Details on disorders of leukocytes

1. Disorders of White Blood Cells

4. • White blood cells are vital components of the blood.
• Their role is to fight infection, and they are essential for health and well-
being.
• A high white blood cell count may indicate that the immune system is
working to destroy an infection.
• It may also be a sign of physical or emotional stress. People with
particular blood cancers may also have high white blood cells counts.
• A low white blood cell count can signal that an injury or condition is
destroying cells faster than they are being made, or that the body is
producing too few of them.

5. There are different types of white blood cells, each with varying
responsibilities:
• Lymphocytes: These are vital for producing antibodies that help the body to
defend itself against bacteria, viruses, and other threats.
• Neutrophils: These are powerful white blood cells that destroy bacteria, fungi
and virus.
• Basophils: These alert the body to infections by secreting chemicals into the
bloodstream, mostly to combat allergies.
• Eosinophils: These are responsible for destroying parasites and cancer cells,
and they are part of an allergic response
• Monocytes: These are responsible for attacking and breaking down germs or
bacteria that enter the body.

7. LEUKEMIA

9. • Leukemia is a cancer of the blood and bone marrow
• Cancer is the uncontrolled growth of abnormal cells.
• Cancer can develop anywhere in the body.
• In leukemia, this rapid, out-of-control growth of abnormal cells
takes place in the bone marrow .
• These abnormal cells then spill into the bloodstream.
• Unlike other cancers, leukemia generally doesn’t form into a mass
(tumor) that can be seen in imaging tests, such as X-rays.

10. In patients with
leukemia, cell
growth goes
"haywire," and
there is a rapid
growth of
abnormal white

11. • Leukemia cells are usually immature white blood cells.
• An excess number of white blood cells are seen when
looking at blood through a microscope

12. Pathophysiology
• Inside the bone marrow, blood cells are beginning to multiply and
differentiate
• However, in leukemia, one of these blood cell types begins to rapidly
multiply, in an out-of-control manner.
• These abnormal cells – called leukemia cells – begin to take over the
space inside the bone marrow.
• They crowd out the other normal cell types that are trying to
develop.

13. •Unlike other blood cell types, the leukemia cells are
abnormal and serve no useful purpose.
•The other normal cells have very little space and support to
continue to grow and multiply inside the bone marrow.
•This results in fewer normal blood cells being made and
released into the blood and more leukemia cells being made
and released into the blood.

14. •Without an adequate amount of normal blood cells:
Body’s organs and tissues will not get the oxygen they need,
It won’t be able to fight off infection
It won’t clot blood when needed.

15. Classification
• Leukemia is classified according to :
How quickly the disease worsens
•Acute leukemia
•Chronic leukemia
The type of blood cell involved.
•Myelogenous leukemia
•Lymphocytic leukemia

17. Classification of Leukemia

18. •By speed of disease development:
Acute leukemia. The leukemia cells are rapidly dividing and
the disease progresses quickly.
•Most common in pediatric

19. Chronic leukemia. Often, these leukemia cells have features of both
immature and mature cells.
• Some of these cells may have developed to the point where they do
function as the cells they were meant to become, but not to the
extent their normal counterparts do.
• The disease typically worsens slowly as compared to acute leukemia.
• Patient may not have noticeable symptoms for years.
• Chronic leukemia is more commonly seen in adults as compared to
children.

20. •By cell type:
Myelogenous or myeloid leukemia means the leukemia has
developed from the myeloid cell line.
• Normal myeloid cells develop into red blood cells, white blood
cells (Granulocytes) and platelets.
Lymphocytic leukemia means the leukemia has developed
from the lymphoid cell line.
• Normal lymphoid cells develop into lymphocytes.

22. Types of leukemia:
Four Major types
• Acute myeloid leukemia (AML): This is the most common type of acute
leukemia. It is more common in older adults ( >65 years) and in men
compared with women.
• Acute lymphocytic leukemia (ALL): This is the most common type of
leukemia in children, teens, young adults and those up to 39 years of
age.

23. Chronic myelogenous leukemia (CML): This leukemia is more
common in older adults (> 65 years of age) and in men.
•It rarely occurs in children.
•Chronic lymphocytic leukemia (CLL): This is the most common
chronic leukemia in adults (> 65 years of age).
•It is more common in men than women and especially in
white men.

24. Causes
•Leukemia starts when the DNA of a single cell in the bone
marrow mutates and can’t develop and function normally.
•All cells that arise from that initial mutated cell also have
the mutated DNA.
•What causes the damage to the DNA in the first place is
still not known in all cases.

