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2 MEH > 5 Haemopoiesis, the Spleen and Bone Marrow > Flashcards

5 Haemopoiesis, the Spleen and Bone Marrow Flashcards

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1
Q

Where does bone marrow become more limited to in adults?

A

Pelvis, sternum, skull, ribs, vertebrae

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2
Q

What cell types can haematopoietic stem cells develop into? (4)

A
  1. Erythroid
  2. Megakaryocyte/Platelet/Thrombocyte
  3. Granulocytes
  4. Lymphocytes
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3
Q

What are 4 properties/characteristics of the HPSC (haemopoietic stem cell)?

A
  1. Has greatest power of self renewal in adult
  2. Can differentiate into lots of different cells
  3. Mobilises out of bone marrow
  4. Can undergo apoptosis
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4
Q

What are the sources of haemopoietic stem cells if needed in a clinical scenario?

A
  1. Bone marrow aspiration
  2. Stem cells- mobilised by GCSF- collected by leucopharesis in peripheral blood
  3. Umbilical cord stem cells
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5
Q

Name the system which removes and controls blood cells.

A

Reticuloendothelial system (RES)

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6
Q

How does the reticuloendothelial system work?

A
  • =Network of cells and tissues- contain phagocytic cells: monocytes, macrophages, kupffer cells, microglial cells (CNS)
    • Identifies and mounts appropriate immune response
    • Dispose of blood cells

Kupffer cell= specialised macrophage

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7
Q

What are the main organs of the Reticuloendothelial system?

A
  1. Spleen
  2. Liver
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8
Q

What are the 2 types of tissue found in the spleen?

A
  1. Red Pulp: sinuses lined with endothelial macrophages and chords
  2. White Pulp: structure=similar to lymphoid follicle
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9
Q

Where does blood enter the spleen?

A

Splenic artery

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10
Q

Which tissue tissue in the spleen do each of the following preferentially pass through?:

White cells

Plasma

RBCs

A
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11
Q

State 4 functions of the spleen (in adults).

A
  1. Sequestration and phagocytosis- removal of old/abnormal red cells - macrophages
  2. Blood pooling - so platelets and RBCs= rapidly mobilised during bleeding
  3. Extramedullary haemopoiesis- pluripotent stem cells
  4. Immunological function- 25% T cells and 15% B cells produced in spleen
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12
Q

What does in mean if you can palpate the spleen below the costal margin?

A

Spleen=enlarged

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13
Q

How can you measure the sze of the spleen?

A
  1. Palpate in right iliac fossa- spleen with move towards hand on inspiration
  2. Feel for splenic notch
  3. Measure CM from costal margin in mid-clavicular line
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14
Q

State some possible causes of splenomegaly?

A
  1. Back pressure- portal hypertension in liver disease
  2. Overworking red and white pulp
  3. Increase in extramedullary haemopoiesis
  4. Infiltrated by cells- eg cancer cells (leukaemia)
  5. Infiltrated material eg Gaucher’s disease, sarcoidosis
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15
Q

What are the 3 categories of Splenomegaly?

A
  1. Massive- chronic myeloid leukaemia, malaria
  2. Moderate- chronic myeloid leukaemia, malaria, lymphoma, liver cirrhosis
  3. Mild- chronic myeloid leukaemia, malaria, lymphoma, liver cirrhosis, hepatitis, autoimmune diseases
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16
Q

What is Hypersplenism?

A

Low blood count due to pooling of blood in spleen

(Removing too many red blood cells)

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17
Q

What is there an increased risk of if the spleen is enlarged?

A

Rupture (no longer protected by ribcage)–> haematoma

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18
Q

What is hyposplenism?

A

Lack of functioning splenic tissue

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19
Q

What causes hyposplenism?

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A
  • Splenectomy
  • Sickle cell disease
  • Multiple infarcts then fibrosis
  • Caeliac disease
20
Q

How might hyposplenism be detected?

Study These Flashcards
A

Howell Jolly Bodies shown on blood film

21
Q

If a patient has hyposplenism, what is the patient at greater risk of?

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A
  • Overwhelming sepsis
  • Especially from Encapsulated Organisms
    • ​Pneumococcus
    • Haemophilus influenzae
    • Meningococcus
22
Q

Name 4 functions of a Red Blood Cell.

