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Chapter 13 Objectives Identify terms relating to the composition, formation, & function of blood. Differentiate among the four major blood types Identify.

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Presentation on theme: "Chapter 13 Objectives Identify terms relating to the composition, formation, & function of blood. Differentiate among the four major blood types Identify."— Presentation transcript:

1 Chapter 13 Objectives Identify terms relating to the composition, formation, & function of blood. Differentiate among the four major blood types Identify terms related to blood clotting Build words & recognize combining forms used in blood system terminology Identify various pathologic conditions affecting blood Describe various laboratory tests & clinical procedures used with hematologic disorders, & recognize relevant abbreviations Apply your new knowledge to understanding medical terms in their proper contexts, such as medical reports & records

2 Blood System Chapter 13 Pages 503 – 546

3 Vocabulary Page 512 albumin differentiation globulin antibody (Ab)
electrophoresis granulocyte antigen eosinophil hematopoietic stem cell basophil erythroblast hemoglobin bilirubin erythrocyte hemolysis coagulation erythropoietin (EPO) heparin colony- stimulating factor (CSF) fibrin immune reaction fibrinogen immunoglobulin ALBUMIN (ăl-BŪ-mĭn) Protein in blood; maintains the proper amount of water in the blood. ANTIBODY (ĂN-tĭ-bŏd-ē) [Ab] Protein [immunoglobulin] made by white blood cells in response to foreign substances [antigens] in the blood – An antibody is specific to an antigen and inactivates it. ANTIGEN (ĂN-tĭ-jĕn) Substance (usually foreign) that stimulates the production of an antibody. BASOPHIL (BĀ-sō-fĭl) White blood cell (leukocyte) containing granules that stain with a basic dye; associated with release of histamine and heparin. BILIRUBIN (bĭl-ĭ-ROO-bĭn) Orange-yellow pigment found in bile; it is released from the breakdown of hemoglobin when red blood cells die. COAGULATION (kō-ăg-ū-LĀ-shŭn) Process of blood clotting COLONY-STIMUALTING FACTOR (KŎL-ō-nē STĬM-ū-lā-tĭng FĂK-tŏr) [CSF] Protein that stimulates the growth and proliferation of white blood cells (granulocytes) DIFFERENTIATION (dĭf-ĕr-ĕn-shē-Ā-shŭn) Change in structure and function of a cell as it matures; Also known as specialization. ELECTROPHORESIS (ē-lĕk-trō-fō-RĒ-sis) Technique used to separate serum proteins by electrical charge. EOSINOPHIL (ē-ō-SĬN-ō-fĭl) White blood cell whose granules stain intensely with an acidic eosin (reddish) dye; associated with allergic reactions. ERYTHROBLAST (ĕ-RĬTH-rō-blăst) Immature, developing red blood cell ERYTHROCYTE (ĕ-RĬTH-rō-sīt) Red blood cell. . There are about 5 million per microliter (µL) or cubic millimeter (mm3) of blood. ERYTHROPOIETIN (ĕ-rĭth-rō-POY-ĕ-tĭn) [EPO] Substance [hormone] produced [secreted] by the kidney to stimulate bone marrow to produce erythrocytes FIBRIN (FĪ-brĭn) Protein threads that form the basis of a blood clot FIBRINOGEN (fī-BRĬN-ō-jĕn) Plasma protein that is converted to fibrin in the clotting process. GLOBULIN (GLŎB-ū-lĭn) Major blood protein; EXAMPLE: alpha, beta, and gamma immunoglobulin GRANULOCYTE (GRĂN-ū-lō-sīt) White blood cell with numerous dark-staining granules; EXAMPLE: neutrophil, eosinophil and basophil HEMATOPOIETIC STEM CELL (hē-mă-tō-pō-EH-tik stĕm sĕl) Cell in the bone marrow that gives rise to different types of blood cells. HEMOGLOBIN (HĒ-mō-glō-bĭn) Blood protein containing iron; carries oxygen in red blood cells. HEMOLYSIS (hē-MŎL-ĭ-sĭs) Destruction or breakdown of blood; specifically red blood cells. HEPARIN (HĔP-ă-rĭn) Anticoagulant found in blood and tissues. IMMUNE REACTION (ĭm-MŪN rē-ĂK-shŭn) Response of the immune system to foreign invasion. IMMUNOGLOBULIN (ĭm-ū-nō-GLŎB-ū-lĭn) Antibody-containing protein in the blood; EXAMPLE: IgG, IgM, IgA, IgE, IgD. Immun/o means protection.

