Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Leukemia The bare-bone facts Pathophysiology Complications Body’s response Treatment Options New Treatments By Jennifer Yeek Instructions Pathophysiology Use Complications Use to go to next slide to go to previous slide. Body’s response Use menu buttons (to the left to move area of topic) Treatment Options When you see a highlighted word, roll over it to get the definition. New Treatments 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 ! What is leukemia? Pathophysiology Complications Body’s response A disease where the neoplasm inside the bone marrow fills up with abnormal white blood cells, so no other cells can be synthesized. Treatment Options New Treatments Do Pathophysiology check point Now! How does leukemia occur? Pathophysiology Pathophysiology First, we must remember that white blood cells (WBC’s), red blood cells (RBC’s) and platelets are made in the bone marrow. Complications Body’s response RBC RBC WBC WBC Treatment Options New Treatments Do Pathophysiology check point Now! Platelet Pathophysiology Pathophysiology Complications Abnormal white blood cells (WBC) divide. This is because there is a mutation in ras pathway which is used for cell division. Body’s response Treatment Options The overproduction of abnormal WBC’s overcrowd normal WBC’s New Treatments Do Pathophysiology check point Now! The patient will have an increased WBC count , but the WBC’s are abnormal. Pathophysiology Pathophysiology Complications Body’s response Treatment Options The overproduction of abnormal WBC’s may spill out into the blood, and infiltrate into other tissues such as : - liver -spleen -lymph nodes New Treatments Do Pathophysiology check point Now! This causes the organ to become Enlarged (Porth, 2005) Pathophysiology Pathophysiology Complications The patient may suffer from side effects such as: -Fever -Sweats Body’s response Treatment Options New Treatments Do Pathophysiology check point Now! This is because the WBC’s are secreting cytokines, such as interleukin 1. . Pathophysiology Pathophysiology Complications There are some potential risks for acquiring leukemia. Some are genetically related, while others are environmental. Body’s response Treatment Options New Treatments Do Pathophysiology check point Now! 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) Pathophysiology Pathophysiology Complications Body’s response Treatment Options New Treatments Do Pathophysiology check point Now! 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) Pathophysiology Pathophysiology Complications Body’s response Treatment Options New Treatments Do Pathophysiology check point Now! Diagnosis for leukemia is done by specific blood tests, along with examining cells in the blood and bone marrow (Leukemia & Lymphoma society, 2006). Check point for Pathophysiology Pathophysiology Complications In leukemia, an overproduction of abnormal WBC’s may spill out into the blood, and do what? Body’s response Treatment Options New Treatments 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 Check point for Pathophysiology Pathophysiology Complications Body’s response Treatment Options New Treatments 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. Check point for Pathophysiology Pathophysiology Great Job! Complications Body’s response Treatment Options New Treatments 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. Check point for Pathophysiology Pathophysiology Complications Body’s response Treatment Options New Treatments 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. Check point for Pathophysiology Pathophysiology Complications Body’s response Treatment Options New Treatments 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. Check point for Pathophysiology Pathophysiology Complications Body’s response Treatment Options 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. New Treatments (Microsoft, 2007) Check point for Pathophysiology Pathophysiology Complications Body’s response Treatment Options New Treatments What type of abnormal cells are being produced? Please try again. Check point for Pathophysiology Pathophysiology Complications Body’s response Treatment Options New Treatments Waste isn’t being produced in the bone marrow, but an abnormal cell type is. Please go back and try again. Check point for Pathophysiology Pathophysiology Complications Patients with leukemia may suffer from systemic side effects such as: fever, and sweats. Why? Body’s response a.) The WBC’s are dividing fast, which increases Treatment Options New Treatments 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. Check point for Pathophysiology Pathophysiology Complications Body’s response Treatment Options New Treatments 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. Check point for Pathophysiology