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A
  1. Oxygen delivery
  2. Maintain haemoglobin in ferrous (reduced) state
  3. Maintain osmotic equilibrium
  4. Generate energy
23
Q

What condition can develop as a result of changes in the red blood cell membrane?

Study These Flashcards
A

Red cell survival reduces (broken down more easily)

Can develop Haemolytic anaemia

24
Q

In 5 steps, describe how the body responds if a patient becomes anaemic.

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A
  1. Cells in kidney- detect reduced pO2
  2. Increased erythropoietin production
  3. (erythropoietin) Stimulates maturation of RBCs
  4. Increase:
    1. RBCs
    2. Haemoglobin
    3. O2 delievered
  5. Eventually- erythropoietin production falls- feedback loop
25
What is cytopenia?
Reduction in number of RBCs
26
What type of blood cell is reduced in number for each of the following conditions?: * Anaemia * Leucopenia * Neutropenia * Thrombocytopenia * Pancytopenia
* Anaemia: RBC/Haemoglobin * Leucopenia: Low WBC * Neutropenia: Low neutrophil * Thrombocytopenia: Low platelet * Pancytopenia: All
27
What has occured in a patient with each of the following conditions? * Erythrocytosis * Leucocytosis * Neutrophilia * Lymphocytosis * Thrombocytosis
Increase in circulating: * Erythrocytosis-RBCs * Leucocytosis-WBCs * Neutrophilia-Neutrophils * Lymphocytosis- Lymphocytes * Thrombocytosis- Platelets
28
What is a neutrophil?
1. First responder phagocyte 2. Most common WBC Circulate in bloodstream- live 1-4 days
29
How is neutrophil maturation controlled?
* Hormone: G-CSF
30
Why might G-CSF be administered clinically?(2)
1. Severe neutropenia 2. Sepsis after chemotherapy
31
What are some possible causes of neutrophilia? (increased circulating neutrophils)
1. Infection 2. Cancer 3. Tissue damage 4. Acute inflammation 5. Drugs eg steroids 6. Acute haemorrhage 7. Myeloproliferative disease
32
What are possible causes of neutropenia due to increased use/removal of neutrophils?
1. Immune destruction 2. Sepsis 3. Splenic pooling
33
Apart from reduced production and increased removal of neutrophils, what are the other (2) causes of neutropenia?
* Benign, ethnic neutropenia * Cyclic neutropenia (autosomal dominant disorder)
34
What are some possible causes of neutropenia due to a reduced production of neutrophils?
1. B12/folate deficiency 2. Infiltration of bone marrow by fibrosis/malignancy 3. Aplastic anaemia- empty bone marrow 4. Radiation 5. Drugs 6. Viral infection 7. Congenital disorders
35
Describe 2 complication of Neutropenia?
1. Mucosal ulceration eg in mouth 2. Neutropenic sepsis (life threatening)= medical emergency. IV antibiotics given immediately
36
What do monocytes develop into?
Macrophages (once migrated to tissues)
37
What may cause monocytosis?
1. Carcinoma 2. Chronic infection 3. Chronic inflammatory conditions eg ulcerative collitis
38
What's the lifespan of an eosinophil?
8-12 days
39
What is the function of eosinophils?
Mediate: allergic response hypersensitivity reactions *Migrate--\> epithelial surfaces*
40
What do the granules in an eosinophil contain?
Arginine, phospholipid, enzymes
41
Name some conditions which eosinophilia is commonly due to:
1. Allergic diseases: 1. Asthma 2. Eczema 3. Hay fever 2. Drug hypersensitivity: 1. Penicillin 3. Parasitic infection: Round worm, flukes
42
Name some conditions which eosinophilia is rarely due to?
* Hodgkin lymphoma * Acute myeloid leukaemia
43
What are basophils?
Least common but LARGEST blood cell Granules contain: * Histamine * Heparin * Hyaluronic acid * Seratonin
44
What may cause Basophilia?
* Immediate hypersensitivity reactions * Ulcerative collitis * Chronic myeloid leukaemia
45
What types of cells do lymphocytes differentiate into?
46
What are some possible causes of lymphocytosis?
Reactive: * Viral infections * Stress related : MI/Cardiac arrest * Post splenectomy (No where for lymphocytes to rest) * Smoking Lymphoproliferative (malignant): * Lymphoma (cells spill out of infiltrated bone marrow) * T-cell leukaemia

2 MEH (18 decks)

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