4 Vocabulary (Cont’d) Page 513 leukocyte platelet lymphocyte
polymorphonuclear macrophage prothrombin megakaryocyte reticulocyte monocyte Rh factor mononuclear serum myeloblast stem cell neutrophil thrombin plasma thrombocyte plasmapheresis LEUKOCYTE (LOO-kō-sīt) White blood cell. LYMPHOCYTE (LĬM-fō-sīt) Leukocyte (White blood cell) with a single nucleus (mononuclear); capable of producing antibodies. MACROPHAGE (MĂK-rō-făj) Large phagocytic cell migrating from the blood into tissues – As a phagocyte, it engulfs foreign material and debris. In the liver, spleen, and bone marrow, macrophages destroy worn out red blood cells. MEGAKARYOCYTE (mĕg-ă-KĀR-ē-ō-sīt) Large, giant cell with a big nucleus; platelet precursor found in the bone marrow. MONOCYTE (MŎN-ō-sīt) White blood cell (agranulocyte) with one large nucleus; become macrophages as they leave the blood and enter body tissues. It is a cell that engulfs foreign material and debris. MONONUCLEAR (mŏn-ō-NŪ-klē-ăr) Pertaining to a white blood cell (leukocyte) with a single, round nucleus; EXAMPLE: monocyte or lymphocyte. MONOBLAST (MŎN-ō-blăst) Immature monocyte; gives rise to granulocytes. NEUTROPHIL (NOO-trō-fĭl) White blood cell (leukocyte ) with dark granules that stain with a neutral dye; phagocyte formed in the bone marrow and the body's first line of defense against disease. Also called a polymorphonuclear leukocyte. PLASMA (PLĂZ-mă) Liquid portion of blood containing proteins, water, salts, nutrients, hormones, and vitamins. PLASMAPHERESIS (plăz-mă-fĕ-RĒ-sĭs) Removal of plasma from withdrawn blood by centrifuge. Collected cells are retransfused back into the donor. Fresh-frozen plasma or salt solution is used to replace withdrawn plasma. PLATELET (PLĀT-lĕt) Clotting cell [thrombocyte]. POLYMORPHONUCLEAR (pŏl-ē-mŏr-fō-NŪ-klē-ăr) Pertaining to a multi-lobed nucleus (in granulocytic white blood cells); EXAMPLE: neutrophil. PROTHROMBIN (prō-THRŎM-bĭn) Plasma protein converted to thrombin in the clotting process. RETICULOCYTE (rĕ-TĬK-ū-lō-sīt) Immature erythrocyte with a network of strands (reticulum); is seen after staining the cell with special dyes. Rh FACTOR (R-h FĂK-tŏr) Antigen [protein] on RBCs of Rh positive [Rh+] individuals. The factor was first identified in the blood of a rhesus monkey. SERUM (SĔ-rŭm) Plasma minus clotting proteins [prothrombin and fibrinogen] and clotting cells. Clear, yellowish fluid that separates from blood when it is allowed to clot. It is formed from plasma, but does not contain protein-coagulation factors. STEM CELLl (STĔM sĕl) Unspecialized cell that gives rise to mature, specialized forms EXAMPLE: Hematopoietic stem cell = the progenitor for all different types of blood cells. THROMBIN (THRŎM-bĭn) Enzyme necessary for blood clotting (converts fibrinogen to fibrin in the clotting process). THROMBOCYTE (THRŎM-bō-sīt) Platelet; clotting cell

5 Page 514 Combining Forms Meaning Examples bas/o chrom/o coagul/o cyt/o eosin/o erythr/o granul/o hem/o, hemat/o base, alkaline color clotting cell red, dawn, rosy red granules blood basophil hypochromic anticoagulant, coagulopathy cytology eosinophil erythroblast granulocyte hemolysis, hematocrit BASOPHIL (BĀ-sō-fĭl) White blood cell (leukocyte) containing granules that stain with a basic dye; associated with release of histamine and heparin – The suffix -phil means attraction to. Granules in basophils are attracted to a basic dye. HYPOCHROMIC (hī-pō-KRŌ-mĭk) Pertaining to deficiency in color; decrease in hemoglobin in red blood cells – Hypochromic anemia is marked by a decreased concentration of hemoglobin in red blood cells. ANTICOAGULANT (ăn-tĭ-cō-ĂG-ū-lănt) Substance that prevents blood clotting COAGULOPATHY (kō-ăg-ū-LŎP-ă-thē) Disease of blood clotting CYTOLOGY (sī-TŎL-ō-jē) Study of cells EOSINOPHIL (ē-ō-SĬN-ō-fĭl) White blood cell whose granules stain intensely with an acidic eosin (reddish) dye; associated with allergic reactions. ERYTHROBLAST (ĕ-RĬTH-rō-blăst) Immature, developing red blood cell – -blast means immature. GRANULOCYTE (GRĂN-ū-lō-sīt) White blood cell with numerous dark-staining granules; EXAMPLE: neutrophil, eosinophil and basophil HEMOLYSIS (hē-MŎL-ĭ-sĭs) Destruction or breakdown of blood; specifically red blood cells. HEMATOCRIT (hē-MĂT-ō-krĭt) Percentage of red blood cells in a given volume of blood – The suffix -crit means to separate.

