Clinical method & Therapeutics

1. Blood Disorders
By
Dr. Laraib Jameel Rph
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2. Anemia
• Definition: Anemia is a medical condition in
which the red blood cell count or the hemoglobin
concentration in blood is less than normal.
• The normal level of hemoglobin is generally
different in males and females.
• For men, a normal hemoglobin level is typically
defined as a level of more than 13.5 gram/100
ml, and
• in women as hemoglobin of more than 12.0
gram/100 ml

4. • Blood is comprised of two parts: a liquid called the
plasma and a cellular part. The cellular part contains
several different cell types. One of the most important
and the most numerous cell types are red blood cells.
The other cell types are the white blood cells and
platelets. The purpose of the red blood cell is to deliver
oxygen from the lungs to other parts of the body.
• Red blood cells are produced through a series of
complex and specific steps. They are made in the bone
marrow (inner part of the femur and pelvic bones that
make most of the cells in the blood), and when all the
proper steps in their maturation are complete, they are
released into the blood stream.

5. • The hemoglobin molecule is the functional unit of the red blood
cells and is a complex protein structure that is inside the red blood
cells
• Hemoglobin is made up of four protein molecules (globulin chains)
• this protein sits in red blood cells that carries oxygen from
the lungs to the body's tissues and returns carbon dioxide from the
tissues back to the lungs.
• Shape: Hemoglobin also plays an important role in maintaining the
shape of the red blood cells. In their natural shape, red blood cells
are round with narrow centers resembling a donut without a hole in
the middle. Abnormal hemoglobin structure can, therefore, disrupt
the shape of red blood cells and impede their function and flow
through blood vessels.
• Note: Contrary to most cells in the human body, red blood cells do
not have a nucleus

6. • Even though the red blood cells (or RBCs) are made within the bone
marrow, many other factors are involved in their production. For example,
• iron is a very important component of the hemoglobin molecule;
erythropoietin, a molecule secreted by the kidneys, promotes the
formation of red blood cells in the bone marrow.
• So it means….
• Having the correct number of red blood cells and prevention of anemia
requires
• cooperation among the kidneys + the bone marrow + nutrients within
the body. If the kidneys or bone marrow are not functioning, or the body
is poorly nourished, then normal red blood cell count and function may be
difficult to maintain.
• Anemia is actually a sign of a disease process rather than bring a disease
itself. It is usually classified as either chronic or acute. Chronic anemia
occurs over a long period of time. Acute anemia occurs quickly.

7. • Cause:
1. Reduced hemoglobin synthesis, which may be
due to lack of nutrients or bone marrow failure
or some chronic disease.
2. Blood loss due to trauma, GIT bleeding,
hemorrhoids
3. Decreased RBCs production due to iron
deficiency or folic acid
4. Increased RBCs breakdown due to genetic
conditions such as sickle cell anemia

8. Types
On the basis of the size of the red blood cells
• In general, there are three major types of anemia based upon size
of erythrocytes in peripheral blood.
• 1- Hypochromic or microcytic anemia If the red blood cells are
smaller than normal, The major causes of this type are normally
reduced amount of Hemoglobin.
• Such as iron deficiency (low level iron) anemia
• 2- normocytic anemia If the red blood cells size are normal in size
(but low in number), such as anemia that accompanies chronic
disease or anemia related to kidney disease, acute blood loss.
• Examples include= Aplastic anemia
• macrocytic anemia If red blood cells are larger than normal, Major
causes of this type are defective RBCs formation.
• Example is megaloblastic anemia

9. Types of Anemia
• Hereditary Anemia: it results from specific gene, which directs the synthesis of
abnormal forms of hemoglobin.
• There are two types:
1. Sickle cell anemia: when oxygen levels are low the sickle cell hemoglobin
molecules may aggregate & cause RBCs to change from biconcave to crescent
shape.
• These abnormal red blood
cells cannot easily pass through
small blood vessels leading to
inadequate oxygen for the
tissues of the body.
• Sickle cells also have a shorter
life span than normal red blood cells
(10 to 20 days compared to 120 days).
This rapid turnover may result in inadequate time to replace the red blood cells and
may result in anemia.

11. • 2- Thalassemia: also known as cooley’s
anemia. It results from defect in synthesis of
hemoglobin, which results thin & fragile
erythrocytes

12. Some other Different types of anemia
• Iron deficiency anemia. This most common type of
anemia is caused by a shortage of iron in your body.
Your bone marrow needs iron to make hemoglobin.
Without adequate iron, your body can't produce
enough hemoglobin for red blood cells.
• Without iron supplementation, this type of anemia
occurs in many pregnant women.
• It is also caused by blood loss, such as from heavy
menstrual bleeding, an ulcer, cancer and regular use of
some over-the-counter pain relievers, especially
aspirin, which can cause inflammation of the stomach
lining resulting in blood loss.

