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Chapter 9
Disorders of White Blood Cells
and Lymphoid Tissues
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Blood enters
tissues
Blood and lymph return to
heart through vena cava
Fluid moves
into tissues
from
capillaries
Excess tissue fluid enters lymph
vessels and is transported to …
Peripheral
lymphoid
organs,
where WBCs
respond to
pathogens
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
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
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
Which type of leukocyte works the hardest when you
receive a vaccination?
a. Eosinophil
b. Basophil
c. B lymphocyte
d. Neutrophil
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
c. B lymphocyte
Rationale: 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.
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Stem Cells in the
Bone Marrow
Create the White
Blood Cells
Pluripotent
stem cells
Multipotent
stem cells
Common
lymphoid
stem cells
Common
myeloid stem
cells
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
common
myeloid stem
cells
committed
precursor
cells
platelets
erythrocytes
monocytes
and
granular
leukocytes
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
common
lymphoid
stem cells
committed
precursor
cells
T
lymphocytes
B
lymphocytes
natural
killer
cells
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Multipotent
stem cells
common
lymphoid
stem cells
common
myeloid stem
cells
committed
precursor
cells
committed
precursor
cells
T
lymphocytes
B
lymphocytes
natural
killer
cells
platelets
erythrocytes
monocytes
and
granular
leukocytes
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
Which type of leukocyte is created in the bone marrow
(myeloid)?
a. Eosinophil
b. Basophil
c. Neutrophil
d. All of the above
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
d. All of the above
Rationale: Granular leukocytes are created in the bone
marrow; eosinophils, basophils, and neutrophils are all
granular leukocytes.
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Scenario
A man has cancer and is being given radiation
therapy.
• His doctor has prescribed several other drugs
including:
– Erythropoietin
– Granulocyte-monocyte colony-stimulating factor
– Thrombopoietin
Question:
• Why have these drugs been prescribed?
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
White Blood Cells
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
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?
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
White Blood Cell Deficiencies
• Leukopenia
• Neutropenia (agranulocytosis)
• Aplastic anemia
• Infectious mononucleosis
• HIV
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
Patients with HIV are immunocompromised. Which type of
leukocyte is the best indicator of immune function?
a. Neutrophil
b. Eosinophil
c. T lymphocyte
d. Monocyte
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
c. T lymphocyte
Rationale: 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
drop to 200 cells/mm3.
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
WBCs are formed
and differentiate in
the bone marrow
They travel to the
lymphoid organs to
mature and develop
Lymph
node
Neoplasms arising here
cause leukemias or
plasma cell dyscrasias
Neoplasms
arising here are
lymphomas
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Leukemias
• Malignant neoplasms of hematopoietic stem cells
• In bone marrow
• Create abnormal white blood cells
– Lymphocytic
– Myelogenous
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Myelocytic
Leukemias
Multipotent
stem cells
common
lymphoid
stem cells
• Mutation of
myeloid cell
line
• Overproduction
of abnormal
monocytes or
granulocytes
• Production of
other cell types
decreases
mutation
neoplastic
inmyeloid
myeloid
stem cells
neoplastic committed precursor cells
abnormal monocytes or granular leukocytes
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Lymphocytic
Leukemias
• Mutation of
lymphoid cell
line
• Overproduction
of abnormal
immune cells
• Production of
other cell types
decreases
Multipotent
stem cells
mutation
neoplasticin
lymphoid
stem cells
common
myeloid stem
cells
neoplastic committed precursor cells
neoplastic
abnormal B or T lymphocytes or natural
Natural
killer
Killercells
cells
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Leukemias
What is the difference between:
• Acute vs. chronic
• Lymphocytic vs. myelogenous
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Leukemias Affect Bone Marrow Activity
Question:
• How would this cause:
– Bone pain and risk of fractures?
– Anemia?
– Thrombocytopenia?
– Immune suppression?
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Scenario
Abnormal WBCs are produced and they:
• Release inflammatory mediators
• Infiltrate peripheral lymphoid organs
• Increase blood viscosity
• Create waste products
Question:
• What signs and symptoms will result?
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
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?
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Lymphomas
• Hodgkin lymphoma
– Malignant B cells invade lymphoid organs
• Non-Hodgkin lymphoma
– B cell
– T cell
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Myeloma
• Abnormal B cells
– Can form tumors
• Produce abnormal antibodies
– Immune depression
– Proteins increase blood viscosity
– Infiltrate organs
• Proliferation of osteoclasts
– Break down bone
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question
Tell whether the following statement is true or false.
Hodgkin lymphoma has a better prognosis than nonHodgkin lymphoma.
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
True
Rationale: Non-Hodgkin lymphoma originates from
malignancies in both T and B lymphocytes, whereas
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.
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins
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