Author Question: Charlie is a 53-year-old man with non-Hodgkin lymphoma. His treatment has been only modestly ... (Read 128 times)

jhjkgdfhk · **on:** Jun 25, 2018

Charlie is a 53-year-old man with non-Hodgkin lymphoma. His treatment has been only modestly successful in delaying the progression of the disease, and he has recently relapsed.

His medical team decided to administer aggressive chemotherapy. Knowing that the intensive treatment would have a destructive effect on Charlie's bone marrow, they removed stem cells from his blood before the chemotherapy began. Afterward, the stem cells were returned by IV to reestablish his bone marrow function.

Before harvesting stem cells, a cytokine growth factor is administered to the patient. What is the benefit of this procedure?

Non-Hodgkin lymphoma is a disease involving B and T lymphocytes. What aspects of the immune response are these cells responsible for?

When considering erythrocytes, how is the body able to meet hematopoietic demand in conditions such as hemolytic anemia or blood loss?

Question 2

Leona is 52 years old and smokes. She is also overweight and has atherosclerosis. When she was given a 2-week vacation from work, she packed up her bags and flew from Minnesota to Sydney, Australia, for the trip she always wanted to take.

Unfortunately, just 3 days after she arrived, she was hospitalized when her left calf became inflamed, causing her considerable pain. The physician attending to her told her she developed a deep vein thrombosis.

Explain, using your knowledge of hypercoagulability, why the trip to Australia contributed to Leona's DVT? Why was Leona already at risk for thrombus development?

How does Leona's atherosclerosis affect platelet function? Conversely, what is the effect of increased platelet activity on the development of atherosclerosis?

How do atherosclerosis and immobility promote changes in blood coagulation?

When Leona was in hospital, she received heparin therapy. Explain why this course of action was taken to treat her DVT. Why was she not given heparin tablets to take back to the hotel with her?

Briannahope · **Reply #1 on:** Jun 25, 2018

Answer to Question 1

What are the therapeutic advantages of an autologous stem cell transplant on Charlie's bone marrow and immune system?
Stem cells are self-renewing and are able to continually proliferate. Removing these healthy cells before intensive chemotherapy or radiation therapy allows them to regenerate and repair damaged bone marrow once they are returned to the body. Using an autologous transplant maintains histocompatibility with the host.

The cytokine growth factor promotes the proliferation of stem cells and their migration from bone marrow. This provides more cells for rescue before the surgery and for later transplantation.

B lymphocytes are responsible for humoral-mediated immunity, and T lymphocytes are responsible for cell-mediated immunity.

Erythropoietin (EPO) is the cytokine responsible for triggering erythrocyte production. With persistent hemolysis or blood loss, there is resubstitution of red bone marrow for yellow. The spleen and liver can also participate in RBC production.

Answer to Question 2

When travelling by plane, particularly for long periods, the individual is relatively immobile. Stasis leads to an accumulation of activated clotting factors and platelets. Immobility also decreases chemical interactions with coagulation inhibitors. The end result is an increased risk for thrombus formation. In Leona's situation, her weight and smoking habit were additional risk factors for the condition.

Atherosclerosis disturbs the flow of blood and damages vessel endothelium causing an increase in platelet adherence. There is also an increased sensitivity by platelets to factors that cause adhesiveness and aggregation.
Adhering platelets release growth factors that enhance smooth muscle proliferation in the vessel wall. Consequently, platelet aggregation is able to contribute to the development and progression of atherosclerosis.

Both conditions increase coagulability. Atherosclerosis increases platelet function by encouraging aggregation and adherence. Immobility, in contrast, contributes to hypercoagulability by increasing procoagulation factors.

Heparin effectively encourages the inactivation of clotting factors, thereby inhibiting fibrin formation. Heparin cannot be absorbed through the gastrointestinal system and can only be administered by injection or IV infusion.