HTHS 1120 Module 6 Leukemia

Three main functions of blood

transportation, regulation, protection

Components of blood plasma

water, solutes, proteins

Formed elements of blood

rbcs, wbc, platelets

Phagocytes

neutrophils and monocytes

Major component of the immune system

lymphocytes

Granular WBC's

neutrophil, eosinophil, basophil

agranular WBC

lymphocyte, monocyte

Site of hematopoiesis after birth

Red bone marrow

cells that can develop into many different cell types

pluripotent stem cells

Site where lymphocytes complete their development

lymphoid tissue

hematopoiesis

blood cell formation

Type of WBCs elevated in an allergic reaction

eosinophils and basophils

anemia

decreased number of circulating RBCs

leukopenia

decreased number of circulating WBCs

leukocytosis

increased number of circulating WBCs

lymphoblast

early cell of the lymphocytic line usually found in the bone marrow

blood-brain barrier

capillary walls in the brain prevent harmful substances from entering the CNS

hypercellularity

increased number of cells in the bone marrow

meninges

three membranes that cover the brain and spinal cord

pneumonia

infection of one or both lungs

pus

accumulation of cells and fluid indicative of an infectious process

petechiae

red spots in the skin that result from blood leaking from capillaries

remission

return to a normal state after treatment

upper-lobe infiltrate

infectious material in the upper portion of the lung

transfusion

blood from a donor given through an IV line

hematocrit

The percentage of red blood cells to total blood volume

CBC

determines number and types of cellular components

throat culture

determines cause of an upper respiratory infection

bone marrow aspirate

analysis of blood-forming portion of the bone

lumbar puncture

check for cells, glucose, and protein in the spinal fluid

chest xray

useful in diagnosing pneumonia

gram stain

differentiates bacteria into two distinct classes

Which type of leukemia progresses slowly at first, affects cells of the myeloid line, and primarily affects adults?

chronic myelocytic leukemia (CML)

chemotherapy

systemic drugs that kill rapidly dividing cells

radiation

ionizing rays kill rapidly dividing cells

bone marrow transplant

transplant of healthy stem cells

hematology/oncology

provide diagnosis and treatment of neoplastic and hematologic disease

pathologist

doctor that analyzes biopsies and blood samples

pediatrics

doctor that is the first contact in diagnosing a child with leukemia

respiratory therapist

performs chest physiotherapy to expand and clear lungs

radiation oncology

doctor that oversees radiation treatment for cancer

clinical laboratory scientist

performs CBC, gram stain, and throat culture

nurse

monitors vital signs

radiology technician

takes chest xray

What symptoms did Noah exhibit?

pallor, bone tenderness, enlarged spleen and lymph nodes, bruising, bleeding (nosebleeds).

What abnormalities were present in the laboratory tests?

Elevated WBC count, decreased RBC, Hct, and platelet count. Decrease in normal White Blood Cells; elevated abnormal White Blood Cells (blasts).

leukemia

cancer of the blood, a large number of abnormal blood cells are produced which do not function properly

What is the difference between a chronic and acute leukemia? How do the symptoms differ?

In acute leukemia, the abnormal blood cells are blasts that remain very immature and cannot carry out their normal functions. The number of blasts increases rapidly, and the disease gets worse quickly. In chronic leukemia, some blast cells are present, but in general, these cells are more mature and can carry out some of their normal functions. Also, the number of blasts increases less rapidly than in acute leukemia. As a result, chronic leukemia gets worse gradually.

In acute leukemia, symptoms appear and get worse quickly. People with this disease go to their doctor because they feel sick. In chronic leukemia, symptoms may not appear for a long time; when symptoms do appear, they generally are mild at first and get worse gradually. Doctors often find chronic leukemia during a routine checkup--before there are any symptoms.

What are the four most common types of leukemia? In which age groups is each most predominantly found?

Acute lymphocytic leukemia (ALL) is the most common type of leukemia in young children. This disease also
affects adults, especially those age 65 and older.

Acute myeloid leukemia (AML) occurs in both adults and children.

Chronic lymphocytic leukemia (CLL) most often affects adults over the age of 55. It sometimes occurs in younger adults, but it almost never affects children.

Chronic myeloid leukemia (CML) occurs mainly in adults. A very small number of children also develop this disease.

What are the common symptoms of leukemia?

Symptoms include:
•Fever, chills, and other flu-like symptoms;
•Weakness and fatigue;
•Frequent infections;
•Loss of appetite and/or weight;
•Swollen or tender lymph nodes, liver, or spleen;
•Easy bleeding or bruising;
•Tiny red spots (called petechiae) under the skin;
•Swollen or bleeding gums;
•Sweating, especially at night; and/or
•Bone or joint pain

What tests help a physician diagnose leukemia?

CBC, bone marrow smear

What abnormality in Noah's bone marrow smear was suggestive of a Leukemia?

A preponderance of one cell line, blasts.

Chemotherapy is the first line of treatment for ALL. What treatments would follow if chemotherapy fails?

Radiation therapy, biologic therapy, bone marrow transplant.

ALL is the most common cancer in young children. What is the approximate cure rate in children?

80%

Why is a lumbar puncture performed?

Diagnostic purposes: obtain a sample of spinal fluid for examination.

Therapeutic purposes: administer antibiotics, cancer drugs or anesthetic agents.

What is cerebral spinal fluid?

The CSF circulates around the brain and spinal cord (the central nervous system). This "water bath" acts as a support of buoyancy for the brain and spinal cord. The support of the CSF helps to protect the brain from injury.

What abnormalities can be detected from a chest x-ray?

Abnormalities of the lungs including: pneumonia, bronchitis, asthma, cysts, and cancers.

Abnormalities of the heart including: fluid around the heart, enlarged heart, heart failure, abnormal anatomy.

Broken chest bones.

Why would an immunocompromised patient be more susceptible to disease?

An immunocompromised patient has a depressed immune system, and is unable to mount a response to disease.

What evidence can be noted in the CBC and Bone Marrow results to indicate Noah is in remission?

Normal cell values and normal cell lines are present.

What is bone marrow and what is its purpose?

Spongy tissue inside some of the bones. It's purpose is to make blood cells.

How is bone marrow transplanted?

Blood stem cells (immature cells that can grow into red blood cells, white blood cells, and platelets) are transfused into the bloodstream.

What are possible sources for transplanted cells

a. iliac crest (hip bone)

b. blood stem cells

c. stem cells from their own blood if they're healthy enough to donate

d. umbilical cord blood

which cells fall within the lymphoid stem cell line?

T, B, NK lymphoblasts (natural killer)

percentage of neutrophils in blood

60-70%

percentage of lymphocytes in blood

20-25%

percentage of monocytes in blood

3-8%

percentage of eosinophils in blood

2-4%

percentage of basophils in blood

1%

hemoglobin

iron containing pigment of RBCs