Pathophysiology

Predisposing Factors: Age Gender Race Family HIstory ETIOLOGY: Unknown

Somatic mutations in the DNA

Precipitating Factors: exposure to radiation and certain chemicals having a sibling with leukemia HTLV-1 virus genetic abnormalities chromosomal translocations

Activate oncogene/ deactivate tumorsupppresor gene

Malignant transformation of lymphoid stem cells s/sx: bone pain joint pain

Uncontrolled proliferation of lymphoblast in the bone marrow Diagnostic Test: BM aspiration BM biopsy

Treatment: Analgesic

Lymphoblast replace the normal marrow elements

Treatment: Remission Induction Therapy Consolidation and Maintenance Therapy BM Transplantation CNS prophylaxis

Decreased production of normal blood cells

Diagnostic Test: CBC

Leukopenia (4.36 x 10 /L)

9

Decreased production of normal blood cells

s/sx: fever, chills seizure

Infection

Spillage of lymphoblast into the bloodstream

s/sx: presence of petechiae bruise & bleed easily anemia fatigue dizziness palpitations dyspnea

Treatment: Blood transfusion Epoetin and hemapoetic stimulants

Organ infiltration If treated: Antibiotic Ig Leukapheresis If not treated

Septicemia

Prevention of complications

Death

Kidneys s/sx: Little/ no UO RR Flank pain Restless n/v legs and feet swelling uremia azotemia

Diagnostic Test: MRI Treatment: Intrathecal chemotherapy

CNS s/sx: h/a, weakness, blurred vision, balance difficulty, vomiting, lethargy Liver / Spleen Diagnostic Test: Ultrasonography

Renal failure

leukocyte cells impairs the circulation of CSF

s/sx: CSF leukocytes s/sx: cranial nerve palsies confusional states optic neuropathy cerebellar dysfunction papilledema

Extra cells cause the liver/spleen to rupture

Diagnostic Test: Spinal Tap

leukocyte cells compresses spinal/ cranial nerves

bleeding Hypovolemic shock

s/sx: hepatomegal y splenomegaly elevated ALT (81 u/L) s/sx: hypotension tachypnea tachychardia

Progress to coma

Overgrown thymus

Compress the Superior Vena Cava

s/sx: shortness of breath cough suffocation

Physical Exam Diagnostic test: Lymph node biopsy

Lymph nodes

Mediastinal lymphadenopathy

s/sx: lymphadenopathy SVC syndrome s/sx: swelling of head, neck and arms obstruction of blood flow Treatment: O2 administration Bronchodilators s/sx: cough, wheezes, respiratory tract obstruction

Bronchial/tracheal obstruction Esophageal compression

s/sx: dysphagia

Erosion of node into a bronchus/ trachea

s/sx: hemoptysis

Severe hypoxia

DEATH