13. • Vitamin deficiency anemia. your body needs folate and vitamin B-12 to produce
enough healthy red blood cells. A diet lacking in these and other key nutrients can
cause decreased red blood cell production.
• In folate deficiency anemia RBCs are abnormally larger, such cells are called
megaloblast- megaloblastic anemia
• Also, some people who consume enough B-12 aren't able to absorb the vitamin.
This can lead to vitamin deficiency anemia, also known as pernicious anemia.
• Folic acid importance: water soluble vit (b9)
• To synthesize DNA & RNA
• Helps in cell division & growth
• Produces healthy RBCs
• Imp for pregnant woman to prevent birth defects
• For brain health (improves memory)
• NOTE: human body doesn’t store folic acid, we have to consume it from diet

14. • Hemolytic anemia:
• Red blood cells typically have a life span of 120 days in
the bloodstream, but they can be destroyed or
removed beforehand.
• One type of anemia that falls into this category is
autoimmune hemolytic anemia, where the body's
immune system mistakenly identifies its own red blood
cells as a foreign substance and attacks them.
• Cause: mechanical causes (leaky heart valves or
aneurysms), infections, autoimmune disorders, or
congenital abnormalities in the red blood cell.

15. • Aplastic anemia:
• is a rare bone marrow failure disorder in which the bone marrow
stops making enough blood cells (red blood cells, white blood cells,
and platelets). This occurs as a result of destruction or deficiency of
blood-forming stem cells in your bone marrow, in particular when
the body’s own immune system attacks the stem cells. However,
the few blood cells the marrow does make are normal. Viral
infections, ionizing radiation, and exposure to toxic chemicals or
drugs can also result in aplastic anemia.
• BONE MARROW---- STEM CELLS-----BLOOD CELLS
• Aplastic= empty.
• Factors which empties bone marrow are:
• Chemotherapy, exposure to chemicals(pesticides), HIV, RI

16. • Symptoms:
• Anemia signs and symptoms vary depending on the cause.
• Fatigue
• Weakness
• Pale or yellowish skin
• Irregular heartbeats
• Shortness of breath
• Dizziness or lightheadedness
• Chest pain
• Cold hands and feet
• Some forms of anemia can have specific symptoms:
• Aplastic anemia: fever, frequent infections, and skin rashes
• Folic acid deficiency anemia: irritability, diarrhea, and a smooth tongue
• Hemolytic anemia: jaundice, dark colored urine, fever, and abdominal pains
• Sickle cell anemia: painful swelling of the feet and hands, fatigue, and jaundice
•

17. • Risk factors:
• poor diet
• intestinal disorders
• Women who are menstruating or pregnant
• Rheumatoid arthritis or other autoimmune disease
• Kidney disease
• Thyroid disease (hypothyroidism- thyroid hormone
stimulates proliferation of erythrocytes precursors through
erythropoietin production enhancement)
• Inflammatory bowel disease (Crohn disease or ulcerative
colitis)
• Family history

18. • Diagnosis: through sign & symptoms
• 1-Complete blood count (CBC).
• This measures a number of blood components, including
hemoglobin and hematocrit levels, or the ratio of the
volume of red blood cells to the total volume of blood.
• A CBC can give an indication of the person's overall health
and whether they have any conditions, such as leukemia or
kidney disease.
• If the red blood cell, hemoglobin, and hematocrit levels are
all below "normal," then anemia is likely.
• 2- Color index: relative amount of hemoglobin present in
single RBC. Its value is 0.85-100
• Color index= Hb%/RBC%

19. • 3- A test to determine the size and shape of your
red blood cells. Some of your red blood cells
might also be examined by taking peripherally
like blood smear & examined under microscope
or anatomically for unusual size, shape and
color.
• 4- serum ferritin level: it can give your doctor
clues about your overall iron levels. Ferritin is
stored in the body’s cells until it’s time to make
more red blood cells.

20. • Procedure:
• ferritin test requires only a small amount of blood to
diagnose your ferritin levels accurately.
• In some instances, your doctor may ask you not to eat
for at least 12 hours before your blood is drawn.
• our ferritin blood test results are first evaluated to see
if your levels are within normal ranges. the typical
ranges are:
• 20 to 500 nanograms per milliliter in men
• 20 to 200 nanograms per milliliter in women

21. • Treatment:
• Iron deficiency anemia: Iron supplements or dietary changes. If the condition is
due to loss of blood, the bleeding must be found and stopped
• .Vitamin deficiency anemias: Treatments include dietary supplements and B-12
shots.
• Thalassemia: blood transfusions and bone marrow transplants
• .Anemia of chronic disease: This is anemia associated with a serious, chronic
underlying condition. There are no specific treatments, and the focus is on the
underlying condition
• Aplastic anemia: The patient will receive blood transfusions or bone marrow
transplants.
• Sickle cell anemia: Treatment includes oxygen therapy, pain relief, and
intravenous fluids. There may also be antibiotics, folic acid supplements, and
blood transfusions.
• Hemolytic anemias: Patients should avoid medication that may make it worse
and they may receive immunosuppressant drugs and treatment for infections.

