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Transplantation and amyloidosis Flashcards

1
Q

Heterologous transplant

A

Transplant between different species

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2
Q

Allogenic Transplant

A

tissue transplant between two individuals of the same species

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3
Q

Autologous transplant

A

patient transplants something to themselves

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4
Q

Factors that determine if host accepts the graft

A

HLA matching- the more matches the better Recipient immunosuppression

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5
Q

Complications of organ transplant

A

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

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6
Q

Rejection mechanisms- T cell mediated

A

CD4 mediated delayed Hypersensitivity rxn CD8 mediated cytotoxicity

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7
Q

Rejection mechanisms- B cell

A

Preformed Ig against graft Acquire or make Ig against graft

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8
Q

Hyperacute Rejection- mediated by

A

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

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9
Q

Hyperacture Rejection - when

A

Quickly in the OR

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10
Q

Acute rejction- mediated by

A

Combined cellular and humoral rejection

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11
Q

Acute rejection- when

A

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

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12
Q

Acute rejection- can transplant be salvaged

A

maybe if the pt goes back on their immunosupressive meds

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13
Q

Chronic rejection is associated with

A

Progressive deterioration vascular damage and fibrosis from host attacking the graft

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14
Q

Chronic rejection- can the transplant be salvaged

A

NO

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15
Q

GVHD

A

immunocompetent cells are transplanted into an immunocompromised host

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16
Q

GVHD- types of transplants

A

Bone marrow

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17
Q

GVHD commonly affects what areas

A

skin, liver, and intestine

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18
Q

Amyloidosis- what is amyloid

A

pathologic proteinatinaceous substance

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19
Q

Amyloidosis appearance

A

amorphous, pink, hyaline

20
Q

Amyloidosis- intra or extracellular

A

extracellular- presses on cells causing pressure atrophy

21
Q

Amyloidosis- structure

A

uniform appearance due to beta pleated sheet structure

22
Q

What is localized amyloidosis?

A

limited to single organ

23
Q

What is generalized amyloidosis?

A

systemic- can be split into primary and secondary

24
Q

Primary amyloidosis is associated with

A

immune system- plasma cell dyscardia

25
Q

Secondary amyloidosis is the result of

A

complication of underlying chronic inflammation

26
Q

What is AL amyloid

A

Immunoglobulin light chains

27
Q

what is AA amyloid

A

Associated amyloid non immunoglobulin synthesized by the liver

28
Q

what is AB amyloid

A

beta amyloid found in CNS ALZ lesions

29
Q

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

A

malignant plasma cell clone Multiple Myeloma

30
Q

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

A

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

31
Q

Where is AA synthesized

A

Liver, but isnt cleared properly

32
Q

stimulation of what cells leads to AA

A

macrophages

33
Q

what diseases are associated with AA

A

rheumatoid arthritis TB chronic osteomyelitis

34
Q

How would bone marrow of AL patients look

A

probably hypercellular due to multiple myeloma

35
Q

when AL is stained what color is it in normal light

A

Pink

36
Q

AL stain under polarized light

A

apple green fluoresence under polarized light

37
Q

what organs are often effected by amyloidosis

A

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

38
Q

Acute cellular rejection- what features do you notice

A

Acute cellular rejection of a renal allograft. A, An intense mononuclear cell infiltrate occupies the space between the tubules.

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

39
Q

Ig mediated acute rejection

A

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.

40
Q

Chronic Rejection

A

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.

41
Q

GVHD rash

A

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

42
Q

GVHD histo

A

Epidermis

Blue dots are donor T cells attacking host epithelial cells

43
Q

Amyloidosis of kidney

A

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

44
Q

Amyloidosis in liver

A

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

45
Q

Cardiac Amyloidosis

A

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

46
Q

Normal colon epithelium vs colon epithelium with amyloidosis

A

Thickened BM that seperates epithelium from the lamina propria.

This can impair absorption leading to diarrhea

47
Q

What is this

what stain is this

A

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

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