Chapter 11: Disorders of White Blood Cells and Lymphoid Tissues.

1. Abnormally low numbers of neutrophils. 2. Important role of defending of the body against infection.

Neutropenia

Diagnostic Hallmark of Chronic Lymphocytic Leukemia (2):

1. Isolated lymphocytes greater than 20,000/uL. 2. Usually 75% to 100% of lymphocytes.

1. The primary pathogen-fighting cells. 2. 55-65% of total WBCs. 3. First line of defense.

Neutrophils

1. Lymphoma originates at extra nodal sites and spreads to anatomically contiguous nodes. 2. Reed-Sternberg cells are not present.

Non-Hodgkin Lymphoma

Signs and Symptoms of Chronic Lymphocytic Leukemia:

Often asymptomatic.

Criteria for Remission of ALL and AML (4):

1. Less than 5% blasts in the bone marrow. 2. Normal peripheral blood counts. 3. Absence of cytogenetic abnormalities. 4. Return to pre-illness performance status.

Lab Work Completed for Chronic Myelogenous Leukemia (3):

1. Leukocytosis. 2. Anemia. 3. Thrombocytopenia.

Accelerated Phase of Chronic Myelogenous Leukemia (4):

1. Low grade fever. 2. Night sweats. 3. Bone pain. 4. Weight loss.

Treatment of Chronic Lymphocytic Leukemia (2):

1. Low risk-no treatment. 2. Moderate risk--Chemotherapy plus MOA rituximab.

Lymphatic System Consists Of:

1. Lymphatic Vessels. 2. Lymph nodes. 3. Lymphatic Tissue. 4. Thymus. 5. Spleen.

Manifestations of Neutropenia (4):

1. Malaise. 2. Chills. 3. Fever. 4. Extreme weakness and fatigue.

Where do lymphocytes come from?:

Originate in lymphoid stem cells found in bone marrow.

Leukemias (4):

1. Malignant neoplasms of hematopoietic stem cells. 2. Created in the bone marrow. 3. Create abnormal white blood cells. 4. Most common cause of cancer in children and adolescents.

List the Three Leukocytes:

1. Neutrophils. 2. Eosinophils. 3. Basophils.

Characteristics of Slow Growing Non-Hodgkin Lymphoma (2):

1. Painless lymphadenopathy (widespread). 2. Disease may fluctuate for 5 to 10 years.

Treatment of Hodgkin Lymphoma (2):

1. Radiation and chemotherapy. 2. 5 yr. cure rate of 85%.

Control immune response. Starts in the bone marrow and matures in the thymus.

T Cells

Characteristics of Fast Growing Non-Hodgkin Lymphoma (3):

1. Fever. 2. Night sweats. 3. Weight loss.

Goals of Treatment for Chronic Myelogenous Leukemia (3):

1. Hematological response characterized by normalized blood counts. 2. Cytogenic response demonstrated by the reduction or elimination of the Ph chromosome from the bone marrow. 3. Molecular response confirmed by the elimination of the BCR-ABL fusion protein.

Leukemic Cells (7):

1. Immature (blasts) and poorly differentiated. 2. Proliferate rapidly and have a long lifespan. 3. Do not function normally. 4. Interfere with the maturation of normal blood cells. 5. Circulate in the bloodstream. 6. Cross the blood-brain barrier. 7. Infiltrate many body organs.

Causes of Non-Hodgkin Lymphoma (3):

1. Increased frequency with AIDS. 2. Epstein-Barr Virus. 3. Hepatitis C.

Treatment of AML (2):

1. Induction Therapy: *Intensive chemotherapy. 2. Supportive Treatment: *Treatment with antimicrobials with chemotherapy agents.

Treatment of ALL (3):

1. Induction therapy: * 2. CNS Prophylaxis: * 3. Maintenance Therapy: *

Characteristics of ALL and AML (8):

1. Abrupt onset. 2. Low grade fever. 3. Night sweats. 4. Fatigue--Due to anemia. 5. Weight Loss--Due to rapid proliferation and hyper metabolism. 6. Bleeding--Due to decrease platelets. 7. Infection--Due to neutropenia. 8. CNS Involvement--More common with ALL vs. AML.

