Disorders of WBCs, RBCs, and Platelets

what are the three generalized WBC disorders?

leukemia, lymphoma, and multiple myeloma

where do all WBCs originate?

pluripotent stem cells

what is hematopoiesis?

blood cell production

where does hematopoiesis occur?

bone marrow

where does the lymphatic vessel drain into?

the lymph node

what does the lymphatic vessel do?

absorb extra fluid caught between cells (ISC) and takes those fluids to the lymph node

where do substances enter in the lymph node?

afferent lymphatic

where do substances exit in the lymph node?

efferent lymphatic

what are the 5 types of WBCs?

neutrophils, lymphocytes, monocytes, eosinophils, basophils

what are granulocytes?

granulation cells that contain granules in their cytoplasm

- eosinophils, basophils, neutrophils

- granulocytes = digestive enzymes

what are agranulocytes?

non-granule cells

- lymphocytes and monocytes

where are WBCs manufactured?

in the bone marrow

where are WBCs matured?

lymphoid tissue like the lymph node, thymus, and spleen

what % do monocytes make up of circulating WBCs?

3% to 7%

how do monocytes mature into macrophages?

they leave circulation and enter tissue

where are a large amount of matured macrophages found?

the spleen and other major organs

what is the primary function of macrophages?

phagocytosis

what kind of immune system are macrophages?

innate immune system; they will eat anything in their path

which WBC is the first responder to defend against antigens?

macrophages

what % of circulating WBCs do lymphocytes compose?

20% to 30%

what are the two types of lymphocytes?

b lymphocytes and t lymphocytes

what response do b lymphocytes produce?

innate immunity -- they are non specific

what response to t lymphocytes produce?

adaptive immunity -- they target antigen specific immune responses, such as antigen specific antibodies

what kind of immunity are lymphocytes a part of?

adaptive immunity?

how do lymphocytes work?

once exposed to an antigen, they recognize, target, and remember the specific invading antigens

- they create MEMORY of it for a faster attack next time they invade the body

- this also grants the body long-term immunity to said antigen

what % of circulating WBCs do neutrophils make up?

60% to 70% of the WBCs in circulation

what is unique about neutrophils?

they are the first WBC to respond to any type of inflammatory reaction, infection, or stressful event

which WBC is the most common?

neutrophils

what are mature neutrophils also referred to as?

polymorphonuclear leukocytes (PMNs)

what shaped nucleus do mature neutrophils have?

segmented, multi-lobed nucleus

what are mature neutrophils referred to based on their nucleus shape?

segs

what shape to immature neutrophils have?

band-like nucleus

what are immature neutrophils referred to based on their nucleus shape?

bands

how do eosinophils work?

they are generated and released by the bone marrow in response to allergy and parasitic infection

how do basophils work?

they are generated and released by the bone marrow in response to many inflammatory reactions, particularly parasitic infections

cbc with differential

measures total RBCs, Hgb, Hct, platelets, total WBCs, and percentage of each WBC

what is leukocytosis?

rise in WBC count above 11,000/uL

what is leukopenia?

decrease in WBC count below 4,000/uL; decreases all types of WBCs

what is a leukemoid reaction?

leukocytosis in excess of 50,000 microliters caused by conditions OTHER THAN LEUKEMIA

what does leukopenia risk?

infection, decreased signs of infection, and diminished ability for the body to heal itself

what is lymphocytosis?

increase in lymphocytes (b and t)

what is monocytosis?

increase in monocytes

what is basophilia?

increase in basophils

what is eosinophilia?

increase in eosinophils

what is neutrophilia?

increase in neutrophils

what is lymphocytopenia?

decrease in lymphocytes (b and t)

what is monocytopenia?

decrease in monocytes

what is basopenia?

decrease in basophils

what is eosinopenia?

decrease in eosinophils

what is neutropenia?

decrease in neutrophils

what are hematologic neoplasms?

cancers that affect blood, bone marrow, and the lymph nodes

what type of neoplasms are hematologic neoplasms?

malignant because they form cancer

what are the malignant neoplasms located in hematologic neoplasms?

primarily the blood (leukemia) or the lymph node (lymphoma)

what kind of cells are present in acute leukemia?

less differentiated; symptoms are much more severe

what kind of cells are present in chronic leukemia?

better differentiated; symptoms are less severe than acute leukemias

what is acute lymphocytic leukemia (ALL)?

- poorly differentiated lymphoid stem cell line cells

- malignancy is in the bone marrow and blood

what happens in acute lymphocytic leukemia?

stem cell precursors for lymphocytes in the bone marrow do not function or mature beyond the lymphoblast stage

what are the signs/symptoms of acute lymphocytic leukemia?

- low WBCs, RBCs, and platelets, which leads to anemia, increased risk to infection, suppressed clotting

- enlarged lymph nodes, splenomegaly

what is the diagnosis for acute lymphocytic leukemia?

- CBC with differential

- bone marrow biopsy

why would a CBC differential lead to leukocytosis in ALL?

because there is still a mass production of WBCs in the form of immature WBCs due to ALL -- the CBC differential accounts for ALL WBCs present, including the immature ones

why would a bone marrow biopsy lead to lymphoblastic hypercellularity in a patient diagnosed with ALL?

similarly to the leukocytosis being present during CBC differential in ALL, the mass production of lymphoblasts (immature lymph cells) would occupy most of the space in the bone marrow, leading to hypercellular characteristics

what is chronic lymphocytic leukemia (CLL)?