22. • Complications:
• Severe fatigue. Severe anemia can make you so tired
that you can't complete everyday tasks.
• Pregnancy complications. Pregnant women with folate
deficiency anemia may be more likely to have
complications, such as premature birth.
• Heart problems. Anemia can lead to a rapid or
irregular heartbeat (arrhythmia). When you're anemic
your heart must pump more blood to make up for the
lack of oxygen in the blood. This can lead to an
enlarged heart or heart failure.
• Death

23. Thalassemia
• Definition: Thalassemia is an inherited (i.e., passed from parents to
children through genes) blood disorder caused when the body doesn’t
make enough of a protein called hemoglobin, an important part of red
blood cells. SO
• Thalassemia is an inherited disease of faulty synthesis of hemoglobin
• When there isn’t enough hemoglobin, the body’s red blood cells don’t
function properly and they last shorter periods of time, so there are fewer
healthy red blood cells traveling in the bloodstream.
• Red blood cells carry oxygen to all the cells of the body. Oxygen is a sort of
food that cells use to function. When there are not enough healthy red
blood cells, there is also not enough oxygen delivered to all the other cells
of the body, which may cause a person to feel tired, weak or short of
breath. This is a condition called anemia. People with thalassemia may
have mild or severe anemia. Severe anemia can damage organs and lead
to death.

24. • Causes:
• You inherit this genetic abnormality from your parents.
• Hemoglobin is made up of four protein molecules (globulin chains)
• Hemoglobin is made of two proteins:
• Alpha globin chain located on chromosome 16 : there is deficient
synthesis of α-chains
• Beta globin chain located on chromosome 11: there is deficient
synthesis of β-chains
• Thalassemia occurs when there is a defect in a gene that helps control
production of one of these proteins.
• The mutations associated with thalassemia are passed from parents to
children.
• The severity of symptoms depends on how many of these genes are lost.
Loss of one or two genes is usually asymptomatic, whereas deletion of
all four genes is fatal to the unborn child.

25. Types of thalassemia
• The type of thalassemia you have depends on the number of gene mutations you
inherit from your parents and which part of the hemoglobin molecule is affected
by the mutations. The more mutated genes, the more severe your thalassemia.
Hemoglobin molecules are made of alpha and beta parts that can be affected by
mutations.
• Alpha-thalassemia
• Four genes are involved in making the alpha hemoglobin chain. You get two from
each of your parents. If you inherit:
• 1 mutated gene, you'll have no signs or symptoms of thalassemia. But you are a
carrier of the disease and can pass it on to your children.
• 2 mutated genes, your thalassemia signs and symptoms will be mild. This
condition may be called alpha-thalassemia trait.
• 3 mutated genes, your signs and symptoms will be moderate to severe.
• 4 mutated genes. This type is rare. Affected fetuses have severe anemia and
usually are stillborn. Babies born with this condition often die shortly after birth
or require lifelong transfusion therapy. In rare cases, a child born with this
condition may be treated with transfusions and a stem cell transplant, which is
also called a bone marrow transplant.

26. Sub types of Alpha Thalassemia
• It has two serious types:
• hemoglobin H disease and hydrops fetalis.
• Hemoglobin H
• Hemoglobin H develops as when a person is missing three alpha globin genes or experiences
changes in these genes. This disease can lead to bone issues. The cheeks, forehead, and jaw may all
overgrow. Additionally, hemoglobin H disease can cause:
• jaundice
• an extremely enlarged spleen: The spleen helps your body fight infection and filter unwanted
material, such as old or damaged blood cells. Thalassemia is often accompanied by the destruction
of a large number of red blood cells. This causes your spleen to enlarge and work harder than
normal
• Malnourishment
• Hydrops fetalis
• Hydrops fetalis is an extremely severe form of thalassemia that occurs before birth. Most babies
with this condition are either stillborn or die shortly after being born. This condition develops
when all four alpha globin genes are altered or missing.

27. • Beta thalassemia: Beta thalassemia occurs when similar gene defects
affect production of the beta globin protein.
• Two genes are involved in making the beta hemoglobin chain. You get one
from each of your parents. If you inherit:
• 1 mutated gene, you'll have mild signs and symptoms. This condition is
called thalassemia minor or beta-thalassemia.
• 2 mutated genes, your signs and symptoms will be moderate to severe.
This condition is called thalassemia major, or Cooley anemia. Babies born
with two defective beta hemoglobin genes usually are healthy at birth but
develop signs and symptoms within the first two years of life. A milder
form, called thalassemia intermedia, also may occur with two mutated
genes.
• Thalassemia intermedia
• Thalassemia intermedia is a less severe form. It develops because of
alterations in both beta globin genes. People with thalassemia intermedia
don’t need blood transfusions.

28. • Sign & Symptoms:
• Thalassemia signs and symptoms may include:
• Fatigue
• Weakness
• Pale or yellowish skin
• Facial bone deformities
• Slow growth
• Abdominal swelling (Spleenomegaly)
• Dark urine
• The signs and symptoms you experience depend on the type and
severity of your condition. Some babies show signs and symptoms
of thalassemia at birth, while others may develop them during the
first two years of life. Some people who have only one affected
hemoglobin gene don't experience any thalassemia symptoms.

