Lab Dx 11-2-98
HO- article “Psychoneuroimmunology: Brain and Immunity” – he read it to us.
11-4-98
www.goask.alice.columbia.edu/0556.html
White cell disorders:
Leukemia – cancer of WBC’s
-abnormal growth of disorganized WBC’s (these cells don’t work)
-impair production of RBC’s, platelets, and normal WBC’s
-large #’s of WBC’s lead to pale blood
-impaired function of organs (liver , spleen, lymph nodes, brain, abdomen-GI)
-undergo mass effect (space occupying process)
-brain can only stand so much pressure before it stops
-blood vessels only stand so much pressure before they bleed
-leukemia uses up nutrients (esp. B12)
-acute vs. chronic forms
-fulminant
-classified by type of WBC’s
-acute- can be fatal in weeks if not treated
-6-7 new cases of acute leukemia per 100,000 people per year
Acute leukemia- very immature WBC’s (blasts)
-2 cell forms: lymphoblasts and myeloblasts
-monoclonal theory – one cell mutates then divides (marrow and blood) uncontrollably until billions of it
-symptoms:
-gumbleeding (due to dec. platelets)
-enlarged lymph nodes (cell proliferation)
-anemia
-headaches (from hypoxia)
-frequent bruising
Lymphadenopathy- 4 types:
-immune stimulus
-infection
-neoplasm
-miscellaneous (ex. CT)
-anemia- myelophthisic (normocytic)
diagnosis- marrow aspiration or biopsy
treatment- chemotherapy, transfusions – platelets etc.
Chronic Leukemia- 2 forms: lymphocytic and myelogenous
4 per 100K people per year. Many out live their chronic leukemia. Incurable. Most patients more than 50. Treatment:
transfusions, antibotics, chemotherapy, radiation therapy
Chronic Myeloid (2 new per 100K/year)- prolonged fatigue, fever, night sweats, weight loss
-chronic phase can last for several years
-symptoms similar to acute form
treatment – chronic phase = chemotherapy
-acute phase – bone marrow transplant
chronic form average survival rate about 3 years from date of diagnosis (20% live more than 10 years)
bleeding – purprua – hard to stop bleeding from a small cut
fatigue
recurrent infections
CBC – usually not more than 100k WBC’s/ platelets show thrombocytopenia / RBC’s show microcytic, normocytic (acute
forms)
(chronic form = no cap on counts may see 800K-1mil WBC’s)
may see bone destruction- collapsed VB’s. 5% of acute cases present with joint pain or knee pain (esp. in kids) distal
femur -osteosarcoma in kids = knee pain
Femur = fastest growing site in skeleton. Why the knee pain is a concern (good place for cancers)
www.mic.ki.se/diseases._____
www.medstudents.com.br/hemat/hematb.htm
Multiple myeloma = most common primary neoplasm of the skeleton(M/C malignant neoplasm of skeleton = metastatic
carcinoma)
-starts in the marrow
-whole marrow goes bad at once
-plasma cell is the target – produces antibodies (IgG, IgA)
-probably a single clone is responsible
*NBQ- IgG elevation is the prime immunoglobulin
Symptoms: skeletal destruction, back pain is earliest complaint (mimics mechanical LBP), anemia, hypercalcemia, renal
failure (kidney stones may be first sign of MM) lead to signs of edema
Hypercalcemia leads to fatigue, general muscular weakness
Hypocalcemia leads to irritability to muscle spasms and seizures
MM- median age (61) black males (4 new cases/100K/year)
Etiology – radiation exposure, benzene and other organic solvents, herbicides, insecticides, may be a genetic
predisposition (increased risk for farmers, woodmakers, oilworkers)
Clinical – bone lesions (punched out skull- lots of diploic marrow) bone pain, lytic lesions, IL-6 and osteoclastic
activation factors, low bone density leads to fractures, imitates osteoporosis
Often they die from infections (pneumonia, pyelonephritis), protein flooding the kidneys stresses them. Anemia in 80%
of pt.'s with MM (normocytic, normochromic with fatigue). Neurological symptoms – radiculopathy , deficits, and
compression
Hypercalcemia- lethargy, dizziness, depression
MM- diagnosis – marrow aspiration more than 10% are plasma cells
-in bone , urine, or serum
-order: CBC, UA, Ig electrophoresis, marrow aspiration (bone scans usually negative)
Treatment of symptomatic MM: Nelphalan, Prednisone (shut down marrow by obliterating stem cells to slow down the
tumor)