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Anatomy and Physiology-DNP > Alterations of leukocyte, lymphoid, and hemostatic function > Flashcards

Alterations of leukocyte, lymphoid, and hemostatic function Flashcards

1
Q

Leukopenia

A

Deficiencies

-See w/ radiation, chemo, autoimmune disorders

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2
Q

Leukocytosis

A

Leukocytes increased

-can occur w/ high dose steroids, infections, inflammation

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3
Q

Quantitative disorders

A

Decreased production in bone marrow or increase in cell destruction in circulation

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4
Q

Qualtitative disorders

A

Phagocytes lose ability to function. Lymphocytes loose capacity to respond to antigens (mono, leukemias)

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5
Q

Granulocytosis (Neutrophils, basophils, eosinophils)(Neutropenia)

A

-Present in first stages of infection or inflammation

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6
Q

Granulocytopenia (agranulocytosis )

A
  • causes: interference c/ hematopoiesis, immune mechanisms, chemotherapy destruction, ionizing radiation.
  • Can result in recurrent persistent life threatening infections (particularly in respiratory system)
  • Sepsis caused by this can result in death w/in 3-6 days
  • S/S: infection (recurrent), sepsis, malaise, fever, tachycardia, mouth sores
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7
Q

Eosinophilia

A
  • Eosinophils are increased

- Hypersenstivity reactions trigger the release (parasites, allergies)

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8
Q

Eosinopenia

A
  • Eosinophil count decreases
  • Causes: surgery, shock, trauma, burns, mental distress, cushing syndrome
  • Migration of cells to inflammatory sites
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9
Q

Basophilia

A
  • Circulating numbers of basophils increase
  • occurs in inflammation and hypersensitivity reactions
  • Contains histamine that is released in allergic reactions
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10
Q

Basopenia

A
  • decrease in numbers

- occurs in acute infections, hyperthyroidism and long-term steroid therapy

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11
Q

Monocytosis

A
  • numbers increase
  • occurs w/ neutropenia in later stages of bacterial infections
  • found in chronic infection and correlates w/ extent of myocardial damage
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12
Q

Monocytopenia

A
  • Numbers decrease

- Prednisone treatments, hairy cell leukemia

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13
Q

Lymphocytosis

A
  • increases
  • occurs from acute viral infections (epstein-barr virus)
  • Other causes: leukemia, lymphomas, some chronic infections
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14
Q

Lymphocytopenia

A
  • count decreases

- immune deficiencies, drug destruction, viral desctruction, radiation, or AIDS

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15
Q

Mononucleosis

A
  • viral infection of B lymphocytes
  • commonly caused by EBV
  • Transmission: saliva, GU, rectal, respiratory and blood
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16
Q

Mono

A
  • S/S: Malaise, athraglia, fever, pharyngitis, lymphadenopathy, cervical lymph nodes
  • Dx: monospot qualitative test for heterophilic antibodies
  • treatment: rest and alleviation of symptoms w/ antipyretics, penicillin or erythromycin, ibuprofen.
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17
Q

Leukemias

A
  • malignant disorders of blood and blood forming organs
  • uncontrolled proliferation of malignant leukocytes (overproduction of bone marrow, decreased production & function of normal hematopoietic cells
  • seen in myeloid or lymphoid and can be acute or chronic
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18
Q

Myeloid cells

A

-neutrophils, red cells, platelets
AML-most common in adults
-ALL-kids

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19
Q

Blast cells

A

-more blast cells in the bone marrow aren’t good

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20
Q

Leukemia risk factors

A
  • cigarette smoking, exposure to benzene, ionizing radiation
  • HIV, Hep C, HTLV
  • Pancytopenia (reduction in all cellular components of blood)
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21
Q

Acute Lymphocytic Leukemia (ALL)

A
  • Most common in kids

- Genetic anomaly: philadelphia chromosome: translocation between chromosomes 9 and 22

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22
Q

Risk factors of ALL

A
  • Prenatal xray exposure
  • postnatal exposure to high-dose radiation
  • HTLV
  • Down syndrome
23
Q