29. • Risk factors:
• Factors that increase your risk of thalassemia include:
• Family history of thalassemia. Thalassemia is passed from parents
to children through mutated hemoglobin genes. If you have a family
history of thalassemia, you may have an increased risk of the
condition.
• Certain ancestry. Thalassemia occurs most often in African-
Americans and in people of Mediterranean and Southeast Asian
ancestry.
• (As Alpha thalassemias occur most often in people from Southeast
Asia, the Middle East, China, and in those of African descent.
• Beta thalassemias occur most often in people of Mediterranean
origin.
• To a lesser extent, Chinese, other Asians, and African Americans can
be affected.)

30. • Diagnosis
• Most children with moderate to severe thalassemia show signs and symptoms
within their first two years of life. If your doctor suspects your child has
thalassemia, he or she may confirm a diagnosis using blood tests.
• A low level of red blood cells
• Size: Smaller than expected red blood cells
• Color: Pale red blood cells
• Shape: Red blood cells that are varied in size and shape
• Microscopic examination: Red blood cells with uneven hemoglobin distribution,
which gives the cells a bull's-eye appearance under the microscope
• Blood tests may also be used to:
• Measure the amount of iron in your child's blood
• Evaluate his or her hemoglobin
• Perform DNA analysis to diagnose thalassemia
or to determine if a person is carrying mutated
hemoglobin genes.

31. • Prenatal testing
Testing can be done before a baby is born to find out if he or she has thalassemia and
determine how severe it may be. Tests used to diagnose thalassemia in fetuses
include:
• Chorionic villus sampling. This test is usually done around the 11th week of
pregnancy and involves removing a tiny piece of the placenta for evaluation.
• Amniocentesis. This test is usually done around the 16th week of pregnancy and
involves taking a sample of the fluid that surrounds the fetus.
• Assisted reproductive technology
• A form of assisted reproductive technology that combines preimplantation genetic
diagnosis with in vitro fertilization may help parents who have thalassemia or who
are carriers of a defective hemoglobin gene give birth to healthy babies. The
procedure involves retrieving mature eggs and fertilizing them with sperm in a dish
in a laboratory. The embryos are tested for the defective genes, and only those
without genetic defects are implanted into the uterus.

32. • Treatment
• Treatment for thalassemia depends on which type you have and
how severe it is.
• Treatments for mild thalassemia
• Signs and symptoms are usually mild with thalassemia minor and
little, if any, treatment is needed. Occasionally, you may need a
blood transfusion, particularly after surgery, after having a baby or
to help manage thalassemia complications.
• People with severe beta-thalassemia will need blood transfusions.
And because this treatment can cause iron overload, they will also
need treatment to remove excess iron. An oral medication called
deferasirox (Exjade, Jadenu) can help remove the excess iron.

33. • Treatments for moderate to severe thalassemia
• Treatments for moderate to severe thalassemia may include:
• Frequent blood transfusions. More-severe forms of thalassemia
often require frequent blood transfusions, possibly every few
weeks. Over time, blood transfusions cause a buildup of iron in
your blood, which can damage your heart, liver and other organs.
To help your body get rid of the extra iron, you may need to take
medications that rid your body of extra iron.
• Stem cell transplant. Also called a bone marrow transplant, a stem
cell transplant may be an option in select cases, including children
born with severe thalassemia. It can eliminate the need for
lifelong blood transfusions and drugs to control iron overload.
During this procedure, you receive infusions of stem cells from a
compatible donor, usually a sibling.

34. • Complications:
• Possible complications of thalassemia include:
• Iron overload. People with thalassemia can get too much iron in their
bodies, either from the disease or from frequent blood transfusions. Too
much iron can result in damage to your heart, liver and endocrine system.
This system includes hormone-producing glands that regulate processes
throughout your body.
• Infection. People with thalassemia have an increased risk of infection. This
is especially true if you've had your spleen removed.
• in cases of severe thalassemia, the following complications can occur:
• Bone deformities. Thalassemia can make your bone marrow expand,
which causes your bones to widen. This can result in abnormal bone
structure, especially in your face and skull. Bone marrow expansion also
makes bones thin and brittle, increasing the chance of broken bones.

35. • Enlarged spleen (splenomegaly). The spleen helps your
body fight infection and filter unwanted material, such as
old or damaged blood cells. Thalassemia is often
accompanied by the destruction of a large number of red
blood cells. This causes your spleen to enlarge and work
harder than normal. Splenomegaly can make anemia
worse, and it can reduce the life of transfused red blood
cells. If your spleen grows too big, your doctor may suggest
surgery to remove it (splenectomy).
• Slowed growth rates. Anemia can cause a child's growth to
slow. And thalassemia may cause a delay in puberty.
• Heart problems. Heart problems — such as congestive
heart failure and abnormal heart rhythms (arrhythmias)
may be associated with severe thalassemia.

36. • Management: Through Lifestyle and home remedies
• You can help manage your thalassemia by following your
treatment plan and adopting healthy-living habits. The
following tips will help:
• Avoid excess iron. Unless your doctor recommends it, don't
take vitamins or other supplements that contain iron.
• Eat a healthy diet. Eating a balanced diet that contains
plenty of nutritious foods can help you feel better and
boost your energy. Your doctor also may recommend you
take a folic acid supplement to help your body make new
red blood cells. Also, to keep your bones healthy, make
sure your diet contains adequate calcium and vitamin D.

