disorders of the wbc

8/14/2019 Disorders of the Wbc

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A condition where there are fewer WBCs thannormal

Causes:

NeutropeniaLymphopenia:


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Neutrophil count less than 2,000/mm3

Causes:Decrease production of neutrophils

Increased destruction of neutrophils.Sequelae:Increase risk for infectionIncreased duration of neutropenia leads to

increased risk of infection.


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There is no definite symptoms of neutropenia

until the patient becomes infected.


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


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LEUKEMIAA neoplastic proliferation of one particular cell

type (granulocytes, monocytes, lymphocytes, or

the megakaryocytes)There is an unregulated proliferation of WBCs in

the bone marrow


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ACUTE MYELOID LEUKEMIA results from a defect in the hematopoietic stem

cell that differentiates into all myeloid cells:monocytes, granulocytes (neutrophils,

basophils, eosinophils), erythrocytes, andplatelets.

Resistant to treatment, resulting in a muchshorter duration of remision.

With treatment, the patient survive an averageof less than 1 year, with death usually a resultof infection or hemorrhage.


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Clinical Manifestations: evolve frominsufficient production of normal blood cells.Fever and infection because of neutropeniaWeakness and fatigue because of anemia

Bleeding tendencies because ofthrombocytopeniaEcchymosis and petechia

Enlarged liver or spleenHyperplasia of the gumsBone pain from expansion of marrow


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Complications:bleedingCorrelates with the level of thrombocytopeniaMajor hemorrhage occurs when the platelet counts

drops to less than 10,000/mm3Common sites of bleeding: Gastrointestinal

Pulmonary

intracrania

InfectionBecause of the lack of mature and normal granulocytes


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CHRONIC MYELOID LEUKEMIAarises 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 chromosome22 (Philadelphia chromosome) translocated

in chromosome 9 causes the WBC to dividerapidly

Patients have overall median life expectancy of3 5 years.


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Clinical Manifestations:Majority are asymptomaticWBC count exceeds 100,000/mm3SOB and Slightly confused due to decreased

capillary perfusion to the lungs and brain fromleukostatis

Enlarged tender spleenEnlarged liver


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ACUTE LYMPHOCYTIC LEUKEMIAResults from uncontrolled proliferation of

immautre cells (lymphoblast) derived from thelymphoid stem cells.

Most common in young childrenClinical manifestations:Reduced number of erythrocytes, leukocytes,

and platelets.

Pain from enlarged spleen or liverBone painheadache and vomiting


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CHRONIC LYMPHOCYTIC LEUKEMIACommon malignancy of older adults

Derives from a malignant clone of BlymphocytesMost of the cells are fully mautre.Clinical Manifestations:Aysmptomatic in early stagesElevated lymphocyte count (>100,000/mm3)LymphadenopathyHepatomegalySplenomegaly

AnemiaThrombocytopeniaAnergy absent or decreased reaction to

skin sensitivity testinfection


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NEOPLASMS OF CELSS OF LYMPHOID ORIGIN


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A relatively rare malignancy that has animpressive cure rate.

Reed-Sternberg cellsMalignant cells of Hodgkins diseaseGigantic tumor cell that is morphologically

unique and is thought to be of immaturelymphoid origin.

Pathologic hallmark and essential diagnosticcriterion for Hodgkins Disease


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Clinical Manifestations:Painless enlargement of one or more

lymph nodes on one side of the neck.Cervical lymph nodesSupraclavicular lymph nodesMediastinal lymph nodes

Mediastinal mass

dyspneaPruritusBrief but severe pain after drinking

alcohol

Cough and pulmonary effusionJaundiceAbdominal painBone pain

Anergy


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Malignant disease of the most mature form ofB lymphocytes, the plasma cells

Malignant plasma cells produced an increasedamount of a specific immunoglobulin that isnon-functional monoclonal protein (M

protein)Serves as a useful marker to monitor the extent

of the disease and the patients response totherapy.


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Clinical manifestatons:

Bone pain (usually in the back or ribs)

classic presenting symptomsLytic lesions in the boneOsteoporosisIncrease risk for fractures

HypercalcemiaExcessive thirst, dehydration, constipation, altered

mental status, confusion, coma

Renal failure

AnemiaReduced WBC and platelets

disorders of the wbc

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