chapter 12 - exam #1

leukocytes (WBC’s)

defend the body from infection and are divided into:

• granulocytes → neutrophils, eosinophils, and basophils

• agranulocytes → lymphocytes (B and T cells)

• monocytes

granulocytes

have chemical containing granules in the cytoplasm

• neutrophils

• eosinophils

• basophils

granulocytes - neutrophils

40% - 80%

first responders to infection; attack bacteria

granulocytes - eosinophils

1% - 7%

respond to allergies and parasites

granulocytes - basophils

< 2%

release histamine during allergic rxn

agranulocytes - lymphocytes

20% - 40%

part of adaptive immunity (have memory for specific antigens)

• B cells → transforms into plasma cell, which produces immunoglobins that attack antigens

• T cells → directly attacks infected cells

monocytes

2% - 10%

become macrophages; perform phagocytosis, they then present pieces of the antigens to T cells to alert them to start attack

nml WBC count

4,000 - 10,000 cells/mcL

hematologic neoplasms

cancers of blood and lymph that are developed as a result of damage to the DNA during development in bone marrow

types of hematologic neoplasms

• leukemia - cancer of WBC’s in bone marrow/blood

• lymphoma - cancer of B or T lymphocytes (in lymph nodes)

• multiple myeloma (MM) - cancer of plasma cells (from B cells)

• myelodysplastic syndrome (MDS) - defective bone marrow stem cells

leukemias

states of neoplastic proliferation involving WBCs

leukemias = numerous immature WBC’s like ants in an ant colony

lymphomas

neoplasms of lymphocytes and are commonly solid tumors found in lymphoid tissue

hematologic neoplasms sx

• large lymph nodes

• enlarged spleen

• leukemia

• anemia (low RBC count)

• thrombocytopenia (low platelet count)

hematologic neoplasms dx

• CBC

• bone marrow aspiration

• FISH - analyze cells chromosome defects

• flow cytometry - analyzes DNA

hematologic neoplasms tx

• chemotherapy

• monoclonal (lab produced) antibodies that target cancer cells specifically

• radiation

• stem cell transplants

hematologic neoplasms develop….

as a result of damage to the DNA during development in the bone marrow

pathophysiology of hematologic neoplasms

leukemia and lymphoma involve overgrowth of nonfunctional cancerous WBCs.

• These cells crowd out healthy blood cells, causing:

  • Anemia

  • Neutropenia (not enough neutrophils)

  • Thrombocytopenia

types of stem cell transplants

• allogeneic hematologic → someone else’s stem cells

• autologous hematologic → transplant of own stem cells

• umbilical → stem cells can be taken from the umbilical cord at birth and be stored

types of leukemias

• acute lymphocytic (lymphoblastic) leukemia

• chronic lymphocytic (lymphoblastic) leukemia

• acute myelogenous leukemia

• chronic myelogenous leukemia

acute lymphocytic leukemia (ALL)

aggressive cancer of immature B and/or T lymphocytes (called lymphoblasts) T or B lymphocytes fail to mature and crowd out healthy blood cells

most common in children

sx:

• frequent infections

• bone pain (sternum, tibia, femur etc.)

• unexplained bruising and bleeding from crowding of platelets

• heavy menstrual bleeding in women

dx: CBC w/ diff

chronic lymphocytic leukemia (CLL)

most common leukemia in the U.S. - usually in older adults

body makes too many abnml B cells that don’t fight infection

sx:

• painless, enlarged lymph nodes

• fatigue

• night sweats

• fever

dx: CBC w/ diff (high WBC count; > 20,000)

acute myelogenous leukemia

rapid overgrowth of immature myeloid cells (called myeloblasts) in the bone marrow - myeloid cells can infiltrate from the bone marrow to the blood, spleen, tissues, liver, and lungs

sx:

• infections

• pallor

• enlarged lymph nodes

• nose bleeds

dx:

CBC w/ diff, bone marrow aspiration with lymphocytosis greater than 20%, bone marrow biopsy, FISH, and PCR

multiple myeloma (MM)

cancer of plasma cells that build up in the bone marrow and make too many abnormal immunoglobulins (Igs and Ig)

causes deterioration of bone

incurable; if asymptomatic = no treatment

MM pathophysiology

• Plasma cells grow out of control in bone marrow → crowd out healthy blood cells.

• They make abnormal antibodies (called M-proteins or Bence Jones proteins) that can damage organs like kidneys.

• They release cytokines (IgS and Ig) that cause bone destruction (leading to pain, fractures, high calcium levels).

• MM can lead to anemia, infections, kidney failure, and bone damage

MM sx

• bone pain (especially in back)

• plasmacytomas → tumors of plasma cells within the bone

• weakness

• pallor

• fatigue

MM dx

• Blood and urine tests → look for M-protein, Bence Jones protein

• 10% or more plasma cells in the bone marrow

• Tumors made of plasma cells (plasmacytomas) may be found in a tissue box

non-hodgkin’s lymphoma

B cells grow out of control in lymph nodes and form tumors

caused by chromosomal translocations (pieces of DNA swap placed)

common in OLD people

non-hodgkin’s lymphoma patterns of tumor growth

follicular = round clusters (less aggressive)

diffuse = cells spread out (more aggressive)

Non-Hodgkin’s lymphoma sx

• fever, chills, night sweats

• Lymphatic blockage which causes numbness and tingling

• Painless enlarged lymph node

in non-hodgkin’s lymphoma, there are enlarged, painless lymph nodes called

Virchow’s node

hodgkins lymphoma

cancer of B-lymphocyte, common in young adults 15-20 years old

Reed-Sternberg cells in hodgkin’s lymphoma

large abnml lymphocyte with two nuclei; this is how hodgkin’s is dx

hodgkins lymphoma sx

• fever

• trouble swallowing

• Sore throat

• SOB

• abdo pain

• enlarged lymph node

Hodgkin’s lymphoma dx

• CBC

• bx of lymph node

• PCR,FISH