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Slide 1 - Leukemia The bare-bone facts By Jennifer Yeek
Slide 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 !
Slide 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!
Slide 4 - Pathophysiology RBC WBC Do Pathophysiology check point Now! First, we must remember that white blood cells (WBC’s), red blood cells (RBC’s) and platelets are made in the bone marrow. Platelet WBC RBC
Slide 5 - Pathophysiology The overproduction of abnormal WBC’s overcrowd normal WBC’s Abnormal white blood cells (WBC) divide. This is because there is a mutation in ras pathway which is used for cell division. The patient will have an increased WBC count , but the WBC’s are abnormal. Do Pathophysiology check point Now!
Slide 6 - Pathophysiology The overproduction of abnormal WBC’s may spill out into the blood, and infiltrate into other tissues such as : This causes the organ to become Enlarged (Porth, 2005) - liver -spleen -lymph nodes Do Pathophysiology check point Now!
Slide 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!
Slide 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!
Slide 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!
Slide 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!
Slide 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
Slide 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.
Slide 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.
Slide 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.
Slide 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.
Slide 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)
Slide 17 - Check point for Pathophysiology What type of abnormal cells are being produced? Please try again.
Slide 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.
Slide 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.
Slide 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.
Slide 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.
Slide 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.
Slide 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!
Slide 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!
Slide 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!
Slide 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!
Slide 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!
Slide 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!
Slide 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!
Slide 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.
Slide 31 - Your answer is not quite right, remember the cells type that is involved. Click the back arrow button and try the question again.
Slide 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.
Slide 33 - Way to Go! Microsoft, 2007
Slide 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.
Slide 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
Slide 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. RBC It’s not enough of me!
Slide 37 - Check point for Complications of Leukemia Good Job! Microsoft, 2007 Shortness of breath, weakness, feeling cold and pallor are all signs of anemia.
Slide 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.
Slide 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
Slide 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
Slide 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.
Slide 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.
Slide 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
Slide 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.
Slide 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.
Slide 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
Slide 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!
Slide 48 - The generalized stress response (GSR) to activate Sweating, Pallor, tachycardia Gives signs and symptoms of Do how the body responds to leukemia checkpoint now!
Slide 49 - Check point for How the body responds to leukemia Kidneys don’t get enough O2, due to low RBC’s (anemia) Secrets erythropoietin Bone marrow is overactive, Expands and Pain results Low RBC’s and pain causes GSR Activates Sweating, Pallor, tachycardia 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
Slide 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.
Slide 51 - Check point for How the body responds to leukemia Fantastic! Pain and low RBC’s would cause the GSR to activate. Microsoft, 2007
Slide 52 - Check point for How the body responds to leukemia 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.
Slide 53 - Check point for How the body responds to leukemia 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.
Slide 54 - Check point for How the body responds to leukemia 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.
Slide 55 - Check point for How the body responds to leukemia 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. What signs or symptoms are caused by complications of leukemia? Click over suspected signs and symptoms to see if you are correct.
Slide 56 - Treatment options for Leukemia Treatment options for leukemia include: Chemotherapy Radiation Blood and bone marrow stem cell transplantation (2006, Leukemia & Lymphoma society) Do check point for Treatment options now!
Slide 57 - Chemotherapy and Radiation 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). (Microsoft, 2007) Do check point for Treatment options now!
Slide 58 - How does Radiation therapy work? Radiation destroys DNA and RNA which inhibits further leukemic cells to divide. Do check point for Treatment options now!
Slide 59 - Blood and Bone marrow stem cell transplantation There are two types: Synergenic – use of identical twin for donor (2006, Leukemia &Lymphoma society). 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). Do check point for Treatment options now!
Slide 60 - Check point for Treatment Options How does radiation work? 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 c.) radiation destroys DNA and RNA so leukemic cells cannot divide
Slide 61 - Sorry, your answer is incorrect. Think about the cell’s genetic code. Click the back arrow button and try the question again.
