Disorders of White blood cells and lymphoid tissues

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non neoplastic disorders

neutropenia
infectious mononucleosis

neoplastic disorders

leukemias
lymphomas
multiple myeloma

leukocytes- wbc major function

to protect against foreign organisms

etiology of wbc disorders

deficiency- inadequate production and excessive destruction
proliferation

classifications of wbc's

granulocytes- neutrophils, basophils, eosinophils
monocytes and macrophages
lymphocytes- B and T.

myeloid stem cell

formed in bone marrow and circulate in blood- granulocytes, monocytes, and macrophages.

lymphoid stem cell

produced in bone marrow and circulate between blood and lymph: b-lymphocytes(humoral immunity) and t-lymphocytes(cell mediated immunity)

lymph system consists of

lymph vessels
lymph fluid
lymph nodes
spleen
thymus

lymph fluid

made from fluid derived from capillaries
filtered in lymph nodes
drains into vascular system
carried into ride side of heart

lymph nodes

important 2nd line of defense

WBC normal ranges

5,000-10,000 per microliter
leukopenia- below normal
neutrophils- most often decreased

neutropenia

<1500 per micro liter
<200 per micro liter- agranulocytosis
acquired or congenital

neutropenia etiology

decreased production and increased destruction

acquired neutropenia

most common etiology is DRUGS

neutropenia clinical manifestations

infections r/t normal flora
resp tract common site:
malaise
chills
fever
fatigue

infectious mononucleosis etiology

epstein barr virus(EBV)- herpes
self resolving lymphocyte proliferation

infectious mononucleosis prevalence

adolescents and young adults
upper socioeconomic groups
child hood occurrence often asymptomatic
provides complete immunity

infectious mononucleosis pathogenesis

virus transmitted by oral route- saliva
b-lymphocytes
infected individuals often asymptomatic and shed virus throughout life.
immunosuppressed individuals shed virus more often
mild contagion.

infectious mononucleosis clinical manifestations

incubation 4-8 wks
anorexia, malaise, chills, fever, sore throat, enlarged lymph nodes.
elevated wbc-mild
can cause hepatitis, splenomegaly
about 10% with fine red rash.

leukemia

malignant disorders with abnormal growth of wbc precursors( stem cells) in bone marrow
immature malignant cells replace normal bone marrow
mortality about 60%
#1 cause of death 1-14yrs
incidence high in adults
incidence and mortality rate decreasing

leukemia risk factors

possible complication of other cancers
environmental toxins-benzene
possible genetic tendency in some cases: highest blood disorder with down Sx and sometimes "runs in families"

spreading of leukemia

spread to lymph nodes, spleen, liver
organs enlarge

leukemia is classified by

course/duration of illness and abnormal type of cells and tissue involved

acute leukemia

rapid onset with lots of immature leukocytes and symptoms

chronic leukemia

gradual onset and leukocytes>mature occurs>in adults and elderly.

leukemias major categories of tissue/cell type

lymphocytic
myelogenous

what is used instead of cytic if majority of cells are immature?

blastic

lymphocytic leukemias

immature lymphocytes and precursors from bone marrow
lymph nodes
spleen
cns
various tissues

myelogenous leukemias

derived from pluripotent myeloid stem cells in bone marrow
depresses growth of all blood cells

leukemia-clinical manifestations

fatigue
fever
bleeding
cns-headache and seizures
infection
increased uric acid
bone pain
abdomen:pain and n/v

leukemia-WBC lab finding

total wbc count> 100,000 per micro liter.

leukemia RX

chemotherapy-acute forms
BMT: autologous-patients own bone marrow and allogenic-someone elses bone marrow

lymphoma

malignant lymphocytes
lymph nodes, spleen
more like solid tumor
may be slower to spread
among the most curable cancers

hodgkins lymphoma

reed-sternberg cell type
metastasis along lymph pathway
epstein barr virus sometimes present

hodgkins lymphoma incidence

bimodel age groups
age 10-20
after age 50
higher in males

hodgkins lymphoma etiology

unknown
possible inflammation r/t virus (epstein-Barr)

clinical manifestations hodgkins lymphoma

single node or group of nodes
painless and progressive enlargement
node usually above disphragm: cervical and mediastinal
earlier: anergy, fever/chills, night sweats, weight loss
later: fatigue, anemia, spread to liver, spleen, bone marrow.

hodgkins lymphoma Stage A

no symptoms other than enlarged node

Hodgkins Lymphoma stage B

fever
weight loss
itching
night sweats

non-hodgkins lymphoma

malignant lymphocyte other than reed sternbern
b-cells, macrophages

non-hodgkin's lymphoma incidence

older adults
HIV
6th most common adult malignancy
mortality about 50%

non hodgkins lymphoma etiology

most often unknown but r/t:
epstein barr virus
human t cell lymphoma virus
hiv
exposure to herbicides and chemical carcinogens
chronic peptic ulcer disease (helicobacter pylori infection)

clinical manifestations of non hodgkins lymphoma

r/t type and stage
b-cell lymphoma most aggressive: about 50% nhl cases
painless, superficial, enlarged lymph nodes
frequent infections
possible noncontigous spread: gi, testes, liver, lung, bone marrow.

lymphoma RX

radiation
chemotherapy
combination therapy

multiple myeloma

malignant proliferation of activated B cells (plasma cells)
invades bone tissue
unknown etiology
poor pronosis 1 1/2- 2 years

multiple myeloma clinical manifestations

similar to leukemia
bone destruction
pathological fractures
spinal compression

multiple myeloma Rx

chemotherapy
radiation
symptom management

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