Pathophys Exam 2

leukemia

cancer of bone marrow; white cells multiply uncontrollably; not solid tumors

bone marrow produces…

RBCs, WBCs, platelets

leukemia causes…

abnormal blood cells take over space in bone marrow; interfere w/ normal blood-cell production

types of leukemia

lymphoid, myeloid

where abnormal WBCs accumulate

blood, bone marrow, lymph nodes, spleen

types of lymphoid leukemia

acute lymphoblastic leukemia (ALL), chronic lymphocytic leukemia (CLL)

types of myeloid leukemia

acute myeloid leukemia (AML), chronic myeloid leukemia (CML)

lymphoid leukemia

can involve B-cell, T-cell, NK cells

ALL most common in…

children; 75% of chilhood leukemias

ALL

involves uncontrolled proliferation/ accumulation of lymphoblasts (immature lymphoid cells)

lymphocyte cell lineage

hemapoietic stem cell —> lymhpoid progenitor cell —> B-cell/ T-cell/ NK-cell

myelogenous leukemias

affects granulocytes, monocytes, RBCS, platelets

AML most common in…

adults

myelogenous leukemia

overproduction of myeloblasts (immature myeloid cells)

manifestations of leukemia

pancytopenia; bone marrow infiltration crowd out normal cells —> decreased production of all blood cells lines

pancytopenia

reduction of RBCs, WBCs, platelets

clinical presentation of pancytopenia

anemia, thrombocytopenia, leukopenia/ neutropenia

anemia clinical manifestations

decreased RBCs/ hemoglobin; hypoxia, fatigue, pallor, SOB, dizziness, headache, blurry vision

thrombocytopenia

decreased platelets; decreased clotting, increased risk of bleeding, easy bruising, bleeding, petechiae

normal platelet range

150,000-450,000

normal WBC range

5,000-10,000

neutropenia

< 2,000

leukopenia

decreased mature WBCs; decreased immunity, opportunistic diseases

normal male RBC count

4,700,000- 6,200,000

normal female RBC count

4,200,000- 5,400,000

pancytopenia lab findings

low RBC, WBC, platelet counts

CLL

affects B lymphocytes

CLL causes…

accumulation of small, mature looking lymphocytes; malignancy of mature lymphocytes

CLL most common in

adults over 50

CML

affects myeloid cells/ older adults

CML mutation

Philadelphia chromosome; Chromosomes 9/ 22 switch places

chronic leukemias are…

slow to progress/ show symptoms

myeloid branch produces…

RBCs, platelets, neutrophils, eosinophils, basophils, monocytes/macrophages

B-cells

produce antibodies/ help coordinate immune responses

T-cells

help control immune responses/ destroy infected/abnormal cells

NK cells

attack infected/ cancerous cells

risk factors for CLL

older age, family history, European ancestry, environmental exposure (agent orange)

risk factors for CML

high dose radiation exposure, Philadelphia chromosome, no strong family link, potential exposure to pesticides

phases of CML

chronic, accelerated, blast phase/ crisis

chronic phase (CML)

no/ mild symptoms, fatigue, splenomegaly, elevated WBC count, weight loss, sweating, feeling of fullness in abdomen

accelerated phase (CML)

becoming more difficult to control; increasing WBC count, increasing number of immature myeloid cells, abnormal platelet count, worsening anemia, increasing splenomegaly, fever, night sweats, weight loss

blast phase/ crisis (CML)

poor prognosis w/o treatment; large increase in blasts, resembles acute leukemia, infection, bleeding, anemia/fatigue, bone pain, possible organ/tissue infiltration

clinical manifestations of CML

anemia, weight loss, night sweats, fever, splenomegaly, bone pain, easy bruising/bleeding, blurry vision, elevated WBC count, LUQ pain

anemia

fatigue

weight loss

increased metabolic activity of leukemic cells

night sweats

disruption in thermoregulation

fever

infection

splenomegaly

production of cells outside of bone marrow

easy bruising/ bleeding

impaired platelet production

blurry vision

leukostasis (WBCs lodged in eye/ decrease in oxygenation)

elevated WBC count

uncontrolled proliferation

LUQ pain

enlarged spleen

general symptoms of CLL

fatigue, low grade fever, night sweats, weight loss

lymphoid tissue manifestations of CLL

painless lymphadenopathy, splenomegaly, hepatomegaly

hematologic manifestations of CLL

pancytopenia (anemia, thrombocytopenia, leukocytosis, neutropenia)

immune manifestations of CLL

recurrent infections (especially respiratory)

leukemia

abnormal cells accumulate in bone marrow/ blood

lymphoma

abnormal lymphoid cells form masses in lymphoid tissue

lymphocytes

B-cells, T-cells, NK cells

where maturity for B-cells occurs

bone marrow

where maturity for T-cells occurs

thymus

function of lymphocytes

antigen recognition/ response, clonal expansion upon activation, apoptosis after immune response resolution

