Week 3 Review

Question 1

features of atypical lymphocytes on blood film?

Answer 1

larger
activated cytoplasm (irregular shape, not smooth and round, scallops around edges of surrounding red cells)
blueish cytoplasm due to proteins

Question 2

activated lymphocytes can be seen in response to what?

Answer 2

mainly viruses

• EBV
• HIV
• others including URTI - RSV, flu, parainfluenza etc

Question 3

how does EBV affect lymphocytes?

Answer 3

infects epithelial cells in throat (sore throat)
infects lymph node tissue (enlarged tonsils and lymph nodes)
infects B cells causing proliferation (infected B cells proliferate which also allows proliferation of virus)
T cells recruited to fight infection (reactive T cells)

Question 4

how is EBV diagnosed?

Answer 4

IgM antibodies against EBV

has to be IgM as IgG shows past infection

Question 5

what shouldnt be given in EBV?

Answer 5

antibiotics

amoxycillin induced rash occurs (diagnostic)

Question 6

what is lymphadenopathy?

Answer 6

enlarged nodes

Question 7

types of lymphadenopathy?

Answer 7

regional

generalised

Question 8

causes of regional lymphadenopathy?

Answer 8

bacterial abscess
metastatic cancer (first spreads to regional nodes)

Question 9

causes of generalised lymphadenopathy?

Answer 9

viral infection (most common, can take a long time to resolve)
connective tissue disorders
rheumatoid arthritis
sarcoidosis (hilar lymphadenopathy)
lymphoid malignancy (lymphoma etc)
metastatic cancer

Question 10

describe nodes in viral infection

Answer 10

tender
hard
smooth
no skin inflammation
no tethering

Question 11

features of neutrophils which are responding to bacterial infection/inflammation?

Answer 11

lots more granules
big vacuoles
“toxic granulation and vacuolation)

Question 12

leucocytosis?

Answer 12

high WCC

Question 13

causes of neutrophilia?

Answer 13

bacterial infection
inflammation (e.g RA)
trauma
post surgery
corticosteroids (aparent neutrophilia)
myeloproliferative disease (CML, myelofibrosis etc)

Question 14

causes of lymphocytosis?

Answer 14

viral infection (often also has mild neutropenia/thrombocytopenia)
pertussis
childhood response to infection
chronic lymphocytic leukaemia (smear cells)

Question 15

when would you suspect hodgkins disease rather than non-hodgkins?

Answer 15

young patient (esp female)
disease only above the diaphragm
presence of B symptoms 
itch
alcohol induced pain
but really need a biopsy

Question 16

commonest cause of hodgkins disease?

Answer 16

nodular sclerosing

nodules of tissue with malignant cells in them along with bands/scars of scar tissues in between (sclerosing)

Question 17

characteristic cells of hodgkins?

Answer 17

reed sternberg cells

also usually have a reactive infiltrate of monocytes and lymphocytes which stimulate the sclerosis

Question 18

what are reed sternberg cells?

Answer 18

used to be B cells

bc of the mutation which has occurred causing the malignancy they have become abnormal with few normal surface proteins

Question 19

high grade NHL?

Answer 19

full of immature cells (blasts) which are large with prominent nucleoi
high mitotic rate

Question 20

low grade NHL histology?

Answer 20

full of mature lymphocytes

normal size cells grow more slowly and gradually accumulate

Question 21

what does leucoerythroblastic mean?

Answer 21

immature circulating RBC and WBC precursors

Question 22

what does leucoerythroblastic picture on blood film indicate?

Answer 22

wither

• marrow infiltration (cancer, fibrosis - immature cells being pushed out as marrow is replaced with abnormal stuff)
• marrow is under stress (sepsis, major bleeding, shock)

Question 23

how does stage of hodgkins disease relate of 5 year survival?

Answer 23

1 = 90%
2 = 80%
3 = 70%
4 = 50%

Question 24

how is hodgkins disease staged?

Answer 24

CT

PET scan

Question 25

cause of pancytopenia in chemo?

Answer 25

chemo kills rapidly growing cells so lymphoma cells are killed but so are the normal immature cells undergoing mitosis in bone marrow

Question 26

general immediate side effects of chemo?

Answer 26

bone marrow suppression
gut mucosal damage
hair loss

Question 27

bone marrow biopsy in aplastic marrow related to chemo?

Answer 27

mainly fat cells

Question 28

consequences of bone marrow failure (hypoplastic/aplastic marrow)

Answer 28

anaemia
neutropenia (infections)
bleeding

Question 29

what infections often occur in neutropenia and why?

Answer 29

gram -ves (mainly)

coliforms released from damaged gut (due to chemo) can enter the blood stream

Question 30

what later infections can occur after chemo if neutrophil count doesnt recover?

Answer 30

fungal
aspergilloma (aspergillus fungus)
therefore often given prophylactic antifungals

Question 31

commonest causes of increased destruction of cells causing a pancytopenia?

Answer 31

autoimmune destruction

sepsis

Question 32

causes of decreased production of blood cells causing a pancytopenia?

Answer 32

infiltration of marrow (malignancy etc)
B12 deficiency
aplastic anaemia
drugs (chemo)
viruses
radiation

Question 33

what else can cause pancytopenia?

Answer 33

sequestration of blood cells in spleen (hypersplenism - most commonly due to liver cirrhosis)

Question 34

approach to diagnosing pancytopenia?

Answer 34

history > exam > investigations (reticulocyte count, B12/folate, abdominal US etc) > bone marrow biopsy (check whether hypo/hypercellular)

Question 35

causes of hypocellular marrow?

Answer 35

drug induced aplasia (cytotoxic drugs etc)

Question 36

causes of hypercellular marrow?

Answer 36

infiltration
peripheral destruction (hypersplenism)

Question 37

what types of supportive therapy is used in haematological malignancy?

Answer 37

prompt treatment of infections with broad spectrum antibiotics
use of hickman line (indweling catheter in SVC)
red cell transfusions
platelet transfusions

Question 38

when should haematology sepsis protocol be started?

Answer 38

pyrexia and neutropenia <0.5 x 10/L

Question 39

when might splenectomy be used?

Answer 39

to treat immune thrombocytopenic purpura and autoimmune haemolytic anaemia

Question 40

what system is spleen a part of?

Answer 40

reticuloendothelial system

Question 41

what must be done after a splenectomy?

Answer 41

vaccinate for meningococcus, pneumococcus and haemophilus

prompt antibiotic use in case of fever