6 Combining Forms (Cont’d)
Pages 514 – 515 Combining Forms (Cont’d) Meaning Examples hemoglobin/o is/o kary/o leuk/o mon/o morph/o myel/o neutr/o hemoglobin same, equal nucleus white one, single shape, form bone marrow neutral (not acid or base) hemoglobinopathy anisocytosis megakaryocyte leukopenia monocyte morphology myeloblast, myelodysplasia neutropenia, neutrophils HEMOGLOBINOPATHY (hē-mō-glō-bĭn-ŎP-ă-thē) Disease or defect of hemoglobin production; EXAMPLE: sickle cell anemia ANISOCYTOSIS (ăn-ī-sō-sī-TŌ-sĭs) Inequality in the size of red blood cells – (anis/o) size; -cytosis means an increase in the number of cells. MEGAKARYOCYTE (mĕg-ă-KĀR-ē-ō-sīt) Large, giant cell with a big nucleus; platelet precursor found in the bone marrow. LEUKOPENIA (loo-kō-PĒ-nē-ă) Deficiency of white blood cells MONOCYTE (MŎN-ō-sīt) White blood cell (agranulocyte) with one large nucleus; become macrophages as they leave the blood and enter body tissues. It is a cell that engulfs foreign material and debris. MORPHOLOGY (mŏr-FŎL-ō-jē) Study of the shape and form of cells, particularly red blood cells MYELOBLAST (MĪ-ĕ-lō-blăst) Immature granulocytic white blood cell; a cell normally only found in the bone marrow – The suffix -blast indicates an immature or embryonic cell. MYELODYSPLASIA (MĪ-ĕ-lō-dĭs-PLĀ-zhē-ă) Pre-leukemic condition. NEUTROPENIA (noo-trō-PĒ-nē-ă) Deficiency of neutrophils

7 Combining Forms (Cont’d)
Page 515 Combining Forms (Cont’d) Meaning Examples nucle/o phag/o poikil/o sider/o spher/o thromb/o nucleus eat, swallow varied, irregular iron globe, round clot ploymorphonuclear phagocyte poikilocytosis sideropenia spherocytosis thrombocytopenia POLYMORPHONUCLEAR (pŏl-ē-mŏr-fō-NŪ-klē-ăr) Pertaining to a multi-lobed nucleus (in granulocytic white blood cells); EXAMPLE: neutrophil. PHAGOCYTE (FĂG-ō-sīt) Cell that engulfs another cell or foreign organism and destroys it POIKILOCYTOSIS (poy-kĭ-lō-sī-TŌ-sĭs) Irregularity in the shape of red blood cells; occurs in certain types of anemia. SIDEROPENIA (sĭd-ĕr-ō-PĒ-nē-ă) Deficiency of iron in the blood. SPHEROCYTOSIS (sfĕr-ō-sī-TŌ-sĭs) In this condition, the erythrocyte has a round shape, making the cell fragile and easily able to be destroyed; occurs in a type of anemia (hemolytic anemia) THROMBOCYTOPENIA (thrŏm-bō-sī-tō-PĒ-nē-ă) Deficiency of clotting cells

8 Suffixes Pages 515 – 516 -apheresis -blast -cyte -cytosis -emia -gen
Meaning Examples -apheresis -blast -cyte -cytosis -emia -gen removal, a carrying away  immature or embryonic cell cell abnormal condition of cells blood condition giving rise to; producing plasmapheresis, leukapheresis, plateletpheresis monoblast erythrocyte macrocytosis, microcytosis leukemia fibrinogen PLASMAPHERESIS (plăz-mă-fĕ-RĒ-sĭs) Removal of plasma from withdrawn blood by centrifuge. Collected cells are retransfused back into the donor. Fresh-frozen plasma or salt solution is used to replace withdrawn plasma. LEUKAPHERESIS (loo-kă-fĕ-RĒ-sĭs) Mechanical separation of white blood cells from the rest of the blood PLATELETPHERESIS (plāt-lĕt-fĕ-RĒ-sĭs) Separation of platelets from the rest of the blood – Note that the a of apheresis is dropped in this term. MONOBLAST (MŎN-ō-blăst) Immature monocyte; gives rise to granulocytes. ERYTHROCYTE (ĕ-RĬTH-rō-sīt) Red blood cell. . There are about 5 million per microliter (µL) or cubic millimeter (mm3) of blood. MACROCYTOSIS (măk-rō-sī-TŌ-sĭs) Presence of large [larger than normal] red blood cells in the blood MICROCYTOSIS (mī-krō-sī-TŌ-sĭs) Increased numbers of smaller than normal red blood cells. Table 13-3 reviews terms related to abnormalities of red blood cell morphology. LEUKEMIA (loo-KĒ-mē-ă) Increase in cancerous white blood cells FIBRINOGEN (fī-BRĬN-ō-jĕn) Plasma protein that is converted to fibrin in the clotting process. – Fibrin is a protein that forms the basis of a blood clot.

