1. Chapter 11 Disorders of White Blood Cells and Lymphoid Tissues
Essentials of Pathophysiology
Chapter 11 Disorders of White Blood Cells and Lymphoid Tissues

2. PRE LECTURE QUIZ (TRUE/FALSE)
White blood cells (granulocytes, monocytes, and lymphocytes) are formed in the bone marrow.
The life span of white blood cells is relatively long, so constant renewal is not necessary to maintain normal blood levels.
In neutropenia, all of the cell lines are affected, resulting in anemia, thrombocytopenia, and agranulocytosis.
Infectious mononucleosis is a self-limiting disorder caused by the Epstein-Barr virus (EBV).
Non-Hodgkin is a form of lymphoma that is associated with the presence of an abnormal cell called a Reed-Sternberg cell.

3. PRE LECTURE QUIZ
Acute
Cell
Leukemia
Philadelphia
(Ph)
thrombocyte/
platelet
Clinical manifestations of acute leukemia include petechiae, ecchymosis, gingival bleeding, and epistaxis, as a result of a decreased ________________________________ level.
More children are stricken with ____________________ than with any other form of cancer, and it is the leading cause of death in children between the ages of 1 and 14 years.
The ________________ leukemias have a sudden and stormy onset with symptoms of depressed bone marrow function (anemia, fatigue, bleeding, and infections).
The leukemias are classified according to their predominant ________________________ type.
Chronic myelogenous leukemia is associated with the presence of the _________________________ chromosome, arising from a reciprocal translocation between the long arm of chromosome 22 and the long arm of chromosome 9.

4. Developmental Stages of Blood Cells

5. White Blood Cells

6. White Blood Cells or Leukocytes
Granulocytes
Neutrophils:
primary pathogen-fighting cells
Eosinophils:
help control allergic responses; fight parasites
Basophils:
release heparin, histamine, and other inflammatory mediators

7. White Blood Cells or Leukocytes (cont.)
Lymphocytes
B cells: create antibodies
T cells: control immune response;
cell-mediated immunity
Natural killer cells: kill antigenic cells
Monocytes/macrophages:
antigen-presenting cells; create inflammatory mediators

8. Question
Which type of leukocyte works the hardest when you receive a vaccination?
Eosinophil
Basophil
B-lymphocyte
Neutrophil

9. Answer
B-lymphocyte
A vaccination introduces antigens, causing your body to create antibodies to fight the antigens. B-lymphocytes create those antibodies.
Eosinophils and basophils are part of the allergic/immune response; neutrophils work to fight infections.

10. Cell differentiation
Author: Please add title.

11. MYELOID TREE common myeloid stem cells committed precursor cells
platelets
erythrocytes
monocytes
and
granular
leukocytes

12. LYMPHOID TREE common lymphoid stem cells committed precursor cells T B
lymphocytes
lymphocytes
natural
killer
cells

13. Multipotent
stem cells
common
common
lymphoid
myeloid stem
stem cells
cells
committed
committed
precursor
precursor
cells
cells T B
platelets
erythrocytes
lymphocytes
lymphocytes
monocytes
natural
and
killer
granular
cells
leukocytes

14. Question
Which type of leukocyte is created in the bone marrow (myeloid)?
Eosinophil
Basophil
Neutrophil
All of the above

15. Answer
All of the above
Granular leukocytes are created in the bone marrow; eosinophils, basophils, and neutrophils are all granular leukocytes.

16. His doctor has prescribed several drugs:
Scenario:
A man has cancer and is being given radiation therapy…
His doctor has prescribed several drugs:
Question:
Why have the following drugs been prescribed?
Erythropoietin
Granulocyte-monocyte colony-stimulating factor
Thrombopoietin

17. White Blood Cell Count White blood cell counts vary between species
The denser the population, the more neutrophils
The more sexual partners, the more eosinophils
Question:
What can you infer about diseases in these populations?

