Transplantation and amyloidosis

Question 1

Heterologous transplant

Answer 1

Transplant between different species

Question 2

Allogenic Transplant

Answer 2

tissue transplant between two individuals of the same species

Question 3

Autologous transplant

Answer 3

patient transplants something to themselves

Question 4

Factors that determine if host accepts the graft

Answer 4

HLA matching- the more matches the better Recipient immunosuppression

Question 5

Complications of organ transplant

Answer 5

Graft rejection Recipient immunosuppresion allowing for opportunisitic infections and neoplasms GVHD- Bone marrow transplants

Question 6

Rejection mechanisms- T cell mediated

Answer 6

CD4 mediated delayed Hypersensitivity rxn CD8 mediated cytotoxicity

Question 7

Rejection mechanisms- B cell

Answer 7

Preformed Ig against graft Acquire or make Ig against graft

Question 8

Hyperacute Rejection- mediated by

Answer 8

Preformed Ig- probably from previous blood transfusions, normally test to ensure this doesn’t occur

Question 9

Hyperacture Rejection - when

Answer 9

Quickly in the OR

Question 10

Acute rejction- mediated by

Answer 10

Combined cellular and humoral rejection

Question 11

Acute rejection- when

Answer 11

Days after transplant or much later if occurs after patient stops their immunosuppressive meds

Question 12

Acute rejection- can transplant be salvaged

Answer 12

maybe if the pt goes back on their immunosupressive meds

Question 13

Chronic rejection is associated with

Answer 13

Progressive deterioration vascular damage and fibrosis from host attacking the graft

Question 14

Chronic rejection- can the transplant be salvaged

Answer 14

NO

Question 15

GVHD

Answer 15

immunocompetent cells are transplanted into an immunocompromised host

Question 16

GVHD- types of transplants

Answer 16

Bone marrow

Question 17

GVHD commonly affects what areas

Answer 17

skin, liver, and intestine

Question 18

Amyloidosis- what is amyloid

Answer 18

pathologic proteinatinaceous substance

Question 19

Amyloidosis appearance

Answer 19

amorphous, pink, hyaline

Question 20

Amyloidosis- intra or extracellular

Answer 20

extracellular- presses on cells causing pressure atrophy

Question 21

Amyloidosis- structure

Answer 21

uniform appearance due to beta pleated sheet structure

Question 22

What is localized amyloidosis?

Answer 22

limited to single organ

Question 23

What is generalized amyloidosis?

Answer 23

systemic- can be split into primary and secondary

Question 24

Primary amyloidosis is associated with

Answer 24

immune system- plasma cell dyscardia

Question 25

Secondary amyloidosis is the result of

Answer 25

complication of underlying chronic inflammation

Question 26

What is AL amyloid

Answer 26

Immunoglobulin light chains

Question 27

what is AA amyloid

Answer 27

Associated amyloid non immunoglobulin synthesized by the liver

Question 28

what is AB amyloid

Answer 28

beta amyloid found in CNS ALZ lesions

Question 29

AL amyloid is often produced by, and is associated with what disease

Answer 29

malignant plasma cell clone Multiple Myeloma

Question 30

how many different types of light chain are in AL vs normal

Answer 30

normally both lambda and kappa type light chains are found AL only consists of one or the other

Question 31

Where is AA synthesized

Answer 31

Liver, but isnt cleared properly

Question 32

stimulation of what cells leads to AA

Answer 32

macrophages

Question 33

what diseases are associated with AA

Answer 33

rheumatoid arthritis TB chronic osteomyelitis

Question 34

How would bone marrow of AL patients look

Answer 34

probably hypercellular due to multiple myeloma

Question 35

when AL is stained what color is it in normal light

Answer 35

Pink

Question 36

AL stain under polarized light

Answer 36

apple green fluoresence under polarized light

Question 37

what organs are often effected by amyloidosis

Answer 37

Kidney Liver heart- stiff and lack elasticity GI tract- poor motility, diarrhea due to lack of absorption

Question 38

Acute cellular rejection- what features do you notice

Answer 38

Acute cellular rejection of a renal allograft. A, An intense mononuclear cell infiltrate occupies the space between the tubules. ## Footnote B, T cells (stained brown by the immunoperoxidase technique) are abundant in the interstitium and infiltrating a tubule. Small nuclei are lymphocytes and lumen of tubules can become fibrotic

Question 39

Ig mediated acute rejection

Answer 39

Antibody-mediated damage to the blood vessel in a renal allograft. The blood vessel is markedly thickened, and the lumen is obstructed by proliferating fibroblasts and foamy macrophages.

Question 40

Chronic Rejection

Answer 40

A, Changes in the kidney in chronic rejection: graft rteriosclerosis, tubular atrophy, and interstial fibrosis B, Graft arteriosclerosis. The vascular lumen is replaced by an accumulation of smooth muscle cells and connective tissue in the vessel intima.

Question 41

GVHD rash

Answer 41

Rash commonly associated with GVHD- seen on skin and mucous membranes

Question 42

GVHD histo

Answer 42

Epidermis Blue dots are donor T cells attacking host epithelial cells

Question 43

Amyloidosis of kidney

Answer 43

Amyloidosis of the kidney. The glomerular architecture is almost totally obliterated by the massive accumulation of amyloid. Pink material in the BM of glomerular caps. Congo red under routine light is pink

Question 44

Amyloidosis in liver

Answer 44

A section of the liver stained with Congo red reveals pink-red deposits of amyloid in the walls of blood vessels and along sinusoids Normally starts near BV wall but it can go anywhere

Question 45

Cardiac Amyloidosis

Answer 45

Cardiac amyloidosis. The atrophic myocardial fibers are separated by structureless, pink-staining amyloid (arrows). - Shrunken myocytes. Wavy material in heart

Question 46

Normal colon epithelium vs colon epithelium with amyloidosis

Answer 46

Thickened BM that seperates epithelium from the lamina propria. This can impair absorption leading to diarrhea

Question 47

What is this what stain is this

Answer 47

Congo red stain of colon mucosa under polarized light thus appearing apple green