37. Leukemia
• Definition: Leukemia is cancer of the body's blood-forming tissues,
including the bone marrow and the lymphatic system.
• Blood forming tissues: Blood cells do not originate in the
bloodstream itself but in specific blood-forming organs, notably the
marrow of certain bones. .The lymphatic tissues, particularly the
thymus, the spleen, and the lymph nodes, produce the lymphocytes
(comprising 20–30 percent of the white cells).
• Leukemia usually involves the white blood cells. Your white blood
cells are potent infection fighters they normally grow and divide in
an orderly way, as your body needs them. But in people with
leukemia, the bone marrow produces abnormal white blood cells,
which don't function properly.
• Bone marrow------produces stem cells---produces blood cells

38. • How Does It Happen?
• Blood has three types of cells: white blood cells that fight infection, red blood
cells that carry oxygen, and platelets that help blood to clot.
• Every day, billions of new blood cells are made in the bone marrow -- most of
them red cells. But when you have leukemia, your body makes more white cells
than it needs.
• There are two main types of white blood cells in your body: lymphoid cells and
myeloid cells. Leukemia can happen in either type.
• These leukemia cells can’t fight infection the way normal white blood cells do.
And because there are so many of them, they start to affect the way your major
organs work. Eventually, there aren’t enough red blood cells to supply oxygen,
enough platelets to clot the blood, or enough normal white blood cells to fight
infection.
• Along with infection, this can cause problems like anemia(less RBCs), bruising
(because their bodies don't make enough platelets to plug bleeding blood
vessels.), and bleeding.

39. Classification of Leukemia
Classification on the basis of progression speed
• During its lifespan, a white blood cell goes through several stages.
1. In acute leukemia, developing cells multiply quickly and collect
in the marrow and blood. They exit the bone marrow too early
and are not functional. Acute leukemia happens when most of
the abnormal blood cells stay immature and can’t carry out
normal functions. It can get bad very fast. and they multiply
rapidly, so the disease worsens quickly. Acute leukemia requires
aggressive, timely treatment.
2. Chronic leukemia happens when there are some immature cells,
but others are normal and can function normally. That means it
gets bad, but more slowly. These blood cells replicate or
accumulate more slowly and can function normally for a period of
time. Some forms of chronic leukemia initially produce no early
symptoms and can go unnoticed or undiagnosed for years.

40. Classification on the basis of type of white blood cell affected
• Lymphocytic leukemia. This type of leukemia affects the lymphoid
cells (lymphocytes), which form lymphoid or lymphatic tissue.
Lymphatic tissue makes up your immune system. OR
• Lymphocytic leukemia occurs if cancerous changes affect the type
of bone marrow that makes lymphocytes. A lymphocyte is a white
blood cell that plays a role in the immune system.
• Myelogenous (my-uh-LOHJ-uh-nus) leukemia. This type of
leukemia affects the myeloid cells. Myeloid cells give rise to red
blood cells, white blood cells and platelet-producing cells. OR
• Myelogenous leukemia happens when the changes affect bone
marrow cells that produce blood cells, rather than the blood cells
themselves.

42. • Causes:
• Scientists don't understand the exact causes of leukemia. It seems
to develop from a combination of genetic and environmental
factors.
• In general, leukemia is thought to occur when some blood cells
acquire mutations in their DNA — the instructions inside each cell
that guide its action.
• Certain abnormalities cause the cell to grow and divide more
rapidly and to continue living when normal cells would die.
• Over time, these abnormal cells can crowd out healthy blood cells
in the bone marrow, leading to fewer healthy white blood cells, red
blood cells and platelets, causing the signs and symptoms of
leukemia.

43. • Symptoms:
• Symptoms of leukemia include the following:
• Poor blood clotting: This can cause a person to bruise or bleed
easily and heal slowly. They may also develop petechia, which are
small red and purple spots on the body. These indicate that blood is
not clotting properly, or bleeding underneath the skin.
• Frequent infections: The white blood cells are crucial for countering
infection. If white blood cells are not working correctly, a person
may develop frequent infections. The immune system may attack
the body's own cells.
• Anemia: As fewer effective red blood cells become available, a
person may become anemic. This means that they do not have
enough hemoglobin in their blood. Hemoglobin transports iron
around the body. A shortage of iron can lead to difficult or labored
breathing and pale skin.

44. • Other symptoms may include:
• nausea
• fever
• chills
• night sweats
• flu-like symptoms
• weight loss
• bone pain
• tiredness
• If the liver or spleen becomes swollen, a person may feel full and
eat less, resulting in weight loss.
• Weight loss may also occur even without an enlarged liver or
spleen. A headache may indicate that cancerous cells have entered
the central nervous system (CNS).

45. • Risk factors
• Factors that may increase your risk of developing some types of leukemia include:
• Previous cancer treatment. People who've had certain types of chemotherapy and
radiation therapy for other cancers have an increased risk of developing certain
types of leukemia.
• Genetic disorders. Genetic abnormalities seem to play a role in the development
of leukemia. Certain genetic disorders, such as Down syndrome also known
as trisomy 21, are associated with an increased risk of leukemia.
• Exposure to certain chemicals. Exposure to certain chemicals, such as benzene
which is found in gasoline and is used by the chemical industry is linked to an
increased risk of some kinds of leukemia.
• Smoking. Smoking cigarettes increases the risk of acute myelogenous leukemia.
• Family history of leukemia. If members of your family have been diagnosed with
leukemia, your risk of the disease may be increased.

