Week 3 Review Flashcards
features of atypical lymphocytes on blood film?
larger
activated cytoplasm (irregular shape, not smooth and round, scallops around edges of surrounding red cells)
blueish cytoplasm due to proteins
activated lymphocytes can be seen in response to what?
mainly viruses
- EBV
- HIV
- others including URTI - RSV, flu, parainfluenza etc
how does EBV affect lymphocytes?
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)
how is EBV diagnosed?
IgM antibodies against EBV
has to be IgM as IgG shows past infection
what shouldnt be given in EBV?
antibiotics
amoxycillin induced rash occurs (diagnostic)
what is lymphadenopathy?
enlarged nodes
types of lymphadenopathy?
regional
generalised
causes of regional lymphadenopathy?
bacterial abscess metastatic cancer (first spreads to regional nodes)
causes of generalised lymphadenopathy?
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
describe nodes in viral infection
tender hard smooth no skin inflammation no tethering
features of neutrophils which are responding to bacterial infection/inflammation?
lots more granules
big vacuoles
“toxic granulation and vacuolation)
leucocytosis?
high WCC
causes of neutrophilia?
bacterial infection inflammation (e.g RA) trauma post surgery corticosteroids (aparent neutrophilia) myeloproliferative disease (CML, myelofibrosis etc)
causes of lymphocytosis?
viral infection (often also has mild neutropenia/thrombocytopenia)
pertussis
childhood response to infection
chronic lymphocytic leukaemia (smear cells)
when would you suspect hodgkins disease rather than non-hodgkins?
young patient (esp female) disease only above the diaphragm presence of B symptoms itch alcohol induced pain but really need a biopsy
commonest cause of hodgkins disease?
nodular sclerosing
nodules of tissue with malignant cells in them along with bands/scars of scar tissues in between (sclerosing)
characteristic cells of hodgkins?
reed sternberg cells
also usually have a reactive infiltrate of monocytes and lymphocytes which stimulate the sclerosis
what are reed sternberg cells?
used to be B cells
bc of the mutation which has occurred causing the malignancy they have become abnormal with few normal surface proteins
high grade NHL?
full of immature cells (blasts) which are large with prominent nucleoi
high mitotic rate
low grade NHL histology?
full of mature lymphocytes
normal size cells grow more slowly and gradually accumulate
what does leucoerythroblastic mean?
immature circulating RBC and WBC precursors
what does leucoerythroblastic picture on blood film indicate?
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)
how does stage of hodgkins disease relate of 5 year survival?
1 = 90% 2 = 80% 3 = 70% 4 = 50%
how is hodgkins disease staged?
CT
PET scan
cause of pancytopenia in chemo?
chemo kills rapidly growing cells so lymphoma cells are killed but so are the normal immature cells undergoing mitosis in bone marrow
general immediate side effects of chemo?
bone marrow suppression
gut mucosal damage
hair loss
bone marrow biopsy in aplastic marrow related to chemo?
mainly fat cells
consequences of bone marrow failure (hypoplastic/aplastic marrow)
anaemia
neutropenia (infections)
bleeding
what infections often occur in neutropenia and why?
gram -ves (mainly)
coliforms released from damaged gut (due to chemo) can enter the blood stream
what later infections can occur after chemo if neutrophil count doesnt recover?
fungal
aspergilloma (aspergillus fungus)
therefore often given prophylactic antifungals
commonest causes of increased destruction of cells causing a pancytopenia?
autoimmune destruction
sepsis
causes of decreased production of blood cells causing a pancytopenia?
infiltration of marrow (malignancy etc) B12 deficiency aplastic anaemia drugs (chemo) viruses radiation
what else can cause pancytopenia?
sequestration of blood cells in spleen (hypersplenism - most commonly due to liver cirrhosis)
approach to diagnosing pancytopenia?
history > exam > investigations (reticulocyte count, B12/folate, abdominal US etc) > bone marrow biopsy (check whether hypo/hypercellular)
causes of hypocellular marrow?
drug induced aplasia (cytotoxic drugs etc)
causes of hypercellular marrow?
infiltration peripheral destruction (hypersplenism)
what types of supportive therapy is used in haematological malignancy?
prompt treatment of infections with broad spectrum antibiotics
use of hickman line (indweling catheter in SVC)
red cell transfusions
platelet transfusions
when should haematology sepsis protocol be started?
pyrexia and neutropenia <0.5 x 10/L
when might splenectomy be used?
to treat immune thrombocytopenic purpura and autoimmune haemolytic anaemia
what system is spleen a part of?
reticuloendothelial system
what must be done after a splenectomy?
vaccinate for meningococcus, pneumococcus and haemophilus
prompt antibiotic use in case of fever
