Question

describe the etiology , description, pathophysiology , diagnostic test and treatment for leukemia and rheumatoid arthritis

Answer 1

LEUKEMIA

DESCRIPTION - It is a group of blood cancers that usually start in the bone marrow whi h result in high numbers of abnormal blood cells.

CLASSIFICATION - They are devided into two groups. ACUTE and CHRONIC and each group is subdivided into MYELOBLASTIC and LYMPHOBLASTIC (which is on what cells is it affecting). So they are as below

ACUTE MYELOBLASTIC LEUKEMIA (AML)

CHRONIC MYELOID LEUKEMIA (CML)

ACUTE LYMPHOBLASTIC LEUKEMIA (ALL)

CHRONIC LYMPHOID LEUKEMIA (CLL)

ETIOLOGY - Exact etiology is UNKNOWN, Different risk factors are proposed like smoking, radiation, some chemicals like benzene, prior exposure to chemotherapy, Down syndrome and family history of leukemia.

CLINICAL FEATURES - Clinical features are due to deficiency of platelets which is caused as there is excessive formation of immature white blood cells and as bone marrow concentrate on making immature celle there is iniatlly deficiency of PLATELETS which results in easy bruising and as there is excessive load on spleen and liver to break deformed cells so there is splenomegaly and hepatomegaly. It is also associated with fever. Later on there is red blood cell deficiency which leads to anemia, which may cause dyspnea and pallor. Other symptoms can also be seen like feeling sick, having fevers, chills, night sweats, feeling fatigued and other flu-like symptoms. If the leukemic cells invade the central nervous system, then it results in neurological symptoms like headaches.

PATHOPHYSIOLOGY. - Initially there is mutations in the DNA due to different risk factor which is losted in etiology. This results into activation of oncogenes or deactivating tumor suppressor genes, and thereby disrupting the regulation of cell death, differentiation or division. Because of this there is uncontrolled formation of immature white blood cells in bone marrow which then are released in blood. As bpne marrow cells are more focused on unnecessary formation of immature WBC there is decreased platelets and RBC formation.

INVESTIGATIONS -

1) CBC - Complete Blood Count which shows elevated WBC, low RBC and low platelets.

2) PERIPHERAL BLOOD SMEAR - Shows immature white blood cells

3) BONE MARROW BIOPSY - Shows hypercellular replacement by immature blast cells instead of normal cells.

TREATMENT - This is done under following headings,

TARGETED THERAPY - drugs lime IMITANIB - TYROSINE KINASE INHIBITOR IS USED IN CML(Chronic Myeloid Leukemia)

CHEMOTHERAPY Druga like VINCRISTINE,VINBLASTINE are used.

RADIATION THERAPY - NOT VERY HELPFUL.

BONE MARROW TRANSPLANT - LAST AND PERMANENT TREATMENT OPTION .

RHEUMATOID ARTHRITIS

DESCRIPTION- It is a long-term autoimmune disease that primarily affects joints resulting in warm, swollen, and painful joints where most commonly affected joint is the wrist and hands.

ETIOLOGY - it's exact cause is also unknown. It is considered to be due to GENETICAL and ENVIRONMENTAL factors.HLA-DR4 is the major genetic factor implicated for it while SMOKING and ALCOHOL consumption are the environmental factor to be considered.

CLINICAL FEATURES - JOINTS are mainly involved - it involves inflammation of the synovial membrane of joints due to AUTO-IMMUNE CELLS FAMAGING it. Joints become swollen, tender and warm, and patient has stiffness which limits their movement. Mainly small joints are involved like of the hands, feet and cervical spine, but larger joints like the shoulder and knee can also be involved. Rarely it may involve larger joint and with time multiple joints are affected.

Other common symptom is RHEUMATOID NODULE on SKIN

PATHOPHYSIOLOGY. - Here the main culprit is patients own immune cells which mks-identifies joints synovial membrane as foreign body and starts auto-immune reaction against it which causes all symptoms.

INVESTIGATIONS -

1) X-rays of the hands and feet are GOLD STANDARD when many joints affected. IN EARLY STAGES there may be no changes on the x-ray, later on shows Osteopenia near the joint, soft tissue swelling, and a smaller than normal joint space

2) BLOOD TEST - A) Test for rheumatoid factor (RF) and B) ANTIBODY TEST anti-citrullinated protein antibodies (ACPAs)

TREATMENT -

1) LIFESTYLE MODIFICATION - Regular exercise is advised as both safe and useful to maintain muscles strength and overall physical function.

2) Disease-modifying antirheumatic drugs (DMARDs) are the primary treatment for RA.- This include drugs like METHOTREXATE, HYDROCHLOROQUINE, SULFASALAZINE etc

3) TNF-alpha inhibitors - certolizumab, infliximab and etanercept are useful drugs which can also be used.

4) MONOCLONAL ANTIBODIES - Rituximab and tocilizumab are monoclonal antibodies used in this disease.

5) Glucocorticoids and NSAIDS are used to decrease inflammation.

6) Physiotherapy for joints

7) Surgery - Patient may require surgery like Synovectomy to prevent pain.