46. • Diagnosis:
• Diagnosis is usually based on repeated complete blood counts and a bone
marrow examination following observations of the symptoms. Sometimes,
blood tests may not show that a person has leukemia, especially in the
early stages of the disease or during remission. A lymph node biopsy can
be performed to diagnose certain types of leukemia in certain situations.
• Physical exam. Your doctor will look for physical signs of leukemia, such as
pale skin from anemia, swelling of your lymph nodes, and enlargement of
your liver and spleen.
• Blood tests. By looking at a sample of your blood, your doctor can
determine if you have abnormal levels of red or white blood cells or
platelets — which may suggest leukemia.
• Bone marrow test. Your doctor may recommend a procedure to remove a
sample of bone marrow from your hipbone. The bone marrow is
removed using a long, thin needle. The sample is sent to a laboratory to
look for leukemia cells. Specialized tests of your leukemia cells may reveal
certain characteristics that are used to determine your treatment options.

47. • Treatment
• Surgery is a possible treatment for some types of leukemia.
• Treatment options will depend on the type of leukemia a person has, their age,
and their overall state of health
• Types of treatment include:
• Chemotherapy: A doctor administers medications intravenously (IV), using either
a drip or a needle. These target and kill cancer cells. However, they can also
damage noncancerous cells and cause severe side effects, including hair loss,
weight loss, and nausea.
• .Sometimes, doctors may recommend a bone marrow transplant.
• Targeted therapy: This type of treatment uses tyrosine kinase inhibitors that
target cancer cells without affecting other cells, reducing the risk of side effects.
Examples include imatinib, dasatinib, and nilotinib.
• Tyrosine kinases are enzymes responsible for the activation of many proteins by
signal transduction cascades by adding a phosphate group to the protein
(phosphorylation), a step that TKIs inhibit
• Phosphorylation= cell signaling, control of DNA replication during cell division.

48. • Interferon therapy: This slows and eventually stops the development and spread
of leukemia cells. This drug acts in a similar way to substances that the immune
system naturally produces. However, it can cause severe side effects.
• interferon-= signaling protein released by host cells in presence of any virus
• Radiation therapy: In people with certain types of leukemia, doctors recommend
radiation therapy to destroy bone marrow tissue before a transplant.
• During radiation therapy, you lie on a table while a large machine moves around
you, directing the radiation to precise points on your body.
• You may receive radiation in one specific area of your body where there is a
collection of leukemia cells, or you may receive radiation over your whole body.
Surgery: Surgery often involves removing the spleen, but this depends on the type
of leukemia a person has.
• Stem cell transplantation: In this procedure, a cancer care team destroys the
existing bone marrow with chemotherapy, radiation therapy, or both. Then, they
infuse new stem cells into the bone marrow to create noncancerous blood cells.

49. Lymphoma
• Definition: Lymphoma is a type of blood cancer that develops
when white blood cells called lymphocytes grow out of control.
• Lymphocytes are part of your immune system. They travel around
your body in your lymphatic system, helping you fight infections.
• Your lymphatic system runs throughout your body, similar to your
blood circulatory system, carrying a fluid called lymph.
• The fluid passes through lymph nodes (glands), which are spread
throughout your body.
• If you have lymphoma, your lymphocytes divide in an abnormal
way or do not die when they should.
• The abnormal lymphocytes build up, usually in lymph nodes in
your armpits, neck or groin. However, they can collect in almost any
part of your body.

51. • Lymphomas in the strict sense are
any neoplasms of the lymphatic tissues (lympho-
+ -oma).
• The main classes are malignant neoplasms (that
is, cancers) of the lymphocytes, a type of white
blood cell that belongs to both the lymph and
the blood and pervades both.
• Thus, lymphomas and leukemias are both tumors
of the hematopoietic and lymphoid tissues, and
as lymphoproliferative disorders

52. Function of lymphnodes
• Lymph nodes appear to be oval or bean-shaped and are surrounded by connective
tissue. This thick tissue forms the capsule or outer covering of the node.
• Internally, the node is divided into compartments called nodules. The nodules are
where B-cell and T-cell lymphocytes are stored. Other infection-fighting white
blood cells called macrophages are stored in a central area of the node called the
medulla.
• Lymph nodes serve two major functions in the body. 1-They filter lymph and assist
the immune system in building an immune response.
• Lymph nodes filter lymph of harmful pathogens such as bacteria and viruses. The
nodes also filter out cellular waste, dead cells, and cancerous cells.
• 2- Lymph nodes house lymphocytes which are immune system cells that originate
from bone marrow stem cells. B-cells and T-cells are lymphocytes found in lymph
nodes and lymph tissues.
• B-cell lymphocytes become activated due to the presence of a particular antigen,
& create antibodies that are specific to that specific antigen.
• T-cell lymphocytes are responsible for cell-mediated immunity and participate in
the destruction of pathogens as well.