Pathophysiology Fantastic! Complications Body’s response Microsoft, 2007 Treatment Options New Treatments Yes, the WBC’s are secreting cytokines which tell the hypothalamus to reset the set point temperature to fever response. Check point for Pathophysiology Pathophysiology Complications Body’s response Treatment Options New Treatments 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. Complications of Leukemia Pathophysiology Complications Body’s response 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. Treatment Options New Treatments Do Check point for complications of leukemia now! Cytokines released by WBC’s can cause fever and sweats. What complications does leukemia cause? Complications of Leukemia Pathophysiology Leukemia causes complications such as: Complications Body’s response Treatment Options New Treatments Do Check point for complications of leukemia now! 1. Anemia 2. Immunodeficiency 3. Inhibition of hemostasis 4. Bone marrow depression Complications of Leukemia What is anemia? Pathophysiology Complications Body’s response Anemia is when your body doesn’t produce enough RBC’s. When someone is anemic they have signs and symptoms such as: Treatment Options New Treatments Do Check point for complications of leukemia now! •Shortness of breath •Weakness •Pallor •Feeling cold •Dizzy •Irritable •And may have headaches (2006, Leukemia & Lymphoma society) Why would someone with leukemia have anemia? Pathophysiology Complications Body’s response 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 Treatment Options New Treatments Do Check point for complications of leukemia now! Complications of Leukemia Pathophysiology Complications Body’s response Treatment Options New Treatments Do Check point for complications of leukemia now! 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. Why would someone with leukemia have an immunodeficiency? Pathophysiology Complications Remember the concept where abnormal WBC’s have taken over the bone marrow, not allowing the bone marrow to make any other cells? Body’s response Treatment Options New Treatments Do Check point for complications of leukemia now! No normal WBC’s can be made. Without a sufficient amount of WBC’s to ward off infections, you’ll have an immunodeficiency. Complications of Leukemia Pathophysiology Complications Hemostasis is the process of forming clots so bleeding can come to a halt. Body’s response Treatment Options Someone with inhibition of hemostasis will have excessive bleeding. Some common examples are: New Treatments Do Check point for complications of leukemia now! Nose bleeds Bruising Petechiae Why would someone with leukemia have inhibition of hemostasis? Pathophysiology Complications Body’s response Treatment Options New Treatments 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. Pathophysiology Complications Body’s response Treatment Options New Treatments Your answer is not quite right, remember the cells type that is involved. Click the back arrow button and try the question again. Pathophysiology Complications Body’s response Treatment Options New Treatments 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. Pathophysiology Complications Body’s response Treatment Options New Treatments Microsoft, 2007 Complications of Leukemia Pathophysiology Bone marrow depression is bone pain and/or fractures. Complications Body’s response Treatment Options 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. New Treatments This causes the bone marrow cavity to expand, which causes pain and gives great risk for fractures. Check point for Complications of Leukemia Pathophysiology Complications Body’s response Shortness of breath, weakness, feeling cold and pallor are all signs of what complication of leukemia? Treatment Options New Treatments a.) bone marrow expansion b.) anemia c.) immunodeficiency Check point for Complications of Leukemia Pathophysiology Complications Body’s response Treatment Options 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! New Treatments RBC Check point for Complications of Leukemia Pathophysiology Good Job! Complications Body’s response Treatment Options Microsoft, 2007 New Treatments Shortness of breath, weakness, feeling cold and pallor are all signs of anemia. Check point for Complications of Leukemia Pathophysiology Complications Body’s response Treatment Options New Treatments 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. Check point for Complications of Leukemia Pathophysiology Complications Body’s response Treatment Options New Treatments 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 Check point for Complications of Leukemia Pathophysiology Complications Body’s response Treatment Options You are correct. A sore that takes a while to heal and reoccurring infections are indicators of an immunodeficiency. New Treatments