- better differentiated lymphoid stem cells

- malignancy is in the blood and bone marrow

what occurs in chronic lymphocytic leukemia?

b cells fail to differentiate from their precursors into mature b cells in the bone marrow

which leukemia is the most common in the united states and least common in china/japan?

chronic lymphocytic leukemia

chronic lymphocytic leukemia etiology?

over 80% genetic changes

chronic lymphocytic leukemia signs/symptoms?

constant proliferation of precursor b cells (B-CLL)

- in bone marrow: decreased RBC, WBC, and platelet development

- in lymphoid tissue: lymphadenopathy and splenomegaly(enlargement of spleen)

CLL diagnosis?

- CBC with differential: lymphocytosis with WBC counter greater than 20,000/uL

- bone marrow biopsy: proliferation of small lymphocytes

what is acute myelogenous leukemia (AML)?

- less differentiated myeloid stem cells

- malignancy is in the blood and bone marrow

what occurs in acute myelogenous leukemia (AML)?

proliferation of undifferentiated (-blast) myeloid cells in the bone marrow

AML etiology?

- genetic mutations in abnormal myeloid cells

- previous chemotherapy/radiation treatment

AML signs/symptoms?

- anemia (lack of RBCs)

- bleeding disorder (lack of platelets)

- infection (neutropenia)

what is chronic myelogenous leukemia (CML)?

- better differentiated myeloid stem cells

- malignancy is in the blood/bone marrow

what occurs in chronic myelogenous leukemia?

overproduction of mature myeloid cells in the bone marrow

CML etiology?

- 95% of diagnosed patients have Philadelphia chromosome (genetic mutation)

- ionizing radiation

CML signs/symptoms?

- decreased number of RBCs, WBCs, and platelets; leads to increased infection, anemia, and thrombocytopenia, fever, fatigue, weakness, and bleeding

- bone pain due to excessive proliferation of -blast cells that occupy all the space in the bone marrow

what is philadelphia chromosome?

translocation between chromosomes 9 and 22 -- caused by CML

what are the two major types of hematologic neoplasms?

myeloid and lymphoid neoplasms

what are myeloid neoplasms?

mutations of the myeloid cell line

what occurs in myeloid neoplasms?

- overproduction of abnormal monocytes or granulocytes

- normal bone marrow cells are replaced with the myeloid neoplastic abnormal cells

what are the two types of myeloid neoplasms?

acute and chronic myelocytic leukemia (AML/CML)

what are lymphoid neoplasms?

mutation of the lymphoid cell line

what occurs in a lymphoid neoplasm?

- overproduction of abnormal lymphocytes (the b and t cells)

what are the four different types of lymphoid neoplasms?

- acute lymphocytic leukemia (ALL)

- chronic lymphocytic leukemia (CLL)

- hodgkin lymphoma

- non hodgkin lymphoma

I definitely already made this question but u need to know it lmao

which type of neoplasm presents the more severe signs/symptoms?

the acute ones!!!

what do leukemias and lymphomas have in common?

they both cause similar pathophysiological conditions

what do nonfunctional, cancerous WBCs do?

proliferate and overwhelm the bone marrow and other lymphoid tissues

what do cancerous WBCs do?

increase in excess numbers and crowd/suppress development of other blood cells in the bone marrow -- this suppresses development of healthy/normal/mature blood cells

what does low RBC mean?

anemia

what does low WBC mean?

increased infection

what does low platelet mean?

bleeding/increased bleeding tendency

what is the common cause of symptoms pertaining to low RBC, WBC, and platelet counts?

immature WBCs occupying the space in the bone marrow instead of these healthy cells/cell fragments

symptoms of hematologic neoplasms?

- anemia (fatigue, weakness, pallor)

- leukopenia (increased infection susceptibility)

- thrombocytopenia (increased susceptibility to bleeding and bruising)

- bone pain (caused by proliferation of cancerous blood cells that take up the space in the bone marrow -- this increases pressure and thus causes pain in the bones)

- enlarged lymph nodes

what is lymphoma?

- involved in the lymphocytic membrane line and is found mostly in the lymph nodes

- the most common type of blood cancer in the united states

what is hodgkin's lymphoma (HL)?

- develops from specific abnormal b-lymphocyte line

- accounts for 17% of lymphoma cases

what is non-hodgkin's lymphoma (NHL)?

- develops from either abnormal b/t-lymphocyte line

- accounts for 83% of lymphoma cases

lymphoma signs/symptoms?

enlarged lymph nodes with no pain felt

what is multiple myeloma (MM)?

hematologic neoplasm within B lymphocytes -- the b cells cannot produce normal antibodies and instead create abnormal antibodies (immunoglobulins or fragments known as M protein/monoclonal protein)

what occurs in multiple myeloma (MM)?

- proliferation of neoplastic plasma cells (abnormal antibodies) in the bone marrow

- synthesis of abnormal Ig's or fragments (M proteins)

- immunodeficiency

- increased blood viscosity

what happens when abnormal immunoglobulins or Ig fragments are synthesized?

1. organ infiltration

2. proliferation of osteoclasts

what happens during the proliferation of osteoclasts in Ig/fragment synthesis?

- bone is reabsorbed (broken down) -> bone destruction -> osteopenia -> compression fracture (such as vertebral bone collapse), radiculopathy, hypercalcemia

- lytic lesions are created

- bone pain as a result of lytic destruction and plasmacytoma formation