53. Cancer
• After we’re born, most of these cells carry on dividing to allow us to grow
and develop. Even when we’re fully grown, cells continue to divide to
replace old cells that die off naturally. In fact, every minute, around 100
million of our cells die and are replaced by new ones.
• Cell division and cell death are normal processes. They are controlled by
chemical signals. Usually, cell division and cell death are kept carefully in
balance so we only make the number of new cells our body needs.
• Cancer develops when a mistake happens during cell division that changes
the DNA inside a cell. This is called a ‘mutation’. Mutations can create
abnormal cells that stop responding to control signals. These cells might:
• start dividing when they shouldn’t
• carry on dividing when they should stop
• stay alive when they should die.
• leading to an uncontrolled build-up of abnormal cells.
• There are many different types of cancer depending on what type of cell
became abnormal.

54. Types of lymphoma
• Several classification systems have existed for lymphoma, which use
histological and other findings to divide lymphoma into different
categories.
• Non-Hodgkin lymphoma
• Swollen glands that do not go away can be a sign of lymphoma.
• Non-Hodgkin lymphoma, which is the most common type, typically
develops from B and T lymphocytes (cells) in the lymph nodes or
tissues throughout the body.
• Tumor growth in non-Hodgkin lymphoma may not affect every
lymph node, often skipping some and growing on others.
• It accounts for 95% of lymphoma cases.
• Doctors call NHL types by the cells they affect, and if the cells are
fast- or slow-growing. NHL forms in either the B-cells or T-cells of
the immune system.

55. • B-cell lymphoma
• Diffuse large B-cell lymphoma (DLBCL) is the most
aggressive type of NHL.
• This fast-growing lymphoma comes from
abnormal B cells in the blood. It can be cured if
treated, but if left untreated, it can lead to death.
• T-cell lymphoma
• T-cell lymphoma is not as common a B-cell
lymphoma; only 15 percent of all NHL cases are
this type. Several types of T-cell lymphoma exist.

56. • Burkitt’s lymphoma
• Burkitt’s lymphoma is a rare type of NHL that is aggressive
and most common in people with compromised immune
systems. Mostly caued by EBV. This type of lymphoma is
most common in children in sub-Saharan Africa, but it does
occur in other parts of the world. n which cancer starts in
immune cells called B-cells. Recognized as the fastest
growing human tumor
• Follicular lymphoma
• This type of NHL, which starts in the white blood cells, is
most common in older individuals. The average age of
diagnosis is 60. This lymphoma is also slow-growing, so
treatments begins with watchful waiting.

57. • Mantle cell lymphoma
• Is a type of non-Hodgkin lymphoma (NHL),develops when
the body makes abnormal B-cells – the lymphoma cells. B-
cells are white blood cells that fight infection. The
lymphoma cells build up in lymph nodes, which makes
them bigger. Sometimes lymphoma cells begin in other
parts of the body. This is called extranodal disease.
• This aggressive form of lymphoma is rare only about 6
percent of NHL cases are this type. Mantel cell lymphoma
is also more commonly diagnosed at a later stage, and it
usually involves the gastrointestinal tract or bone marrow.

58. • Hodgkin lymphoma
• The cancer cells in HL are called Reed-Sternberg cells.
These cells are usually an abnormal type of B
lymphocyte.
• Enlarged lymph nodes in people with HL usually have a
small number of Reed-Sternberg cells with a lot of
normal immune cells around them. These other
immune cells cause most of the swelling in the lymph
nodes.
• In people with Hodgkin lymphoma, the cancer usually
moves from one lymph node to an adjacent one.
• REED- TALL /STIFF

59. • Cause:
• Doctors aren't sure what causes lymphoma.
• But it begins when a disease-fighting white blood cell
called a lymphocyte develops a genetic mutation. The
mutation tells the cell to multiply rapidly, causing many
diseased lymphocytes that continue multiplying.
• The mutation also allows the cells to go on living when
other cells would die. This causes too many diseased
and ineffective lymphocytes in your lymph nodes and
causes the lymph nodes to swell.

60. • Symptoms
• The symptoms of lymphoma are similar to those of some viral
diseases, such as the common cold. However, they typically
continue for a more extended period.
• Some people will not experience any symptoms. Others may notice
a swelling of the lymph nodes. There are lymph nodes all around
the body. Swelling often occurs in the neck, groin, abdomen, or
armpits.
• The swellings are often painless. They may become painful if the
enlarged glands press on organs, bones, and other structures. Some
people confuse lymphoma with back pain. Because spinal nerves
may press due to lymphnode swelling.
• Lymph nodes can also swell during common infections, such as a
cold. In lymphoma, the swelling does not resolve.

61. • Other symptoms of both types of lymphoma may include:
• ongoing fever without infection
• night sweats, fever, and chills
• weight loss and reduced appetite
• unusual itching
• persistent fatigue or a lack of energy
• Some additional symptoms include:
• persistent coughing
• shortness of breath
• pain or swelling in the abdomen
• Lymphoma can spread rapidly from the lymph nodes to other parts
of the body through the lymphatic system. As cancerous
lymphocytes spread into other tissues, the immune system cannot
defend against infections as effectively.