Diagnostic Feature of Chronic Myelogenous Leukemia (2):

1. An elevated white blood count with median count of 150,000 uL. 2. Presence of the BCR-ABL gene product.

Treatment of Neutropenia (2):

1. Antimicrobial medications. 2. Private room.

Three Subsets of Lymphocytes:

1. B Cells. 2. T Cells. 3. Natural Killer Cells.

Diagnosis of Hodgkin Lymphoma (2):

1. Biopsy of node shows Reed-Sternberg cells. 2. CT scan and PET scan show lymph node involvement.

Diagnosis for ALL and AML (3):

1. Blood--Immature WBCs in the circulation and bone marrow which is 60% to 100% of the cells. 2. Bone Marrow Studies--Characteristics of leukemia, the degree of bone marrow involvement, morphology and histology of disease. 3. Lumbar puncture--For ALL to see if there is CNS involvement.

Signs and Symptoms of Multiple Myeloma (7):

1. Bone Pain (first symptom). 2. Anemia. 3. Recurrent infections. 4. Weight loss. 5. Weakness. 6. Renal insufficiency. 7. Hypercalcemia.

Staging the Disease for Non-Hodgkin Lymphoma (5):

1. Bone marrow biopsy. 2. Blood studies. 3. Chest and abdominal CT scans. 4. PET scan. 5. Bone scan.

Main sites Multiple Myeloma affects? (2):

1. Bones. 2. Bone Marrow. *There is a proliferation of malignant plasma cells in the bone marrow and osteolytic bone lesions throughout the skeletal system.

Diagnostic Test (3):

1. CT Scan of Abdomen: 2. Massive splenomegaly present. 3. No gallbladder present.

Types of Chronic Leukemia (2):

1. Chronic Lymphocytic Leukemia (CLL). 2. Chronic Myelogenous Leukemia (CML).

Clinical Course of Chronic Myelogenous Leukemia (3):

1. Chronic phase of variable length. 2. A short accelerated phase. 3. Terminal blast crisis phase.

Diagnosis of Multiple Myeloma (3):

1. Classic Triad. 2. Lytic Bone Lesions. 3. Either serum M-protein spike or the presence of Bence Jones proteins in the urine.

Non-Hodgkin Lymphoma (4):

1. Either B-Cell or T-Cell neoplasms. 2. Cause is largely unknown: Could be caused from the impairment of the immune system and infectious agents. 3. Fifth most common cause of cancer in the US. 4. Most commonly originate in lymph nodes.

Causes of Mono (2):

1. Epstein-Barr Virus, a member of the herpes virus family; transmitted in saliva. 2. Contact through infected oral secretions.

Create antibodies. Starts in the bone marrow and matures in the bone marrow.

B Cells

What percentage of total WBCs are Lymphocytes?:

20-30%.

Which condition is characterized by, "B-Cell turns into a plasma cell therefore this is why multiple myeloma is called a plasma cell dyscrasia"?:

B-Cell Malignancy.

The nurse explains to the client that a biopsy of the enlarged lymph node is important because, if Hodgkin's lymphoma is present, the histologic examination will reveal which of the following?: A. Absence of Reed-Sternberg Cells. B. Tay-Sachs cells. C. Presence of Reed-Sternberg Cells. D. Myeloid stem cells.

C. Presence of Reed-Sternberg Cells.

What term is defined as, "malignancies involving the proliferation of well-differentiated myeloid and lymphoid cells"?:

Chronic Leukemia

The most common form of leukemia in adults in Western world:

Chronic Lymphocytic Leukemia (CLL)

What does (CLL) stand for?

Chronic Lymphocytic Leukemia:

When a client with a high fever and a diagnosis of viral infection is admitted to the hospital, the nurse would expect the lymphocyte (T cell) count to be?: A. Higher than normal. B. Lower than normal. C. Within normal limits. D. Absent.

A. Higher than normal.

When assessing the client with the potential diagnosis of Hodgkin's disease, the nurse is alert for which of the following findings? A. Infectious mononucleosis infections. B. Discolored teeth. C. Hemorrhage. D. Hypercellular immunity.

A. Infectious mononucleosis infections.

Both involve immature lymphocytes and their progenitors in the bone marrow, the spleen, lymph nodes, CNS, and other tissues.

ALL and CLL.

Both involve pluripotent myeloid stem cells in bone marrow and interfere with the maturation of all blood cells.

AML and CML.

What does (ALL) stand for?

