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Pathophysiology (NRSG 502) > White Blood Cells & Lymphoid Tissues (Ch. 24)-- Definition First > Flashcards

White Blood Cells & Lymphoid Tissues (Ch. 24)-- Definition First Flashcards

Exam 2

1
Q
  • Osteolytic bone lesions → Bone pain
    • Hypercalcemia
    • Pathological fractures
  • Bone marrow infiltration
    • Thrombocytopenia
    • Anemia
    • Neutropenia
  • ⇣ Ig production → Recurrent infections
  • ⇡ WBCs→ ⇡ Blood viscosity
  • Weight loss
  • Weakness
  • Renal insufficiency
    • ~50%
  • Neuropathy
  • Spinal cord compression fractures
A

Multiple Myeloma Clinical Manifestations

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2
Q

Synthesized in bone marrow → Differentiated to plasma cells → Move to lymph nodes

A

B Lymphocytes

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3
Q

Made in bone marrow

  • Erythrocytes
    • RBCs
  • Megakaryocytes
    • Platelets
  • Leukocytes
    • WBCs
      • Granulocytes
        • Neutrophils
        • Esosinophils
        • Basophils
      • Monocytes/Macrophages
      • Lymphocytes
        • T-Cells
        • B-Cells
        • NK Cells
A

Types of Blood Cells

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4
Q

⇡ # Immature or abnormal leukocytes

Most common cause of CA in children & adolescents

d/t– Genetics (Down syndrome, Neurofibromatosis, Philadelphia chromosome (CML)), Occupational hazards (radiation, chemical carcinogens)

  • Malignant neoplasms
    • Lymphoid stem cells
      • Infiltrate spleen, lymph nodes, & CNS
    • Myeloid stem cells
      • Interfere w/ maturation of WBCs, RBCs, & platelets
  • Replacement of bone marrow w/ unregulated, proliferating, immature neoplastic cells
    • Normal WBC:RBC
      • 1:600-700
    • Leukemia WBC:RBC
      • 600-700:1
      • Opposite of normal
A

Leukemia

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5
Q
  • Non-neoplastic
    • Leukopenia
    • Neutropenia
    • Infectious mononucleosis
  • Neoplastic
    • Leukemia
    • Lymphoma
    • Multiple myeloma
A

Classifications of WBC Disorders

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6
Q
  • Painless lymph node enlargement
    • Single node or group of nodes
    • Located above diaphragm
  • Pruritis
  • Intermittent fevers
  • Night sweats
  • Weight loss
  • Chest discomfort w/ mediastinal mass
    • Cough
    • Dyspnea
  • ⇣ Cell-mediated immune response
    • T-cell dysfunction
      • Viral, fungal, or protozoal infection risk

Diagnosis– Reed-Sternberg cells in biopsy

A

Hodgkin Lymphoma Clinical Manifestations

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7
Q
  • Parenchyma
    • Outer (Superficial cortex)
      • Primary follicle
        • Inactive B-cells
      • Secondary follicle
        • Active, mature B-cells
      • Mantle zone
      • Paracortex
        • T-cells
    • Inner Medulla
      • Blood supply
      • Lymphatic vessels
A

Lymph Node Structure

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8
Q
  • ⇣ WBC
  • ⇣ ANC
  • Mild-moderate
    • Skin lesions
    • Stomatitis
      • Sores around mouth
    • Pharyngitis
      • Sore throat
  • Severe
    • NO S/S of infection
      • No Inflammatory response
    • Strict precautions
      • Full PPE
A

Neutropenia Clinical Manifestations

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9
Q

Cancers of the lymph nodes

  • Solid tumors of neoplastic lymphoid cells (originate from lymph nodes & MALT)
    • B-cells
    • T-cells
    • NK cells
  • Hodgkin Lymphoma
  • Non-Hodgkin Lymphoma
A

Malignant Lymphomas

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10
Q

Pluripotent Stem Cells → Lymphoid OR Myeloid Stem Cells → Progenitor Cells → Unipotent Cells

A

Leukocyte Differentiation

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11
Q
  • Large, atypical cells
    • Reed-Sternberg cells
      • Atypical cell
        • Mirror-image nuclei
  • Originate from single node or chain of nodes
    • Spread from there
A

Hodgkin Lymphoma

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12
Q

Synthesized in bone marrow → Mature in thymus → Differentiate to CD4+/CD8+ → Move to lymph nodes

A

T Lymphocytes

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13
Q

Plasma cell dyscrasia → Malignant B-cell proliferation (bone marrow) → Osteolytic bone lesions (skeletal system) → IgG or IgA in blood (80-85%) and/or Bence Jones proteins in blood & urine (15-20%) → Renal injury & failure

d/t– Aging ( > 60 y.o.)