Slide 62 - You are incorrect. What would make a cell able to pass on its information? Please go back and try again
Slide 63 - You are correct! Radiation destroys the leukemic cells DNA or RNA so they can no longer divide. (Microsoft, 2007)
Slide 64 - In synrgenic bone marrow stem cell transplantation, what is the unique trait the donor must have? a.) The donor must be an identical twin. b.) The donor must have the same blood type. c.) The donor must have a history clear and free of any illnesses.
Slide 65 - 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. (Microsoft, 2007)
Slide 66 - True, but were looking for a unique trait, one that is rare. Click the back arrow button and try the question again.
Slide 67 - 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.
Slide 68 - New-Available Treatments for Leukemia Some of the new treatments for leukemia are: Imatinib mesylate (Gleevec) Immunotherapy Gene Therapy Vaccines (2006, Leukemia & Lymphoma society). Do check point for New-Available treatment Now!
Slide 69 - Imatinib mesylate (Gleevec) This is used for newly diagnosed Chronic myelogenous leukemia (CML) patients. How does this drug work? It blocks the oncogene that starts the transformation process of leukemic cells The advantages of this drug is the following: Orally administrated Low side effects Few altering tissue effects High response rate to leukemic cells (2006, Leukemia & Lymphoma society) Do check point for New-Available treatment Now!
Slide 70 - Immunotherapy Immune cells or antibodies are used to destroy Leukemic cells, and slows down the process of new leukemic cell growth (2006, Leukemia & Lymphoma society). Do check point for New-Available treatment Now!
Slide 71 - Gene Therapy An agent is used to block encoding instructions of an oncogene; acts on both DNA, or RNA (2006, Leukemia & Lymphoma society). Do check point for New-Available treatment Now!
Slide 72 - Vaccines 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)! Do check point for New-Available treatment Now!
Slide 73 - Check point for new available 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 c.) It works by blocking the oncogene which initiates transformation of leukemic cells.
Slide 74 - Check point for new available treatment options No, it does just the opposite. Click the back arrow button and try the question again.
Slide 75 - Check point for new available treatment options It doesn’t do this. Think of another way to stop cells from dividing. Click the back arrow button and try the question again.
Slide 76 - Check point for new available treatment options Way to go! This is correct. Imstinib mesylate blocks the oncogene, which inhibits the process of transformation of leukemic cells. (Microsoft, 2007)
Slide 77 - Check point for new available treatment options 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
Slide 78 - Check point for new available treatment options 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.
Slide 79 - Check point for new available treatment options Very good. Immunotherapy is the process of using immune cells and antibodies to destroy leukemic cells, thus slow down future cell growth (Microsoft, 2007)
Slide 80 - Check point for new available treatment options This is very possible, however it’s not being applied to the leukemic cells. Click the back arrow button and try the question again.
Slide 81 - Check point for new available treatment options What is the advantage of using vaccines against leukemia? a.) vaccines help the patient feel better with therapy b.) vaccines give the patient an extra boost of energy c.) vaccines may extend the remission time
Slide 82 - Check point for new available treatment options Sorry this is incorrect. What is the main goal in treating leukemia? Click the back arrow button and try the question again.
Slide 83 - Check point for new available treatment options 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.
Slide 84 - Check point for new available treatment options 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. (Microsoft, 2007)
Slide 85 - 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! CONGRADULATIONS! (Microsoft, 2007)
Slide 86 - A Special Thanks 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)
Slide 87 - This Web Tutorial has been created in loving memory of my mother, Edith May Jacob Whom I love and miss dearly (Microsoft,2007)
Slide 88 - References Bowne, P., (2004-2006). PATHO Interactive Physiology Tutorials, Retrieved March 12, 2007 from http://faculty.alverno.edu/bowneps/hemostasis/h5.htm. Microsoft. (2007). Clipart. Retrieved March 12, 2007 from http://office.microsoft.com/en-us/clipart/default. Porth, C. M., (2005). Pathophysiology Concepts of Altered Health Sciences. (7th ed.) Phiadelphia: Lippincott Williams & Wilkins Porth, C. M., (2007). Essentials of Pathophysiology. (2nd ed.) Philadelphia: Lippincott Williams & Wilkins.