Acute Lymphocytic (Lymphoblastic) Leukemia:

What does (AML) stand for?

Acute Myelogenous (Myeloblastic) Leukemia.

Myeloma has been associated with?:

Agent Orange.

What does (CML) stand for?

Chronic Myelogenous Leukemia.

Laboratory findings indicate that a child with leukemia is also anemic. The nurse interprets this finding as most likely resulting from which of the following?: A. Inadequate dietary folic acid intake. B. Decreased red blood cell production. C. Increased destruction of red blood cells by lymphocytes. D. Progressive replacement of bone marrow with scar tissue.

B. Decreased red blood cell production.

A 15 year old has been admitted to the hospital with the diagnosis of acute lymphocytic leukemia. Which of the following signs and symptoms require the most immediate nursing intervention?: A. Fatigue and anorexia. B. Fever and petechiae. C. Swollen neck lymph glands and lethargy. D. Enlarged liver and spleen.

B. Fever and petechiae.

A common problem of patients diagnosed with multiple myeloma is: A. Thrombosis. B. Fractures (broken bones) C. Impaired clotting. D. Hypoxia.

B. Fractures (broken bones)

The nurse is evaluating a neutropenic patient's food tray. What item should be removed from the tray. A. Plastic silverware. B. Fresh fruits. C. Carton of milk. D. Cooked vegetables.

B. Fresh fruits.

1. Release heparin, histamine, and other inflammatory mediators. 2. 0.3%-0.5% of total WBCs.

Basophils

1. 3-8% of total WBCs. 2. Phagocytic--engulfing bacteria, viruses, etc. 3. Antigen-presenting cells; create inflammatory mediators.

Monocytes/Macrophages.

Manifestations of Hodgkin Lymphoma:

Most people will have painless enlargement of a single or group of nodes.

Abnormal growth of monocytes and granular leukocytes.

Myelogenous

Cells that kill antigenic cells.

Natural Killer Cells

1. Help control allergic response; fight parasites. 2. 1-3% of total WBCs.

Eosinophils.

Additional Signs of Hodgkin Lymphoma:

Fatigue and anemia is indicative that the disease has spread.

1. Lymphoma arises in a single node or chain of nodes. 2. Reed-Sternberg cells are present.

Hodgkin Lymphoma

Also known as Hodgkin disease. The cause of Hodgkin Lymphoma is largely unknown. *After bone marrow transplant. *Most people who had infectious mononucleosis are at higher risk for development of Hodgkin lymphoma.

Hodgkin Lymphoma

1. This is referred to as the "kissing disease" 2. Affects adolescents and young adults.

Infectious Mononucleosis

Complications of Acute Leukemia (2):

Leukostasis: *Circulating blast count markedly elevated. Hyperuricemia: *Increased uric acid levels. *Increased breakdown of purine nucleotides secondary to chemotherapy.

Cells that function in lymph nodes, or spleen to defend against foreign microbes in the immune response:

Lymphocytes.

Mutation of the B and T cells and natural killer cells.

Lymphotic

Manifestations of Mono (5):

1. Fever. 2. Generalized lymphadenopathy. 3. Sore throat. 4. The appearance in the blood of atypical lymphocytes and several antibodies. 5. Hepatitis and splenomegaly.

Lab Results for Mono (3):

1. Increase in leukocytes. 2. WBC between 12,000 and 18,000. 3. Increase liver enzymes with liver involvement.

Treatments of Multiple Myeloma (3):

1. Melphalan (an alkylating agent) and prednisone. 2. Thalidomide (immunosuppressant) with dexamethasone (corticosteroid). 3. High dose chemotherapy with autologous stem cell transplantation.

Treatment for Non-Hodgkin Lymphoma (2):

1. Radiation alone (early stages). 2. Combination chemotherapy and radiation, most common.

Recovery from Mono (4):

1. Treatment is symptomatic and supportive. 2. Acute phase is 2 to 3 weeks then recovery is rapid. 3. May persist for 2 to 3 months. 4. Education is important.

Manifestations of Chronic Myelogenous Leukemia (4):

1. Weakness. 2. Fatigue. 3. Exertional dyspnea. 4. Splenomegaly.

What is the purpose of a lymph node biopsy?:

Used to confirm the diagnosis of NHL.

Classic Signs of Hodgkin Lymphoma:

Pruritus (itching) intermittent fevers along with night sweats.