Hodgkin Lymphoma (HL)

Hodgkin & Reed-Sternberg cells, single chain of lymph nodes/ spreads

Hodgkin Lymphoma peak ages

13-35; 50

Hodgkin Lymphoma risk factors

EBV, immunologic disorders, family history

Non-Hodgkin Lymphoma (NHL)

originates in any lymph tissue; spreads in non-contagious/ unpredictable manner

Non-Hodgkin Lymphoma most common in

older adults

clinical symptoms of NHL

distended abdomen/ early satiety, easy bruising/ bleeding, frequent infections, chest pain/ SOB, skin rash/ nodules, neurologic symptoms

clinical symptoms of HL/ NHL

unexplained low grade fever, diaphoresis, unintentional weight loss, fatigue, painless lymphadenopathy (neck, axilla, groin area)

Burkitt Leukemia/ Lymphoma

highly aggressive mature B-cell neoplasm; recognized as a single entity due to shared molecular features

where Burkitt Leukemia/ Lymphoma’s endemic in

Africa

immunodeficiency associated w/ Burkitt Leukemia/ Lymphoma

AIDS

multiple myeloma

malignant proliferation of plasma cells in bone marrow; production of monoclonal immunoglobulin (M protein); genetic mutations involving IgH

multiple myeloma causes

clonal plasma cells accumulate in bone marrow/ bone suppression due to increased osetoclast activity/ suppressed osteoblast activity

multiple myeloma bone lesions

spinal column; look like red gelatin

multiple myeloma symptoms

neurologic symptoms, bone pain, pathologic fractures, osteolytic lesions, hypercalcemia

multiple myeloma clinical summary

CRAB

hyperCalcemia

bone resorption by osteoclasts

renal failure

nephropathy

anemia

marrow infiltration

bone lesions

osteolytic activity

immune thrombocytopenic purpura

autoimmune disorder; IgG target platelet membrane —> macrophages destroy antibody coated platelets in spleen/ liver —> thrombocytopenia

dysregulation of T-cells from immune thrombocytopenic purpura causes

inflammation

immune thrombocytopenic purpura clinical manifestations

easy bruising, petechiae, prolonged bleeding, spontaneous bleeding, heavy menstrual bleeding, heamturia, melena, fatigue

severe complications of immune thrombocytopenic purpura

internal bleeding, bleeding after procedures/ traumas, retinal hemorrhages, neurological symptoms

function of erythrocytes (RBCs)

transport oxygen from lungs to body tissue via hemoglobin/ carry carbon dioxide waste away from cells back to lungs

RBC structure

no cytoplasmic organelles, nucleus, mitochondria, ribosomes

anemia

deficit of RBCs, tissue hypoxia, low oxygen-carrying capacity of the blood

types of absolute anemia

decreased production of RBCs, increased destruction of RBCs

general effects of anemia

reduction in oxygen carrying capacity —> tissue hypoxia —> compensatory mechanisms

compensatory mechanisms

increased HR, increased blood flow to vital organs

early symptoms of anemia

fatigue, generalized weakness, loss of stamina, tachycardia, DOE

moderate to severe anemia symptoms

vasoconstriction, pallor, tachypnea, dyspnea, agina pectoris, headache, lightheadedness, faintness

aplastic anemia

stem cell disorder; reduction of hematopoietic tissue in bone marrow, fatty marrow replacement, pancytopenia

cause of aplastic anemia

toxic, radiation, immunologic injury to bone marrow stem cells

acquired aplastic anemia

chemical/ physical agents; hepatitis, EPV, HPV

Fanconi pancytopenia

inherited bone marrow failure

how to diagnose aplastic anemia

interpretation of bone marrow biopsy

clinical manifestations of aplastic anemia

decrease of RBCs, weakness, fatigue, lethargy, dyspnea, tachycardia, fever, chills, bacterial infections, petechiae, bruising, nosebleeds, retinal hemorrhage

anemia of chronic kidney disease

impairment of renal endocrine function