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Pathophysiology > 11 Malignant disorders of WBC > Flashcards

11 Malignant disorders of WBC Flashcards

1
Q

malignant disorders of WBC’s

A

1 leukemia
2 lymphoma
3 plasma cell myeloma

-common neoplastic disorders of bone marrow + lymphoid tissues

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2
Q

leukemia

A
  • circulating tumors

- primarily involve blood + bone marrow

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3
Q

lymphoma

A
  • tends to localize in lymph tissues

- often disseminated to other sites at diagnosis

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4
Q

plasma cell myeloma

A
  • malignant transformation of B-cell plasma cells

- likes to form localized tumors in bony structures

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5
Q

lymphoid stem cells differentiate into…

A

1 NK cell
2 B cell
3 T cell

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6
Q

myeloid stem cells differentiate into…

A

1 neutrophil
2 monocyte
3 RBC
4 megakaryocyte

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7
Q

NK cell neoplasm

A

NK-cell leukemia/lymphoma

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8
Q

B cell neoplasm

A

B cell leukemia/lymphoma/myeloma

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9
Q

T cell neoplasm

A

T cell leukemia/lymphoma

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10
Q

Neutrophil neoplasm

A

granulocytic leukemia

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11
Q

Monocyte neoplasm

A

monocytic leukemia

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12
Q

RBC neoplasm

A

PV/erythroid leukemia

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13
Q

megakaryotic neoplasm

A

essential thrombocythemia/megakaryocytic leukemia

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14
Q

lymphoid vs myeloid neoplasms

A

LYMPH: leukemia, lymphoma, myeloma (B cells)

MYEL: leukemia, thrombocythemia (megakaryote)

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15
Q

___ of leukemia cells would also decide which types of blood cells would be affected

A

ASNAPLASIA

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16
Q

categories of hematologic neoplasms are based on ______ rather than its location in the body

A

based on cell type of the neoplasm

such as myeloid lineages (RBC, platelets, etc), or lymphoid lineage (NK, T, B cells)

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17
Q

types of myeloid neoplasms

A

1 Myoproliferative Disease
2 Myelodysplastic/Proliferative Disease
3 Myelodysplastic Syndrome
4 Acute Myeloid Leukemia (AML)

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18
Q

types of lymphoid neoplasms

A

1 B-cell neoplasm
2 T-cell + NK-cell neoplasm
3 Hodgkin disease

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19
Q

types of non-hodgkin lymphoma

A

lymphomas of B, T, NK cell origin

-includes large diverse group of malignancies

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20
Q

signs + symptoms of malignant WBC’s

A
  • enlarged, nontender lymph nodes (lymphadenopathy) w lymphoma + some leukemias
  • recurrent infections
  • V high WBC count or presence of abnormal cell types
  • malaise, weakness, unexplained fever, night sweats
  • anorexia, weight loss
  • hepatomegaly
  • splenomegaly
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21
Q

clinical manifestations of hematologic neoplasms

A
  • anemia
  • thrombocytopenia
  • leukopenia, neutropenia
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22
Q

tumor vs neoplasm

A

tumor refers to swelling or a lump like swollen state that would normally be associated with inflammation, whereas a neoplasm refers to any new growth, lesion, or ulcer that is abnormal

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23
Q

treatments for malignant WBC

A
  • chemotherapy (primary)
  • stem cell transplant (primary)
  • radiation
  • tissue-specific drug therapy
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24
Q

chemotherapy

A
  • induce long-term remission
  • removes malignant cells
  • usual treatment includes MANY chemotherapy cycles
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25
Q

complete remission (CR)

A

return to normal hematopoiesis

-no detectable neoplastic cells

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26
Q

most chemotherapeutic agents induce ___

A

apoptosis

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27
Q

chemotherapy treatment phases

A

1 remission induction
2 post-remission or consolidation
3 remission maintenance

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28
Q

remission induction

A
  • 1st phase of chemotherapy

- eliminate all detectable neoplastic cells + achieve CR

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29
Q

post-remission or consolidation

A
  • 2nd phase of chemo after CR is attained

- eliminates an UNdetected cells (may have escaped initial induction-phase)

30
Q

remission maintenance

A
  • 3rd phase in chemo

- manages some neoplasms to prolong remission interval

31
Q

prevention + mgmt of complications

A

1 bone marrow transplant (BMT)

2 peripheral stem cell transplantation

32
Q

bone marrow transplant (BMT)

A
  • used to manage certain leukemias
  • manage bone marrow failure due to intense chemotherapy
  • stem cells reintroduced to bone marrow via IV
33
Q

peripheral stem cell transplantation

A

allows stem cells to be harvested fr circulating bloodstream

34
Q

what may occur if bone marrow transplantation is NOT from a close match

A

graft-versus-host may occur

35
Q

common types of Myeloproliferative Diseases

A

1 Chronic Myeloid Leukemia (granulocytes)
2 Polycythemia Vera (RBC)
3 Essential Thrombocytopenia

36
Q

Chronic Myeloid Leukemia [CML]

avg age of onset

A

adult: 40-50 yrs

37
Q

Chronic Myeloid Leukemia [CML]

usual clinical presentation

A
  • ***high granulocyte count on the CBC

- spenomegaly

38
Q

Chronic Myeloid Leukemia [CML] is characterized by _____

A

CML is characterized by MALIGNANT TUMORS that carry the Phladelphia chromosome [Ph+]

39
Q

Ph+

A

philadelphia chromosome

  • translocation of chromosomes 9 + 22 to create new fusion gene called bcr/abl
  • causes myelogenous leukemia

-incr cell proliferation + reduce apoptosis

40
Q

Chronic Myeloid Leukemia [CML]

treatments

A
  • CML does NOT respond well to chemo (untreated patients have median survival of 2 yrs)
  • ANTI-BCR/ABL THERAPY [IMATINIB]
41
Q

imatinib

A

anti-bcr/abl therapy

-reduce number of leukemic cells w bcr/abl type to undetectable levels

42
Q

Acute Myeloid Leukemia [AML]

onset

A
  • abrupt onset of symptoms
  • 80% of cases are adults
  • median age 64 yrs
43
Q

between AML and ALL, which has the worse prognosis?

