White Blood Cell and Lymphatic Disorders Flashcards
1. Illustrate the haematopoietic system 2. Knowledge of WBCs and their functions 3. Knowledge of signs and symptoms of WBC disorders 4. Knowledge of indices used to analyse WBC disorders 5. Interpret basic haematological data for WBC disorders 6. Elucidate dental aspects of WBC disorders
1
Q
Name the three types of granulocytes
A
- Neutrophils
- Eosinophils
- Basophils, mast cells
2
Q
Describe the morphology of neutrophils
A
Lobed nucleus
Granulocytes in cytoplasm
3
Q
Where are neutrophils located
A
Mostly circulating; few in tissues except in inflammation
4
Q
What is the function of neutrophils
A
Phagocytose and digest engulfed material
5
Q
Describe the morphology of eosinophils
A
Non-segmented/bilobed nucleus
Large eosinophilic granules
6
Q
Where are eosinophils located
A
Few in tissues except in inflammation or allergies
7
Q
What is the function of eosinophils
A
Participate in inflammatory reaction and immunity to parasites
8
Q
Describe the morphology of basophils
A
Lobed nucleus
Large basophilic granules
9
Q
Where are basophils located
A
They are circulating as mast cells in most tissues
10
Q
What is the function of basophils
A
Release histamine and inflammatory-causing chemicals
11
Q
Name the three types of mononuclear phagocytes
A
- Monocytes
- Macrophages
- Dendritic cells
12
Q
Describe the morphology of monocytes and macrophages
A
Single nucleus
Abundant in cytoplasm
13
Q
Where are monocytes located
A
In circulation where they differentiate into macrophages or dendritic cells once they reach tissues
14
Q
What is the function of monocytes
A
Phagocytose and digest engulfed materials
15
Q
Where are macrophages located
A
In all tissues
16
Q
What is the function of macrophages
A
Phagocytose and digest materials
17
Q
Describe the morphology of dendritic cells
A
They are branched
18
Q
Where are dendritic cells located
A
Initially in all tissues, but migrate to the lymph nodes
19
Q
What is the function of dendritic cells
A
To gather antigens from tissues and present it to lymphocytes
20
Q
Describe the morphology of lymphocytes
A
Single nucleus
Little cytoplasm before differentiation
21
Q
Where are lymphocytes located
A
In lymphoid organs and in circulation
22
Q
What is the function of lymphocytes
A
Participate in adaptive immune response
23
Q
What WBC disorder involves increased production of WBCs
A
Leucocytosis (WBC > 11 bil/L)
Increased production due to reactive leucocytosis or drugs (prednisolone)
24
Q
What WBC disorder involves decreased production of WBCs
A
Leucopenia (WBC < 4 bil/L)
Secondary to aplastic anaemia
Cyclic neutropenia (rare autosomal dominant condition)
Chemotherapy; radiation; HIV drugs
25
What is leukaemia
The malignant proliferation of WBCs due to;
genetics, radiation, chemotherapy, viruses, myelodysplastic syndromes (not enough healthy blood cells causing blood cancer)
26
What are the classifications used for leukaemia
1. Cell of origin : Lymphoid or Myeloid
| 2. Cell maturity : Immature (acute) or Mature (chronic)
27
Define ALL
Acute lymphoblastic leukaemia
28
Define AML
Acute myeloblastic leukaemia
29
Define CLL
Chronic lymphocytic leukaemia
30
Define CML
Chronic myeloid leukaemia
31
What are the common symptoms of leukaemia
- fevers, frequent infections, night sweats, fatigue
- easy bleeding, general CNS symptoms an GI symptoms
- shortness of breath, painful lymph nodes
- blurred vision, poor gait, bone + joint pain
32
What are the characteristics of Acute Leukaemia
1. Rapid accumulation of dysfunctional immature cells in blood and bone marrow
2. Reduction in normal functions of RBCs/WBCs/platelets
3. Short history of feeling unwell; neutropenic fever, bleeding and increased blasts in blood film
4. Rashes, lumps, gingival enlargement, testiscular swelling, inter cranial pressure (meninges)
33
What is ALL
Most common childhood leukaemia with peak incidence at ages 2-4
- prognosis is worse in adults
- clinically indistinguishable from AML
- myeloperoxidase; auer rod marker
34
What is AML
Most common adult acute leukaemia
- poor prognosis in adults and children
- gingival swelling in 20-30% of patients
- nuclear stained TdT marker (DNA polymerase found in lymphoblasts/myeloblasts)
35
What are the characteristics of Chronic Leukaemia
1. Progresses slowly so allows more mature cell production from bone marrow
2. Often asymptomatic so found accidentally
3. Both forms are more common in adults
4. Blood film: increased circulating mature lymphocytes/myeloid cells