9 Suffixes (Cont’d) Page 516
Meaning Examples -globulin, -globin -lytic -oid -osis -penia -phage protein pertaining to destruction derived or originating from abnormal condition deficiency eat, swallow hemoglobin, immunoglobulin thrombolytic therapy myeloid thrombosis granulocytopenia, pancytopenia macrophage HEMOGLOBIN (HĒ-mō-glō-bĭn) Blood protein containing iron; carries oxygen in red blood cells. IMMUNOGLOBULIN (ĭm-ū-nō-GLŎB-ū-lĭn) Antibody-containing protein in the blood; EXAMPLE: IgG, IgM, IgA, IgE, IgD. Immun/o means protection. THROMBOLYTIC THERAPY (thrŏm-bō-LĬ-tĭk THĔR-ă-pē) Treatment with drugs to break down clots that may abnormally form in blood vessels [Used to dissolve clots] MYELOID (MĪ-ĕ-loyd) Derived from bone marrow THROMBOSIS (thrŏm-BŌ-sĭs) Condition of clot formation GRANULOCYTOPENIA (grăn-ū-lō-sī-tō-PĒ-nē-ă) Deficiency of granulocytes PANCYTOPENIA (păn-sī-tō-PĒ-nē-ă) Deficiency of all (blood) cells MACROPHAGE (MĂK-rō-făj) Large phagocytic cell migrating from the blood into tissues – As a phagocyte, it engulfs foreign material and debris. In the liver, spleen, and bone marrow, macrophages destroy worn out red blood cells.

10 Suffixes (Cont’d) Page 516 -philia -phoresis -poiesis -stasis
Meaning Examples -philia -phoresis -poiesis -stasis attraction for (an increase in cell numbers) carrying, transmission formation stop, control eosinophilia, neutrophilia electrophoresis hematopoiesis, erythropoiesis, myelopoiesis hemostasis EOSINOPHILIA (ē-ō-sĭn-ō-FĬL-ē-ă) Increase in numbers of eosinophils in the bloodstream NEUTROPHILIA (noo-trō-FĬL-ē-ă) Increased numbers of neutrophils ELECTROPHORESIS (ē-lĕk-trō-fō-RĒ-sis) Technique used to separate serum proteins by electrical charge.  HEMATOPOIESIS (hē-mă-tō-poy-Ē-sĭs) Formation of blood cells ERYTHROPOIESIS (ĕ-rĭth-rō-poy-Ē-sĭs) Formation of red blood cells – Erythropoietin is produced by the kidneys to stimulate erythrocyte formation. MYELOPOIESIS (mī-ĕ-lō-poy-Ē-sĭs) Formation and development of bone marrow or cells that originate from it HEMOSTASIS (hē-mō-STĀ-sĭs) Stoppage of bleeding or circulation of blood