62. • Risk factors
• Different risk factors can increase the risk of both types of
lymphoma.
• Family history: If a sibling has Hodgkin lymphoma, the risk
is slightly higher. If the sibling is an identical twin, this risk
increases significantly.
• immunodeficiency: A person with a less active immune
system has a higher risk. This may be due to anti-rejection
medications following an organ transplant or HIV.
• Chemicals and radiation: Nuclear radiation and certain
agricultural chemicals have links to non-Hodgkin
lymphoma.

63. • Autoimmune diseases: This type of disease occurs when
the immune system attacks the body's own cells. Examples
include rheumatoid arthritis and celiac disease.
• Infection: Certain viral and bacterial infections that
transform lymphocytes, such as the Epstein-Barr virus
(EBV), increase the risk. This virus causes glandular fever.
• Breast implants: These can lead to anaplastic large cell
lymphoma in the breast tissue. ALCL develops when white
blood cells called T-cells become abnormal
• Body weight and diet: The American Cancer Society (ACS)
has suggested that overweight and obesity may have some
involvement in the development of lymphoma. However,
more research is necessary to confirm the link.

64. Stages of lymphoma
• Stages of lymphoma
• Both NHL and Hodgkin’s lymphoma can be classified into four
stages. The state of lymphoma is determined by where the cancer is
and how far it has or has not spread.
• Stage 1. Cancer is in one lymph node or one organ cite.
• Stage 2. Cancer is in two lymph nodes near to one another and on
the same side of the body, or the cancer is in one organ and nearby
lymph nodes.
• Stage 3. At this point, cancer is in lymph nodes on both sides of the
body and in multiple lymph nodes.
• Stage 4. The cancer can be in an organ and spread beyond nearby
lymph nodes. As NHL progresses, it may begin to spread.
• While stage 4 lymphoma is advanced, it’s still treatable

65. • Diagnosis
• There are no routine screenings for lymphoma. If a
person has persistent viral symptoms, they should
seek medical consultation.
• The doctor will ask about the person's individual and
family medical history and try to rule out other
conditions.
• They will also carry out a physical examination,
including an inspection of the abdomen and chin, neck,
groin, and armpits, where swellings may occur.
• The doctor will look for signs of infection near lymph
nodes since this can account for most cases of swelling.

66. • Tests for lymphoma
• Tests will confirm whether lymphoma is present.
• Blood tests and biopsies: These can detect the presence of
lymphoma and help a doctor distinguish between different types.
• A biopsy involves a surgeon taking a sample of lymph tissue. The
doctor will then send it for examination in a laboratory. The surgeon
may remove a small section or all of a lymph node. In some cases,
they might use a needle to take a tissue sample.
• It might be necessary to carry out a bone marrow biopsy. This may
require a local anesthetic, a sedative, or a general anesthetic.
• Biopsies and other tests can confirm the stage of the cancer to see
whether it has spread to other parts of the body.

67. • Imaging tests: A doctor may request imaging scans, such as:
• a CT scan
• an MRI scan
• a PET scan: A positron emission tomography (PET) scan is an imaging test that
helps reveal how your tissues and organs are functioning. A PET scan uses a
radioactive drug (tracer) to show this activity. The tracer will collect in areas of
higher chemical activity, which is helpful because certain tissues of the body, and
certain diseases, have a higher level of chemical activity. These areas of disease
will show up as bright spots on the PET scan. Before the scan, you’ll get tracers
through a vein in your arm, through a solution you drink, or in a gas you inhale.
Your body needs time to absorb the tracers, so you’ll wait about an hour before
the scan begins.
• undergo the scan, which can last from 30 to 45 minutes.
• X-ray imaging of the chest, abdomen, and pelvis
• ultrasound
• A spinal tap: A lumbar puncture (LP)In this procedure, a surgeon uses a long, thin
needle to remove and test spinal fluid under local anesthetic. It is like blood test.

68. • Treatment
• The course of treatment depends on the type of lymphoma a
person has and the stage it has reached.
• Indolent, or slow growing lymphoma may not need treatment.
• If treatment is necessary, it may involve the following:
• Biologic therapy: This is a drug treatment that stimulates the
immune system to attack the cancer. The drug achieves this by
introducing living microorganisms into the body. immunotherapy
(such as vaccines, cytokines), gene therapy, and some
targeted therapies.
• Antibody therapy: A medical professional inserts synthetic
antibodies into the bloodstream. These respond to the cancer's
toxins.
• Chemotherapy: A healthcare team administers aggressive drug
treatment to target and kill cancer cells.

69. • Radioimmunotherapy: This delivers high powered
radioactive doses directly into cancerous B cells and T-cells
to destroy them.
• Radiation therapy: A doctor may recommend this type of
therapy to target and destroy small areas of
cancer. Radiation therapy uses concentrated doses of
radiation to kill cancerous cells.
• Stem cell transplantation: This can help restore damaged
bone marrow following high dose chemotherapy or
radiation therapy.
• Steroids: A doctor may inject steroids to treat lymphoma.
• Surgery: A surgeon may remove the spleen or other organs
after the lymphoma has spread.