The Spleen, White Cells and Cytopenia

Question 1

Where is the spleen located?

Answer 1

In the left upper quadrant of the abdomen

Question 2

The spleen is split by two types of tissue, what are they?

Answer 2

Red pulp: sinuses linked by endothelial macrophages

White pulp: similar structure to lymphoid follicles “giant lymph nodes”

Question 3

Which cells pass through the red pulp and which cells pass through the white pulp, primarily?

Answer 3

Red cells primarily through red pulp

White cells and plasma pass though white pulp

Question 4

What is the primary function of the spleen?

How does the function of the white pulp differ from that of the red pulp?

Answer 4

Filters blood
Red pulp: removes old RBCs and metabolises haemoglobin
White pulp: synthesises antibodies and removes antibody coated bacteria and blood cells

Question 5

What are the other important functions of the spleen?

Answer 5

Extramedullary haemopoiesis
Immunological function
Blood pooling

Question 6

Enlarged spleen is known as what?

How can you tell if someone has an enlarged spleen?

Answer 6

Splenomegaly

Palpate it, it is never normal to be able to feel the spleen

Question 7

What is the spleen at risk of when it is enlarged?

Answer 7

Rupture

Question 8

Name some causes of splenomegaly

Answer 8

Haemolytic anaemia
Congestion due to portal hypertension
Infiltration by lymphomas and leukaemias e.g. CLL
Accumulation of waste products e.g. Gaucher’s disease

Question 9

What is hyposplenism?

Answer 9

Reduced/absence of splenic function

Question 10

What are some causes of hypospenism?

Answer 10

Splenectomy
Sickle cell disease
Coeliac disease - destroys spleen tissue

Question 11

What are Howell-Jolly bodies?

Answer 11

Basophilic DNA remnants (clusters of DNA) in circulating erythrocytes

Question 12

When will Howell-Jolly bodies be present on a blood film?

Answer 12

If the patient has hyposplenism (reduced spleen function)

Question 13

Asplenic patients are at particular risk from what?

How is this prevented?

Answer 13

Encapsulated bacteria

Vaccinating against “NHS” and education/counselling

Question 14

What is meant by “cytopenia”?

Answer 14

A reduction in the number of blood cells

Question 15

Low RBC count is known as what?

Answer 15

Anaemia

Question 16

Low white cell count is known as what?

Answer 16

Leucopenia

Question 17

Low neutrophil count is known as what?

Answer 17

Neutropenia

Question 18

What is thrombocytopenia?

Answer 18

Low platelet count

Question 19

What is “Pancytopenia”?

Answer 19

Low RBCs, Low WBCs and low platelets

Question 20

What two suffixes indicate an increase in the production of cells?

Answer 20

“cytosis”

“philia”

Question 21

A high RBC count is known as what?

Answer 21

Erthyrocytosis

Question 22

A high white cell count is known as what?

Answer 22

Leukocytosis

Question 23

What is neutrophilia?

Answer 23

High neutrophil count

Question 24

What is lymphocytosis?

Answer 24

High lymphocyte count

Question 25

A high platelet count is known as what?

Answer 25

Thrombocytosis

Question 26

In which two categories can leukocytes be classed based on their structure?

Answer 26

Granulocytes | Agranulocytes

Question 27

In which two categories can leukocytes be classed based on their cell lineage?

Answer 27

Myeloid | Lymphoid

Question 28

How do neutrophils stain with H&E? | How are these cells easily recognised on a blood film?

Answer 28

Neutral pink | They have a 2-5 lobed nucleus

Question 29

How do basophils stain with H&E?

Answer 29

Dark blue

Question 30

How do eosinphils stain with H&E?

Answer 30

Bright red

Question 31

Neutrophil function is controlled by what? | How does it work?

Answer 31

G-CSF (Granulocyte-colony stimulating factor) | Increases their production in the bone marrow, decreases their maturation time, enhances chemotaxis and phagocytosis

Question 32

G-CSF can be administered to do what?