11 Pathology: Blood Pages 517 – 519 Types of Anemia
iron deficiency anemia aplastic anemia hemolytic anemia pernicious anemia sickle cell anemia thalassemia ANEMIA (ă-NĒ-mē-ă) Deficiency in erythrocytes or hemoglobin EXAMPLE: 1. Iron deficiency anemia: most common type; ETIOLOGY: lack of iron, which is required for hemoglobin production 2. APLASTIC ANEMIA (ā-PLĂS-tĭk ă-NĒ-mē-ă) Failure of blood cell production due to aplasia (absence of formation) of bone marrow cells. ETIOLOGY: unknown (idiopathic), but some have been linked to benzene exposure and rarely to antibiotics such as chloramphenicol.  Pancytopenia occurs when stem cells fail to produce leukocytes, platelets, and erythrocytes. TREATMNET: Blood transfusions prolong life, allowing the marrow time to resume its normal functioning, and antibiotics control infections. Bone marrow transplantation and regimens of drugs that inhibit the immune system are successful treatments in cases in which spontaneous recovery is unlikely. 3. HEMOLYTIC ANEMIA (hē-mō-LĬ-tĭk ă-NĒ-mē-ă) Reduction in erythrocytes due to excessive destruction of red blood cells EXAMPLE: congenital spherocytic anemia (hereditary spherocytosis) = Instead of their normal biconcave shape, erythrocytes become spheroidal. This rounded shape makes them fragile and easily destroyed (hemolysis). Shortened red cell survival results in increased reticulocytes in blood as the bone marrow compensates for hemolysis of mature erythrocytes. TREATMENT: removal of the spleen usually improves this anemia (Because the spleen destroys red cells) PICTURE 4. PERNICIOUS ANEMIA (pĕr-NĬSH-ŭs ă-NĒ-mē-ă) Lack of mature erythrocytes; Pernicious means ruinous or hurtful. ETIOLOGY: inability to absorb vitamin B12 into the body which can be caused by a lack of intrinsic factor (ĭn-TRĬN-sĭk FĂK-tŏr) [necessary for vitamin B12 absorption] which is normally found in gastric juice. The result is unsuccessful maturation of red blood cells, with an excess of large, immature, and poorly functioning cells in the bone marrow and large, often oval red cells (macrocytes) in the circulation. TREATMENT: injection or oral administration of vitamin B12 for life.  5. SICKLE CELL ANEMIA (SĬK-l sĕl ă-NĒ-mē-ă) Hereditary condition marked by abnormal sickle shape of erythrocytes and by hemolysis ETIOLOGY: Genetic defect (presence of the hemoglobin S gene) particularly prevalent among people of African or Hispanic ancestry and appears with different degrees of severity. The distorted, fragile erythrocytes cannot pass through small blood vessels normally. SYMPTOM: arthralgias, acute attacks of abdominal pain, and ulcerations of the extremities. Persons with the sickle cell trait inherit just one gene for the disorder and usually do not have symptoms. COMPLICATION: thrombosis and infarction (local tissue death from ischemia) 6. THALASSEMIA (thāl-ă-SĒ-mē-ă) Inherited defect in the ability to produce hemoglobin leading to hypochromia, usually seen in persons of Mediterranean background ETIOLOGY:A defect in a gene affects production of globin, the protein that is the major component of hemoglobin. Particularly prevalent among people of Mediterranean or Asian background, manifests in varying forms and degrees of severity COMPLICATION: hypochromic anemia [diminished hemoglobin content in red cells]

12 Pathology (Cont’d) Pages 517 – 519 Dyscrasia Hemochromatosis
polycythemia vera hemophilia purpura DYSCRASIA (dĭs-KRĀ-zē-ă) Any abnormal or pathology condition of the blood HEMOCHROMATOSIS (hē-mō-krō-mă-TŌ-sĭs) Excessive deposits of iron throughout the body ETIOLOGY: may be hereditary SYMPTOM: skin pigmentation, joint pain, and fatigue. COMPLICATION: cirrhosis, diabetes, and cardiac failure may occur POLYCYTHEMIA VERA (pŏl-ē-sī-THĒ-mē-ă VĔR-ă) Increase in numbers of erythrocytes [red blood cells]; Blood consistency is viscous (thick) – Also known as erythremia. The bone marrow is hyperplastic, and leukocytosis and thrombocytosis commonly accompany the increase in red blood cells. TREATMENT: phlebotomy (removal of blood from a vein) and myelotoxic drugs [suppresses blood cell production] HEMOPHILIA (hē-mō-FĬL-ē-ă) Hereditary disease of blood clotting failure with abnormal bleeding; affected individuals are lacking a blood clotting factor (factor VIII or factor IX) Platelet count is normal, deficiency in clotting factors = a prolonged coagulation time. COMPLICATION: bleed into weight-bearing joints, especially ankles and knees. TREATMENT: administration of the deficient factors. PICTURE - Lower limbs of a male with hemophilia showing the effect of recurrent hemorrhage into the left knee. PURPURA (PŬR-pū-ră) Multiple PETECHIAE (pĕ-TĒ-kē-ā) [Small, pinpoint hemorrhages caused by bleeding under the skin] and ECCHYMOSES (ĕk-kĭ-MŌ-sēs) [Large blue or purplish patches on the skin (bruises)] caused by deficiency of clotting cells (platelets) ETIOLOGY: thrombocytopenia [too few platelets] or immunologic [antiplatelet factor] in nature. EXAMPLE: Autoimmune thrombocytopenic purpura → the patient makes an antibody that destroys platelets. SYMPTOM: Bleeding time is prolonged TREATMENT: splenectomy (the spleen is the site of platelet destruction) and drug therapy with glucocorticoids are common treatments. PICTURE A, Petechiae result from bleeding from capillaries or small arterioles.  B, Ecchymoses are larger and more extensive than petechiae.

