Module 6 - Lymphatic and Hematologic Systems

What is the Lymphatic system?

A one way system that moves fluid from the periphery into the central circulation

What is the Lymphatic system responsible for?

Carrying fluid and plasma proteins back to the blood circulation

True or False: The lymphatic system is a pressure-driven system based on principles of osmotic diuresis

True

What are the smallest lymphatic vessels at the periphery?

Lymphatic capillaries

What is the function of lymphatic capillaries?

They function as force pumps powered by variations of total pressure caused by movement and muscular contractions; without the changes in pressure fluid will accumulate causing edema

What are the steps of the Lymphatic System?

1. Blood capillaries release fluid into surrounding tissues

2. The fluid is collected by tiny vessels (initial lymphatic vessels)

3. The fluid (now lymph) travels through lymph nodes where its filtered

4. Filtered lymph moves through larger vessels

5. The lymph reaches two main ducts (right lymphatic duct and thoracic duct)

6. Lymph emptied into bloodstream at subclavian veins

What is the purpose of lymph nodes?

Act as filters to cleanse the lymph of waste products and cell debris

What do lymph nodes produce?

Lymphocytes and macrophages

What is inflammation of a lymphatic vessel?

Lymphangitis

What is infection of one or more lymph nodes?

Lymphadenitis

What is increased amount of lymph fluid in the soft tissues?

Lymphedema

What is inflammation of the lymph nodes?

Lymphadenopathy

What is lymphedema?

Swelling of the soft tissues that results from the accumulation of protein-rich fluid in the extracellular space

What typically accompanies lymphedema?

Tissue fibrosis

Name the Lymphedema Stage:
Impaired lymph transport but no evidence of swelling; may report sensation of heaviness

Stage 0

Name the Lymphedema Stage:
Soft, pits on pressure, reverses with elevation

Stage 1

Name the Lymphedema Stage:
Nonpitting, does not resolve on elevation and fibrosis is present

Stage 2

Name the Lymphedema Stage:
Severe nonpitting, fibrotic edema with hyperkeratosis, leaking lymph fluid

Stage 3

What is the most common cause of secondary lymphedema?

Filariasis (parasitic worm from mosquito bite)

What is the most common cause of Lymphedema in the US?

Cancer treatment

What is the pathogenesis of lymphedema?

Inadequate recycling of proteins and inadequate transport of normal lymph volume

What are some signs/symptoms of Lymphedema?

Rings feel tight
Heavy, tight feeling
Swelling
Decreased Flexibility

What are some complications of lymphedema?

Hair Loss
Sweat gland loss
Keratotic patches on the skin
Papillomas
Chronic fungus (tinea)

True or False: There is no clear-cut pharmaceutical drug to treat lymphedema.

True

How can PTs recognize lymphedema early?

Lightly compress areas
Circumferential measurements
Document skin integrity

What is Manual Lymphatic drainage?

Light, skin-stretching massage to promote movement of lymphatic fluid out of the swollen limb

True or False: Deep diaphragmatic breathing does not promote lymphatic drainage

False

What are the 3 main lymphedema PT interventions?

Exercise guidelines
Compression garments
Compression pumps

What is a branch of science that studies the form, structure, and function of blood and blood-forming tissues

Hematology

Blood is composed of three things:

Leukocytes (white blood cells)
Erythrocytes (red blood cells)
Thrombocytes (platelets)

Where does the development of red blood cells take place in?

Bone marrow

What do Platelet disorders contribute to (3)?

Hypo/Hyper-coagulopathy
Increased risk of thrombus
Impaired tissue perfusion

What is a solid mass of clotted blood within an intact blood vessel or chamber of the heart

Thrombus

What is a mass of solid, liquid, or gas that moves within a blood vessel to lodge at a site distant from its place of origin

Embolus

What is a localized region of necrosis caused by reduction of arterial perfusion below a level required for cell viability

Infarction

True or False: When bruising occurs with minor trauma or bleeding continues longer than normal, there is a concern for a platelet disorder of the blood

True

What is one of the main signs of a platelet disorder?

Purpura (red/purple patches on skin)

What does Purpura signify?

There is not enough normal platelets available to plug damaged vessels or prevent leakage

True or False: When there is a low platelet count we do not need to limit or avoid resistance exercises

False

What is an Erythrocyte disorder?

Altered oxygen carrying capacity of the blood

What are 3 main Leukocyte disorders?

Blood cancer
Lymphadenopathy
Splenomegaly

What is Lymphadenopathy?

Abnormal enlargement of lymph nodes

What’s the difference between malignant nodes and inflammatory nodes?

Malignant nodes are not tender or mobile, they are firm and enlarged
Inflammatory nodes are mobile, soft and tender

What is Splenomegaly?

Enlargement of the spleen

What type of disorder is Anemia?

Erythrocyte (RBC) disorder

What is Anemia?

A state that results in a reduction of the oxygen-carrying capacity of the blood from an abnormal quantity of RBC’s

World Health Organization defines anemia as a hemoglobin of _____ for men and _____ for women

< 13 g/dL for men
<12 g/dL for women

True or false: Anemia is a disease

False; its a symptom of other diseases

What are 3 possible causes of Anemia?

Excessive blood loss (surgery)
Increased destruction of erythrocytes (hemolysis)
Decreased production of erythrocytes

True or false: Signs and symptoms of Anemia are related to the severity

True

What are some signs and symptoms of anemia?

