White blood cell disorders Flashcards
What 2 cells form after the first differentiation of the multipoint haemotopoietic stem cell
- Common Myeloid progenitor
- Common lymphoid progenitor
What are the 2 types of leukocyte
granular and agranular
Name the agranular leukocytes
lymphocytes
Monocytes
Name the granular leukocytes
Basophil
Neutrophil
Eosinophil
What is leukocytosis and what can cause it
Increased WBCs
- increased production - leukaemia, myeloproliferative diseases
- reactive leukocytosis - 2ry to infection or inflammation
What is Leukopenia and what can cause it
Decreased WBCs
- 2ry to aplastic anaemia
- cyclic neutropenia
- drugs - chemotherapy
- overwhelming bacterial/viral infections (HIV)
- Radiation - 2ry to radiotherapy
What is leukaemia and describe it in its acute form
- Malignant proliferation of WBCs
- Proliferation of immature blast cells in blood and bone marrow
- Reduction in number of normal, mature RBCs and platelets
- Acute lymphoblastic leukaemia (lymphoblasts) = ALL
- Acute myeloid leukaemia (myeloblasts) - AML
Describe the chronic form of leukaemia
- Proliferation of mature cells
- Progresses slowly allowing the bone marrow to keep producing more mature functional cells
- Often asymptomatic
- Chronic lymphocytic leukaemia (lymphocytes) - CLL
- Chronic myeloid leukaemia (myelocytes) = CML
Who is more likely to get Acute lymphoblastic leukaemia (ALL) and who has a poor prognosis
- More common in children
- Poor prognosis in adults
Who is more likely to get Acute myeloid leukaemia (AML) and who has a poor prognosis
- More common in adults
* Poor prognosis in both adults and children
Who is more likely to get CLL and CML
Both forms more common in adults
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CML may progress to acute leukaemia
What are the clinical presentations of acute leukaemias
- Short history of feeling unwell
- May present with neutropenia (susceptible to infections), fever, bleeding tendencies, bruising, anaemia
- Organ infiltration may occur: skin, gums, testes, meninges
- Blood film: leucocytosis ~ circulating blasts and cytopenias
What are the clinical presentations of chronic leukaemias
- Often diagnosed incidentally
- Usually long history of non-specific symptoms
- Splenomegaly is common
- Lymphadenopathy is common in CLL
- Blood film: leucocytosis ~ circulating mature lymphocytes or myeloid cells
What are the dental signs and symptoms of decreased RBCs
- Fatigue
- Pallor
- Inability to perform routine daily activities
What are the dental signs and symptoms of decreased platelets
- Mucosal bleeding
- Petechiae
- Easy bruising and bleeding
What are the dental signs and symptoms of decreased mature, normal, functioning WBCs
- Increased susceptibility to infections
- Poor wound healing
What are the dental signs and symptoms of increased immature, abnormal, dysfunctional WBCs, infiltrating organs
- lymphadenopathy
- gingival enlargement
- abdominal fullness due to enlarged spleen/liver
What are the adjunct supportive therapies that are used to compensate for lack of functioning cell lines in leukaemias
- Red cell transfusion
- Platelet transfusion
- GCSF (granulocyte colony stimulating factor)
What specific treatments are there for leukaemia
- chemotherapy - cytotoxic drugs
- radiotherapy
- targeted therapy
- stem cell transplantation
What are lymphomas and what types are there
These are solid tumours caused by malignant proliferation of the lymphocytes within nodal and extra nodal sites
- Hodgkin’s
- Non-Hodgkin’s
What is hodgkin’s lymphoma caused by and what risk factors are there
B-cell dysfunction resulting in the accumulation of abnormal B cells
• Bimodal age distribution–early 20s and>70
• M>F
• Immunocompromised - HIV/AIDS, chemo- & radio-therapy
• Previous history of infectious mononucleosis
• Positive family history
What are the clinical features of hodgkin’s lymphoma
- Progressive, painless enlargement of lymph nodes esp in neck
- Fatigue
- night sweats
- fever
- anorexia
- weight loss
- bone pain
- jaundice (when disease spreads to liver)
- shortness of breath (when disease spreads to lungs)
- pruritus
- flu-like symptoms
What special investigations are used for hodgkin’s lymphoma
- lymph node biopsy - reed-sternberg cells
