Porth's Essentials of Pathophysiology, 4e

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Disorders of White Blood Cells and Lymphoid Tissues

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1. Many of the primary immunodeficiency disorders, in which there is a defect in the development of immune cells of T- or B-lymphocyte origin, can be cured with allogeneic stem cell transplantation from an unaffected donor. A. Explain why stem cells are used rather than mature lymphocytes. You might want to refer to Figure 11-5. B. Describe how the stem cells would go about the process of repopulating the bone marrow. 2. A mother brings her 4-year-old son into the pediatric clinic because of irritability, loss of appetite, low-grade fever, pallor, and complaints that his legs hurt. Blood tests reveal anemia, thrombocytopenia, and an elevated leukocyte count with atypical lymphocytes. A diagnosis of acute lymphocytic leukemia (ALL) is confirmed with bone marrow studies. A. What is the origin of the anemia, thrombocytopenia, elevated leukocyte count, and atypical lymphocytes seen in this child? B. Explain the cause of the child’s fever, pallor, increased bleeding, and bone pain. C. The parents are informed that the preferred treatment for ALL consists of aggressive chemotherapy with the purpose of achieving a remission. Explain the rationale for using chemotherapy to treat leukemia. D. The parents are told that the child will need intrathecal chemotherapy administered by a lumbar puncture. Why is this treatment necessary? 3. A 36-year-old man presents to his health care clinic with fever, night sweats, weight loss, and a feeling of fullness in his abdomen. Subsequent lymph node biopsy reveals a diagnosis of non- Hodgkin lymphoma (NHL). A. Although lymphomas can originate in any of the lymphoid tissues of the body, most originate in the lymph nodes, and most (80% to 85%) are of B-cell origin. Hypothesize as to why B cells are more commonly affected than T cells. B. A newly developed monoclonal antibody, rituximab, is being used in the treatment of NHL. Explain how this agent exerts its effect and why it is specific for B-cell lymphomas.

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