White Blood Cell Disorders Flashcards
What cells are produced in the lymphoid lineage?
Lymphocytes such as B and T cells
Where do B and T cell precursors mature?
B cells in the bone marrow and T cells in the thymus
What makes up the primary lymphoid system?
The thymus and the bone marrow
Where are mature lymphocytes contained (general)?
Secondary or peripheral organs
What 5 organs make up the peripheral lymphoid system?
Tonsils, spleen, lymph nodes, adenoids, Peyer’s patches
B cells are for what kind of immunity? How and what do they attack?
Humoral immunity, they secrete antibodies that attack extracellular pathogens such as bacteria
T cells are for what kind of immunity? How and what do they attack?
For cellular immunity, they attack intracellular pathogens like viruses with cytokines or lysis proteins
The concave side of the lymph node contains?
The hilum
The hilum contains?
Veins, arteries, and efferent lymphatics
What is on the convex side of the lymph node?
The capsule
The capsule contains?
Afferent lymphatics
Where is lymph filtered through in a lymph node, what cells are contained here?
The follicles, B cells reside here
Where does lymph drain and what cells are contained here?
The sinuses and parafollicular cortex which contains T cells
What two cells are contained within germinal centers?
centrocytes and centroblasts
Which of these cells is “cleaved”?
Centrocytes
What cells are generated by secondary follicles that secrete antibodies?
Plasma cells
Where is MALT found?
GI, respiratory, and urinary tracts
What 3 things make up MALT?
Tonsils in Waldyer’s ring, Peyer’s patches, appendix
What is neutrophilia?
When there is excess production of neutrophils
What are the 5 possible causes of neutrophilia?
Infection, medication such as growth factors, inflammatory disorders like autoimmune, tumors, and acute tissue necrosis
What is lymphocytosis?
There is an abnormally high lymphocyte count
What is the usual cause of lymphocytosis in kids?
Bordatella pertusis
What are 3 possible causes of lymphocytosis?
Viral infection, chronic immune stimulation from TB for example, lymph proliferative disorders
What type of lymphocyte does pertussis cause to be produced?
Small mature ones but a lot of them
Epstein-barr causes the production of what type of lymphocytes?
Reactive and atypical. They are large and oddly shaped. See darkening at the periphery known as dutch skirting
HIV and rheumatoid arthritis cause production of what type of lymphocytes
Large and granular
What are the most common sites of chronic lymphadenitis?
Inguinal and axillary lymph nodes
What is lymphoma?
Proliferation of precursors or lymphocytes in tissue mass
What is leukemia?
Proliferation of neoplastic cells in the blood or bone marrow
What type of cell makes up the majority of neoplasms?
B cells
When do these develop?
Before 6 years of age
Describe what happens to the cells?
They are arrested in a stage preceding surface expression of immunoglobulin
When is the peak incidence of T cell neoplasms?
In adolescence or when the thymus reaches its maximum size
What is a possible emergency caused by T cell neoplasms?
Compress the tracheae and large vessels of the neck
What cells are involved in non-Hodgkin lymphoma?
Mature B, T, and NK cells
What cells are involved in Hodgkin lymphoma?
Certain B cells
What are the clinical presentations for lymphoma?
Weight loss, fever, night sweats, painless lymphadenopathy
Where do Hodgkin and non-Hodgkin lymphomas typically turn up?
Hodgkin is usually in nodal sites. Non-Hodgkin in extra nodal sites such as the GI tract, skin, or CNS
How is immunophenotyping used to diagnose lymphoma?
Look at antigen expression, cells that are neoplasm derived will all express the same antigens
What is the definitive way to diagnose lymphoma?
Excisional lymph node biopsy
What hormone should be tested for in lymphoma patients?
LDH, high levels mean the tumor is aggressive
What viruses should lymphoma patients be tested for?
Hepatitis B and C as they may cause lymphoma
What is the most common leukemia of adults in the western world?
Chronic lymphocytic leukemia
CLL is basically the same thing as what type of lymphoma?
Small lymphocytic lymphoma
What is the difference between the two?
Where the cells are, leukemias occur in blood and bone marrow, lymphomas are in the lymphatic system
Who is usually afflicted with chronic lymphocytic lymphoma?
Males older than 65
What are signs of CLL?
