L1B.1 NUR 2040 MEDICAL SURGICAL NURSING 3, LECTURE 1B (PATHO.

), WEEK 1 LEUKOCYTE PATHOPHYSIOLOGY Key Terms: myeloid leukopenia neutropenia multiple myeloma glandular fever lymphoid pancytopenia leukocytosis lymphoma plasma cells myelosuppression leukaemia Hodgkin's disease

Objectives:

To review the characteristics of human leukocytes. To examine the processes of leukopoiesis. To examine the major lymphoid neoplasms of the bone marrow. To overview the more common disorders of the lymphoid tissues. Normal leukocyte characteristics Leukopoiesis Abnormal leukocyte states Smeltzer and Bare pages 755 - 760; 763 - 767.

Major Topics:

Relevant Textbook Pages:

NORMAL LEUKOCYTE CHARACTERISTICS Important features of human leukocytes in the circulating blood are that they all have nuclei, the shapes of which are distinctive; are about 70% granulocytes (mainly neutrophils but also eosinophils and basophils); are 30% agranulocytes (mainly lymphocytes but 4% are monocytes); are phagocytic (monocytes probably become tissue macrophages) except for lymphocytes; are vitally involved in the immune defences if they have lymphoid origins; mostly survive only a few weeks and spend more time out of the blood stream than in it. LEUKOPOIESIS You should note that
leukocytes come from the same primitive cells as red cells ( but have specific cytokines); granulocytes and monocytes are myeloid (made in separate bone marrow series); lymphocytes come from lymphoid organs and from the bone marrow to a lesser extent; plasma cells (not found in plasma) are committed B lymphocytes that make antibodies; T lymphocytes (embryologically linked with the thymus) cause cell-mediated immunity.

ABNORMAL LEUKOCYTE STATES Important clinical conditions are 1. leukopenia, which is

a pathologically low leukocyte count in the circulating blood (always undesirable); seen when aplastic anaemia is associated with pancytopenia; a common consequence of radiation exposure or chemotherapy (myelosuppression); sometimes treated by transplantation of stem cells of bone marrow or cord blood origins; often reduced by use of granulocyte colony stimulating factor ( lenograstim); also treated by administration of the human stem cell factor, ancestim. L1B.2

2.

neutropenia, which

is a pathologically low circulating neutrophil count; can occur in neoplastic lymphoid conditions in which the total leukocyte is elevated; may be secondary to chemotherapy or other sources of bone marrow damage; is very serious because the low phagocyte numbers lower the body's resistance to infections.

3.

leukocytosis, which is an increase in circulating leukocyte numbers and may be due to

an infection (mainly granulocytes in excess); neoplastic changes in the leucocyte-forming tissues (may be myeloid or lymphoid); a severe immune response such as rejection of a transplant (mainly lymphocytes).

It is important to understand that

the term leukaemia implies a leukocyte neoplasm primary to the bone marrow; multiple myeloma is a plasma cell neoplasm located in the bone marrow; the lymphomas (Hodgkin and other types) are primary tumours of lymphoid organs; glandular fever is a lymph gland disorder caused by the Epstein Barr virus.

Leukaemias can be

acute myeloid: common in young adults, this has primitive myeloid cells in the blood; acute lymphoblastic: the blood has primitive lymphoid cells; most patients are children; chronic myeloid: the cells are less primitive; most patients are middle-aged; chronic lymphoid: the white cells are relatively mature; this is often seen in the elderly. mixed white cell neoplasms, with a variety of abnormal cell types possible.

The white cell count of the blood of a leukaemia patient can increase to several times the normal value

but blood viscosity is little changed since WBCs are less than 0.1% of the blood volume; and the excess of primitive neoplastic cells crowds out the bone marrow/lymphoid spaces; and there may be secondary damage to organs such as the liver, spleen and kidneys; and the secondary anaemia, haemostatic and phagocytic/immune defects are life-threatening.

Multiple myeloma differs from a 'true' leukaemia in that

the transformed cells present are derived from plasma cells; extensive erosive bone damage is done by this neoplasm; large amounts of useless immunoglobulin are added to the circulating blood plasma; the prognosis (incurable; death in 2-3 years) is worse than for most of the leukaemias.

Lymphomas

include Hodgkin's disease as well as non-Hodgkin and other lymphomas; are characterised by swelling of one or more lymphoid organs; can involve any lymphoid cell type and vary in the degree of hazard they present.

L1B3 Glandular fever (infectious mononucleosis) is

characterised by the presence of large numbers of abnormal lymphocytes; probably transmitted by oronasopharyngeal mucus; manifested as headache, malaise, fatigue, sore throat, and enlarged lymph nodes; essentially benign and self-limiting.