13 Pathology (Cont’d) Pages 517 – 522 Leukemia
Acute myeloid leukemia (AML) Acute lymphoid leukemia (ALL) Chronic myeloid leukemia (CML) Chronic lymphoid leukemia (CLL) LEUKEMIA (loo-KĒ-mē-ă) Increase in cancerous white blood cells [leukocytes] Four types of leukemia are: Two types are acute and these have some common clinical characteristics: abrupt onset of signs and symptoms—fatigue, fever, bleeding, bone pain, lymphadenopathy, splenomegaly, and hepatomegaly. If the disease has spread to the spinal canal, headache and vomiting also may occur. In addition, because normal blood cells are crowded out, patients have little defense against infection. 1. ACUTE MYELOID [myelocytic] LEUKEMIA (ă-KŪT MĪ-ĕ-lōyd loo-KĒ-mē-ă) [AML] Malignant, immature granulocytes called myeloblasts multiply in the bone marrow and bloodstream PICTURE 2. ACUTE LYMPHOID LEUKEMIA (ă-KŪT LĬM-fōyd loo-KĒ-mē-ă) [ALL] Malignant, immature lymphocytes called lymphoblasts multiply in the blood, bone marrow, and lymphatic system This form is seen most often in children and adolescents; TREATMENT: for acute leukemia → Transplantation of normal bone marrow from donors of similar tissue type is successful in restoring normal bone marrow function. This procedure is performed after high-dose chemotherapy, which is administered to eliminate the leukemic cells. Two types are chronic: 3. CHRONIC MYELOID [myelocytic] LEUKEMIA (KRŎ-nĭk MĪ-ĕ-lōyd loo-KĒ-mē-ă) [CML] Malignant, but relatively mature granulocytic leukocytes multiply in the bloodstream; progresses slowly → patients (often adults older than 55) may live for many years without encountering life-threatening problems. TREATMENT: New therapies (such as the drug Gleevec) target abnormal proteins responsible for malignancy and produce long-term control. 4. CHRONIC LYMPHOID [lymphocytic] LEUKEMIA (KRŎ-nĭk LĬM-fōyd loo-KĒ-mē-ă) [CLL] Malignant, but relatively mature lymphocytes, multiply in bone marrow, lymph nodes, and spleen; most common form of leukemia – usually occurs in the elderly and progresses slowly. TREATMENT: does not require immediate treatment TREATMENT: All forms of leukemia → chemotherapy [drugs that prevent cell division and selectively injure rapidly dividing cells]; Effective treatment can lead to a remission (rē-MĬSH-ŭn) [disappearance of signs and symptoms of disease] Relapse (RĒ-lăps) occurs when disease symptoms and signs reappear, necessitating further treatment.

14 Pathology (Cont’d) Pages 517 – 522 granulocytosis mononucleosis
multiple myeloma GRANULOCYTOSIS (grăn-ū-lō-sī-TŌ-sis) Abnormal increase in numbers of granulocytes in the blood ↑ neutrophils → infection or inflammation of any type ↑ eosinophil → Eosinophilia  → allergic conditions, such as asthma, or in parasitic infections (tapeworm, pinworm).  ↑ basophil → Basophilia  → leukemia. MONONUCLEOSIS (mŏ-nō-nū-klē-Ō-sĭs) Infectious disease marked by increased numbers of leukocytes and enlarged cervical lymph nodes; transmitted by the Epstein-Barr virus (EBV). Atypical lymphocytes are present in the blood, liver, and spleen; affects primarily young adults. SYMPTOM: Lymphadenitis, fever, fatigue, asthenia (weakness), and pharyngitis. COMPLICATION: hepatomegaly and splenomegaly TRANSMITTED: direct oral contact (salivary exchange during kissing) TREATMENT: No treatment is necessary; Antibiotics are not effective; Rest during the period of acute symptoms and slow return to normal activities are advised. MULTIPLE MYELOMA (MŬL-tĭ-pl mī-ĕ-LŌ-mă) Malignant tumor of bone marrow; overproduction of immunoglobulins that cause destruction of bone tissue COMPLICATION: osteolytic lesions, hypercalcemia, anemia, renal damage, and increased susceptibility to infection. TREATMENT: analgesics, radiotherapy, various doses of chemotherapy, and special orthopedic supports. Drugs such as thalidomide and Velcade (bortezomib) are palliative (PĂL-ē-ă-tĭv) [relieving symptoms] and stop disease progression, which improves the outlook for this disease. Autologous bone marrow transplantation (ABMT), in which the patient serves as his or her own donor for stem cells, may lead to prolonged remission.