25. Those at Risk:
Previous cancer treatment with radiation or chemotherapy.
History of smoking or working with industrial chemicals.
• Benzene and formaldehyde are known cancer-causing chemicals
found in tobacco smoke and building materials and household
chemicals.
Having a genetic disorder, such as neurofibromatosis, Klinefelter
syndrome, or Down Syndrome.
Leukemia can happen to anyone. Some may get leukemia and have
none of these risk factors.
Other people have one or more of these risk factors and never get
leukemia

26. Signs and Symptoms
•Tire easily, little energy, weakness.
•Pale skin.
•Fever.
•Easy bruising and bleeding. Nosebleeds and bleeding gums.
Tiny red spots in skin (petechiae). Purplish patches in the skin.
•Bone or joint pain and/or tenderness.

27. • Swollen lymph nodes in the neck, underarm, groin or stomach;
enlarged spleen or liver.
• Frequent infections.
• Unplanned weight loss.
• Night sweats.
• Shortness of breath.
• Pain or full feeling under the ribs on the left side.

30. • Diagnosis
Physical exam: Check for swollen lymph nodes, swollen or bleeding
gums, look for bruises or a tiny red skin rash (petechiae) and signs of
an enlarged spleen.
Complete blood count (CBC): Total number of red blood cells, white
blood cells and platelets. Lower than normal counts of red blood cells
and platelets, and higher than normal counts of white blood cells.
• Some leukemia cells may be found. (still developing immature cells –
usually white blood cells – that rapidly multiply in bone marrow and
spill over into the bloodstream.)

31. •Blood cell examination. Other tests may help identify
chromosomal abnormalities and other markers on the cells
that help identify the type of leukemia.
•Bone marrow biopsy: Determine the percentage of abnormal
cells in the bone marrow, which confirms the diagnosis of
leukemia.

33. • Imaging and other tests: Chest X-ray, CT scan, or magnetic resonance
imaging (MRI) scan indicate a complication of the leukemia
(Metastasis)
• A lumbar puncture ( spinal tap) may be ordered to see if the cancer
had spread to the spinal fluid surrounding the brain and spinal cord.

34. TREATMENT
Radiation therapy: This treatment uses strong beams of
energy to kill leukemia cells or stop them from growing.
Immunotherapy: This treatment, also called biologic therapy,
uses certain drugs to boost the body’s own defense system –
immune system – to fight leukemia.
•Immunotherapies include interferon, interleukins

35. Targeted therapy: This treatment uses drugs that are focused
on a specific features of leukemia cells.
• Targeted therapies work by blocking the ability of leukemia
cells to multiply and divide, cutting off the blood supply
needed for the cells to live, or killing the cells directly.
•Targeted therapy is less likely to harm normal cells. Examples
of targeted therapy include monoclonal antibodies (such as
inotuzumab [Besponsa], gemtuzumab, [Mylotarg], rituximab
[Rituxan], ofatumumab [Arzerra]

36. Hematopoietic cell transplant (stem cell or bone marrow transplant):
This procedure replaces the cancerous blood-forming cells that have
been killed by chemotherapy and/or radiation therapy with new,
healthy hematopoietic cells.
• Healthy hematopoietic cells grow and multiply forming new bone
marrow and blood cells that develop into all the different types of cells
the body needs.
• In the case where the cells are taken from a different person (donor),
the new immune system recognizes the cancer cells as foreign and kills
them (similar to other immunotherapies).

37. Phases of Management
Induction phase - Is the first phase.
• Its goal is to kill as many leukemia cells as possible in the
blood and bone marrow to achieve remission.
• In remission, blood cell counts return to normal levels, no
leukemia cells are found in the blood and all signs and
symptoms of disease are gone.
•Induction therapy usually lasts four to six weeks.

38. Consolidation (intensification) phase -The second phase
• Begins after leukemia is in remission.
• The goal of this phase is to kill any remaining undetected
leukemia cells in the body so the cancer does not return.
• Consolidation therapy is usually given in cycles over four to
six months.

39. Maintenance (therapy) phase - Is given to kill any leukemia cells that
may have survived the first two treatment phases.
• The goal of maintenance therapy is to prevent the return of leukemia
(relapse).
• Treatment usually lasts for about two years.
• Treatment can also be directed at the brain and spinal cord during each
of these phases (intrathecal)
• This is done to kill cancer cells that hide in these areas of the body
where the chemotherapy cannot reach.
• These “hidden” cancer cells are a reason why leukemia comes back or
relapses.)

