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Essentials of Pathophysiology
CHAPTER 11
DISORDERS OF WHITE BLOOD CELLS
AND LYMPHOID TISSUES
PRE LECTURE QUIZ (TRUE/FALSE)
T

F

F

T

F

White blood cells (granulocytes, monocytes, and
lymphocytes) are formed in the bone marrow.
The life span of white blood cells is relatively long,
so constant renewal is not necessary to maintain
normal blood levels.
In neutropenia, all of the cell lines are affected,
resulting in anemia, thrombocytopenia, and
agranulocytosis.
Infectious mononucleosis is a self-limiting disorder
caused by the Epstein-Barr virus (EBV).
Non-Hodgkin is a form of lymphoma that is
associated with the presence of an abnormal cell
called a Reed-Sternberg cell.
PRE LECTURE QUIZ
Acute

Clinical manifestations of acute leukemia include petechiae,
ecchymosis, gingival bleeding, and epistaxis, as a result of a
decreased ________________________________ level.

More children are stricken with ____________________ than
with any other form of cancer, and it is the leading cause of
death in children between the ages of 1 and 14 years.
Cell
Leukemia
Philadelphia  The ________________ leukemias have a sudden and stormy
onset with symptoms of depressed bone marrow function
(Ph)
(anemia, fatigue, bleeding, and infections).
thrombocyte/ The leukemias are classified according to their predominant
________________________ type.
platelet
 Chronic myelogenous leukemia is associated with the presence
of the _________________________ chromosome, arising from
a reciprocal translocation between the long arm of chromosome
22 and the long arm of chromosome 9.
DEVELOPMENTAL STAGES OF BLOOD CELLS
WHITE BLOOD CELLS
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
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
QUESTION
Which type of leukocyte works the hardest when
you receive a vaccination?
a. Eosinophil
b. Basophil
c. B-lymphocyte
d. Neutrophil
ANSWER
B-lymphocyte
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.
c.
Cell differentiation
MYELOID TREE
common
myeloid stem
cells
committed
precursor
cells
platelets
erythrocytes
monocytes
and
granular
leukocytes
LYMPHOID TREE
common
lymphoid
stem cells
committed
precursor
cells
T
lymphocytes
B
lymphocytes
natural
killer
cells
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
QUESTION
Which type of leukocyte is created in the bone
marrow (myeloid)?
a. Eosinophil
b. Basophil
c. Neutrophil
d. All of the above
ANSWER
All of the above
Granular leukocytes are created in the bone
marrow; eosinophils, basophils, and
neutrophils are all granular leukocytes.
d.
SCENARIO:
A man has cancer and is being given radiation therapy…

His doctor has prescribed several drugs:
Question:

Why have the following drugs been prescribed?
 Erythropoietin
 Granulocyte-monocyte
factor
 Thrombopoietin
colony-stimulating
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?
WHITE BLOOD CELL DEFICIENCIES





Leukopenia
Neutropenia (agranulocytosis)
Aplastic anemia
Infectious mononucleosis
HIV
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
ANSWER
T-lymphocyte
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 drops to 200 cells/mm3.
c.
LEUKEMIAS



Malignant neoplasms of hematopoietic stem cells
In bone marrow
Create abnormal white blood cells: 2 types of leukemia
 Lymphocytic
 Myelogenous
Acute myeloid leukemia (AML)
AML MYELOID BLASTS


Bone marrow
aspirate showing
acute myeloid
leukemia. Several
blasts have Auer
rods.
Auer rods are
clumps of granular
material that form
elongated needles
seen in the
cytoplasm of
leukemic blasts.
MYELOCYTIC LEUKEMIAS



Mutation of
myeloid cell line
Overproduction of
abnormal
monocytes or
granulocytes
Production of
other cell types
decreases
Multipotent
stem cells
common
lymphoid
stem cells
mutation
neoplastic
inmyeloid
myeloid
stem cells
neoplastic committed precursor cells
abnormal monocytes or granular leukocytes
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
LEUKEMIAS
What is the difference between:
 Acute vs. chronic
 Lymphocytic vs. myelogenous
AML GENE TRANSLOCATION
LEUKEMIAS AFFECT BONE MARROW ACTIVITY
Question:
 How would this cause:
 Bone pain and risk of fractures?
 Anemia?
 Thrombocytopenia?
 Immune suppression?
QUESTION
What signs and symptoms will result when…?
Abnormal WBCs are produced and they…
 Release inflammatory mediators
 Infiltrate peripheral lymphoid organs
 Increase blood viscosity
 Create waste products

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?

ANSWER

When there is a breakdown or destruction of
cells, the electrolyte potassium moves from
inside of the cell to outside of the cell
wall. This shift of potassium outside of the
cells causes hyperkalemia.
Lymphoma vs. Leukemia or Dyscrasias
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
LYMPHOMAS


Hodgkin lymphoma
 Malignant B cells invade lymphoid organs
Non-Hodgkin lymphoma
 B cell
 T cell
MYELOMA

Abnormal B cells
 Can


form tumors
dyscrasias - a malfunction
or abnormal condition, esp.
an imbalance of the
constituents of the blood.
Produce abnormal antibodies
 Immune
depression
 Proteins
increase blood viscosity
 Infiltrate
organs
Proliferation of osteoclasts
 Break
down bone
QUESTION
True or False:
Hodgkin lymphoma has a better prognosis than
non-Hodgkin lymphoma.
ANSWER
True
Non-Hodgkin lymphoma originates from
malignancies in both T- and B-lymphocytes,
where Hodgkin malignancies originate in Bcells (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.