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Metabolism, Endocrinology & Haematology > The Spleen, White Cells and Cytopenia > Flashcards

The Spleen, White Cells and Cytopenia Flashcards

1
Q

Where is the spleen located?

A

In the left upper quadrant of the abdomen

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2
Q

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

A

Red pulp: sinuses linked by endothelial macrophages

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

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3
Q

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

A

Red cells primarily through red pulp

White cells and plasma pass though white pulp

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4
Q

What is the primary function of the spleen?

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

A

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

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5
Q

What are the other important functions of the spleen?

A

Extramedullary haemopoiesis
Immunological function
Blood pooling

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6
Q

Enlarged spleen is known as what?

How can you tell if someone has an enlarged spleen?

A

Splenomegaly

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

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7
Q

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

A

Rupture

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8
Q

Name some causes of splenomegaly

A

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

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9
Q

What is hyposplenism?

A

Reduced/absence of splenic function

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10
Q

What are some causes of hypospenism?

A

Splenectomy
Sickle cell disease
Coeliac disease - destroys spleen tissue

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11
Q

What are Howell-Jolly bodies?

A

Basophilic DNA remnants (clusters of DNA) in circulating erythrocytes

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12
Q

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

A

If the patient has hyposplenism (reduced spleen function)

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13
Q

Asplenic patients are at particular risk from what?

How is this prevented?

A

Encapsulated bacteria

Vaccinating against “NHS” and education/counselling

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14
Q

What is meant by “cytopenia”?

A

A reduction in the number of blood cells

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15
Q

Low RBC count is known as what?

A

Anaemia

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16
Q

Low white cell count is known as what?

A

Leucopenia

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17
Q

Low neutrophil count is known as what?

A

Neutropenia

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18
Q

What is thrombocytopenia?

A

Low platelet count

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19
Q

What is “Pancytopenia”?

A

Low RBCs, Low WBCs and low platelets

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20
Q

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

A

“cytosis”

“philia”

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21
Q

A high RBC count is known as what?

A

Erthyrocytosis

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22
Q

A high white cell count is known as what?

A

Leukocytosis

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23
Q

What is neutrophilia?

A

High neutrophil count

24
Q

What is lymphocytosis?

A

High lymphocyte count

25
Q

A high platelet count is known as what?

A

Thrombocytosis

26
Q

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

A

Granulocytes

Agranulocytes

27
Q

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

A

Myeloid

Lymphoid

28
Q

How do neutrophils stain with H&E?

How are these cells easily recognised on a blood film?

A

Neutral pink

They have a 2-5 lobed nucleus

29
Q

How do basophils stain with H&E?

A

Dark blue

30
Q

How do eosinphils stain with H&E?

A

Bright red

31
Q

Neutrophil function is controlled by what?

How does it work?

A

G-CSF (Granulocyte-colony stimulating factor)

Increases their production in the bone marrow, decreases their maturation time, enhances chemotaxis and phagocytosis

32
Q

G-CSF can be administered to do what?

A

Reduce neutropenic infection

33
Q

Neutrophilia can result from what?

A 
Bacterial infection 
Smoking 
Tissue damage 
Cancer 
Drugs e.g. steroids 
Acute inflammation
Acute haemorrhage 
Myeloproliferative diseases
34
Q

Neutropenia can result from what?

A 
B12/folate deficiency 
Infiltration of BM by malignancy or fibrosis 
Aplastic anaemia 
Chemotherapy 
Viruses!! 
Immune destruction 
Sepsis
35
Q

What are some of the consequences of neutropenia?

A

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

36
Q

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

A

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

37
Q

Monocytes are the _________ type of leukocyte

A

Largest

38
Q

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

A

macrophages

dendritic cells

39
Q

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

A

Phagocytosis
Antigen presentation
Cytokine production

40
Q

Under what circumstances might monocytosis occur?

A

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

41
Q

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

A

Short: 3-8 hours

42
Q

Eosinophils are responsible for dealing with what kinds of infection?

A

Parasitic infections

Allergic response- hypersensitivity reactions

43
Q

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

A

“Burnt face with sunglasses on”

Bilobed nucleus, stain red with EOSIN

44
Q

How do eosinophils destroy invading pathogens?

A

They release their granular contents of enzymes, ROS and cytokines

45
Q

What are some diseases that will present with eosinophilia?

A

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

46
Q

Basophils are the ______ common of the leukocytes

A

Least

47
Q

How might a basophil appear on a blood slide?

A

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

48
Q

What is the role of basophils?

A

Allergic response

Parasitic infection

49
Q

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

A

Histamine and heparin

Released following binding to IgE receptors

50
Q

Under what conditions might basophilia occur?

A

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

51
Q

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

A

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

52
Q

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

A

Infection

53
Q

How might pancytopenia be caused?

A 
Reduced B12/folate production 
Immune destruction 
Splenic pooling, hyposplenism 
Malignancy or fibrosis 
Drugs 
Viruses
54
Q

What is aplastic anaemia?

A

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

55
Q

What are the symptoms of pancytopenia?

A

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

Metabolism, Endocrinology & Haematology (13 decks)

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