36
What is CLL
It is more common in men
Rare in asians
Mostly B-cell neoplasm
Splenomegaly + lymphadenopathy is common in CLL
37
What is CML
Most patients are over 40
| Associated with Philadelphia chromosome in 90% of cases (were part of chromosome 9 translocates to chromosome 22)
38
What are the clinical features and oral manifestations of leukaemia
1. Decreased RBCs - fatigue, pallor, hard to perform tasks
2. Decreased platelets - mucosal bleeding, petechiae, easy bleeding and bruising
3. Decreased WBCs - increased infection risk, poor wound healing
4. Increased immature, abnormal, dysfunctional WBCs infiltrating organs - enlargement of gingival, lymph nodes, spleen and liver
39
Management of leukaemia
1. Adjunct supportive therapy
- if anaemic give blood transfusion
- if bleeding problems give platelet transfusion
- if increased infection risk give granulocyte colony stimulating factor transfusion (stimulate bone marrow to make WBCs)
2. Specific treatments
- chemotherapy
- radiotherapy
- targeted therapy
- bone marrow (stem cell) transplantation (matching donor and immunosuppressants needed)
40
What is a lymphoma
A solid tumour (Hodgkin's/Non-Hodgkin's = most)
41
Why do lymphomas occur
Due to malignant proliferation of lymphocytes within extranodal sites
42
What are the signs of a lymphoma
- painful lymph node
- non-specific symptoms; fever, chills, weight loss, sweats, lack of energy, pruritus
- swollen cervical lymph nodes and occasional mouth swellings
43
What causes Hodgkin's lymphoma
B-cell dysfunction therefore accumulation of abnormal B-cells
44
What are the risk factors for Hodgkin's lymphoma
1. Male
2. Bimodal age distribution; early 20s and >70
3. Immunocompromised
4. Positive family history
5. History of infectious mononucleosis
45
Describe the clinical presentation of Hodgkin's lymphoma
- progressive painless enlargement of lymph nodes (neck)
- this pressurises neighbouring ducts
- tiredness/weakness/fatigue
- fever, anorexia, weight loss, flu-like symptoms
- jaundice (when spread to liver), shortness of breath (when spread to lungs), bone pain
- pruritis
46
How is Hodgkin's lymphoma testes for
Paplation/visually and then lymph node biopsy which show Reed-Sternberg cells (owl-like)
FBC, radiographs, CT, MRI, PET scans
47
Stage I lymphoma (description and treatment given)
Single lymph node is involved/ single extra lymphatic
Radiotherapy
48
Stage II lymphoma (description and treatment given)
2 or more lymph nodes on the same side of diaphragm; may have localised extralymphatics
Radiotherapy
49
Stage III lymphoma (description and treatment given)
Lymph nodes on both sides of diaphragm; may include spleen/ localised
Radiotherapy/ Quadruple therapy (combined chemotherapy)
50
Stage IV lymphoma (description and treatment given)
Diffuse extra lymphatic disease (liver, bone marrow, lung, skin)
Bone marrow transplant
51
Dental presentation of lymphomas (rarely affects mouth)
Cannot distinguish Hodgkins/Non-Hodgkin's lymphoma
- oral infections
- mucositis/ oral ulceration by cytotoxic drug
- hypo salivation
- anaemia, bleeding tendancies
- impaired resperitary function
LA regional blocks cannot be used if bleeding tendencies so give GA in hospital
52
What is Non-Hodgkin's lymphoma
1. B/T cell associated
2. More common than HL and has a poorer prognosis and occurs at any age
3. Can be aggressive (high grade) or non-aggressive (low)
4. Greater presentation for EN sites (GIT, CNS)
5. Usually multi-focal
6. Dental aspects; Waldeyer's ring (tonsils) is more common that in HL
53
What is Burkitt's lymphoma
Highly aggressive NHL associated with EBV
| - starry sky pattern Burkitt cells with lipid droplets
54
Endemic Burkitt's lymphoma
- African children and young adults
- Boys
- Jaw swellings and abdominoviscero involvement (pain and nausea)
55
Sporadic Burkitt's lymphoma
- Western world
- Males
- Greater incidence in HIV/AIDS
56
What are the causes of multiple myeloma
Proliferation of malignant plasma cells; overabundance of monoclonal paraproteins (M-proteins) produced by defective immunoglobulins
Malignant plasma cells release osteoclast-activating factors which cause bone resorption and pain
This had genetic links
57
What are the risk factors for multiple myeloma
1. >60
2. Males
3. African
4. Immunosuppression
5. Radiation exposure
6. Strong family history
58
Outline the pathogenesis of multiple myeloma
Malignant plasma cells overwhelm the bone marrow and so 3 cell types are damaged as it causes...