- FBC radiographs, CT/MRI and PET scans
What are the treatment options for hodgkin’s lymphoma
- Radiation therapy: Stage 1/2
- Combined chemotherapy: stage 3/4
- Stem cell transplant: recurrent hodgkin’s lymphoma
- Targeted therapy
What are the main dental problems that come from hodgkin’s lymphoma
- Oral infections – esp. with viruses and fungi
- Mucositis or oral ulceration caused by cytotoxic drugs
- Hyposalivation – from salivary gland irradiation damage
- Anaemia
- Bleeding tendencies
- Painless enlarged cervical lymph nodes
- Impaired respiratory function (pulmonary fibrosis due to irradiation)
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LA regional blocks should be avoided if there is any bleeding tendencies
Describe all the features of non-hodgkin’s lymphoma
- More common than hodgkin’s lymphoma
- B or T cell associated subtypes
- Most NHLs are of B cell origin
- Greater propensity for extranodal sites
- Any age
- Poor prognosis
What are the risk factors for Non Hodgkin’s lymphomas
- Increasingage
- Immunosuppression
- Certain infections
- Exposure to certain chemicals, including benzene, herbicides and pesticides
- Strong family history of NHL
What are the signs, symptoms, staging, treatments and dental aspects of NHLs
All the same as hodgkin’s lymphoma
What is Burkitt’s lymphoma associated with
Previous epstein-barr virus infection
What 3 subtypes are there for burkitt’s lymphoma
Endemic
Sporadic
Immunodeficiency
Who is most susceptible to endemic burkitt’s lymphoma and what is a characteristic feature of it
- African children and young adults
- Boys > Girls
- Jaw Swelling
Who is most susceptible to sporadic burkitt’s lymphoma and what is a characteristic feature of it
- Western world
- Males > Females
- Linked to EBV
Who is most susceptible to immunodeficiency burkitt’s lymphoma and what is a characteristic feature of it
- Increased incidence in HIV/AIDs
- Organ transplant
What are the signs/symptoms/dental aspects/treatments etc of burkitt’s lymphoma
Same as hodgkin’s lymphoma
What is multiple myeloma and what causes it
• Proliferation of malignant plasma cells
• Malignant plasma cells produce defective immunoglobulins - overabundance of monoclonal
paraproteins or M-proteins
• Malignant plasma cells release osteoclast-activating factors which cause bone resorption and pain
What are the risk factors for multiple myeloma
- Increasing age: more common around age 60
- Gender: M > F
- More prevalent in Africans
- Immunosuppression
- Past exposure to radiation
- Strong Family history
What are the classic signs and symptoms
CRAB
- Calcium elevation (hyperCalcaemia)
- Renal failure
- Anaemia
- Bone pain (esp. spinal)
Name some other features of multiple myeloma
- Blood hyperviscosity - thrombosis
- weakness
- visual disturbance
- bleeding/ bruising tendencies
- susceptibility to infections
- osteoporosis
- amyloidosis
What are some of the special investigations for multiple myeloma
- Serum protein electrophoresis - M proteins
- Urine - pence-jones protein
- bone marrow aspiration
- FBC - anaemia, thrombocytopenia, leukopenia
- renal function
- bone profile - hypercalcaemia
- Radiographies, CTs/MRIs
What are the treatment options for multiple myeloma
- Chemotherapy + steroids
- Immunomodulatory drugs – inhibits the growth and survival of myeloma cells
- Bone marrow transplant
What can be done to treat the symptoms/complications of multiple myelomas
- Analgesic
- Blood transfusion
- Dialysis
- Bisphosphonates – help prevent pathological fractures
- Radiotherapy
- Surgery
What is the prognosis for multiple myelomas
- Variable
* Median survival is about 3 years
What are some of the dental aspects for multiple myelomas
- Jaw osteolytic lesions (involving posterior mandible)
- Root resorption, loosening of teeth and pathological fractures
- Risk of osteonecrosis (MRONJ) – due to IV bisphosphonates
What are some of the rare complications of multiple myelomas
• Gingival bleeding
• Oral petechiae
- Cranial nerve palsies
- Herpes simplex and zoster infections
What are the causes of reactive leukocytosis
- Infections
- Inflammation
- Disease
- Neoplastic conditions
AY BAWS CAN I HABE DE NOTE PLZ
idfk what’s going on with this evaluate WBC differential count