Microsoft, 2007 Check point for Complications of Leukemia Pathophysiology Complications Body’s response Treatment Options New Treatments 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. Check point for Complications of Leukemia Pathophysiology Complications Body’s response Treatment Options New Treatments Lets think this over, what body system aids in fighting off infections? Click the back arrow button and try the question again. Check point for Complications of Leukemia Pathophysiology Complications What is a sign of inhibition of hemostasis? Body’s response Treatment Options New Treatments a.) reoccurring infections b.) fractures in bones c.) excessive bleeding Check point for Complications of Leukemia Pathophysiology Complications Body’s response Treatment Options New Treatments 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. Check point for Complications of Leukemia Pathophysiology Complications Body’s response Treatment Options New Treatments 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. Check point for Complications of Leukemia Pathophysiology Complications Way to Go! You deserve an ice cream cone. Body’s response Treatment Options Microsoft, 2007 New Treatments Lets take a look at how the body responds to leukemia How Does the Body Respond to Leukemia Pathophysiology Kidneys don’t get enough O2, due to low RBC’s (anemia) Complications Secrets erythropoietin Body’s response Treatment Options Bone marrow is overactive, It expands and pain results New Treatments Do how the body responds to leukemia checkpoint now! Low RBC’s and pain Causes… The generalized stress response (GSR) to activate Pathophysiology Complications Body’s response Treatment Options New Treatments Do how the body responds to leukemia checkpoint now! Gives signs and symptoms of Sweating, Pallor, tachycardia Check point for How the body responds to leukemia Pathophysiology What causes the Generalized stress response to activate in leukemia? Kidneys don’t get enough O2, due to low RBC’s (anemia) Complications Secrets erythropoietin Body’s response Bone marrow is overactive, Expands and Pain results a.) the kidney secreting erythropoietin Treatment Options New Treatments b.) low RBC’s and pain c.) an overactive bone marrow Low RBC’s and pain causes GSR Activates Sweating, Pallor, tachycardia Check point for How the body responds to leukemia Pathophysiology Complications Body’s response Treatment Options New Treatments 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. Check point for How the body responds to leukemia Pathophysiology Complications Fantastic! Pain and low RBC’s would cause the GSR to activate. Body’s response Treatment Options New Treatments Microsoft, 2007 Check point for How the body responds to leukemia Pathophysiology Complications Body’s response Treatment Options New Treatments The overactive bone marrow would cause pain. You’re so close. What stimuli would activate the GSR? Click the back arrow button and try the question again. Check point for How the body responds to leukemia Pathophysiology Complications Body’s response Treatment Options New Treatments Lets try a clinical question. A patient comes into your clinic with pain in his legs, high blood pressure, a rapid pulse, complains of feeling weak and tired. He has much bruising on his body and his pupils are dilated. What are caused from the Generalized stress response? Click over suspected signs and symptoms to see if you are correct. Check point for How the body responds to leukemia Pathophysiology Complications Body’s response Treatment Options New Treatments Later, the patient had tachycardia, angina and is feeling very weak. They are also having fainting spells. The lab reports indicate that the patients erythropoietin, and thrombopoetin levels are elevated. Are any of these caused by the GSR? Click over suspected signs and symptoms to see if you are correct. Check point for How the body responds to leukemia Pathophysiology Complications Body’s response Later, the patient has tachycardia, angina and is feeling very weak. They are also having fainting spells. The lab reports indicate that the patients erythropoietin, and thrombopoetin levels are elevated. Treatment Options New Treatments What signs or symptoms are caused by complications of leukemia? Click over suspected signs and symptoms to see if you are correct. Treatment options for Leukemia Pathophysiology Treatment options for leukemia include: Complications Body’s response Treatment Options New Treatments Do check point for Treatment options now! 1. 2. 