40. End

41. LYMPHOMAS

42. Blood Cell and Lymphocytes Development
STEM CELLS
Multipotential
myeloid cells
Multipotential
lymphocytic cells
Differentiate & mature into 6
Types of blood cells
red cells basophils
neutrophils monocytes
eosinophils platelets
Differentiate & mature into 3
Types of lymphocytes
T lymphocytes
B lymphocytes
Natural Killer Cells

44. Lymphocytes
• Most lymphocytes are in lymph nodes, spleen, bone marrow
and lymphatic vessels
• 20% of white blood cells in blood are lymphocytes
T cells, B cells, natural killer cells
• B cells produce antibodies that help fight infectious agents
• T cells help B cells produce antibodies and they fight viruses

45. Lymphatic system
• Made up of organs, such as the tonsils, spleen, liver, bone marrow
and a network of lymphatic vessels that connect lymph nodes
• Lymph nodes are located throughout the body
• Lymph nodes filter foreign particles out of the lymphatic fluid
• Contain B and T lymphocytes

46. • There are 2 broad categories of Lymphomas.
Hodgkin and non-Hodgkin lymphomas.
• Non-Hodgkin lymphomas begin when T cell or B cell, become
abnormal.
• The cell divides again and again, making more and more abnormal
cells. These abnormal cells can spread to almost any other part of the
body.
• Cause of non-Hodgkin lymphoma is unknown
• Those with a weakened immune system or have certain types of

47. causes
In most cases the cause is unknown
One might be more at risk if :
• > 60yrs or older for non-Hodgkin lymphoma
• Is between 15 and 40 or older than 55 for Hodgkin lymphoma
• Is male
• Has a weak immune system from HIV/AIDS, an organ transplant or
because was born with an immune disease
• Has an immune system disease such as rheumatoid arthritis, lupus, or
celiac disease

48. • Has been infected with a virus such as Epstein-Barr, hepatitis C
or human T-cell leukemia
• Has a close relative who had lymphoma
• Was exposed to benzene or chemicals that kill bugs and weeds
• Was treated for Hodgkin or non-Hodgkin lymphoma in the past
• Was treated for cancer with radiation

50. Signs and Symptoms
• Swollen glands (lymph nodes), often in the neck, armpit, or
groin that are painless
• Cough
• Shortness of breath
• Fever
• Night sweats
• Fatigue
• Weight loss

51. Diagnosis
• History taking
• Physical examination
• Lymph node biopsy to check for cancer cell
• Bone marrow aspiration or biopsy- to look for lymphoma cells
• PET (Positron Emission Tomography) scan. This imaging test uses a
radioactive substance to look for cancer cells in the body.
• Molecular test. This test is used to find changes to genes, proteins, and
other substances in cancer cells to help determine the type of lymphoma
• Blood tests
• CXray
• CT scan

52. Stages of lymphoma
• Both NHL and Hodgkin’s lymphoma can be classified into four
stages depending on where the cancer is and how far it has or has not
spread.
• Stage 1. Cancer is in one lymph node or one organ side.
• 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.

53. • Stage 3. 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.
• The most common sites for advanced NHL include the liver, bone
marrow, and lungs.
• While stage 4 lymphoma is advanced, it’s still treatable.

55. Assignment: Read on the 2 types of lympomas in details

57. MANAGEMENT
• Chemotherapy – Use of cytotoxic drugs
• Radiation therapy, which uses high-energy rays to destroy cancer
cells
• Immunotherapy, which uses the body's immune system to attack
cancer cells
• Targeted therapy that targets aspects of lymphoma cells to curb
their growth
• A stem cell transplant.

58. End

59. MYELOMAS

61. • Multiple myeloma is a cancer of plasma cells.
• Normal plasma cells are found in the bone marrow and are an
important part of the immune system.
• Lymphocytes are one of the main types of white blood cells in
the immune system and include T cells and B cells.
• Lymphocytes are in many areas of the body, such as lymph
nodes, the bone marrow, the intestines, and the bloodstream.

62. • When B cells respond to an infection, they mature and change into
plasma cells.
• Plasma cells make the antibodies (immunoglobulins) that help the
body attack and kill germs.
• Plasma cells, are found mainly in the bone marrow.
• When plasma cells become cancerous and grow out of control, this is
called multiple myeloma.

