Chapter 11 1 Normal CBC Values a You don t have to know this whole chart only certain points b KNOW i Platelets thrombocytes ii Erythrocytes RBCs iii Leukocytes WBCs iv Remember for hemoglobin the normal range is 12 16 g L v Remember normal values for cells should be high neutrophils high lymphocytes and low monocytes eosinophils and basophils 2 Malignant Disorders of WBC a Leukemias i Circulating tumors disseminating from the onset of the disease ii Primarily involves blood and bone marrow b Lymphomas i Localized gradually disseminate to other sites by time of diagnosis 1 Start off in one place then break off and spread to other tissues This can happen in any lymphoid tissue ii Involves lymphatic tissues c Plasma Cell Myelomas i Localized malignant transformation of B cell plasma cells ii Involves bony structures 3 Hematologic Neoplasms Classification a WHO Classification based on neoplasm cell type i not based on location staging b Myeloid lineage RBC platelets monocytes granulocytes i Acute and chronic myeloid leukemia AML and CML c Lymphoid lineage B cells T cells NK cells i Chronic lymphoid leukemia CLL ii Acute lymphoblastic leukemia Lymphoma ALL d NAMES i First name will be A acute or C chronic ii Second name will be M myeloid or L lymphoid iii Third name will be L leukemia 4 Hematologic Neoplasms Etiology a Exact cause unknown idiopathic b Basic mechanisms involve cell mutations that disrupt growth control and differentiation pathways c Possible etiological factors i Viruses ii Radiation iii Chemicals iv Chronic disorders 1 Know that the Epstein Barr Virus predisposes to Burketts 5 Hematologic Neoplasms Lymphoma a Clinical Manifestations these are non specific i Anemia 1 pallor fatigue malaise dyspnea decreased activity tolerance a decreased activity tolerance because you don t have working RBCs which decreases oxygen intake ii Thrombocytopenia 20 000 platelets l low thrombocytes petechiae easy bruising bleeding gums occult hematuria blood is hidden in the urine need a urine analysis to find retinal hemorrhages spontaneous intracranial bleeding iii Leukopenia low WBCs lymphadenopathy joint swelling and pain weight loss and anorexia decreased appetite to where it is physically not possible to eat pruritis itchy rash not due to allergy hepatomegaly enlarged liver splenomegaly enlarged spleen 1 1 iv Neutropenia 500 neutrophils l low neutrophils v Leuko neutropenia predispose to infections b Diagnosis i History and Physical Exam 1 Differentiate between petechiae and purpura google image both to know the difference ii CBC and peripheral blood smear 1 WBC differential 2 Under microscope iii Bone marrow aspiration 1 Under microscope iv Lymph node biopsy 1 Under microscope v emia cytosis philia all mean in excess of vi penia deficiency 6 Hematologic Neoplasms Treatment a Combination chemotherapy cytotoxic affects most rapidly dividing cells first i Remove malignant cells via apoptosis ii Induce long term remission b Radiation and tissue specific drug therapy burning tumor away c Maintain adequate nutrition status and provide antiemetics anti vomiting anti nausea medications biological drugs i Prevent or treat anorexia weight loss nausea vomiting stomatitis stoma mouth growth delay specific to tumor d Complete remission count i Return to normal hematopoiesis with normal RBC platelet and leukocyte ii No detectable neoplastic cells no tumor cells for 5 years iii Not a cure 7 Hematologic Neoplasms Treatment a Bone marrow transplant stem cells are taken from a donor and transplanted into a recipient i Manage certain leukemias ii Peripheral stem cell transplant normal stem cells are rescued from circulating bloodstream and then reintroduced into the bone marrow iii Close match necessary to prevent GVHD 1 Graft versus host disease a Type IV b The host can die because of a non close match c You will usually be kept in the hospital for a longer period of time iv Autologous own blood harvested v Allogenic blood harvested from closely matched relative Identical twins are the best options 1 2 Siblings would be next since you receive chromosomes from both your father and mother just like your siblings 3 your parent would only give you one 8 Hematologic Neoplasms Complications a Infection due to disease therapy sequel indirect or direct increase risk of infection i Monitor for early prevention and detection as well as rapid management ii Neutropenia can be managed with growth factors GF b Bone marrow failure due to therapy c Anemia due to disease therapy i Suppressed production by bone marrow ii Normocytic normochromic 1 Normal cell size normal cell color there are not just enough cells iii Treat erythropoietin GF growth of RBCs RBC transfusion therapy prevent bleeding because of thrombocytopenia d Pain due to disease therapy i Infiltration and accumulation of neoplastic cells in bone marrow causes pressure ii Bone joint pain hemarthrosis iii Nausea stomatitis mouth pain from chemo e Epithelial cell damage due to chemoradiation i Sloughing of skin and mucous membranes shedding of skin like a ii snake alopecia hair loss Increases infection risk contributes to pain because hair and skin contribute to the innate immune system and helps to keep bacteria and toxins out f Delayed growth and development g Infertility 9 Myeloid Neoplasms DON T NEED TO KNOW THIS SLIDE 10 Myeloid Neoplasms Classification a Myeloproliferative Diseases SPREADING of myeloids i Chronic myeloid leukemia CML polycythemia vera PV increased RBCs and platelets essential thrombocytopenia ET too few thrombocytes ii Discovered on CBC iii Involve multipotent hematopoietic progenitor cells chromosomal abnormalities iv Bone marrow hypercellularity functional blood cell overproduction v Spontaneous normal cells just too many of them bone marrow fibrosis conversion to AML possible 1 AML short and severe very fatal vi Increased clotting risk patients are encouraged to donate blood a lot since there is already too much vii Increased chance of leukemia in Downs Syndrome patients b Myelodysplastic Syndrome and AML i Neoplastic cells are morphologically and functionally abnormal ii Poor prognosis iii Intensive treatment required to extend life 1 Treatment not to cure but to extend time and quality of life 11 Myeloid Neoplasms CML a 15 of all leukemia cases in the U S b Average age of onset 40 50 years very common in middle aged i Occasionally in childhood adolescence c Pathogenesis Chromosomal mutation i Malignant granulocytes carry the