Disorders Of The Wbc

A condition where there are fewer WBCs than

normal Causes:  Neutropenia  Lymphopenia:

Neutrophil count less than 2,000/mm3 Causes:  Decrease production of neutrophils  Increased destruction of neutrophils.

Sequelae:  Increase risk for infection Increased duration of neutropenia leads to increased risk of infection.

There is no definite symptoms of neutropenia

until the patient becomes infected.

LEUKOCYTOSIS  Increased level of WBCs in the circulation.  Causes: Increase need (e.g. In acute infection) Malignancy

LEUKEMIA  A neoplastic proliferation of one particular cell

type (granulocytes, monocytes, lymphocytes, or the megakaryocytes)  There is an unregulated proliferation of WBCs in the bone marrow

ACUTE MYELOID LEUKEMIA  results from a defect in the hematopoietic stem

cell that differentiates into all myeloid cells: monocytes, granulocytes (neutrophils, basophils, eosinophils), erythrocytes, and platelets.  Resistant to treatment, resulting in a much shorter duration of remision.  With treatment, the patient survive an average of less than 1 year, with death usually a result of infection or hemorrhage.

 Clinical Manifestations: evolve from

insufficient production of normal blood cells. Fever and infection  because of neutropenia Weakness and fatigue  because of anemia Bleeding tendencies  because of

thrombocytopenia  Ecchymosis and petechia

Enlarged liver or spleen Hyperplasia of the gums Bone pain from expansion of marrow

 Complications: bleeding  Correlates with the level of thrombocytopenia  Major hemorrhage occurs when the platelet counts

drops to less than 10,000/mm3  Common sites of bleeding:  Gastrointestinal  Pulmonary  intracrania

Infection  Because of the lack of mature and normal granulocytes

CHRONIC MYELOID LEUKEMIA  arises from the mutation in the myeloid stem

cell.  Normal myeloid cells continue to be produced but there is a preference for immature (blast) forms.  A section of DNA is missing from chromosome 22 (Philadelphia chromosome)  translocated in chromosome 9  causes the WBC to divide rapidly  Patients have overall median life expectancy of 3 – 5 years.

 Clinical Manifestations: Majority are asymptomatic WBC count exceeds 100,000/mm3 SOB and Slightly confused due to decreased capillary perfusion to the lungs and brain from leukostatis Enlarged tender spleen Enlarged liver

ACUTE LYMPHOCYTIC LEUKEMIA  Results from uncontrolled proliferation of

immautre cells (lymphoblast) derived from the lymphoid stem cells.  Most common in young children  Clinical manifestations: Reduced number of erythrocytes, leukocytes,

and platelets. Pain from enlarged spleen or liver Bone pain headache and vomiting

CHRONIC LYMPHOCYTIC LEUKEMIA  Common malignancy of older adults  Derives from a malignant clone of B

lymphocytes  Most of the cells are fully mautre.  Clinical Manifestations: Aysmptomatic in early stages Elevated lymphocyte count (>100,000/mm3) Lymphadenopathy Hepatomegaly Splenomegaly Anemia Thrombocytopenia Anergy

 absent or decreased reaction to skin sensitivity test infection

NEOPLASMS OF CELSS OF LYMPHOID ORIGIN

A relatively rare malignancy that has an

impressive cure rate. Reed-Sternberg cells  Malignant cells of Hodgkin’s disease  Gigantic tumor cell that is morphologically

unique and is thought to be of immature lymphoid origin.  Pathologic hallmark and essential diagnostic criterion for Hodgkin’s Disease

Clinical Manifestations:  Painless enlargement of one or more

lymph nodes on one side of the neck. Cervical lymph nodes Supraclavicular lymph nodes Mediastinal lymph nodes

 Mediastinal mass dyspnea  Pruritus  Brief but severe pain after drinking

alcohol  Cough and pulmonary effusion  Jaundice  Abdominal pain  Bone pain  Anergy

Malignant disease of the most mature form of

B lymphocytes, the plasma cells Malignant plasma cells produced an increased amount of a specific immunoglobulin that is non-functional  monoclonal protein (M protein)  Serves as a useful marker to monitor the extent

of the disease and the patient’s response to therapy.

Clinical manifestatons:  Bone pain (usually in the back or ribs) 

classic presenting symptoms  Lytic lesions in the bone  Osteoporosis Increase risk for fractures

 Hypercalcemia Excessive thirst, dehydration, constipation, altered

mental status, confusion, coma  Renal failure  Anemia  Reduced WBC and platelets