Answer 32

Reduce neutropenic infection

Question 33

Neutrophilia can result from what?

Answer 33

``` Bacterial infection Smoking Tissue damage Cancer Drugs e.g. steroids Acute inflammation Acute haemorrhage Myeloproliferative diseases ```

Question 34

Neutropenia can result from what?

Answer 34

``` B12/folate deficiency Infiltration of BM by malignancy or fibrosis Aplastic anaemia Chemotherapy Viruses!! Immune destruction Sepsis ```

Question 35

What are some of the consequences of neutropenia?

Answer 35

Severe life-threatening infection: bacterial or fungal Mucosal ulceration Neutropenic sepsis !!!! Emergency

Question 36

What are non-lobed neutrophils in the peripheral circulation indicative of? Why?

Answer 36

Overwhelming sepsis or blood cancer | These are immature cells that the bone marrow is pumping out in order to try and deal with the overwhelming infection

Question 37

Monocytes are the _________ type of leukocyte

Answer 37

Largest

Question 38

Monocytes circulate in the blood before moving into tissues and differentiating into ________ or ___________

Answer 38

macrophages | dendritic cells

Question 39

Monocytes, macrophages and dendritic cells have three main function, what are they?

Answer 39

Phagocytosis Antigen presentation Cytokine production

Question 40

Under what circumstances might monocytosis occur?

Answer 40

Chronic inflammatory conditions: RA, lupus, UC, Crohn's Chronic infection e.g. TB Carcinoma Myeloproliferative/leukaemias: CMML, aCML, JMML

Question 41

What is this life span of a typical eosinophil in the circulation?

Answer 41

Short: 3-8 hours

Question 42

Eosinophils are responsible for dealing with what kinds of infection?

Answer 42

Parasitic infections | Allergic response- hypersensitivity reactions

Question 43

What is the classic appearance of an eosinophil on a blood slide?

Answer 43

"Burnt face with sunglasses on" | Bilobed nucleus, stain red with EOSIN

Question 44

How do eosinophils destroy invading pathogens?

Answer 44

They release their granular contents of enzymes, ROS and cytokines

Question 45

What are some diseases that will present with eosinophilia?

Answer 45

Allergic disease: Asthma, Eczema Drug hypersensitivity Parasitic infections Myeloproliferative conditions/ leukaemias: Hodgkin lymphoma, acute ML

Question 46

Basophils are the ______ common of the leukocytes

Answer 46

Least

Question 47

How might a basophil appear on a blood slide?

Answer 47

Large, looks like a blackberry- contains dense granules that may distort the nucleus

Question 48

What is the role of basophils?

Answer 48

Allergic response | Parasitic infection

Question 49

What is contained within the dense granules that occupy basophils? When would these be released?

Answer 49

Histamine and heparin | Released following binding to IgE receptors

Question 50

Under what conditions might basophilia occur?

Answer 50

Immediate hypersensitivity reactions: drugs, allergy Inflammatory conditions (UC, RA) Chicken pox, TB Myeloproliferative neoplasms: leukaemia

Question 51

What are the three types of lymphocyte and what is their role in immune function?

Answer 51

B lymphocytes - humeral, antibody-driven adaptive immunity T lymphocytes - cell-mediated adaptive immunity NK cells - cell-mediated cytotoxic innate immunity

Question 52

Lympocytosis is a common feature of what, especially in children?

Answer 52

Infection

Question 53

How might pancytopenia be caused?

Answer 53

``` Reduced B12/folate production Immune destruction Splenic pooling, hyposplenism Malignancy or fibrosis Drugs Viruses ```

Question 54

What is aplastic anaemia?

Answer 54

Pancytopenia with a hypocellular bone marrow in the absence of an abnormal infiltrate with no fibrosis

Question 55

What are the symptoms of pancytopenia?

Answer 55

Fatigue, dizziness, chest pain, shortness of breath, bleeding, bruising, infection, ulcers