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82 Cards in this Set

  • Front
  • Back
WBC lineage?
a. Granulocytes
i. neutrophils
ii. eosinophils
iii. basophils
b. Agranulocytes
i. macrophages

a. T cells
b. B cells
What is the normal WBC count in circulation?
about 5-10,000 cells/mcL)
What is leukopenia?
a WBC disorder

absolute decrease in WBC #

-may affect any WBC, but most often PMNs
What are PMNs aka?
polymorphin NEUTROPHILS (compromise about 60-70% of all WBCs)
What is neutropenia?
a WBC disorder

-decrease in PMN #

-circulating PMN count reduced to less than 1500cells/mcL
What is agranulocytosis?
severe neutropenia

-circulating PMN count of less than 200 cells/mcL
Describe the 2 general causes of neutropenia?
either decreased production of wbcs...or increased removal of wbcs
The lifespan of a neutrophil?
1 day
2 ways in which you can attain neutropenia?
1. acquired

2. congenital
Describe acquired neutropenia and list 5 causes?
-impaired granulopoiesis (formation of granulocytes) due to

1. chemotherapy

2. infection

3. radiation

4. CA

5. medications
Describe congenital neutropenia?
inherited disorders (seen at birth), including:

1. cyclic neutropenia (waxes and wanes, sometimes normal)

2. Kostmann's syndrome (severe neutropenia but you have enough platelets, etc...just lack neutrophils)
General manifestations of leukopenia?
1. decreased neutrophils so increased susceptibility to infection

2. also increased inflammation
Tx for leukopenia?
1. antibiotics

2. stim. factors to produce neutrophils ("colony stimulating factors")
What kind of disease is infectious mononucleosis?
viral, self-limiting proliferative disorder

-proliferation of certain cell types
Cause of infectious mononucleosis?
epstein-barr virus (EBV)

-virus present in all human pop.s

-transmission: oral (EBV contaminated saliva)
What is pathgenesis?
the development and production of a disease?
Describe the pathogenesis of infectious mononucleosis?
1. invades B cells, viral genome incorporation
-produce heterophil abs (heterophil : reacts with humans and other species, ie, sheep)

2. T-cells proliferative
-large atypical lymphocytes characterisic of disease
5 manifestations of infectious mononucleosis?
1. fever, chills

2. sore throat (severe)

3. lymphadenopathy

4. anorexia

5. malaise
What is lymphadenopathy?
manifestation of infectious mononucleosis (lymph nodes enlarge b/c churning out cells)
2 presentations and diagnosis for mono?
1. heterophil abs (appear 2nd to 3rd week)

2. atypical lymphocytes (greater than 20% of the total)
Which lymphocytes are atypical in mono?
t cells
Tx for mono?
usually relieves on own...acute phase is 2-3 weeks
Name 3 neoplastic disorders?
1. lymphoma

2. leukemia

3. plasma cell dyscrasia
The 3 different types of neoplastic disorders are characterized according to what?
Two types of lymphomas?
1. hodgkins

2. non-hodgkins
two types of leukemia?
1. acute

2. chronic
What is multiple myeloma?
a types of plasma cell dyscrasia
Hodgkins disease and non-hodgkins disease are ? lymphomas.
malignant...metastatic, uncontrolled growth
Describe distribution of hodgkins disease?
bimodal rise after 10yo, peaks in early 20s, another increase in incidence after 50yo
Etiology of hodgkins disease?
unknown, perhaps viral
Signs and symptoms of hodgkins disease?
painless, progressive enlargement of single or group of lymph nodes (sometimes fevers)
Diagnosis for malignant lymphomas?
biopsy lymphnodes and examine for Reed-Greenberg Cell type
Tx for hodgkins disease?
it's irradiation and chemotherapy
Cure rate for hodkins disease?
After 5 years there is an 85% survival rate
Describe the appearance of a Reed-Sternberg cell?
indicates hodgkins disease

-one cell with mirror-image nucleus (may look like 2 cells)

-nuclei stains red
Cause of non-hodgkins lymphomas?
unknown, perhaps viral

-disease of older people...typically over 50 and immunosuppressed, like transplant pts
Non-hodgkins lymphomas are heterogenous. Name 3 groups?
1. low grade

2. intermediate grade

3. high grade
Describe low grade non-hodgkins lymphomas?
least aggressive of dev. cancer

-mostly B cells and not rapid

-may asymptomatic for a long time (10 yrs)

-will eventually progress to high grade
Describe intermediate grade non-hodgkins lymphomas?
T cells and B cells rapidly dividing
Describe high grade non-hodgkins lymphomas?
most aggresive, T and B cells rapidly dividing
Signs and symptoms of non-hodgkins lymphomas?
enlarged lymph nodes...fever...sweating....(these symptoms are assoc. with WBCs in general)
diagnosis for non-hodkins lymphomas?
have to visually examine cells...see B and T (atypical) and increased number of cells
Tx for non-hodgkins lymphomas?
depends which lymph nodes involved and which grade...but generally chemo and irradiation
Survival rate for non-hodgkins?
55% after 5 years
What does the suffix "-emia" indicate?
in blood
What is leukemia characterized by?
WBC disorders