3. Chemotherapy Radiation Blood and bone marrow stem cell transplantation (2006, Leukemia & Lymphoma society) Chemotherapy and Radiation Pathophysiology Complications Body’s response Usually this kind of treatment is used with a combination of two or more drugs. There are over 50 drugs used (2006, Leukemia & Lymphoma society). Treatment Options New Treatments Do check point for Treatment options now! (Microsoft, 2007) How does Radiation therapy work? Pathophysiology Complications Body’s response Treatment Options New Treatments Do check point for Treatment options now! Radiation destroys DNA and RNA which inhibits further leukemic cells to divide. Blood and Bone marrow stem cell transplantation Pathophysiology Complications Body’s response There are two types: Synergenic – use of identical twin for donor (2006, Leukemia &Lymphoma society). Treatment Options New Treatments Do check point for Treatment options now! Allogentic – use of blood and bone marrow from healthy individual with the same tissue type such as a brother’s or sister’s (2006, Leukemia &Lymphoma society). Check point for Treatment Options Pathophysiology How does radiation work? Complications Body’s response Treatment Options a.) radiation changes the osmolarity of cells so leukemic cells cannot survive b.) radiation alters the ionic balance in cells so leukemic cells cannot survive New Treatments c.) radiation destroys DNA and RNA so leukemic cells cannot divide Pathophysiology Complications Body’s response Treatment Options New Treatments Sorry, your answer is incorrect. Think about the cell’s genetic code. Click the back arrow button and try the question again. Pathophysiology Complications Body’s response Treatment Options New Treatments You are incorrect. What would make a cell able to pass on its information? Please go back and try again Pathophysiology Complications Body’s response You are correct! Radiation destroys the leukemic cells DNA or RNA so they can no longer divide. Treatment Options New Treatments (Microsoft, 2007) Pathophysiology Complications In synrgenic bone marrow stem cell transplantation, what is the unique trait the donor must have? Body’s response a.) The donor must be an identical twin. Treatment Options New Treatments b.) The donor must have the same blood type. c.) The donor must have a history clear and free of any illnesses. Pathophysiology Complications Body’s response Treatment Options You bet! In synergenic bone marrow stem cell transplantation, the unique trait that the donor must have is that they are an identical twin to the recipient. New Treatments (Microsoft, 2007) Pathophysiology Complications Body’s response Treatment Options New Treatments True, but were looking for a unique trait, one that is rare. Click the back arrow button and try the question again. Pathophysiology Complications Body’s response Treatment Options New Treatments This would be impossible. Everyone may get an illness at some point of their life. To what extent would the donor need to match the recipient in this type of transplant? Click the back arrow button and try the question again. New-Available Treatments for Leukemia Some of the new treatments for leukemia are: Pathophysiology Complications Body’s response Treatment Options New Treatments Do check point for New-Available treatment Now! 1. 2. 3. 4. Imatinib mesylate (Gleevec) Immunotherapy Gene Therapy Vaccines (2006, Leukemia & Lymphoma society). Imatinib mesylate (Gleevec) This is used for newly diagnosed Chronic myelogenous leukemia (CML) patients. Pathophysiology Complications How does this drug work? Body’s response It blocks the oncogene that starts the transformation process of leukemic cells The advantages of this drug is the following: Treatment Options New Treatments Do check point for New-Available treatment Now! • • • • Orally administrated Low side effects Few altering tissue effects High response rate to leukemic cells (2006, Leukemia & Lymphoma society) Immunotherapy Pathophysiology Complications Body’s response Treatment Options New Treatments Do check point for New-Available treatment Now! Immune cells or antibodies are used to destroy Leukemic cells, and slows down the process of new leukemic cell growth (2006, Leukemia & Lymphoma society). Gene Therapy Pathophysiology Complications Body’s response Treatment Options New Treatments Do check point for New-Available treatment Now! An agent is used to block encoding instructions of an oncogene; acts on both DNA, or RNA (2006, Leukemia & Lymphoma society). Vaccines Pathophysiology Complications Body’s response Treatment Options New Treatments Do check point for New-Available treatment Now! Vaccines induce the immunoresponse to specific antigens that mimic cancer cells which the patient may have, or acquire in the future The advantages to using vaccines are that the patient may extend their time of remission which is an ideal long-term goal(2006, Leukemia & Lymphoma society)! Check point for new available treatment options Pathophysiology Complications Body’s response Treatment Options How does Imatinib mesylate work? a). It works by