18. White Blood Cell Deficiencies
Leukopenia
Neutropenia (agranulocytosis)
Aplastic anemia
Infectious mononucleosis
HIV

19. Question
Patients with HIV are immunocompromised. Which type of leukocyte is the best indicator of immune function?
Neutrophil
Eosinophil
T-lymphocyte
Monocyte

20. Answer
T-lymphocyte
Because T-lymphocytes direct the immune response, they are used to evaluate immune function. Patients with HIV are usually treated pharmacologically when their T-cell counts drop below 350 cells/mm3; they are considered to have AIDS when their T-cell counts drops to 200 cells/mm3.

21. Author: Please add title.

22. Acute myeloid leukemia (AML)
Leukemias
Malignant neoplasms of hematopoietic stem cells
In bone marrow
Create abnormal white blood cells: 2 types of leukemia
Lymphocytic
Myelogenous
Acute myeloid leukemia (AML)

23. AML Myeloid Blasts
Bone marrow aspirate showing acute myeloid leukemia. Several blasts have Auer rods.
Auer rods are clumps of granular material that form elongated needles seen in the cytoplasm of leukemic blasts.

24. Myelocytic Leukemias Mutation of myeloid cell line
Overproduction of abnormal monocytes or granulocytes
Production of other cell types decreases
Multipotent
stem cells
common
neoplastic
mutation
lymphoid
in myeloid
myeloid
stem cells
stem cells
stem cells
neoplastic committed precursor cells
abnormal monocytes or granular leukocytes

25. Lymphocytic Leukemias
Mutation of lymphoid cell line
Overproduction of abnormal immune cells
Production of other cell types decreases
Multipotent
stem cells
common
mutation in
neoplastic
myeloid stem
lymphoid
lymphoid
cells
stem cells
stem cells
neoplastic committed precursor cells
neoplastic B or T lymphocytes or natural
abnormal B or T lymphocytes or Natural
killer cells
Killer cells

26. Leukemias What is the difference between: Acute vs. chronic
Lymphocytic vs. myelogenous

27. AML GENE TRANSLOCATION
Author: Please add title.

28. Leukemias Affect Bone Marrow Activity
Question:
How would this cause:
Bone pain and risk of fractures?
Anemia?
Thrombocytopenia?
Immune suppression?

29. Question
What signs and symptoms will result when…?
Abnormal WBCs are produced and they…
Release inflammatory mediators
Infiltrate peripheral lymphoid organs
Increase blood viscosity
Create waste products

30. A child develops night sweats and nosebleeds…
Scenario:
A child develops night sweats and nosebleeds…
He appears pale, weak, and fatigued
Cervical lymph nodes are enlarged
Blast count is elevated
After chemotherapy, he develops hyperkalemia.
Question:
Why did this happen?

31. Answer
When there is a breakdown or destruction of cells, the electrolyte potassium moves from inside of the cell to outside of the cell wall.  This shift of potassium outside of the cells causes hyperkalemia.

32. Lymphoma vs. Leukemia or Dyscrasias
They travel to the lymphoid organs to mature and develop
WBCs are formed and differentiate in the bone marrow
Lymph node
Neoplasms arising here cause leukemias or plasma cell dyscrasias
Neoplasms arising here are lymphomas

33. Lymphomas Hodgkin lymphoma Malignant B cells invade lymphoid organs
Non-Hodgkin lymphoma
B cell
T cell

34. Myeloma Abnormal B cells Can form tumors Produce abnormal antibodies
dyscrasias - a malfunction or abnormal condition, esp. an imbalance of the constituents of the blood.
Abnormal B cells
Can form tumors
Produce abnormal antibodies
Immune depression
Proteins increase blood viscosity
Infiltrate organs
Proliferation of osteoclasts
Break down bone

35. Question
True or False: Hodgkin lymphoma has a better prognosis than non-Hodgkin lymphoma.

36. Answer
True Non-Hodgkin lymphoma originates from malignancies in both T- and B-lymphocytes, where Hodgkin malignancies originate in B-cells (a specific type called the Reed-Sternberg cell). Therefore, more immune function is lost in non-Hodgkin lymphoma, and the prognosis is not as good.