Leukemia The bare-bone facts

1. LeukemiaThe bare-bone facts By Jennifer Yeek

2. Instructions Use to go to next slide Use to go to previous slide. Use menu buttons (to the left to move area of topic) When you see a highlighted word, roll over it to get the definition. At check points you will be asked a few questions. If you choose the incorrect answer, go back to the question and try again. Most importantly, have fun !

3. What is leukemia? A disease where the neoplasm inside the bone marrow fills up with abnormal white blood cells, so no other cells can be synthesized. How does leukemia occur? Do Pathophysiology check point Now! Do Pathophysiology check point Now! Do Pathophysiology check point Now!

4. Pathophysiology First, we must remember that white blood cells (WBC’s), red blood cells (RBC’s) and platelets are made in the bone marrow. RBC WBC RBC WBC Do Pathophysiology check point Now! Platelet

5. Pathophysiology Abnormal white blood cells (WBC) divide. This is because there is a mutation in ras pathway which is used for cell division. The overproduction of abnormal WBC’s overcrowd normal WBC’s The patient will have an increased WBC count , but the WBC’s are abnormal. Do Pathophysiology check point Now!

6. Pathophysiology The overproduction of abnormal WBC’s may spill out into the blood, and infiltrate into other tissues such as : - liver -spleen -lymph nodes This causes the organ to become Enlarged (Porth, 2005) Do Pathophysiology check point Now!

7. Pathophysiology . The patient may suffer from side effects such as: -Fever -Sweats This is because the WBC’s are secreting cytokines, such as interleukin 1. Do Pathophysiology check point Now!

8. Pathophysiology There are some potential risks for acquiring leukemia. Some are genetically related, while others are environmental. Genetic disorders related to leukemia risk are: -Down syndrome -von Reckinghausen’s disease -Fanconi’s anemia (Porth,2005) -Philidelphia chromosome (for chronic leukemia) (Leukemia & Lymphoma Society, 2006) Do Pathophysiology check point Now!

9. Pathophysiology Here is a list of environmental factors that may increase your risk in acquiring leukemia • Oncogenic viruses (Porth, 2005) • Irradiation • Chemical benzene • Therapeutic radiation • Tobacco smoke (Leukemia &Lymphoma Society) Do Pathophysiology check point Now!

10. Pathophysiology Diagnosis for leukemia is done by specific blood tests, along with examining cells in the blood and bone marrow (Leukemia & Lymphoma society, 2006). Do Pathophysiology check point Now!

11. Check point for Pathophysiology In leukemia, an overproduction of abnormal WBC’s may spill out into the blood, and do what? a.) Fight off infections more adequately b.) Infiltrate into other tissues, and cause them to enlarge c.) Bond with RBC’s and aid in clot formation

12. Check point for Pathophysiology The WBC’s are abnormal, and they wouldn’t be able to fight off infections well. Click the back arrow button and try the question again.

13. Check point for Pathophysiology Great Job! Microsoft, 2007 Yes, the overproduction of WBC’s would infiltrate into other tissues such as the liver, spleen and lymph nodes and cause them to enlarge.

14. Check point for Pathophysiology The WBC’s would not bond with RBC’s and form clots; however, they will move into something. Click the back arrow button and try the question again.

15. Check point for Pathophysiology Leukemia is a disease where the neoplasm inside the bone marrow does what? a.) fills up with abnormal white blood cells, and no other cells can be made. b.) fills up with abnormal reds blood cells, yet allows more cells to be made. c.) fills up with cellular waste, and increases the production of acid.

16. Check point for Pathophysiology Yes, very good. The neoplasm in the bone marrow fills up with abnormal WBC’s and this overcrowds the bone marrow not allowing any more cells to be made. (Microsoft, 2007)

17. Check point for Pathophysiology What type of abnormal cells are being produced? Please try again.

18. Check point for Pathophysiology Waste isn’t being produced in the bone marrow, but an abnormal cell type is. Please go back and try again.

19. Check point for Pathophysiology Patients with leukemia may suffer from systemic side effects such as: fever, and sweats. Why? a.) The WBC’s are dividing fast, which increases body temperature. b.) The WBC’s are secreting cytokines, which reset the set point temperature in the hypothalamus. c.) The patient gets bursts of energy from the abnormal WBC’s and decides to exercise more, producing sweat.

20. Check point for Pathophysiology Yes the WBC’s are dividing, but something else is occurring, What do you think? Click the back arrow button and try the question again.

21. Check point for Pathophysiology Fantastic! Microsoft, 2007 Yes, the WBC’s are secreting cytokines which tell the hypothalamus to reset the set point temperature to fever response.

22. Check point for Pathophysiology Sorry, this answer is incorrect. The rapid division of abnormal WBC’s did not cause bursts of energy, What to you think the WBC’s are doing to cause a fever? Click the back arrow button and try the question again.

23. Complications of Leukemia What complications does leukemia cause? So far we know that leukemia causes an increase of abnormal WBC production, leaving no room for RBCs, WBCs or platelets to form in the bone marrow. Cytokines released by WBC’s can cause fever and sweats. Do Check point for complications of leukemia now!

24. Complications of Leukemia Leukemia causes complications such as: • Anemia • Immunodeficiency • Inhibition of hemostasis • Bone marrow depression Do Check point for complications of leukemia now!

25. Complications of Leukemia What is anemia? Anemia is when your body doesn’t produce enough RBC’s. When someone is anemic they have signs and symptoms such as: • Shortness of breath • Weakness • Pallor • Feeling cold • Dizzy • Irritable • And may have headaches • (2006, Leukemia & Lymphoma society) Do Check point for complications of leukemia now!

