hematopoetic part 1 Flashcards
Leukocytosis
an increase in total circulating white blood cells
when are these seen?
individual cell forms of leukocyotsis
Neutrophilia (granulocytosis) - bacterial infections
Lymphocytosis - viral infections
Eosinophilia - parasitic infections, allergic reactions
confused with? test?
leukemoid rxn
an elevated white blood cell count that is a physiologic response to stress or infection
can be confused with leukemia- clarified with LAP test (low in leukemia)
Leukopenia
a decrease in total circulating white blood cell count
can be due to?
forms of leukopenia
Neutropenia – antineoplastic therapy, drugs
Lymphopenia – steroid therapy
Pancytopenia – all cell lines affected – anemia, thrombocytopenia,
neutropenia
interchangable terms of neutropenia
The terms agranulocytosis, granulocytopenia and neutropenia are
often used interchangeably
normal/abnormal count?
Neutropenia
Normal adult peripheral white blood cell count – 4,500 – 11,000 /mm3
Clinically relevant neutropenia –
Absolute Neutrophil Count (ANC) < 500 /mm3
neutropenia can allow sus to?
Susceptibility to bacterial and fungal infections
causes neutropenia
Decreased production due to:
* Drugs
* Hematologic disease – cyclic neutropenia
* Nutritional deficiency – B12, Folate
* Myelophthisis
Increased destruction - autoimmune reactions
severe neutropenia ana signs of infection
In severe neutropenia the signs of infection may be absent
WNL WBC
cells/ul (4,000 – 11,000)
Cyclic Neutropenia
Regular, periodic reductions in neutrophils
when are symptoms the greatest?
symptoms of cyclic neutropenia
Symptoms greatest at nadir – fever, lymphadenopathy, malaise, pharyngitis, ulcerations, periodontitis
tx cyclic neutropenia
Treatment - supportive care, cytokine
therapy (G-CSF)
where are the neoplastic cells
Leukemias
the neoplastic cells are in the bone marrow and blood
where are the neoplastic cells
Lymphomas
Lymphomas - the neoplastic cells are in the
lymph nodes – (also extranodal sites)
terms? describe?
Neoplasms of
Hematopoietic Cells
Leukemia and Lymphoma describe the tissue distribution of disease
Leukemia
* Arises in bone marrow
* Spreads to peripheral blood
Lymphoma
* Arises in peripheral lymphoid tissue, usually in lymph nodes
* Forms a discrete tissue mass
* May eventually spread to peripheral blood and bone marrow
onset? maturation? tx/death? cure?
Acute vs Chronic Leukemia
Classification of Leukemias by Cell of
Origin and Clinical Course
cell level? bleeding? fever? energy? what is each due to?
Clinical Symptoms of Acute Leukemia
Cytopenias - depression of normal bone marrow function
Bleeding – petechiae, ecchymoses, epistaxis, gingival hemorrhage due to thrombocytopenia
Fever - infections due to absence of mature granulocytes
Fatigue - anemia
gingiva with acute leukemia
Spontaneous Gingival Hemorrhage
what can be on palate with AL
Palatal Petchiae
what oral hemmorhage can be seen (aside from petechaie) with AL?
Ecchymoses
nose and AL
epitaxis (nose bleed)
Acute Lymphoblastic Leukemia
cells invovled?
A disease of?
prognosis ?
Lymphoblasts - immature precursor B or T lymphocytes
arrested at early stage of development
A disease of children
Good prognosis with aggressive chemotherapy
Acute Myeloblastic Leukemia
cells?
Age?
Prognosis?
Gingiva?
Myeloblasts – immature myeloid precursors (granulocytic,
monocytic, erythroid, megakaryocytic) with no terminal
myeloid differentiation
Adults
Prognosis – chemotherapy, bone marrow transplantation.
More difficult to treat than ALL.
Gingival enlargement in monocytic types of AML
which leukemia likely caused this
AML
Clinical Symptoms of Chronic Leukemia
Often clinically silent
Incidental leukocytosis on CBC
Chronic Myelogenous Leukemia
Age?
onset/progression?
chr?
signs?
crisis?
tx?
Adults
Insidious onset, slow progression
Philadelphia chromosome – t(9:22) bcr-abl fusion gene
Splenomegaly, fever, fatigue
Blast crisis
Bone marrow transplantation
seen with which neoplasm?
Philadelphia Chromosome
SEEN WITH CML
Translocation t(9:22)
Proto-oncogene abl on long arm chromosome 9(q34)
Transposed to bcr region (breakpoint cluster region) on chromosome 22(q11)
Results in bcr-abl fusion gene
Gene product is abnormal bcr-abl tyrosine kinase
Induces cell proliferation
Chronic Lymphocytic Leukemia
commonality?
age? symptoms?
infections?
autoantibodies?
Richter syndrome?
Most common type of leukemia
Adults, often asymptomatic
Hypogammaglobulinemia – infections
Anti red cell autoantibodies – autoimmune hemolytic anemia
Anti platelet autoantibodies – autoimmune thrombocytopenia
Richter syndrome – may transform to high grade lymphoma
4 kinds of Lymphoid Neoplasms
Lymphocytic Leukemia
Hodgkin Lymphoma
Non-Hodgkin Lymphoma
Plasma cell neoplasms
Clinical Presentation of Lymphoid Neoplasms: Related to ________
Related to Anatomic Distribution
Lymphoma presentation
Lymphoma - non-tender lymph node enlargement, extra-nodal mass