Acute Myelogenous Leukemia (AML)

A
  • Most common in adult leukemias (mean age 67)
  • Down syndrome increases risk
  • Abnormal proliferation of myeloid precursor cells
  • Decreased rate of apoptosis (cells aren’t dying off like they should)
  • Arrest in cellular differentiation is a result
  • Mutations in receptor tyrosine kinase FLT3
  • Risks: exposure to radiation, benzene, and chemo, hereditary conditions
24
Q

AML manifesations

A
  • Fatigue caused by anemia
  • bleeding resulting from thrombocytopenia, fever from infection, anorexia, wt loss, diminished sensitivity to sour or sweetness, wasting of muscle and difficulty swallowing, CNS involvment
25
Q

AML dx and tx

A
  • DX: Bone marrow bx, blood count, LP to check CSF for leukemic cells, peripheral blood smear
  • TX: induction chemo, then ALLO HSCT. Supportive measures: blood transfusions, abx, allopurinol, stem cell transplant, antifungals, abx, antivirals
26
Q

Complications of leukemia

A

Anemia (give blood products), neutropenia (give granulocyte colony stimulating factor-GCSF) or GM-CSF). Low WBC count

27
Q

Chronic myelogenous leukemia (CML)

A
  • usually diagnosed in adults
  • Myeloproliferative disorder that also includes polycythemia vera, primary thrombocytosis, and idiopathic myelofibrosis
  • Philadelphia chromosome is often present in BCR-ABL1 causes initiation of CML
28
Q

Chronic Lymphocytic leukemia (CLL)

A
  • Affects monoclonal B lymphocytes
  • Familial tendency
  • Common in adults older than 50
  • Asymptomatic at the time of dx, lymphadenopathy is most common finding, suppresses humoral immunity and increases infection w/ encapsulated bacteria
29
Q

CML s/s

A
  • Infections, fever, wt loss,
  • Chronic phase: 2-5 yrs-symptoms may not be apparent
  • Accelarated phase: 6-18 months-primary symptoms develop: splenomegaly
  • Terminal blast phase: blast crisis: survival is 3-6 months
30
Q

Tests/Tx for CML and CLL

A
  • Blood smear
  • Tx: chlorambucil, adminstered w/ or without corticosteroids, chemo
  • no cure for CML: Combined chemo, biologic response modifiers, allogenic stem cell transplant
31
Q

Leukemia Table

A

ALL:
-Rapid, most common in kids, 91% survival, greater than 30% lymphoblasts and B cells
CLL
-Slow, common in adults, 85% survival, monoclonal B
AML
-Rapid, common in adult form, 24% survival, precursor to myeloid cells
CML
-Slow, found mostly in adults, no cure, neutrophilic or eosinophilic C or clonal: arise from a hematopoetic stem cell

32
Q

Lymphadenopathy

A

-Enlarged lymph nodes that become palpable and tender
Local: drainage of an inflammatory lesion located near the enlarged node
General: Occurs in the presence of malignant or nonmalignant disease

33
Q

Causes of lymphadenopathy

A
  • Neoplastic disease
  • Immunologic or inflammatory conditions
  • Endocrine disorders
  • Lipid storage diseases
  • Unknown causes
34
Q

Primary lymphoid tissue

A

-Thymus, bone marrow

35
Q

Secondary Lymphoid tissue

A

-Lymph nodes, spleen, tonsils. intestinal lymphoid tissue

36
Q

Malignant lymphomas (Hodgkin lymphoma, non-hodgkin lymphoma)

A
  • Hodgkin lymphoma: Linked to EBV

- Non-hodgkin lymphoma: result from genetic mutations or a viral infection

37
Q

Hodgkin lymphoma

A
  • Reed sternberg cells in the lymph nodes
  • RS cells are necessary for dx but not specific to hodgkin along w/ symptoms
  • Types: classic hodgkin lymphoma, nodular lymphocyte-predominant hodgkin
38
Q