26. Why would someone with leukemia have anemia? The red blood cells are synthesized in the bone marrow, however, abnormal WBC’s are overcrowding the bone marrow, and no RBC’s can be made ↓ Anemia Do Check point for complications of leukemia now!

27. Complications of Leukemia An immunodeficiency is when the body is unable to fight infections, and heal sores adequately. Someone will exhibit reoccurring illnesses and infections that don’t go away as well as sores that don’t heal in a sufficient amount of time. Do Check point for complications of leukemia now!

28. Why would someone with leukemia have an immunodeficiency? Remember the concept where abnormal WBC’s have taken over the bone marrow, not allowing the bone marrow to make any other cells? No normal WBC’s can be made. Without a sufficient amount of WBC’s to ward off infections, you’ll have an immunodeficiency. Do Check point for complications of leukemia now!

29. Complications of Leukemia Hemostasis is the process of forming clots so bleeding can come to a halt. Someone with inhibition of hemostasis will have excessive bleeding. Some common examples are: Nose bleeds Bruising Petechiae Do Check point for complications of leukemia now!

30. Why would someone with leukemia have inhibition of hemostasis? Platelets aid in clot formation. Not enough platelet forming cells (magakaroyocytes) can be made in the bone marrow (Bowne, 2004-06). What is the reasoning behind this? a.) There are too many abnormal RBC’s are being made in the bone marrow, giving no room for other cells to be made. b.) The bone marrow has shrunken c.) There are too many abnormal WBC’s being made in the bone marrow, not allowing any room for platelet making cells to be made by the bone marrow.

31. Your answer is not quite right, remember the cells type that is involved. Click the back arrow button and try the question again.

32. The bone marrow has expanded due to a certain type of abnormal cells that divide out of control. Please go back and see if you know what type of cells are responsible for this.

33. Way to Go! Microsoft, 2007

34. Complications of Leukemia Bone marrow depression is bone pain and/or fractures. This occurs because the bone marrow is trying to synthesize RBC’s, WBC’s and platelets, but cant because the abnormal WBC’s are taking over the space in the bone marrow, overcrowding other cells out. This causes the bone marrow cavity to expand, which causes pain and gives great risk for fractures.

35. Check point for Complications of Leukemia Shortness of breath, weakness, feeling cold and pallor are all signs of what complication of leukemia? a.) bone marrow expansion b.) anemia c.) immunodeficiency

36. Check point for Complications of Leukemia The signs and symptoms of bone marrow depression are pain in the bones and fractures. Think about what aids in transporting oxygen throughout the body. It’s not enough of me! RBC

37. Check point for Complications of Leukemia Good Job! Microsoft, 2007 Shortness of breath, weakness, feeling cold and pallor are all signs of anemia.

38. Check point for Complications of Leukemia An immunodeficiency would give the signs and symptoms of reoccurring infections as well as sores that don’t heal adequately. Think about what aids in transporting oxygen throughout the body. Click the back arrow button and try the question again.

39. Check point for Complications of Leukemia Reoccurring illnesses and infections that don’t go away as well as sores that don’t heal in a sufficient amount of time can be a complication of leukemia. What are these signs of? a.) immunodeficiency b.) inhibition of hemostasis c.) bone marrow expansion

40. Check point for Complications of Leukemia You are correct. A sore that takes a while to heal and reoccurring infections are indicators of an immunodeficiency. Microsoft, 2007

41. Check point for Complications of Leukemia Inhibition of hemostasis would give the sign of excessive bleeding, such as nose bleeds and bruising. What system aids in fighting off infections? Click the back arrow button and try the question again.

42. Check point for Complications of Leukemia Lets think this over, what body system aids in fighting off infections? Click the back arrow button and try the question again.

43. Check point for Complications of Leukemia What is a sign of inhibition of hemostasis? a.) reoccurring infections b.) fractures in bones c.) excessive bleeding

44. Check point for Complications of Leukemia Reoccurring infections is not a sign of inhibition of hemostasis; remember that the process of hemostasis uses platelets. Click the back arrow button and try the question again.

45. Check point for Complications of Leukemia Fractures in bones is not a sign of inhibition of hemostasis. What would occur to someone who isn’t producing enough platelets? Click the back arrow button and try the question again.

46. Check point for Complications of Leukemia Way to Go! You deserve an ice cream cone. Lets take a look at how the body responds to leukemia Microsoft, 2007

47. How Does the Body Respond to Leukemia Kidneys don’t get enough O2, due to low RBC’s (anemia) Secrets erythropoietin Bone marrow is overactive, It expands and pain results Low RBC’s and pain Causes… Do how the body responds to leukemia checkpoint now!

48. The generalized stress response (GSR) to activate Gives signs and symptoms of Sweating, Pallor, tachycardia Do how the body responds to leukemia checkpoint now!

49. Check point for How the body responds to leukemia GSR Activates Kidneys don’t get enough O2, due to low RBC’s (anemia) What causes the Generalized stress response to activate in leukemia? a.) the kidney secreting erythropoietin b.) low RBC’s and pain c.) an overactive bone marrow Secrets erythropoietin Bone marrow is overactive, Expands and Pain results Low RBC’s and pain causes Sweating, Pallor, tachycardia

50. Check point for How the body responds to leukemia The kidneys secreting erythropoietin normally would cause the bone marrow to synthesize more RBC’s. What stimuli would activate the GSR? Click the back arrow button and try the question again.