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2 - MEH > Spleen, White Cells, Cytopenia > Flashcards

Spleen, White Cells, Cytopenia Flashcards

1
Q

Distinguish between red and white pulp in spleen

A
  • Red pulp - sinuses lined by endothelial macrophages and cords
    • Removes old red cells and metabolises haemoglobin
  • White pulp - similar structure to lymphoid follicles
    • Synthesises antibodies and removes antibody-coated bacteria and blood cells
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2
Q

Explain how blood enters the spleen

A
  • Blood enters via the splenic artery
    • White cells and plasma preferentially pass through the white pulp
    • Red cells preferentially pass through the red pulp
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3
Q

What are the functions of the spleen

A
  • Sequestration and phagocytosis - old/abnormal red cells removed by macrophages
  • Blood pooling - platelets and red cells mobilised during bleeding
  • Extramedullary haemopoiesis - pluripotent stem cells proliferate if bone marrow fails or during haematological stress
  • Immunological function - check for pathogens in blood
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4
Q

What are the causes of splenomegaly

A
  • Back pressure - portal hypertension in liver disease
  • Overworking red pulp - removing red cells
  • Overworking white pulp - synthesising antibodies
  • Reverting to what it used to do - extramedullary haemopoiesis
  • Infiltration of cells - leukaemia, lymphomas
    • Chronic lymphocytic leukaemia - expanded white pulp and infiltration of lymphocyte
  • Accumulation of waste products of metabolism
    • Gaucher’s disease
  • Infiltrated by other material - sarcoidosis
    • Infiltration of granulomas
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5
Q

How is splenomegaly seen on a scan

A

Attenuation (spots) seen and grown irregularly

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6
Q

What is hypersplenism and its effects

A
  • Overactive spleen
    • Pooling of blood in enlarged spleen - destroy blood cells due to pancytopenia or thrombocytopenia
    • Risk of rupture if enlarged and no longer protected by rib cage
      • Haematoma (blood clotting) around enlarged spleen after rupture - could cause anaemia or hypertension
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7
Q

What is hyposplenism and its risk

A
  • Lack of functioning splenic tissue

- Associated with increased risk of sepsis

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8
Q

What are the causes of hyposplenism

A
  • Splenectomy
  • Sickle cell disease in older children and adults (due to multiple infarcts then fibrosis)
  • Coeliac disease (inflammation of small intestine)
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9
Q

Explain the blood film in hyposplenism

A
  • Howell jolly bodies (DNA remnants)
    • Basophilic clusters of DNA in circulating erythrocytes
    • During erythropoiesis, erythroplasts normally expel their nuclei but in some cases a small portion of DNA remains
      • Normally removed in spleen
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10
Q

Define cytopenia

A

Reduction in number of blood cells

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11
Q

What colour do basophils, neutrophils and eosinophils stain in H&E stain

A
  • Basophils - dark blue
  • Neutrophils - neutral pink
  • Eosinophils - bright red
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12
Q

How can neutrophils be identified on a blood film

A

Polymorph - multilobed nucleus

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13
Q

What is the role of G-CSF glycoprotein

A
  • Neutrophils maturation controlled by a hormone G-CSF
    • Increase production of neutrophils
    • Decrease time to release mature cells from bone marrow
    • Enhances chemotaxis
      • Enhances phagocytosis and killing of pathogens
  • Can be administered for patients who need neutrophils
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14
Q

How is neutrophilia caused

A
  • Occurs in infection, tissue damage, acute inflammation, acute haemorrhage, cancer
  • Minor increases by drugs, cytokines (G-CSF), metabolic/endocrine disorders, smoking
  • Myeloproliferative disorders - increase production of blood cells in bone marrow
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15
Q

What are the causes of neutropenia

A
  • Due to reduced production or increased removal/use
    • Increased removal/use caused by immune destruction, sepsis, splenic pooling
    • Reduced production due to B12/folate deficiency
      • Infiltration of bone marrow by malignancy or fibrosis
      • Aplastic anaemia (empty marrow)
      • Radiation
      • Drugs
      • Viral infection - very common
      • Congenital disorders
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16
Q

What are the consequences of neutropenia

A
  • Susceptible to severe bacterial and fungal infection

- Mucosal ulcerations eg. Painful mouth ulcers

17
Q

What is the medical term for high/low RBC, white cell, neutrophil, platelet, lymphocytes and low red + white cell + platelet

A
  • RBC - anaemia, erythrocytosis
  • White cell - leucopenia, leucocytosis
  • Neutrophil - neutropenia, neutrophilia
  • Platelet - thrombocytopenia, thrombocytosis
  • Lymphocytes - lymphocytopenia, lymphocytosis
  • Red + white + platelet - pancytopenia
18
Q

Explain monocytes and their role

A
  • Response to inflammation and antigenic stimuli
  • Circulate in blood for 1-3 days before moving into tissues and differentiating into macrophages or dendritic cells
  • Half are stored in red pulp in spleen
  • Monocytes, macrophages and dendritic cells - phagocytosis, antigen presentation, cytokine production
19
Q

When does monocytosis occur

A

Chronic inflammatory conditions

20
Q

What does eosinophils look like on a blood film

A

Bi-lobed nucleus

21
Q

What is the role of eosinophils

A
  • Responsible for dealing with parasites
  • Mediator for allergic reactions eg. Asthma
  • Migrate to epithelial surfaces
  • Release granular content containing enzymes aids in destruction and subsequent phagocytosis of pathogens
22
Q

What are the causes of eosinophilia

A
  • Allergic diseases - asthma, eczema, hay fever
  • Drug hypersensitivity - penicillin
  • Churg-Strauss - blood vessel inflammation
  • Parasitic infection - roundworm, tapeworm, flukes, helminths
  • Skin diseases
  • Lymphoma, leukaemia, myeloproliferative conditions
23
Q

How do basophils look on a blood film

A

Contain large cytoplasmic granules which may obscure cell nucleus when stained

24
Q

What is the role of basophils

A
  • Active in allergic reactions and parasitic infections
  • Dense granules contain histamine, heparin, hyaluronic acid, serotonin
    • Released following binding of IgE to surface receptors
25
Q

What are the causes of basophilia

A
  • Hypersensitivity to drugs
  • Infections - chicken pox, influenza, tuberculosis
  • Myeloproliferative - leukaemia, thrombocythemia
26
Q

Describe the role of lymphocytes

A
  • Natural killer cells - cell-mediated cytotoxic innate immunity
  • T cells - facilitate cell-mediated adaptive immunity
  • B cells - facilitate humoral, antibody-driven adaptive immunity
  • Mainly found in the lymph
27
Q

What are the causes of lymphocytosis

A
  • Viral infections, bacterial infections
  • Stress related
  • Post splenectomy
  • Smoking
  • Lymphoproliferative malignancies - chronic lymphocytic leukaemias, T or NK-cell leukaemia, lymphoma - cells ‘spill’ out of infiltrated bone marrow
28
Q

What are the causes of pancytopenia

A
  • Increased removal due to immune destruction, splenic pooling (hypersplenism) or rarely haemophagocytosis (chewing up of cells in bone marrow)
  • Reduced production due to B12/folate deficiency, bone marrow infiltration by malignancy, marrow fibrosis, radiation, viruses, congenital bone marrow failure

2 - MEH (16 decks)

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