aiding the oncogene in transformation of leukemic cells b.) It works by destroying the cells DNA and RNA, so they cannot divide New Treatments c.) It works by blocking the oncogene which initiates transformation of leukemic cells. Check point for new available treatment options Pathophysiology Complications Body’s response Treatment Options New Treatments No, it does just the opposite. Click the back arrow button and try the question again. Check point for new available treatment options Pathophysiology Complications Body’s response Treatment Options New Treatments It doesn’t do this. Think of another way to stop cells from dividing. Click the back arrow button and try the question again. Check point for new available treatment options Pathophysiology Complications Body’s response Treatment Options Way to go! This is correct. Imstinib mesylate blocks the oncogene, which inhibits the process of transformation of leukemic cells. New Treatments (Microsoft, 2007) Check point for new available treatment options Pathophysiology Complications Body’s response Treatment Options New Treatments How does immunotherapy work? a.) immune cells block leukemic cells’ receptors b.) immune cells and antibodies destroy leukemic cells and slows down the process of new leukemic cell growth. c.) Immune cells and antibodies ward off new infections that may occur in a patient with leukemia Check point for new available treatment options Pathophysiology Complications Body’s response Treatment Options New Treatments Sorry, you’re incorrect. Think about the role of immune cells and apply it to the leukemic cells. Click the back arrow button and try the question again. Check point for new available treatment options Pathophysiology Complications Body’s response Treatment Options Very good. Immunotherapy is the process of using immune cells and antibodies to destroy leukemic cells, thus slow down future cell growth New Treatments (Microsoft, 2007) Check point for new available treatment options Pathophysiology Complications Body’s response Treatment Options New Treatments This is very possible, however it’s not being applied to the leukemic cells. Click the back arrow button and try the question again. Check point for new available treatment options Pathophysiology What is the advantage of using vaccines against leukemia? Complications Body’s response a.) vaccines help the patient feel better with therapy Treatment Options New Treatments b.) vaccines give the patient an extra boost of energy c.) vaccines may extend the remission time Check point for new available treatment options Pathophysiology Complications Body’s response Treatment Options New Treatments Sorry this is incorrect. What is the main goal in treating leukemia? Click the back arrow button and try the question again. Check point for new available treatment options Pathophysiology Complications Body’s response Treatment Options New Treatments A boost of energy for the patient doesn’t sound like a bad idea, however, this is incorrect. Think about this, do we want the patient to get leukemia again? Click the back arrow button and try the question again. Check point for new available treatment options Pathophysiology Complications Body’s response Terrific! The key benefit in vaccinating someone with leukemia is to extend their time of remission. We don’t want the patient to get leukemia again. Treatment Options New Treatments (Microsoft, 2007) Pathophysiology Complications Body’s response Treatment Options New Treatments You have completed this tutorial. You should now be fully familiarized with the basic concepts of leukemia. Thank you for participating in this interactive tutorial. Have a great day! (Microsoft, 2007) A Special Thanks Pathophysiology Complications Body’s response Treatment Options New Treatments To the people who have made it possible for me to create this web tutorial. Thank you Pat for giving me the learning opportunity and allowing me to create this. Thank you Dan for aiding me by editing my drawings for this creation (Microsoft, 2007) Pathophysiology Complications Body’s response Treatment Options This Web Tutorial has been created in loving memory of my mother, Edith May Jacob Whom I love and miss dearly New Treatments (Microsoft,2007) References Pathophysiology Bowne, P., (2004-2006). PATHO Interactive Physiology Tutorials, Retrieved March 12, 2007 from Complications http://faculty.alverno.edu/bowneps/hemostasis/h5.htm. Microsoft. (2007). Clipart. Retrieved March 12, 2007 from Body’s response Treatment Options http://office.microsoft.com/en-us/clipart/default. Porth, C. M., (2005). Pathophysiology Concepts of Altered Health Sciences. (7th ed.) Phiadelphia: Lippincott New Treatments Williams & Wilkins Porth, C. M., (2007). Essentials of Pathophysiology. (2nd ed.) Philadelphia: Lippincott Williams & Wilkins.