-char. by unregulated, proliferating, immature neoplastic cells replacing bone marrow
In most cases of leukemia what occurs?
leukemic cells enter blood and start to replace RBCs

-these neoplastic cells can infiltrate liver, spleen, lymph nodes (cause enlargement of organs)
Leukemia is the leading cause of death for who?
1-14 yo.s
Is the number of diagnosis of leukemia greater for adults or children?
adults...but kids die from it more
2 ways of classifying leukemias
1. lymphocytic or myelocytic

2. acute or chronic
lymphocytic and myelocyte refer to what?
whether the cells involved are from the lymphoid lineage or myeloid lineage
Acute or Chronic leukemias are distinguished by what?
acute= rapid = immature cells

chronic= slower= more mature

( so rapidity of onset, and cell maturity)
The myelocytic cells that may be involved in leukemia?
1. macrophages

2. neutrophils

3. eosinophils

4. basophils
The lymocytic cells you may see in leukemia?
1. t cells

2. b cells
Lymphocytic aka what?
Myelocytic aka what?
4 types of leukemias?
1. acute lymphocytic leukemia (ALL)

2. acute myelocytic leukemia (AML)

3. Chronic lymphocytic leukemia (CLL)

4. Chronic myelocytic leukemia (CML)
Leukemic cells are almost always what?
Etiology of leukemias?
4 things possibly associated with leukemia?
1. radiation (high incidence)

2. benzene exposure (increased incidence)

3. antitumor drugs

4. congenital? (correlation b/n it and people with congenital disorders)
Molecular biology of leukemias?
chromosomal changes associated with leukemia, may include:

a. deletions (missing genes on chromosomes)

b. translocations (genes in wrong location)

c. inversion (gene order flipped)
9 manifestations of leukemia?
1. bone marrow depression (normal cells not produced bc your churning out abnormals)

2. malaise, fatigue

3. fever (WBCs assoc w fever)

4. bleeding (petechiae, eccysmosis, gingival)

5. bone pain/ tenderness

6. headache

7. abdominal discomfort

8. infections

9. anemia
What is ecchymosis?
small hemorrhages in mucous membrane
What is bone pain in leukemias caused by?
increased cell production
Why are infections associated with leukemias?
b/c the cells produced are not mature enough to fight off infections
Describe acute lymphocytic lymphoma (ALL)?
-rapid, more immature lymphoid lineage

-see in children and young adults

-most are B cell precursors cell type

-prognosis: 80% of children cured, 30-40% of adults achieve long-term survival
Describe acute myelocytic leukemias (AML)?
-predominantly adults

-strong toxin and congenital disorder correlation

-heterogenous cell types

-prognosis: 30-40% achieve 4-years disease free
5 warning signs of acute leukemias?
1. fatigue

2. pallor

3. weight loss

4. repeated infections

5. bleeding
Diagnosis of acute leukemias?
have to look at blood smear (increased counts)(anemic because decreased RBC and platelets)
Tx for acute leukemias?
What is tumor lysis syndrome?
associated with acute leukemias

-during tx normal cells dying and tumor cells are dying...these lysed cells release content and can be life threatening
Describe chronic lymphcytic leukemia (CLL)?
-seen in older persons (less than 10% under 50 yo)

-2x more men than women

-gradual (chronic) accum. of nearly mature B cells
Describe chronic myelocytic leukemia (CML)?
-predom. 30-50yo

-slightly more men than women

-malignant transformation of pluripotent hematopoietic stem cells (granulocytes)

-assoc. with translocation of gene (the philadelphia chromosome from #9 to #22)
Chronic leukemias have a more ? onset than acute.
3 manifestations of CLL?
1. fatigue

2. reduced exercise tolerance

3. enlarged superficial lymph nodes, splenomegaly
3 CML manifestations?
1. chronic (asymptomatic) phase

2. accelerated phase

3. terminal blast phase
Describe chronic (asymptomatic) phase of CML?
could be years before symptoms. Unfortunate because it holds off tx.
Describe accelerated phase of CML?
-start to see changes

-enlargement of spleen...feel full

-increased #s of myelocytic cells...ex. basophils

-low grade fever


-bone pain

-bleeding..bc platelets needed for clogging
Describe terminal blast crisis of CML?
"the end"

-an acute leukemia at this point

-very immature cells

-only survive about 3 months

-increased spleen size

-cells may go into lymph nodes
Diagnosis for Chronic leukemias?
blood and bone marrow studies (may or may not see depending on stage for blood studies)
Tx of CLL?
survival is less than 2 years to about 10 depending on how quick you catch it

-variable, depending upon cell type involved, stage of disease, persons health and age

-early: no tx or chemo

-aggressive: in young pts, stem cell transplant
Tx of CML?
survival is 3-4 years without transplant


-bone marrow/stem cell transplant