Mary DeLetter, PhD, RNAssociate ProfessorDept. of Baccalaureate and Graduate NursingEastern Kentucky University

Hematology Alterations:Altered Leukocyte FunctionAltered Lymphoid Function

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Alterations in Leukocyte Function

QuantitativeDecreased production in bone marrowAccelerated destruction of circulating WBCResponse to infections

QualitativeDisruption in function

↓ phagocytosis: granulocytes, monocytes, macrophages↓ antigen response: lymphocytesInfectious mononucleosisCancer: leukemia, myeloma 2

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Quantitative Alterations

-cytosis: ↑ WBC count (>10,000/mm3)

-philia: ↑ WBC count -penia: ↓ WBC count (<3,500/mm3)

LeukocytosisNormal response to physiologic stress

Leukopenia↑ infection riskEndogenous or exogenous causes

Hemocytoblast

MyeloblastMonoblast Lymphoblast

Progranulocyte

. . .

Basophil

NeutrophilicMyelocyte

EosinophilicMyelocyte

BasophilicMyelocyte

Eosinophil Neutrophil LymphocyteMonocyte

Granulocytes

Leukocyte Development

Agranulocytes

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Granulocytes

NeutrophiliaEarly stages of infection or inflammation

NeutropeniaSevere prolonged infectionsAbsence of infection:

↓ neutrophil production↓ neutrophil survivalAbnormal neutrophil distribution/sequestration

NeutrophilsEosinophilsBasophils

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Granulocytes

NeutropeniaPrimary Congenital

Immunodeficiencies – ↓ neutrophil productionPrimary Acquired

Hematologic disordersAnorexia/starvation

SecondaryMalignanciesChemotherapyImmunosuppressive drugs

NeutrophilsEosinophilsBasophils

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Granulocytes

EosinophiliaAllergic disordersParasitic infections↑ Tryptophan ingestionFibromyalgia Syndrome

EosinopeniaMigration of eosinophils to inflammatory siteHypercortisol secretion (Cushing syndrome)

NeutrophilsEosinophilsBasophils

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Granulocytes

BasophiliaInflammationImmediate hypersensitivity reactionsMyeloproliferative disorders

Basopenia (basophilic leukopenia)HyperthyroidismAcute infectionsHypercortisol (exogenous)Ovulation/pregnancy

NeutrophilsEosinophilsBasophils

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Agranulocytes

MonocytosisBacterial infectionsChronic infectionsMyocardial damage (MI)

MonocytopeniaRare

MonocytesLymphocytes

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Agranulocytes Lymphocytosis

Acute viral infections – Epstein-BarrRare in bacterial infections

LymphocytopeniaAltered lymphocyte production

NeoplasmsImmune deficiencies

Lymphocyte destruction Drugs, radiationViruses, HIVAutoimmune

MonocytesLymphocytes

Other Conditions Associated with Leukophilias &Leukopenias

Table 29-1

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Infectious Mononucleosis

Infection of B-lymphocytesAcute, self-limitingTransmission

Saliva (personal contact)Incubation: 30-50 days85% of cases - Epstein-Barr virus

B cells have an EBV receptor siteOther viral causes:

Cytomegalovirus (CMV), hepatitis, influenza, HIV

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Infectious Mononucleosis

Signs and symptoms: FeverSore throatCervical lymphadenopathy↑ lymphocyte countAtypical lymphocytes

Serious complications are infrequent (<5%)Splenic rupture is the most common cause of death

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Leukemia

CharacteristicsMalignant disorder of the lymphocytes and blood-forming organs

Excessive accumulation of malignant leukocytes

Overcrowding of bone marrow

↓ production of normal hematopoietic cells

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Leukemias

Acute leukemiaPresence of undifferentiated or immature cells, usually blast cells

Acute lymphocytic leukemia (ALL)> 30% lymphoblasts in bone marrow or blood

ChildrenMean age = 13>95% of children have remission

Adults 20% of ALL casesGreater mortality than children

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Leukemias

Acute myelogenous leukemia (AML)Causes:

Abnormal proliferation of myeloid precursor cells↓ ApoptosisLoss of cellular differentiation

PathophysiologyLeukocytosisPredominance of blast cells

OccurrenceAdults – mean age 67

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LeukemiasChronic leukemia

Predominant cell is mature but does not function normally30% of leukemia cases

Chronic lymphocytic leukemia (CLL)Pathophysiology

Malignant transformation and Slow ↑B lymphocytesCancerous cells spread from the bone marrow to the bloodInvolves lymph nodes

OccurrenceAdults > 50

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Leukemias

Chronic myelogenous leukemia (CML)Definition

↑ myeloid cell production in bone marrowCauses

Philadelphia chromosomesTranslocation of chromosomes 9 and 22Found in the affected WBC Allows uncontrollable cell growth

High dose radiation treatmentsOccurrence

Children and middle-age adults.

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LeukemiaClinical manifestations

__________________Leukemiapictures.org

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Myeloma

Proliferation of hematopoietic cells (bone marrow)

Solitary or multifocal tumors (multiple myeloma)

Malignant plasma cells produce abnormally large amounts immunoglobulin (Bence-Jones proteins)

Pass through the glomerulus and damage renal tubular cells

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Myeloma

Multiple myeloma causes increased osteoclastic bone destruction

Clinical manifestationsCortical (outer) and medullary (inner) bone lossSkeletal painRecurring infections - ↓humoral immune response

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Lymphadenopathy

Enlarged lymph nodes that become palpable and tender

Local lymphadenopathyDrainage of an inflammatory lesion located near the enlarged node

General lymphadenopathyMalignant or nonmalignant disease

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Malignant LymphomasProliferation of malignant lymphocytes in lymphoid system.

Hodgkin lymphomaReed-Sternberg cells in the lymph nodes

Large, multinucleated or bilobular nucleusAdenopathy, mediastinal mass, splenomegaly, and abdominal massPrognosis good

OccurrenceBoth children and adults

Early adulthood (ages 15 to 40, especially in a person’s 20s) Late adulthood (after age 55).

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Malignant Lymphomas

Non-Hodgkin lymphomasTypes

B-cellsT-cellsSlow-growingFast-growing

OccurrenceEqual in males and females95% in adults

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Alteration in Platelet Function

ThrombocytopeniaPlatelet count < 150,000 platelets/mm3

Causes:↓ platelet production in bone marrow↑ breakdown intravascular platelets↑ breakdown of extravascular platelets in spleen or liver

Hematology Alterations:Altered Leukocyte FunctionAltered Lymphoid Function