m4 (2/3 RBC, WBC diseases)

polycythemia

excessive RBC’s

2 forms of polycythemia

• relative: from dehydration, easily fixed

• absolute: primary or secondary

erythropoietin

hormone stimulating bone marrow to produce RBC’s

difference between primary and secondary polycythemia

polycythemia → absolute → primary or secondary

• primary = non-malignant (cancerous or harmful) from overabundance of bone marrow stem cells

• secondary = hypoxia from higher altitudes, COPD, smokers

  • low oxygen levels = compensates by overproducing erythropoietin

physiological manifestations of polycythemia

• increased RBC level

• increased hemoglobin

• increased BV and viscosity in hematocrit

other

• hypertension from the increased BV

• splenomegaly

• depleted iron

splenomegaly

enlargement of the spleen

• manifestation of polycythemia

leukocyte types

granulocytes

• neutrophils

• eosinophils

• basophils

agranulocytes

• lymphocytes

• monocytes

WBC function is affected with too few/many cells (______ changes), or if cells are functionally defective (______ changes)

[quantitative - too few/many cells] [qualitative - functionally defective cells]

leukocytosis

increase in WBC count

• normal response to infection, surgery, pregnancy, hormones

• can be caused by blood disorders, malignancies

leukocytopenia / leukopenia

decrease in WBC count

never a normal response

what is leukopenia caused by?

result of radiation, chemotherapy, autoimmune disease

reasons why granulocyte counts increase vs decrease

increase - due to infection types

decrease - production falls behind need

most common granulocyte type that fluctuates in its count

neutrophils - most numerous granulocyte

neutrophilia

early response to infection (shift to the left)

neutropenia

severe prolonged infections where body’s production cannot keep up with demand

• starvation, HIV, autoimmune disorders, chemo

agranulocytosis (granulocytopenia)

extremely low granulocyte count caused by chemo, aplastic anemia

lymphocytosis

increase in lymph cells from viral infections

lymphocytopenia

decrease in lymph cell count - immune deficiencies, drugs

example of lymphocytosis

infectious mononucleosis (IM)

(lymphocytosis - increase in lymph cell count)

infectious mononucleosis (IM)

• virus name

• transmission method

• cell type and count affected

• age most frequently affected

epstein-barr virus (EBV) infects B lymphocytes

• kissing disease - transmission through saliva

• lymphocytosis - increased lymphocyte number

• commonly affects 15-19 yr olds

specific antibody tested for when determining diagnosis of IM (infectious mononucleosis)

heterophile antibodies - AB that bind to antibodies other than the ones originally triggering them

pathophysiology & symptoms of IM (infectious mononucleosis)

epstein-barr virus invades upper respiratory tract (oro/nasopharynx, salivary epithelium) → moves to lymphoid tissues, infects B lymphocytes

symptoms = fever, sore throat, cervical lymph node enlargement → sometimes leads to splenomegaly

leukemia

cancer of the bone marrow stem cells (blood + blood forming organs)

genetic mutations cause abnormal immature cells to be rapidly overproducted - the immature cells do not function as mature cells, spilling into bloodstream and causing patient’s clinical manifestations as they do not function maturely (condition of pancytopenia)

pancytopenia

condition in leukemia from the reduced number of normal mature blood cells in peripheral blood - low counts cause leukemia’s physical manifestations

• uncontrolled proliferation of the malignant leukocytes cause “crowding” in bone marrow, causing production of other cell types to cease

risk factors for leukemia

• hereditary abnormalities (ex/ down syndrome)

• cigarette smoke

• ionizing radiation

• infections like HIV, HCV

• chemotherapies

describe leukemic cells

immature, poorly differentiated

rapid proliferation, abnormal function

interfere w/ normal blood cell maturation

infiltrate bodily organs and circulate bloodstream

leukemia vs lymphoma

leukemia - cancer of blood forming cells

lymphoma - cancer of the lymph nodes, spreads through lymphatic system

naming structure of leukemia

1. cell line affected/proliferating

   1. lymphocytic - lymphoid stem cell → abnormal B and T cells

   2. myelogenous - myeloid stem cell → abnormal RBC, granulocytes, monocytes, platelets

2. disease progression

   1. acute - can develop rapidly

   2. chronic - can develop slowly, more mature cells

4 classes of leukemia

• ALL - acute lymphoblastic leukemia

• AML - acute myeloid leukemia

• CLL - chronic lymphocytic leukemia

• CML - chronic myeloid leukemia

defining characteristics and clinical manifestations of acute leukemias

rapid growths of immature blood cells - abrupt onset and short survival time. difficult to detect early

clinical manifestaitons

• anemia-induced fatigue

• anorexia & weight loss

• thrombocytopenia-induced bleeding

• leukocytopenia (decreased # of WBC) - infections and fever

types

• ALL: acute lymphocytic

• AML: acute myelogenous

evaluation and treatment of acute leukemias

evaluation = blood tests and bone marrow biopsies: high immature WBC count

treatment = induction chemotherapy, blood transfusions, antimicrobial agents

cause of death for those with acute leukemias

metastatic infiltration of tissues causing infection, hemorrhage

ALL: acute lymphocytic leukemia

• cell type affected

• unique characteristic

• B cell lymphocytes

• most common type in children

AML: acute myelogenous leukemia

• cell type affected

• unique characteristic

• cells EXCEPT lymphocytes (NEUTROPHILS, PLATELETS, ERYTHROCYTES)

• occurs more in older adults

defining characteristics of chronic leukemias, clinical manifestations and types

slow growth of more mature cells, abnormal functioning, longer survival, gradual onset — majority of adult cases

clinical manifestations

• fatigue

• weight loss

• splenomegaly

types

• CLL: chronic lymphocytic leukemia

• CML: chronic myelogenous leukemia

evaluation and treatment of chronic leukemias

evaluation = blood tests, bone marrow biopsies

treatments = combined chemotherapy, bone marrow transplant, biologic response modifiers (to increase immune response)

CLL: chronic lymphocytic leukemia

• cell type affected

• manifestations resulting from affected cell type

• unique characteristic

• B cell refusing apoptosis commands, accumulates while inactive. no AB production either!

• increased infections due to no ABs being produced

• can be slow onset, which is often asymptomatic

CML: chronic myelogenous leukemia

• cell type affected

• 3 phases

• unique characteristic (HINT: CHROMOSOME)

• marrow granulocytes, RBC precursors, megakaryocytes

• phases:

  • chronic: asymptomatic

  • accelerated: primary symptoms, immature cells, infections, fever

  • terminal blast phase: more blast cells, severe symptoms, poor prognosis

• unique: philadelphia chromosome - an abnormal shortened chromosome that is apparent in 95% of CML cases

CML survival rates

90% live 5 yrs or longer

CLL survival rate

high variation survival rate: indolent forms = many years, aggressive forms = rapid onsets