1. Over production of BJ (Bence Jones) protein
2. Decrease in immunoglobulins
3. Increased osteoclastic activity
This overwhelm bone marrow
59
What does the over production of BJ proteins in multiple myeloma cause
1. Hyperviscocity
2. Amyloidosis
3. Renal failure
4. M proteins show up as spikes in electrophoresis
60
What does the decrease in immunoglobulins cause in multiple myeloma
Impaired humoral immunity and increased infection
| M proteins show up as a spike in electrophoresis
61
What does the increased osteoclastic activity in multiple myeloma cause
Multiple punched out lesions affecting large bones e.g. skull
Hyper calcaemia
Pathalogical bone fractures
62
What does the overwhelmed bone marrow in multiple myeloma lead to
1. Leucopenia
2. Anaemia
3. Thrombocytopenia
63
What are the other clinical features of multiple myeloma
- Blood hyperviscosity - thrombosis risk
- Weakness
- Visual disturbance
- Bleeding/bruising - petechiae/ecchymosis
- Infection risk
- Osteoporosis
- Amyloidosis (tongue) = abnormal protein infiltration
64
How is multiple myeloma tested for
- FBC, renal function (urea, electrolytes, creatine)
- Bone profile (serum Ca2+ levels)
- Serum protein electrophoresis (M protein spike)
- Urine BJ protein
- Bone marrow aspiration (total bone survey shows punched out lesions)
- Radiography of affected bone (CT/MRIs)
- Total body bone survey
65
What is the dental relevance of multiple myeloma
1. Dental treatment his complicated by anaemia, infections and hemorrhagic tendencies
2. Jaw osteolytic lesions can involving post. mandible
3. Root resorption, loosening teeth and pathological fractures
4. Oral complications of chemo and radiotherapy
5. Risk of MRONJ
6. Rare complications include
- gingival bleeding
- oral petechiae
- cranial nerve palsies
- herpes simplex and zoster infections
66
What dental treatment should be done pre-chemo
Removal of unstable teeth
Treat caries, OH, diet tips
Chlorhexidine prophylaxis
67
What dental treatment should be done during induction
Prevenetative OH
| Antivirals (acyclovir) and anti-fungal (nystatin/flucondzole) prophylaxis
68
What dental treatment should be done during remission
Continued oral health preventative care
69
What dental treatment should be done long term
Continued oral health preventative care and monitoring of orofacial and dental development
70
What causes reactive leucocytosis
Disease, infections, inflammation, neoplastic conditions
It is the elevated count of WBCs
71
Clinical presentation of acute leukaemia
- short history of feeling unwell
- present with neutropenia (susceptible to infections)
- fever, bleeding tendencies, bruising, anaemia
- organ infiltration can occur: skin, gums, testes, meninges
- leucocytosis = circulating blasts and cytopenias
72
Clinical presentation of chronic leukaemia
- incidental finding
- long term history of non-specific symptoms
- splenomegaly
- lymphadenopathy
- leucocytosis = circulating mature lymphocytes/myeloid cells
73
Risk factors for NHL
1. Increasing age
2. Immunosuppression
3. EBV, H.pylori infections
4. Exposure to benzene, herbicides, pesticides
5. Strong family history of NHL
74
Immunodeficiency related Burkitt's lymphoma
Increased in HIV/AIDS
| Oran transplants
75
What is the classic tetrad of clinical features for multiple myeloma
1. Calcium elevation (hypercalcaemia)
2. Renal failure
3. Anaemia
4. Bone pain (especially spinal, pathological fractures)
76
Outline treatment options for multiple myeloma
- Chemotherapy + steroids to increase chemo effectiveness
- Immunomodulatory drugs to inhibit growth and survival of myeloma cells
- Bone marrow transplant
77
How are the symptoms and complications of multiple myeloma treated
Analgesics, blood transfusion, dialysis, bisphosphonates helps with fractures, radiotherapy, surgery
78
What is the prognosis for multiple myeloma
Variable; median survival is 3 years
