hemo

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Biology

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Oct 30, 2023

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Introduction Hematology means the study of the blood or hematopoietic system in humans, which consists of several interconnected components: the peripheral blood, the bone marrow, and the lymph nodes. The circulating blood, consisting of some five liters in a man (almost 10 percent less in a woman) comprises a fluid component (the plasma) and makes up some 55 percent of total blood volume. The plasma contains the three basic cell types: erythrocytes (red cells), leukocytes (white cells), and thrombocytes (platelets). The erythrocytes are largely concerned with oxygen transport; the leukocytes play various parts in defense against infection and tissue injury; and the thrombocytes are involved in maintaining the integrity of blood vessels and the prevention of blood loss by helping the blood to clot. An abnormal condition of blood is called blood dyscrasia or disease. Diseases of red and white blood cells, bone marrow, and disorders of blood clotting are examples of blood dyscrasias. Anemia, hemochromatosis , and polycythemia vera are diseases of red blood cells. Diseases of white blood cells include leukemia and granulocytosis . Two disorders of blood clotting are hemophilia and purpura . Lymph , the other main fluid in the body, does not circulate as does the blood. Lymph travels in one direction through lymph vessels, which drain into large veins of the circulatory system situated in the neck region. Although lymph does not contain erythrocytes or platelets, it does contain lymphocytes and monocytes . Lymph capillaries, lymphatic vessels, lymphatic ducts, and lymph nodes form the lymphatic system. This system serves as a drainage medium to transport needed proteins and fluid that have leaked out of the blood capillaries back to the bloodstream via the veins. In addition, the lymphatic vessels absorb lipids (fats) from the small intestine and carry them to the bloodstream. The lymphatic system also assists the immune system in protecting the body by producing antibodies or by engulfing and destroying foreign matter.
Though they are not specific parts of the lymphatic system, the spleen, faucial tonsils , and thymus are closely related to it by virtue of the functions they perform in the body. Of particular importance is the thymus, which manufactures infection-fighting T cells . These cells play a very important role in the body’s immune response. T-cell lymphocytes also form in stem cells in the bone marrow. A practicing hematologist spends a great deal of time treating patients suffering from blood malignancies. One of the most common forms of blood tumor is lymph-node cancer (Hodgkin disease and non-Hodgkin lymphoma) . Oncology is a word derived from the Greek onchos , meaning a lump or tumor. Oncology is the study of cancer. An oncologist is a physician who specializes in the diagnosis and treatment of cancer. Cancer is a proliferation of cells that grow in an uncontrolled manner, invading local tissues and spreading widely through the blood or lymphatics to produce secondary deposits, or metastases , in distant parts of the body. The cells composing the tumor reproduce faster than normal cells. More than 200 different types of cancer have been identified; however, these different types can be divided into three main groups based on the tissue from which the tumor cells originate—carcinomas, sarcomas, and mixed-tissue tumors. Carcinomas comprise the largest group and are malignant tumors that arise from the epithelial tissues that line internal and external body surfaces. For example, lung carcinoma arises from the epithelium lining the main airways, or bronchi; breast carcinoma develops from the ductal tissue in the breast; stomach and colon carcinomas originate from their epithelial linings. Sarcomas develop from supportive and connective tissue such as cartilage, bone, muscle, fat, and bone marrow, as well as from cells of the lymph system. Another word for bone sarcomas is osteosarcomas; fat sarcomas are called liposarcomas. Sarcomas are commonly seen in children and spread via the bloodstream, whereas carcinomas are more