Weakness
Dyspnea on exertion
Fatigue
Pallor
Tachycardia
Headaches
Irritability

How is Anemia diagnosed?

A complete blood count

True or False: A patient with Anemia will have high hemoglobin/hematocrit

False

True or False: Anemia is a normal part of aging

False

What are some PT implications of Anemia?

Mobility problems
Bleeding and easy bruising
Soft tissues

Why do individuals with Anemia have a diminished exercise tolerance?

Physical activity increases the demand for oxygen, which may not be adequately available in the circulating blood

What type of disorder is Leukocytosis?

Leukocyte (WBC) disorder

What is Leukocytosis from?

An increase in the number of leukocytes (WBC) in the blood, typically from infection but sometimes leukemia

Alterations in blood leukocyte concentration are indicative of (3):

Infection
Inflammation
Tissue damage or degeneration

What is Leukopenia?

Reduction in the number of white blood cells

What is Neutropenia?

Type of leukopenia that is a decrease in circulating neutrophils

True or False: Neutrophils are the first line of defense against infection, so when they decrease the risk of infection increases.

True

What is Leukemia?

Broad term for cancers of the blood; malignant neoplasm (tumor) of the blood-forming cells

Why is Leukemia hard to treat?

Malignant cells replace the normal bone marrow with a malignant clone of lymphocytic or myelogenous cells

What are the 3 main symptoms of Leukemias?

Anemia
Infection
Bleeding tendencies

What is the goal of Leukemia treatment?

Bring about complete remission with return to normal blood and marrow cells without relapse

What is a rapidly progressive malignant disease that results in the accumulation of immature, functionless cells called blast cells in the bone marrow and blood that block the development of normal cell development

acute leukemia

What are the 2 major forms of acute leukemia?

Acute lymphoblastic (lymphocytic) leukemia
Acute myeloid leukemia

What is Acute Lymphoblastic Leukemia?

Involves the lymphocytes (B or T lymphocytes) and lymphoid organs

What is Acute myeloid leukemia?

Involves hematopoietic stem cells that are committed to differentiate into myeloid cells

What is the most common Leukemia in adults?

Acute Myeloid Leukemia

What is the hallmark presentation of Acute Myeloid Leukemia?

Pancytopenia (reduction in all cell lines)

How is Acute Myeloid Leukemia diagnosed?

Blood test to reveal an elevated leukocyte count with an excessive amount of immature cells

What is Acute Lymphoblastic Leukemia characterized by?

Inability of lymphocytic progenitor cells, lymphoblasts, to mature into normal T and B cells

Whats the median age of diagnosis for Acute Lymphoblastic Leukemia?

15 years old

Is ALL or AML more likely to have leukemic cells spread to extramedullary sites?

ALL

How is Acute Lymphoblastic Leukemia diagnosed?

Lumbar puncture to collect cerebral spinal fluid

What is the best treatment for ALL?

Vincristine

What is Chronic Leukemia?

Neoplastic accumulation of mature lymphoid or myeloid elements of the blood

Chronic leukemia causes crowding of the _____ by leukemic cells that inhibits normal blood cell production

bone marrow

What is Chronic Myeloid Leukemia?

Neoplasm of the hematopoietic stem cell due to an abnormal gene

Chronic Myeloid Leukemia causes ______ pain and early ____

left upper quadrant; satiety

What is Chronic Lymphocytic Leukemia?

B-cell affected cancer that presents with fatigue, and enlarged lymph nodes

What are some PT implications of leukemia?

Exercise during medical management of leukemia improves health related quality of life and reduces symptoms

What is Lymphoma?

General term for cancers that develop in the lymphatic system that primarily involves lymph nodes

What are two groups of Lymphoma cancers?

Hodgkin and Non-Hodgkin

What lymphoma has the presence of Reed-Sternberg cells in the lymph nodes?

Hodgkin’s Lymphoma

What are Reed-Sternberg Cells?

B-cell lineage and have twin nuclei that give them the appearance of owl eyes

What are some signs and symptoms of Hodgkin’s Lymphoma?

Fever, night sweats, weight loss, pruritus

What is one specific, and weird, sign of HL?

Pain with alcohol consumption

True or False: Hodgkin’s Lymphoma is not a highly curable disease

False

What are some PT implications for patients with Hodgkin’s Lymphoma?

PT may palpate enlarged, painless lymph nodes during an exam

What is Non-Hodgkin’s Lymphoma?

Solid tumor arising from cells of the lymphatic system

In Non-Hodgkin’s Lymphoma what is usually involved first?

Lymph nodes

What is the hallmark sign of Non-Hodgkin’s Lymphoma?

Lymphadenopathy (very swollen lymph nodes)

The clinical staging of Non-Hodgkin’s Lymphoma is according to the ____ Classification System

Lugano

Non-Hodgkin’s Lymphoma is often clinically separated into two general prognostic groups:

indolent and aggressive

Is Non-Hodgkins or Hodgkins associated with EBV? What about HIV or autoimmune diseases?

Hodgkins = EBV
Non-Hodgkins = HIV and autoimmune

What is Multiple Myeloma?

Primary malignant neoplasm of plasma cells arising in the bone marrow

What does Multiple Myeloma initially effect?

Bones and bone marrow of the vertebrae, ribs, skull, pelvis and femur