Clinical manifestations of hodgkin lymphoma

A
  • Enlarged painless neck lymph nodes
  • Lymphadenopathy causing pressure or obstruction
  • Mediastinal mass
  • Fever, weight loss, night sweats, pruritus, fatigue
  • Tests: CXR, lymphangiography, and biopsy
  • Stage 2 is above and below diaphragm
39
Q

Treatment of HL

A
  • Cure rate is 75%. combined treatment with radiation therapy, and chemotherapy.
  • High dose chemo w/ bone marrow stem cell transplant
  • Monoclonal antibodies
  • nonmyelobative allogenic stem cell transplant
40
Q

Non-Hodgkin lymphoma

A
  • now called B cell neoplasms and includes T cell and natural killer (NK) neoplasms
  • Linked to chromosome translocations
  • Expansions of B cells, T cells, NK cells
  • Three phases
  • Dx: bone marrow bx, CT CAP, CBC
41
Q

NHL manifestations

A

-ascitis, leg swelling, retroperitoneal and abdominal masses, nodal enlargement

42
Q

Comparison of NHL and HL

A 
HL: 
-nodes are localized (cervical, mediastinal, para-aortic), 
-extranodal involvement is rare, 
-spread is orderly, 
-fever, night sweats and weight loss is common, -reed-sternberg cells are present, 
-extent of disease is localized
NHL
-Multiple peripheral nodes
-Extranodal involvement is common
-Spread is not contagious
-fever, night sweats, weight loss is uncommon
-Reed sternberg cells are not present
-Extent of disease is rarely localized
43
Q

Symptoms/conditions that mimic lymphomas

A

-TB, syphilis, systemic lupus, erythematosus, lung cancer, bone cancer

44
Q

Plasma cell malignancies (Multiple myeloma)

A
  • plasma cells proliferate in the bone marrow: translocation involves immunoglobin heavy chain on chromosome 14
  • s/s: hypercalcemia, renal failure, anemia, lytic lesions, skeletal pain, hyperviscosity syndrome, recurring infections
45
Q

Tx of mulitple myeloma

A

Prognosis is poor, combinations of chemotherapy, radiation, high dose chemo followed by blood forming stem cell transplantation, bisphophonates (to reduce skeletal damage), hydration and diuretics, abx

46
Q

Waldenstrom macroglobulinemia (Lymphoplamacytic lymphoma)

A

-Rare type of slow growing plasma cell tumor that secretes IgM molecule

47
Q

Splenomegaly

A

May be classified as pathologic

-May or may not have disease

48
Q

Hypersplenism

A

Overactive spleen

-See leukopenia, TCP, anemia, cellular bone marrow.

49
Q

Congestive splenomegaly

A

occurs with hepatic cirrhosis

-Seen with ascites, portal HTN, esophageal varices

50
Q

Thrombocytopenia

A

<50,000 hemorrhage from minor trauma
<15,000 spontaneous bleeding
<10,000 severe bleeding that can be fatal

51
Q

Immune thrombocytopenic purpura (ITP)

A
  • IgG antibody targets platelet glycoproteins
  • Antibody-coated platelets are sequestered and removed from circulation
  • Acute form develops after viral infections (common childhood bleeding disorder)
  • Chronic form usually is found in adults
  • S/S: petechiae, purpura, progressing to major hemorrhage
  • Treatment: palliative, not curative, prednisone, romiplostim, eltrombopag, splenectomy
52
Q

Thrombotic Thrombocytopenic purpura (TTP)

A

-Platelets aggregate and cause occlusion of arterioles and capillaries

53
Q

Thrombocytosis (Thrombocythemia)

A
  • Platelet >400,000

- Accelerated platelet production in the bone marrow

54
Q

DIC (Disseminated intravascular coagulation)

A
  • Clotting and hemorrhaging simultaneously
  • Causes: sepsis, cancer, acute leukemia, trauma blood transfusion
  • Increase in fibrin and thrombin activity in the blood
  • Magnitude of clotting may result in increased consumption of plts=bleeding
  • Can be caused by sepsis due to endothelial damage
  • Give plts, FFP, cryoprecipitate-replaced fibrinogen

Anatomy and Physiology-DNP (18 decks)

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