commonly seen in adults and usually spread via the lymphatics. Mixed-tissue tumors originate in tissue that can separate into both epithelial and connective tissue. When cancer occurs simultaneously in adjacent tissue types, it is known as a mixed- tissue tumor. The method of classifying tumors involves establishing the tumor’s grade (degree of maturity) and its stage (extent of metastasis) within the body. The aggressiveness of tumor malignancy is classified using the Broders index on a scale of 1 to 4. A grade 1 tumor indicates the most differentiation and best prognosis, whereas a grade 4 indicates the least differentiation and poorest prognosis. Other classification systems are used to describe malignancies in different parts of the body; for example, Dukes A, B, and C are used to classify the extent of operable adenocarcinoma of the colon or rectum, and FIGO stages describe gynecologic malignancies, particularly carcinomas of the ovary. FIGO stages are expressed using roman numerals. Although the evolution of a normal cell into a cancerous one is not understood fully, the genetic material deoxyribonucleic acid (DNA) of the cell holds the key. DNA contains genes (codes) that direct the production of new cells. During cell division, DNA replicates itself to pass the same genetic material to two new cells. This process is called mitosis . Sometimes during mitosis the process is disrupted because the DNA stops making the codes that allow cells to function normally. Instead, the cells begin to make new signals that cause them to move and invade adjacent tissue and metastasize or spread. These are malignant cells. As these malignant cells reproduce, the mutations (cell changes) are passed on to the new cells, and the process is replicated over and over, leading to malignant growths. Chemicals, drugs, radiation, and some viruses can cause DNA changes that lead to cancer. Heredity can also predispose a person to certain types of cancer. Although cancer occurs frequently in the elderly, it can occur at any age and can affect any body tissue.
Each type of cancer requires a specific type of therapy. The four basic methods used to treat cancer are chemotherapy, surgery, radiation therapy, and biological therapy. At times a combination of these methods is used for the most effective treatment plan. Chemotherapy employs drugs to treat cancer. Chemotherapeutic agents fall into five classifications: alkylating agents, antibiotics, antimetabolites, plant derivatives, and steroids. Surgery removes the cancerous tissue from the body through excision. Radiation therapy involves the use of radiation to the tumor tissue; high doses damage DNA. Biological therapy uses the body’s own immune system to fight tumor cells. As cancer research continues to be aggressively pursued, new treatment methods continue to emerge. Research and development being done all over the world plays the most important role in finding new drugs and treatment methods to not only help treat cancer but also to ultimately find a cure for it. Hematology/Oncology Abbreviations The abbreviations, acronyms, and terms in the following abbreviations and terminology sections are often dictated in this specialty. We offer abbreviated definitions here. Please see an unabridged medical dictionary or the suggested web sites in this chapter for more information on each term. adeno- CA adenocarcinoma AHF antihemophilic factor ALL acute lymphocytic leukemia AML acute myelogenous leukemia AVM arteriovenous malformation BAC blood-alcohol concentration baso basophils BL Burkitt lymphoma BMT bone-marrow transplant
CA cancer or carcinoma CEA carcinoembryonic antigen CFS chronic fatigue syndrome chemo chemotherapy CLL chronic lymphocytic leukemia CMF cytoxan, methotrexate, 5-fluorouracil (combination chemotherapy) CML chronic myelogenous (myelocytic) leukemia CMV cytomegalovirus CR complete response DES diethylstilbestrol Dif differential (count) DNA deoxyribonucleic acid eos eosinophil(s) ER estrogen receptors ESR erythrocyte sedimentation rate Ga Gallium Hct hematocrit HD Hodgkin disease Hgb, Hg hemoglobin Hp haptoglobin HTLV human T-cell leukemia-lymphoma virus IgA, IgD immunoglobulin A, immunoglobulin D IgE, IgG immunoglobulin E, immunoglobulin G IgM immunoglobulin M IL-2 interleukin-2 LAK lymphokine-activated killer (cells) LGV lymphogranuloma venereum lymphs lymphocytes MCH mean corpuscular hemoglobin—average amount of hemoglobin per cell
MCHC mean corpuscular hemoglobin concentration— average concentration of hemoglobin in a single red cell MCL mantle cell lymphoma MCV mean corpuscular volume—average volume or size of a single red blood cell mets metastasis/metastases NED no evidence of disease NHL non-Hodgkin lymphoma NSCLC non-small-cell lung cancer PCV packed cell volume PMN, PMNL polymorphonuclear neutrophil poly polymorphonuclear leukocyte PR partial remission prot. protocol PSA prostate-specific antigen PT, pro time prothrombin time PTT partial thromboplastin time R&D research and development Rh Rhesus (factor) RIA radioimmunoassay RNA ribonucleic acid sed rate erythrocyte sedimentation rate segs segmented, mature white blood cells TNF tumor necrosis factor TNM tumor, node, metastasis VIP vasoactive intestinal peptides WBRT whole-brain radiation therapy XRT radiation therapy YSC yolk sac carcinoma
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