A

AML (acute myeloid leukemia) has the worse likely course

-50% of kids + 30% of adults survive long-term

44
Q

lymphoid neoplasms

A
  • includes malignant transformations of B, T NK cells
  • leukemia
  • lymphoma
45
Q

leukemia vs lymphoma

A

leukemia is present in blood or marrow

lymphoma is localized in lymphoid tissues

46
Q

precursor cell neoplasms

A

characterized by cells that have arrested dvlpt in early blast stage

47
Q

mature cell neoplasms

A

more differentiated than precursor cells;

often located in peripheral sites

48
Q

Chronic Lymphoid Leukemia [CLL]

A
  • most common leukemia in U.S. (30%)
  • 95% are malignant B-CELL PRECURSORS
  • –asymoptomatic, usually found by accident in routine blood exams
  • 5% are aggressive T-CELL transformation
49
Q

Chronic Lymphoid Leukemia [CLL] invades ______

A

lymphoid tissue + bone marrow

-disrupts function, enlarged + painless lymph nodes + spleen

50
Q

Chronic Lymphoid Leukemia [CLL] infiltrates bone marrow and causes…

A

a reduction of RBC/platelet production

51
Q

Acute lymphoblastic Leukemia/Lymphoma [ALL]

A

-primarily a children’s disorder (3-7 yrs, then middle age)

  • causes severe bleeding
  • hemathrosis
52
Q

Plasma Cell Myeloma [Multiple Myeloma]

A

-malignant disorder of mature antibody-secreting B lymphocytes (aka plasma cells)

53
Q

Plasma Cell Myeloma [Multiple Myeloma]

age of onset + location

A

-exclusively in adults 40 yrs or older, peak 65 yrs

  • malignant plasma cells invade bones + form multiple tumors
  • may also target lymph nodes, liver, spleen, kidney
54
Q

Plasma Cell Myeloma produces….

A
  1. excessive identical monoclonal antibodies
    - accumulates in bloodstream
  2. bence jones protein/light-chain antibody fragments
    - accumulates in blood + urine, kidney (damages kidney)
55
Q

accumulation of monoclonal antibodies fr malignant plasma cells are detected by….

A

serum protein electrophoresis

56
Q

when plasma cell myeloma accumulates in bone…

A

1 pathologic fractures are common

2 incr in Ca released in bloodstream fr bone destruction

57
Q

Plasma Cell Myeloma [Multiple Myeloma]

diagnosis

A 
based on:
1 monoclonal antibody peak
2 presence of bence jones protein
3 hypercalcemia 
4 bone lesions
58
Q

Bence Jones Protein

A
  • light-chain antibody fragments
  • produced by malignant plasma cell
  • accumulates in blood + urine + kidney (damages kidney)
59
Q

Hodgkin Disease

A

malignant disorder of lymph nodes

  • 30% of malignant lymphoma
  • occurs across lifespan (20-40 yrs)
  • higher incidence + worse prognosis in males
  • 5 yr survival rate
60
Q

Hodgkin Disease

pathogenesis

A
  • characterized by REED-STERNBERG CELLS

- originate fr B cells in germinal centers of lymph nodes (malignant but grow/spread in predictable way)

61
Q

Hodgkin Disease usually metastasizes along ___

A

contiguous lymphatic pathways (predictable metastasis route)

62
Q

_____ is frequently found in genome of transformed Reed-Sternberg (in Hodgkin disease)

A

Epstein-Barr virus

-usually present in single node or localized node chain

63
Q

hodgkin disease is often asymptomatic in ___ stage

A

early stage

64
Q

most common enlargement site of hodgkin

A

cervical nodes - lymph node enlargement above diaphragm

65
Q

Hodgkin Disease

prognosis + treatment

A

stage dictates treatment modality

  • localized tumors : radiation therapy (most common)
  • disseminated disease : chemotherapy
66
Q

Non Hodgkin

A

most arise from B, T, NK Cell

  • no Reed-Sternberg cells
  • spread early + unpredictably when compared to Hodgkin’s
67
Q

Epstein Barr virus is known to cause

A

Burkitt lymphoma

68
Q

Non Hodgkin lymphoma complications

A

2 serious oncologic emergencies:
1 superior vena cava obstruction
2 spinal cord compression

69
Q

vocab

1 leukemia
2 lymphoma
3 plasma cell myeloma
4 myeloid
4 lymphoid stem cell
A

1 circulating tumors (blood + marrow)
2 localize in lymph tissue
3 malignant mature B cells, tumors localized in bony structures
4 stem cells that diff. into neutro, monocyte, RBC, megakaryote

70
Q

most common form of leukemia

A

chronic lymphoid leukemia CLL

71
Q

liver associated bleeding issue is due to a deficiency of ___

A

vitamin K

Pathophysiology (32 decks)

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