White Blood Cells & Lymphoid Tissues (Ch. 24)-- Term First Flashcards
Exam 2
Leukopenia
⇣ Absolute # of any type of WBC in blood
- Commonly affects neutrophils
-
Neutropenia
- ⇣ # neutrophils
-
Agranulocytosis
- absence of neutrophils
-
Neutropenia
Classifications of WBC Disorders
-
Non-neoplastic
- Leukopenia
- Neutropenia
- Infectious mononucleosis
-
Neoplastic
- Leukemia
- Lymphoma
- Multiple myeloma
Malignant Lymphomas
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
Lymphatic System
Lymphatic vessels, lymphoid tissue, lymph nodes, thymus, & spleen (blood cell storage)
Acute Leukemia Classifications
- Acute Lymphocytic Leukemia (ALL)
- Immature lymphocytes and progenitors that originate in bone marrow
- Acute Myelogenous Leukemia (AML)
- Pluripotent myeloid stem cells in bone marrow
Infectious Mononucleosis
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…
-
Onset of S/S
-
Acute phase
-
Worst S/S
- Fever, pharyngitis, lymphadenopathy
- 2-3 weeks
-
Worst S/S
- Complications
- Hepatitis
-
Splenomegaly
- 50-60% of cases
-
Incubation phase
T Lymphocytes
Synthesized in bone marrow → Mature in thymus → Differentiate to CD4+/CD8+ → Move to lymph nodes
Leukocyte Differentiation
Pluripotent Stem Cells → Lymphoid OR Myeloid Stem Cells → Progenitor Cells → Unipotent Cells
Types of Blood Cells
Made in bone marrow
-
Erythrocytes
- RBCs
-
Megakaryocytes
- Platelets
-
Leukocytes
- WBCs
-
Granulocytes
- Neutrophils
- Esosinophils
- Basophils
- Monocytes/Macrophages
-
Lymphocytes
- T-Cells
- B-Cells
- NK Cells
-
Granulocytes
- WBCs
Multiple Myeloma Clinical Manifestations
- 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
Types of Lymphoid Tissue
- MALT
- Mucosa-associated
- Protects entry points
- Mucosa-associated
- GALT
- Gut-associated
- Alimentary canals
- Gut-associated
- NALT
- Nasal-associated
- Respiratory passages
- Nasal-associated
- Genitourinary systems
Neutropenia
⇣ 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
-
Chemotherapy
-
Autoimmune
ANC= (segs + bands x WBC)/100
segs– mature neutrophils
bands– immature neutrophils
Hodgkin Lymphoma Clinical Manifestations
-
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
-
T-cell dysfunction
Diagnosis– Reed-Sternberg cells in biopsy
B Lymphocytes
Synthesized in bone marrow → Differentiated to plasma cells → Move to lymph nodes
Leukemia
⇡ # 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
-
Lymphoid stem cells
- 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
- Normal WBC:RBC
Non-Hodgkin Lymphoma
-
Mature B-cell lymphomas
-
Germinal center
- Active, mature B-cells
-
Germinal center
-
Burkitt lymphoma
-
Chromosomal translocation (8 & 14)
- Aggressive, rapidly growing tumors
- African Burkitt lymphoma = History of EBV infection
-
Chromosomal translocation (8 & 14)
Hodgkin Lymphoma
- Large, atypical cells
-
Reed-Sternberg cells
- Atypical cell
- Mirror-image nuclei
- Atypical cell
-
Reed-Sternberg cells
-
Originate from single node or chain of nodes
- Spread from there
Chronic Leukemia Classifications
- Chronic Lymphocytic Leukemia (CLL)
- Immature lymphocytes and progenitors that originate in bone marrow
- Chronic Myelogenous Leukemia (CML)
- Pluripotent myeloid stem cells in bone marrow
-
Philadelphia chromosome in >90% CML cases
- Translocation 9 & 22
Hematopoietic Growth Factors
Control WBC production & support hematopoietic colony formation
- Cytokines
-
IL-1, IL-4, IL-6, IFN
- Support function of growth factors
-
IL-1, IL-4, IL-6, IFN
- Lineage-specific growth factors
-
Erythropoietin
- RBCs
- GM-CSF
- Granulocytes & Macrophages
- M-CSF
- Monocyte/Macrophage
-
Erythropoietin
Non-Hodgin Lymphoma Clinical Manifestations
- 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
-
Slow (indolent)
Diagnosis– Lymph node biopsy
Leukocyte Abundance
Never Let Monkeys Eat Bananas
-
Neutrophils (60%)
- First responders
- ⇡ w/ Infection
-
Lymphocytes (30%)
- ⇡ w/ CA
- Monocytes (6%)
- Eosinophils (3%)
- Basophils (1%)
Neutropenia Clinical Manifestations
- ⇣ 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
-
NO S/S of infection
Lymph Node Structure
-
Parenchyma
- Outer (Superficial cortex)
-
Primary follicle
- Inactive B-cells
-
Secondary follicle
- Active, mature B-cells
- Mantle zone
-
Paracortex
- T-cells
-
Primary follicle
-
Inner Medulla
- Blood supply
- Lymphatic vessels
- Outer (Superficial cortex)
Multiple Myeloma
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