63. Pathophysiology
• In multiple myeloma, the plasma cells undergo a malignant
transformation and become cancerous.
• These myeloma cells stop making different forms of protein in
response to the immune system's needs and instead start to produce
a single abnormal type of protein sometimes termed as monoclonal
or M protein.
• Multiple myeloma plasma cell populations accumulate in the bone
marrow, and these collections of cells called plasmacytomas can
erode the hard outer shell or cortex of the bone that normally
surrounds the marrow.

64. Features of Multiple Myeloma
• In multiple myeloma, the overgrowth of plasma cells in the bone
marrow can crowd out normal blood-forming cells, leading to low
blood counts causing:
Anemia .
Thrombocytopenia- bleeding tendencies
Leukopenia- Infections

65. • Myeloma cells also interfere with cells that help keep bones strong.
• Two kinds of bone cells work together to keep bones healthy and
strong:
Osteoclasts break down old bone
Osteoblasts lay down new bone
• Myeloma cells make a substance that makes the osteoclasts to speed up
dissolving the bone.
• So old bone is broken down without new bone to replace it, making the
bones weak and easy to break.
• Fractured bones are a major problem in people with myeloma. This
increase in bone break-down can also raise calcium levels in the blood.
• Bone pain

66. Causes
• What triggers the malignancy of plasma cells in multiple myeloma is
unknown.
• However, triggers or causes related to multiple myeloma may include
toxic chemicals, radiation, some viruses, immune disorders, and family
history of the disease

67. Diagnosis
•Bone marrow aspiration and/or biopsy.
•Other tests include blood monoclonal immunoglobulin and
radiology tests to determine the extent of bone lesions.
•Although there are several staging systems, stages I, II, and
III usually represent multiple myeloma with increasing
severity of disease.

68. Staging
• Smoldering: Multiple myeloma with no symptoms
• Stage I: Early disease with little anemia, relatively small amount of
M protein and no bone damage
• Stage II: More anemia and M protein as well as bone damage
• Stage III: Still more M protein, anemia, as well as signs of kidney
damage

69. Management
• Although the patient's primary care physician is involved in
organizing treatments, specialists who treat multiple myeloma
include :
Oncologists,
Hematologists,
Radiologists,
Experts in stem cell transplantation
Orthopedic and/or spine surgeons.
The prognosis for myeloma is only fair.

70. Treatment for multiple myeloma include
• Immune Modulators,
• Chemotherapy drugs,
• Radiation therapy,
• Stem cell transplants,
• Surgery in some patients.

71. End

72. Nursing Diagnosis
Nursing intervention
Rationale
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73. Myeloproliferative disorders

74. • Conditions that cause blood cells - platelets, white blood cells, and
red blood cells to grow abnormally in the bone marrow.
• Excess cells are produced.
• They are related to, and may evolve into, myelodysplastic syndrome
and acute myeloid leukemia
• The prognosis largely depends on the type of disorder.

75. Diagnosis
• Depending on the nature of the myeloproliferative disorder, diagnostic
tests may include;
Red cell mass determination (for polycythemia),
Bone marrow aspirate and biopsy,
Arterial oxygen saturation
Neutrophil alkaline phosphatase level,

76. Classification
Chronic myelogenous leukemia (CML)-cancer of the bone marrow
that produces abnormal granulocytes,
Polycythemia vera
• Occurs when the bone marrow produces too many red blood cells
Essential thrombocythemia
Occurs when the body produces too many platelet cells
Clots can block blood vessels leading to heart attack or stroke.

77. Causes
• All myeloproliferative disorders are caused by overproduction of
one or more types of cells.
• No one knows what triggers the overproduction of cells, but
theories include:
Genetics -.
Environment - Some studies suggest that myeloproliferative
disorders may result from an overexposure to radiation or
chemicals

78. AT RISK
• Gender - Men are 2 times more likely than women to develop
the condition.
• Age - People older than 60 are most likely to develop the
condition, though it may happen at any age.
• Environment - Exposure to intense radiation may increase the
risk for the condition

79. Treatment:
There is no cure for most myeloproliferative disorders.
However, there are several treatments that help improve
symptoms and prevent complications associated with the
conditions.
The treatment for each type of myeloproliferative disorder is
slightly different:
Polycythemia vera –
• Lower red blood cell count by therapeutic phlebotomy.
• Treatment with myelosuppressive therapy.

80. Essential thrombocytosis
• Targeted therapy
• Chemotherapy, biologic therapy,
• High-dose chemotherapy with stem cell transplant,
• Donor lymphocyte infusion (DLI),

81. • Nursing Diagnosis
• Intervention
• Rationale

82. Thank you