15 Laboratory Tests Pages 522 – 523 Antiglobulin test Platelet count
Bleeding time Prothrombin time Coagulation time Red blood count Complete blood count Red blood cell morphology Erythrocyte sedimentation rate White blood cell count Hematocrit White blood cell differential Hemoglobin test ANTIGLOBULIN TEST (ăn-tē-GLŎB-ū-lĭn tĕst) Test for the presence of antibodies that coat and damage erythrocytes; Also known as Coombs test. This test determines the presence of antibodies in infants of Rh-negative women or in patients with autoimmune hemolytic anemia. BLEEDING TIME (BLĒ-dĭng tīm) Time required for blood to stop flowing from a tiny puncture wound. Normal time is 8 minutes or less. Either the Simplate or the Ivy method is used. Platelet disorders and the use of aspirin prolong bleeding time. COAGULATION TIME (kō-ăg-ū-LĀ-shŭn tīm) Time required for venous blood to clot in a test tube. Normal time is less than 15 minutes. COMPLETE BLOOD COUNT (kŏm-PLĒT blŭd kount) [CBC] Determination of the number of red and white blood cells, platelets, hemoglobin, hematocrit, and red cell indices (MCH, MCV, MCHC) in a sample of blood ERYTHROCYTE SEDIMENTATION RATE (ĕ-RĬTH-rō-sīt sĕd-ĭ-mĕn-TĀ-shŭn rāt) [ESR or sed rate] Measurement of the speed at which erythrocytes settle or fall to the bottom of a test tube. DIAGNOSISES: rate ↑ = infections, joint inflammation, and tumor, which increase the fibrinogen content of the blood. HEMATOCRIT (hē-MĂT-ō-krĭt) [Hct] Percentage of red blood cells [erythrocytes ] in a given volume of blood. HEMOGLOBIN TEST (HĒ-mō-glō-bĭn tĕst) [H, Hg, Hgb, HGB] Total amount of hemoglobin in a sample of blood PLATELET COUNT (PLĀT-lĕt kount) Number of platelets per cubic millimeter (mm³) or microliter (µL) of blood. Normally average between 150, ,000 per mm3 (or µL). PROTHROMBIN TIME (prō-THRŎM-bĭn tīm) [PT] Test of the ability of blood to clot. Prothrombin is one of the clotting factors (factor II) made by the liver. This test is used to monitor (follow) patients taking anticoagulant drugs. Another blood clotting test, partial thromboplastin time (PTT), measures other clotting factors. Both PT and PTT are often done at the same time to check for bleeding problems. RED BLOOD CELL COUNT (rĕd blŭd sĕl kount) [RBC] Number of erythrocytes per cubic millimeter (mm3) or microliter (µL) of blood. Normal number is 4 million to 6 million per mm3 (or µL). RED BLOOD CELL MORPHOLOGY (rĕd blŭd sĕl mŏr-FŎL-ō-jē) Microscopic examination of a stained blood smear to determine the shape of individual red blood cells. Abnormal morphology includes anisocytosis (ăn-ī-sō-sī-TŌ-sĭs), poikilocytosis (poy-kĭ-lō-sī-TŌ-sĭs), and sickle cells. WHITE BLOOD CELL COUNT (wīt blŭd sĕl kount) [WBC] Number of leukocytes per cubic millimeter (mm3) or microliter (µL) of blood. Normal number averages between 5000 and 10,000 per mm3 (or µL). WHITE BLOOD CELL DIFFERENTIAL (wīt blŭd sĕl dĭ-fĕr-ĔN-shŭl) [count] Percentage of the total white blood cell count made up by the different types of leukocytes. Percentages of neutrophils, eosinophils, basophils, monocytes, lymphocytes, and immature cells (bands) are determined.

16 Clinical Procedures Page 524 apheresis blood transfusion
bone marrow biopsy hematopoietic stem cell transplantation APHERESIS (ă-fĕ-RĒ-sĭs) Withdrawal and separation of blood elements into component parts and removal of a select portion from the blood. This procedure can remove toxic substances or autoantibodies from the blood and can collect blood cells. EXAMPLE: Leukapheresis, plateletpheresis, and plasmapheresis PICTURE -  Leukapheresis. BLOOD TRANSFUSION (blŭd trăns-FŪ-zhŭn) Blood cells or whole blood from a closely matched donor are infused into a patient. Appropriate testing to ensure a match of red blood cell type (A, B, AB, or O) is essential. Tests also are performed to detect the presence of hepatitis and the acquired immunodeficiency syndrome (AIDS) virus (HIV).  EXAMPLE: AUTOLOGUS TRANSFUSION (ăw-TŎL-ō-gŭs trăns-FŪ-zhŭn) Removal and then reinfusion of a patient's own blood or blood components BONE MARROW BIOPSY (bōn MĂ-rō BĪ-ŏp-sē) Needle aspiration of a small amount of bone marrow followed by examination under a microscope EXAMPLE: bone marrow aspiration DIAGNOSISES: blood disorders such as anemia, pancytopenias, and leukemia. PICTURE - Bone marrow aspiration and biopsy. A, Placement of a bone marrow needle into the iliac crest (upper portion of hipbone) and aspiration of liquid bone marrow.  B,Trephine needle is then inserted and anchored in the bone.  C, A solid piece of bone marrow (biopsy sample) is then extracted through the needle. HEMATOPOIETIC STEM CELL TRANSPLANT (hē-mă-tō-poy-Ĕ-tĭk stĕm sĕl TRĂNS-plănt) Peripheral (found in the blood) stem cells from a compatible donor are administered into the vein of a recipient. TREATMENT FOR: Patients with malignancies, such as AML, ALL, CLL, CML, lymphoma and multiple myeloma. METHOD: First the donor is treated with a drug that mobilizes stem cells into the blood. Then stem cells are removed from the donor, a process like leukapheresis in the top picture. Meanwhile, the patient (recipient) undergoes a conditioning process in which radiation and chemotherapy drugs are administered to kill malignant marrow cells and inactivate the patient's immune system so that subsequently infused stem cells will not be rejected. A cell suspension containing the donor's stem cells, which will repopulate the bone marrow, is then given through a vein to the recipient. In autologous stem cell transplantation, the patient's own stem cells are collected, stored, and reinfused after potent chemotherapy. COMPLICATION: serious infection, graft-versus-host disease (GVHD), and relapse of the original disease despite the treatment. In GVHD, the immunocompetent cells in the donor's tissue recognize the recipient's tissues as foreign and attack them. Because the recipient patient is totally immunosuppressed, his or her immune system cannot defend against the attack. Intensive prophylaxis (prevention) with immunosuppressive drugs is standard for patients undergoing allogeneic transplants. These drugs include cyclosporine, methotrexate, glucocorticoids, sirolimus (Rapamune), and mycophenolate. PICTURE - Hematopoietic stem cell and bone marrow transplantation.

