WBC

infectious mononucleosis “mono”

• Self-limiting lymphoproliferative disorder

• Infection of B lymphocytes

• Most prevalent in adolescence/young adults

mono cause

• Epstein-Barr virus (EBV) (EBV-contaminated saliva)

• atypical lymphocytes proliferate

mono onset

insidious, incubation 4-8 wks

mono clinical manifestations

• lymphadenopathy, hepatitis, splenomegaly

• WBC increased (about 12-18,000) 95% lymphocytes

• acute phase: 2-3 wks

• lethargy/debility

mono treatment

symptomatic + supportive

myelodysplastic syndrome

• “a group of related hematologic disorders characterized by a change in the quantity and quality of bone marrow elements”

• Affects elderly (>65)

myelodysplastic syndrome CM

• cytopenias

• anemia, infection, and spontaneous bleeding or bruising

myeolodysplastic syndrome etiology

unknown, maybe an environmental trigger

myelodysplastic syndrom dx

laboratory + bone marrow biopsy

myelodysplastic syndrome tx

depends on disease severity- supportive, Granulocyte colony -stimulating factor (G-CSF), erythropoietin, chemotherapy, bone marrow transplant

leukemia

• Malignant neoplasms of cells originally derived from a single hematopoietic cell line

• disease of children and adults

leukemic cells are:

• Are immature and unregulated (undifferentiated)

• Proliferate in bone marrow

• Circulate in blood

• Infiltrate spleen, lymph nodes

how are cells classified?

• Classified according to their predominant cell type (i.e., lymphocytic or myelocytic) & whether the condition is acute or chronic

cell leukemia classification

• Acute lymphocytic (lymphoblastic) leukemia (ALL)* (most common childhood leukemia)

• Chronic lymphocytic leukemia (CLL)** (most common leukemia in older adults)

• Acute myelocytic leukemia (AML)

• Chronic myelocytic leukemia (CML

leukemia cause

unknown, increased exposure to radiation

leukemia pathogenesis (leukemic cells)

• Are an immature type of WBC

• Capable of increased rate of proliferation/have prolonged life span

• Cannot perform function of mature leukocytes → are ineffective as

phagocytes

• Interfere with maturation of normal bone marrow cells (including RBC &

platelets)

leukemia s/s

• Sudden, stormy onset

• S/S related to decreased (mature) WBC, decreased RBC, decreased platelets

dx leukemia acute

• Blood/bone marrow tissue ↔ presence of immature WBC’s

(blasts) – may constitute 60-100% of cells

chronic leukemia

• More insidious onset

• May be discovered during a routine medical exam by a blood count

• CLL → older adults

    • Relatively mature lymphocytes that are immunologically incompetent

• CML → adults & children

     • Leukocytosis with immature cell types

leukemia tx

• Goal – attain remission

• Cytotoxic chemotherapy

• Stem Cell Transplant

     • Allogeneic – volunteer donor

     • Syngeneic – identical twin

     • Autologous – patient’s own

• Risks

• Infection, rejection, relapse

What would be an expected finding of

leukemia during bone marrow biopsy?

A. Immature WBC

B. Neutrophils

C. Red blood cells

D. Macrophages

A

malignant lymphomas

• Neoplasms of cells derived from lymphoid tissue

     • Hodgkin Disease

     • Non-Hodgkin Disease

Hodgkin disease

• Characterized by painless, progressive, rubbery enlargement of a single node or group of nodes – usually in neck area

• Reed-Stenberg cell – distinctive tumor cell found with lymph biopsy

• Diagnosis: peripheral blood analysis (abnormal CBC), lymph node biopsy, bone marrow exam, radiographic evaluation (CT, MRI, PET)

• Etiology- unknown

• Interacting factors- Epstein Barr Virus, genetic predisposition, exposure to toxins

hodgkin s/s

insidious onset; painless enlarged lymph nodes & other nonspecific

symptoms

hodgkin tx

• Chemotherapy

• Radiation

• Stem Cell Transplant

hodgkin disease prognosis

Good since spread is slow and predictable

non-hodgkin disease

• Another neoplastic disorder of lymphoid tissue

• However, spreads early → liver, spleen & bone marrow

• Also characterized by painless, superficial lymphadenopathy; also extranodal symptoms

• Etiology-unknown

• Majority of patients have widely spread disease at the time of diagnosis

non-hodgkin s/s

painless lymph node enlargement & non-specific symptoms

non-hodgkin dxx

similar to Hodgkins lymphoma; increased extranodal sites

non-hodgkin tx

• chemotherapy

• radiation

• refractory cases- stem cell transplant

• Biologic drug therapy

non-hodgkin prognosis

Poorer compared to Hodgkin since this disease spreads quickly and unpredictably

Which statement describes a difference between

Hodgkins and Non-Hodgkins lymphoma?

A. Unknown etiology

B. Treated with chemotherapy

C. Abnormal lab values in CBC

D. Reed-Sternberg cell

multiple myeloma

• Plasma cell cancer (B cells)

• Atypical proliferation of one of immunoglobulins, “M protein” – a monoclonal antibody

multiple myeloma etiology

• Malignant cells invade bone → increased osteoclast activity; leading to bone destruction/resorption)

• Unable to maintain humoral immunity

multiple myeloma s/s

Characterized by bone pain/fractures; also symptoms r/t impaired production of RBC & WBC

• slow and insidious, skeletal pain, hypercalcemia

• men >women, 65 yo, african american > whites

multiple myeloma dx

• laboratory, radiographic, bone marrow exam

• Monoclonal antibody protein in serum and urine

• Pancytopenia

• Hypercalcemia

• Bence Jones proteins in urine

• Elevated serum creatinine

• X-rays osteolytic lesions

multiple myeloma tx

watching, corticosteroids, chemotherapy, biologic therapy, stem cell

transplant, biphosphonates; adequate hydration

What is a manifestation of multiple

myeloma?

A. Lymphadenopathy

B. Presence of “blasts”

C. Splenomegaly

D. Bone pain

D