Chapter 24 Disorder Of White Blood Cells And Lymphoid Tissues

Question 1

Formed Elements of Blood

Answer 1

.Red blood cells
. Platelets
. Granulocytes ( ie neutrophils, eosinophils, and basophils)
. Monocyte and macrophage lineage
- both are derived from the myeloid stem cell in

Question 2

Continuation from former elements of blood

Answer 2

Monocyte and macrophage lineage
- both are derived from the myeloid stem cell in the bone marrow and circulate in the blood
. Lymphocytes
- T lymphocytes ( T cells) and B lymphocytes ( B cells) originate in the bone marrow and migrate between the blood and the lymph.

Question 3

Hematopoietic tissue

Answer 3

. Myeloid tissue
- Bone marrow 
. Lymphoid tissue
- Nodes
- Thymus
- Spleen

Question 4

Hematopoiesis

Answer 4

. White blood cells are formed partially in the bone marrow and partially in the lymph system
- they are formed from hematopoietic stem cells that differentiate into committed progenitor cells
- These in turn develop into the myelocytic and lymphocytic lineages needed to form white blood cells.
. RBCs and platelets are formed in the marrow and released into circulation

Question 5

Growth and Reproduction of white blood cells

Answer 5

. The growth and reproduction of different stem cells are controlled by multiple hematopoietic growth factors or inducers
. The life span of WBC’s relatively short; constant renewal is necessary to maintain normal blood levels
. Conditions that decrease availability of stem cells or hematopoietic growth factors produce a decrease in WBCs.

Question 6

Diseases of deficient Blood cell Production

Answer 6

. Leukopenia deficiency of leukocytes 
-Neutropenia 
-Granulocytopenia
. Aplastic Anemia
- Anemia, thrombocytopenia, and agranulocytosis

Question 7

Causes of Neutropenia

Answer 7

. Accelerated removal 
. Drug- induced granulocytopenia
. Periodic or cyclic neutropenia
. Neoplasms involving bone marrow
- Idiopathic neutropenia occurring in the absence of other disease or provoking influence
- Felty syndrome

Question 8

Sign and symptoms of neutropenia

Answer 8

. Initially, those of bacterial or fungal infections 
- Malaise 
- Chills
- Fevers
- Extreme weakness and fatigue
. Reduced white blood cell count

Question 9

Infectious Mononucleosis

Answer 9

. Definition
- self- limited lymphoproliferative disorder
. Causes and characteristics
- Caused by the b- lymphocytes EBV, a member of the herpes virus family ; transmitted in saliva
- Characterized by fever, generalized lymphadenopathy, sore throat, and the appearance in the blood of atypical lymphocytes and several antibodies
- Highest incidence in adolescents and young adults
- Treatment is symptomatic and supportive

Question 10

Neoplastic Disorder of Hematopoietic and Lymphoid Origin

Answer 10

. Represent the most important of the white cell disorders
. Include somewhat overlapping categories
- Lymphomas
- Leukemia
- Plasma cell dyscrasias ( multiple myeloma

Question 11

Clinical Features of Neoplasms

Answer 11

. Largely determined by 
- their site of origin
- the progenitor cell from which they originated 
- the molecular events involved in their transformation into a malignant neoplasm
. Chromosomal aberrations
- Deletions
- polyploidy 
- Translocations
- hyperploidy
- inversions

Question 12

Hodgkin Disease and Non- Hodgkin Disease

Answer 12

. Hodgkin disease

• lymphoma arises in a single node or chain of nodes
• Reed - Sternberg cells are present

Non - Hodgkin disease
Lymphoma originates at extranodal sites and spreads to anatomically contiguous nodes.
Reed - Sternberg cells are not present
- Reed Sternberg cells are derived from B lymphocytes

Question 13

Symptoms of Hodgkin Disease

Answer 13

. Stage A
- Lack constitutional symptoms
. Stage B
Significant weight loss, fevers, pruritus, or night sweats
. Advanced Stages
- Fatigue and anemia
-Liver, lungs , digestive tract, and CNS may be involved