17 Abbreviations Page 526 Ab baso eos ABMT BMT EPO ABO CBC ESR ALL CLL Fe
AML CML G-CSF ANC DIC GM-CSF ASCT diff g/dL banda EBV Ab = antibody ABMT = autologous bone marrow transplantation—patient serves as his or her own donor for stem cells ABO = four main blood types—A, B, AB, and O ALL = acute lymphoid leukemia AML = acute myeloid leukemia ANC = absolute neutrophil count—total WBC times a measure of the number of bands and segs present in the blood; an ANC less than 1500 cells/uL is neutropenia ASCT = autologous stem cell transplantation bands = immature white blood cells (granulocytes) Baso = basophils BMT = bone marrow transplantation CBC = complete blood count CLL = chronic lymphoid leukemia CML = chronic myeloid leukemia DIC = disseminated intravascular coagulation—bleeding disorder marked by reduction in blood clotting factors due to their use and depletion for intravascular clotting diff = differential count (white blood cells) EBV = Epstein-Barr virus; cause of mononucleosis eos = eosinophils EPO = erythropoietin ESR = erythrocyte sedimentation rate Fe = iron G-CSF = granulocyte colony-stimulating factor—promotes neutrophil production GM-CSF = granulocyte-macrophage colony-stimulating factor—promotes myeloid progenitor cells with differentiation to granulocytes g/dL = gram per deciliter (1 deciliter = one tenth of a liter; 1 liter = quarts)

18 Abbreviations (Cont’d)
Page 527 Abbreviations (Cont’d) GVHD Polys, PMNs, PMNLs lymphs HCL MCH PT, pro time Hct MCHC PTT Hgh, HGB MCV RBC H and H µL sed rate HLA MDS segs IgS, IgD, IgE, IgG, IgM Mm3 SMAC mono WBC ITP WNL GVHD = graft-versus-host disease—immune reaction of donor's cells to recipient's tissue HCL = hairy cell leukemia—abnormal lymphocytes accumulate in bone marrow, leading to anemia, thrombocytopenia, neutropenia, and infection Hct = hematocrit Hgb, HGB = hemoglobin H and H = hemoglobin and hematocrit HLA = human leukocyte antigen IgA, IgD, IgE, IgG, IgM = immunoglobulins ITP = idiopathic thrombocytopenic purpura lymphs = lymphocytes MCH = mean corpuscular hemoglobin—average amount of hemoglobin per cell MCHC = mean corpuscular hemoglobin concentration—average concentration of hemoglobin in a single red cell; when MCHC is low, the cell is hypochromic MCV = mean corpuscular volume—average volume or size of a single red blood cell; when MCV is high, the cells are macrocytic, and when low, the cells are microcytic µL = microliter—one millionth of a liter; 1 liter = quarts MDS = myelodysplastic syndrome—preleukemic condition (anemia, cytopenias, and possible transformation to AML) mm3 = cubic millimeter—one millionth of a liter; 1 liter = quarts Mono = monocyte polys, PMNs, PMNLs = polymorphonuclear leukocytes; neutrophils, eosinophils, basophils PT, pro time = prothrombin time PTT = partial thromboplastin time RBC = red blood cell; red blood cell count sed rate = erythrocyte sedimentation rate segs = segmented, mature white blood cells (neutrophils) SMAC = Sequential Multiple Analyzer Computer—an automated chemistry system that determines substances in serum WBC = white blood cell; white blood cell count WNL = within normal limits


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