  • Risk factors
    • Chronic immune stimulation
    • Autoimmune disorder
    • Exposure
      • Ionizing radiation
      • Pesticides/Herbicides
      • Agent Orange
        • Vietnam vets
A

Multiple Myeloma

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14
Q
  • Chronic Lymphocytic Leukemia (CLL)
    • More fully differentiated lymphocytes and progenitors that originate in bone marrow
    • Treatment
      • Corticosteroids
      • Splenectomy
  • Chronic Myelogenous Leukemia (CML)
    • More fully differentiated pluripotent myeloid stem cells in bone marrow
    • Philadelphia chromosome in >90% CML cases
      • Translocation 9 & 22
    • Treatment
      • Bone marrow or stem cell transplant

Manifestations– Lymphadenopathy, Splenomegaly, Hepatomegaly, Anemia, Thrombocytopenia, Neutropenia

A

Chronic Leukemia Classifications

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15
Q

⇣ Absolute Neutrophil Count (ANC) → ⇡ Risk opportunistic infection

d/t– Chemotherapy, ⇣ Inflammatory response

  • Congenital
    • Myeloid stem cells
    • Cyclic
      • Every 21 days, patients have 2-3 days of neutropenia
  • Severe Congenital (Kostmann Syndrome)
    • Autosomal dominant or recessive
    • Premature destruction
      • ½ of newborns develop infection by 1 month
    • Treatment– G-CSF: Filgrastim (Neupogen)
      • Colony-stimulating factor
  • Acquired
    • Autoimmune
      • Primary– rare, benign
      • Secondary– lupus, rheumatoid arthritis
    • Infection-related
      • Viral, bacterial, parasitic
    • Drug-induced
      • Chemotherapy
        • Febrile (T > 101 & ANC < 500/uL)
      • Antipsychotics

ANC= (segs + bands x WBC)/100

segs– mature neutrophils

bands– immature neutrophils

A

Neutropenia

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16
Q

Epstein Barr Virus (EBV) invades epithelial & B-cells → Kills B-cells OR Incorporates self into DNA → Infected B-cells produce heterophils (antibodies) → B-cells proliferate → ⇡ Heterophils → CD8+ & NK Cells attack

Some infected B-cells survive & virus remains in B-cells for rest of the life of the cell → Asymptomatic shedding in saliva for 12-18 months

  • Spread via oral secretions
    • “Kissing disease”
  • Clinical course
    • Incubation phase
      • No S/S 4-6 wks
    • Prodromal phase
      • Onset of S/S
        • Malaise, anorexia, chills…
    • Acute phase
      • Worst S/S
        • Fever, pharyngitis, lymphadenopathy
        • 2-3 weeks
    • Complications
      • Hepatitis
      • Splenomegaly
        • 50-60% of cases
A

Infectious Mononucleosis

17
Q

Never Let Monkeys Eat Bananas

  • Neutrophils (60%)
    • First responders
    • ⇡ w/ Infection
  • Lymphocytes (30%)
    • ⇡ w/ CA
  • Monocytes (6%)
  • Eosinophils (3%)
  • Basophils (1%)
A

Leukocyte Abundance

18
Q
  • Mature B-cell lymphomas
    • Germinal center
      • Active, mature B-cells
  • Burkitt lymphoma
    • Chromosomal translocation (8 & 14)
      • Aggressive, rapidly growing tumors
    • African Burkitt lymphoma = History of EBV infection
A

Non-Hodgkin Lymphoma

19
Q
  • Vary by type of lymphoma
    • Slow (indolent)
      • Isolated or widespread
      • Painless lymphadenopathy
    • Intermediate/Aggressive
      • Fever
      • Night sweats
      • Weight loss
      • Infection susceptibility
        • Bacterial, viral, & fungal
      • ⇣ IgG
        • Poor humoral immune response

Diagnosis– Lymph node biopsy

A

Non-Hodgin Lymphoma Clinical Manifestations

20
Q

Lymphatic vessels, lymphoid tissue, lymph nodes, thymus, & spleen (blood cell storage)

A

Lymphatic System

21
Q
  • Acute Lymphocytic Leukemia (ALL)
    • Immature lymphocytes and progenitors that originate in bone marrow
  • Acute Myelogenous Leukemia (AML)
    • Immature pluripotent myeloid stem cells in bone marrow

Manifestations– Bone pain, CNS (HA, N/V), Lymphadenopathy, Splenomegaly, Hepatomegaly, Anemia, Thrombocytopenia, Neutropenia

Complications– Leukostasis (increased blood viscosity), Hyperuricemia, Tumor lysis syndrome (renal failure)

Treatment– Chemotherapy, Bone marrow or stem cell transplant

A

Acute Leukemia Classifications

22
Q
  • MALT
    • Mucosa-associated
      • Protects entry points
  • GALT
    • Gut-associated
      • Alimentary canals
  • NALT
    • Nasal-associated
      • Respiratory passages
  • Genitourinary systems
A

Types of Lymphoid Tissue

23
Q

⇣ Absolute # of any type of WBC in blood

  • Commonly affects neutrophils
    • Neutropenia
      • ⇣ # neutrophils
    • Agranulocytosis
      • absence of neutrophils
A

Leukopenia

24
Q

Control WBC production & support hematopoietic colony formation

  • Cytokines
    • IL-1, IL-4, IL-6, IFN
      • Support function of growth factors
  • Lineage-specific growth factors
    • Erythropoietin
      • RBCs
    • GM-CSF
      • Granulocytes & Macrophages
    • M-CSF
      • Monocyte/Macrophage
A

Hematopoietic Growth Factors

Pathophysiology (NRSG 502) (16 decks)

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