelofibrosis
• malaria

Question 7

What can cause a moderate splenomegaly?

Answer 7

• lymphoproliferative disorders
• myeloproliferative disorders
• liver cirrhosis
• glandular fever (EBV infection)

Question 8

What can cause a mild splenomegaly?

Answer 8

• Hepatitis
• endocarditis
• sarcoidosis
• autoimmune disorders

Question 9

What complications are there to an enlarged spleen?

Answer 9

• if its enlarged its not protected by the spleen and so ruptures more easily leading to massive haemorrhage
• can also get pancytopenia due to blood pooling in the spleen

Question 10

What causes hyposplenism?

Answer 10

splenectomy
sickle cell (causes many infarcts in spleen)
coeliac

Question 11

What is seen on a blood film in someone with hyposplenism?

Answer 11

howell jolly bodies

- DNA remnant accumulations which look like red dots within cells

Question 12

What is the difference between cytopenia and cytosis/ cytophilia ?

Answer 12

Cytopenia is decrease in the number of blood cells.

Cytophillia is increase

Question 13

What is the name for a decrease in the number of WBCs?

Answer 13

leucopenia

Question 14

What is the name for a decrease in the number of neutrophils?

Answer 14

neutropenia

Question 15

What is the name for a decrease in the number of platelets?

Answer 15

thrombocytopenia

Question 16

What is the name for a decrease in the number of WBCs, RBCs and platelets?

Answer 16

pancytopenia

Question 17

What is the name for an increase in the number of WBCs?

Answer 17

leucocytosis

Question 18

What is the name for an increase in the number of RBCs?

Answer 18

erythrocytosis

Question 19

What is the name for an increase in the number of neutrophils?

Answer 19

neutrophillia

Question 20

What is the name for an increase in the number of lymphocytes?

Answer 20

lymphocytosis

Question 21

What is the name for an increase in the number of platelets?

Answer 21

thrombocytosis

Question 22

What promotes neutrophil maturation?

Answer 22

G- CSF

Question 23

What can cause neutrophilia?

Answer 23

• drugs- steroids
• tissue damage
• infection
• cancer
• cytokines
• metabolic/ endocrine disorders
• smoking
• haemorrhage (acute)
• myeloproliferative disorders

Question 24

What can cause neutropenia?

Answer 24

decreased production:
- drugs (chemo, antiphychotics)
- radiation 
- bone marrow failure 
- viral infections 
- B12/ folate deficiency 
increased removal/ use:
- sepsis 
- splenic pooling 
- immune destruction

Question 25

What are the consequences of neutropenia?

Answer 25

• severe bacteria and fungal infections

- painful mouth ulcers

Question 26

What can cause monocytosis? (increase)

Answer 26

• chronic infections (TB)
• chronic inflammatory conditions (RA, crohns, UC)
• Myeloproliferative disorders

Question 27

How long do eosinophils last and what do the respond to?

Answer 27

• 8-12 days

- deal w/ parasites, allergic responses and hypersensitivity reactions

Question 28

What can cause eosinophilia?

Answer 28

• allergic reactions
• drug hypersensitivity
• parasite infections
• skin diseases
• hodgkin lymphoma, leukaemia, myeloproliferative disorders and eosinphillic leukaemia

Question 29

What do basophils look like and what is their role?

Answer 29

• like berries

- release granules of histamine, heparine ect in inflammation and allergic reactions

Question 30

What causes basophilia?

Answer 30

• chronic inflammation disorders (RA, UC)
• immediate hypersensititivy reactions
• myeloproliferative disorders

Question 31

name some lymphocytes?

Answer 31

B cells, T cells, NK cells

Question 32

What can cause lymphocytosis?

Answer 32

• bacterial infections
• viral infections
• MI/ cardiac arrest
• leaukaemia of T, B or NK cells
• lymphoma where cells spill out of bone marrow
• smoking
• post splenectomy

Question 33

What can cause pancytopenia?

Answer 33

reduced production:
- B12/ folate deficiency 
- malignancy
- marrow fibrosis 
- aplastic anaemia 
- radiation 
- drugs (chemo, antibiotics)
- viruses (EBV, HIV, hepatitis)
increased removal 
- splenic pooling 
- haemophagocytosis 
- immune destruction

Question 34

What are symptoms of pancytopenia?

Answer 34

• anaemia (dizzy, fatigue, chest pain ect)
• low platelets (bleeding, bruising)
• low neutrophils (infection, ulcers, fevers)
• also symptoms from underlying cause