University:
American Career College
Course:
NURS115 | Intermediate Medical
Academic year:

2020
Views:

264

Pages:

26
Author:

Gracie Bullock

DISEASES OF BLOOD & BONE MARROW Leukaemia Definition: Neoplastic proliferation of leukocyte forming cells of bone marrow with invasion of blood & tissues by malignant leukocytes. Causes:  Exposure to irradiation  Exposure to carcinogenic chemicals.  Certain viral infections as human T‐cell leukemia virus & Epstein‐Barr virus.  Philadelphia chromosome. I. Acute leukaemia 1‐ Acute lymphoblastic leukaemia (ALL): Children and young adults below 15 years. 2‐ Acute myeloblastic leukaemia: • Affects adults 15‐30 years. • FAB classification classify it into types M1‐M7 according to the predominant neoplastic cells. Pathological features:  Hypercellular bone marrow, mainly blasts.  Increased total leucocytic count with many blasts in peripheral blood.  Severe anaemia, leukopenia & thrombocytopenia.  Lymphadenopathy & hepatosplenomegaly.  Short fatal course of about 6 months. II. Chronic leukaemia 1. Chronic lymphocytic leukaemia (CLL):      Above 50 years TLC (100000‐200000/cmm) Marked increase in small & large lymphocytes. Greyish white hypercellular marrow rich in lymphoid cells. Marked generalized lymphadenopathy with moderate hepatosplenomegaly and leukaemic infiltration of some organs.  Anaemia, thrombocytopenia, bleeding tendency & autoimmune haemolysis. 2. Chronic myeloid leukaemia (CML):  30‐60 years  Most patients are positive for Philadelphia chromosome.  TLC usually more than 200000/cmm with marked increase in metamyelocytes and granulocytes.  Hypercellular greyish white bone marrow rich in myeloid cells.  Marked hepatosplenomegaly & leukaemic infiltrates of other organs. Leukocytosis: TLC is above 10000/cmm. Types: 1‐ Lymphocytosis: TB. 2‐ Monocytosis: Infectious mononucleosis. 3‐ Neutrophilia: Pyogenic infections. 4‐ Eosinophilia: Allergic & parasitic infections. Leukopenia: TLC is below 4000/cmm. Causes: • Decreased leukocyte formation or increased destruction. • Bone marrow replacement. • Drug intake. Anaemias A‐ Haemolytic anaemias: 1. 2. 3. 4. 5. 6. Hereditary spherocytosis. Sickle cell disease. Thalassemias. Glucose 6 phosphate dehydrogenase deficiency. Paroxysmal haemoglubinuria. Erythroblastosis foetalis. B‐ Post haemorrhagic anaemia C‐ Iron deficiency anaemia D‐ Macrocytic hyperchromic anaemia NB: Polycythaemia: 1ry or 2ry increases in red cell count Diseases of Lymph nodes & spleen Lymphadenitis 1. Acute bacterial lymphadenitis: In LNs draining acute inflammation. 2. Acute viral lymphadenitis: Measles & infectious mononucleosis. 3. Acute chlamydial lymphadenitis: Lymphogranuloma venerum. 4. Chronic non specific lymphadenitis: LNs draining chronic inflammation. 5. Chronic specific lymphadenitis: TB, syphilis, …. Tumors of Lymph nodes 1ry (malignant lymphoma): Hodgkin’s & Non‐ Hodgkin’s lymphomas. 2ry (metastasis). I‐ Hodgkin’s lymphoma It is the commonest type of malignant lymphoma & may affect any age. Gross:  It starts localized , usually in cervical region then becomes generalized.  Enlarged, firm, painless, discrete LNs.  The LNs are 1st mobile, later fused and fixed to surroundings with homogenous greyish cut section.  Enlarged firm spleen with multiple tumor nodules.  Other organs may show infiltration by tumor nodules. Microscopically:  The affected nodes show replacement of normal nodal architecture by pleomorphic cellular infiltrate formed of histiocytes, lymphocytes, neutrophils, eosinophils, plasma cells & neoplastic Reed‐Sternberg cells (RS) cells.  RS cells is the pathognomonic for Hodgkin’s disease.  RS cells are giant cells with abundant cytoplasm and multiple nuclei (2‐8) showing mirror image arrangement and prominent nucleoli.  Mononuclear Hodgkin’s cells and lacunar cells are subtypes of RS cells. Classification: 1‐ Lymphocyte predominance type (15%). 2‐ Nodular sclerosing type (60%). Lymphocyte predominance Nodular sclerosis 3‐ Mixed cellularity type (20%). 4‐ Lymphocyte depletion type (5%). Clinical staging: II‐ Non‐ Hodgkin’s lymphoma According to the Working formulation NHL is classified into: 1‐ Low grade NHL. 2‐ Intermediate grade NHL. 3‐ High grade NHL. 1‐ Low grade NHL: A‐Small lymphocytic lymphoma. B‐ Follicular lymphoma, small cleaved cell. C‐ Follicular lymphoma, mixed small cleaved & large cells. Small lymphocytic lymphoma Follicular lymphoma 2‐ Intermediate grade NHL: A‐ Follicular lymphoma, large cell. B‐ Diffuse lymphoma, small cleaved cell. C‐ Diffuse lymphoma, mixed small cleaved & large cells. D‐ Diffuse lymphoma, large cell. Diffuse small cleaved cell lymphoma Diffuse large cell lymphoma 3‐ High grade NHL: A‐ Large cell immunoblastic lymphoma: Usually B‐cell origin, may be of T‐cell origin. B‐ Lymphoblastic lymphoma: T‐ cell origin C‐ Small non cleaved cell lymphoma ( Burkitt’s lymphoma): Related to EBV infection. Large cell immunoblastic lymphoma Burkitt’s lymphoma Causes of splenic enlargement (splenomegaly): 1. 2. 3. 4. 5. 6. Infections. Metabolic diseases. Circulatory disturbances. Blood diseases. Tumors. Hypersplenism: ‐ 1ry hypersplenism. ‐ 2ry hypersplenism.