Usually asymptomatic but might see lymphadenopathy and hepatosplenomegaly
What are complications of CLL in relation to other blood cells?
Lymphomas produce antibodies that destroy RBCs and platelets so you may see anemia and thrombocytopenia
The presence of what two cells indicates CLL?
Smudge cells and prolymphocytes
What organelle is very prominent in pro lymphocytes?
The nucleolus
What is a risk of CLL, it may transform into?
Higher grade lymphomas such as Richter’s syndrome or diffuse large cell lymphoma
Follicular lymphoma occurs in the?
Germinal centers
Mostly nodal or extra nodal?
Most nodal but may occur in the spleen, bone marrow, blood, or Waldeyer’s ring
What causes follicular lymphoma?
A translocation from chromosome 14 to 18. The BCL-2 gene fuses with IgH locus which leads to over expression of BCL-2. BCL-2 prevents apoptosis
Histologically what is diagnostic of follicular lymphoma?
Small cleaved lymphoid cells
Is follicular lymphoma curable?
It is indolent meaning its not an aggressive disease but not exactly curable either
Where does Burkitt’s lymphoma originate?
Germinal center but its aggressive and will often be found in extra nodal sites
Who gets Burkitt’s lymphoma?
Children and young adults
What does Burkitt’s lymphoma manifest itself as?
A large maxillary or mandibular mass in Africa. In the western world a mass in the bowels, ovaries, or retroperitoneum
What causes Burkitt’s lymphoma?
A translocation of the myc gene from chromosome 8 to 14, possible 2 or 22 as well. Specifically one with antibody activity
What does c-myc do?
It promotes cell division
The presence of what cell indicates Burkitt’s lymphoma?
Tingible body macrophages all over the node
What is a common cause of Burkitt’s lymphoma in Africa?
Epstein-Barr virus
Who is extra nodal NK/T cell lymphoma typically seen in?
Asian and South American men
NK/T cell lymphoma is associated with which virus?
The Epstein Barr virus
What is a major feature of NK/T cell lymphoma?
Angiodestruction
Multiple myeloma is a disease of what cell?
Plasma cells
Who typically gets multiple myeloma?
Black men around 70 years old
What is overproduced in multiple myeloma? What organ does this affect?
Immunoglobulin paraprotein or M protein of the IgG type which may cause kidney damage
How does M protein affect RBCs?
See rouleaux or stacks of RBCs
How does multiple myeloma affect bones?
Usually involves bone marrow leading to bone lytic lesions, pathologic fracture and chronic pain
Aside from bone what else does multiple myeloma cause?
Increased calcium levels, renal dysfunction (2nd most common cause of death), anemia
How is multiple myeloma treated?
Bone marrow transplant or chemo
Who does Hodgkin lymphoma affect?
There is a bimodal age distribution, one peak in the 20’s and another between 50-60
How does Hodgkin lymphoma present itself?
A non-tender, rubbery neck mass
What lymph nodes are affected in Hodgkin lymphoma?
80% of the time its the cervical lymph nodes, the other 10-20% is the axillary or inguinal
What are the B symptoms of Hodgkin lymphoma and what does this indicate?
Fever, weight loss, and night sweats. This indicates a more aggressive disease
What are the 4 subtypes of classical Hodgkin lymphoma?
Nodular sclerosis, mixed cell, lymphocyte depleted, lymphocyte rich
Which type of Hodgkin lymphoma is associated with HIV?
Lymphocyte depleted
What type of cell is often present in lymphoma masses?
Reed-Sternberg cell
These RS cells express what antigens that are unique?
CD15 and CD30
What is the precursor to a Reed Sternberg cell?
Hodgkin cell
What types of cells are present in nodular sclerosis?
Inflammatory and RS cells
What cells are present in the lymphocyte rich and depleted types?
Lymphocytes and RS cells
RS cells and Hodgkin cells
What are the complications of Hodgkin lymphoma?
They are mostly due to treatment and include other cancers, accelerated atherosclerosis and pulmonary fibrosis
What is the typical treatment for Hodgkin lymphoma?
Chemotherapy plus ABVD and involved field radiation therapy
What is a treatment for recurrent Hodgkin lymphoma?
Autologous bone marrow or hematopoietic stem cell transplant