Question 14

Categories of Non- Hodgkin lymphomas

Answer 14

. Low - grade lymphomas 
- Predominately b- cell tumors
. Intermediate- grade lymphomas
. Intermediate- grade lymphomas 
. High - grade lymphomas 
- Largely immunoblastic (B cell), lymphoblastic (T cell), Burkett, and non- Burkitt lymphomas

Question 15

Diagnosis of Hodgkin Disease

Answer 15

. Reed-Sternberg cell present is a biopsy specimen of lymph node tissue
. Computed tomography (CT) scans of the chest and abdomen to assess for involvement of mediastinal, abdominal, and pelvic lymph nodes
. A bipedal lymphangiogram to detect structural changes in the lymph nodes too small to visualize on CT scan
. A positron emission tomography (PET) imaging
. A bilateral bone marrow biopsy may be performed if disease is disseminated.

Question 16

Staging of Non- Hodgkin Lymphomas Disease

Answer 16

. Bone marrow Biopsy
. Blood studies 
. Chest and abdominal CT scans
. Nuclear medicine studies 
. Cytologic examination of the cerebrospinal fluid

Question 17

Treatment for Hodgkin and NHL

Answer 17

. Depends on the histologic type, stage of the disease, and clinical status of the person
. Types 
 - Radiation 
- Combination chemotherapy 
- For NHL only
. Adjuvant radiation therapy 
.  Monoclonal antibodies

Question 18

Leukemias

Answer 18

. Definition
- Malignant neoplasms arising from the transformation of a single blood cell line derived from hematopoietic stem cells

. Classification according to cell lineage

• lymphocytic ( lymphocytes)
• Myelocytic ( granulocytes, monocytes)

Question 19

Chronic Leukemia’s

Answer 19

Definition 
- Malignancies involving the proliferation of well- differentiated myeloid and lymphoid cells
. Types of chronic leukemia 
- chronic lymphocytic leukemia ( CLL)
- Chronic myelogenous leukemia ( CML)

Question 20

Classification of Leukemia Types

Answer 20

. Acute lymphocytic ( lymphoblastic) leukemia
. Chronic lymphocytic leukemia
-Both involve immature lymphocytes and their progenitors in the both marrow, the spleen, lymph nodes, CNS, and other tissue.
- Acute myelogenous leukemia
- Chronic myelogenous leukemia
- Both involve the pluripotent myeloid stem cells in bone marrow and interfere with the maturation of all blood cells

Question 21

Goals of treatment for CML

Answer 21

. A hematological response characteristics by normalized blood counts
. A cytogenetic response demonstrated by the reduction or elimination of the Ph chromosome from the bone marrow
. A molecular response confirmed by the elimination of the BCR - ABL fusion protein

Question 22

Criteria for Remission of ALL and AML

Answer 22

. Less than 5% blasts in the bone marrow
. Normal peripheral blood counts
- Absence of cytogenetic abnormalities
. Return to preillness performance status

Question 23

Factors Affecting the likelihood of Achieving Remission

Answer 23

. Age
. Type of leukemia
. Stage of the disease at time of presentation

Question 24

Leukemic Cells

Answer 24

. Are immature and poorly differentiated
. Proliferation rapidly and have a long life span
. Do not function normally
. Interfere with the Maturation of normal blood cells
. Circulate in the blood stem
. Infiltrate May body organs

Question 25

Warning signs Complications of Acute Leukemia

Answer 25

. Signs.                     Complications
- Fatigue                 - Leukostasis
- Pallor.                -Tumor lysis syndrome 
- weight loss.        -Hyperuricemia 
- repeated infections  - Blast crisis
- easy bruising
- nosebleed 
. Other types of hemorrhage

Question 26

Multiple Myeloma

Answer 26

. Definition
- a plasma cell dyscrasia characterized by expansion of single clone of immunoglobulin- producing plasma cells and a resultant increase in serum levels of a single monoclonal immunoglobulin or its fragments
. Main sites involved
- The bones and bone marrow
- Proliferation and activation of osteoclasts that lead to bone resorption and destruction
- pathological fractures
- hypercalcemia