1) Explain the symptoms that Mrs. Brown has been having(5 marks)
Leukaemia is an abnormal blood cell that travels through the body, depending on the number and where these abnormal cells collect confirms what type of leukaemia a person might have and their symptoms. Chronic leukaemias are divided into three groups, chronic lymphocytic leukaemia (CLL), hairy-cell leukaemia (HCL) and chronic myeloid leukaemia (CML). The difference between the types of chronic leukaemias is the type of white blood cell that has been cancerous. Both CLL and CML leukaemia’s are a slow growing cancer in which the bone marrow makes too many white blood cells. In CLL the abnormal cells develop from lymphoid blood stem cells and the B cells are cancerous, on the other hand CML is the cause by the change in a chromosome called the Philadelphia chromosome in bone marrow cells that leads to overproduction of white blood cells. Under the microscope HCL looks hairy hence the name hairy cell leukaemia which is a cancer of the blood that is caused by abnormal growth of B cells, this disease can decrease the normal blood cell level.
( [i] Stevens A. 2009 et al)
Mrs Brown shows classic symptoms of chronic leukaemia which means many white cells in the blood, leukaemia cells differ from normal white blood cells that are part of the body’s immune system that splits into numerous subgroups with different roles in recognising foreign invaders caused by germs such as viruses and bacteria, when the leukaemia cell overload and increase variety it overtake the space where the normal white blood cell where pushing it into a smaller area, it produces itself where the normal white blood cells are produced which is in the bone marrow and this results in fewer normal white blood cells as well as their survival and gives rise to the symptoms of chronic leukaemia, when such situations occur, it is usually only a matter of time before clear sign of the disease is detectable. Simplified weakness, weight loss, infections which do not heal, bruise, and joint and bone pain.
( [ii]Montague S.E. 2004 el al)
Mrs Brown bruises and unhealing infections can be the lack of red blood cells and platelets to carry oxygen around the body. Another reason can be that the normal white blood cells are not under the normal conditions by reason of leukaemia cells, the cells are immature and do not have the ability to fight foreign invaders as like viral infection. The increasing leukaemia cells cannot fight the disease like normal white blood cell. The synthesis of blood platelets requires bone marrow cells (white blood cells) without it will affect the process of blood clotting and resulting in excessive bleeding and dark patches on the skin, which is due to the build up of these immature white blood cell in the bone marrow. This harmfully affected Mrs Brown’s immune system giving her a cold infection.
A different symptom of chronic leukaemia is the growth of hypogammaglobulinemia that affects the immune system, it affects the fight against infection by decreasing the level of gamma globulin ([iii] Furine B. 2003 et al). This condition is highly not likely to be the cause of Mrs Brown infections as it tends effect infant’s antibodies. The reason why Mrs Brown is feel discomfort around here her joints and bone is because there is an increased amount of cancerous leukaemia cells present. Also leukaemia releases harmful chemical substance around the abdominal area kidney, liver, spleen thereby organs becoming inflamed consequences to abdominal pain or discomfort explaining why Mrs Brown felt no appetite consequently suffering from plenty of (unexplained) weight loss.
( [iv] Mazza J.J. 2002 et al )
2) Why did the surgeon ask for a familial match first(2 marks)
The reason why the surgeon asked for a familial match is to determine the most appropriate donor match by marrow transplantation, it is the process where stem cells from a healthy donor is transferred into the patient’s bone then injected into their bloodstream. Mrs Brown would need a transplant surgery in order to cure or treat the chronic leukaemia. There are two main transplants, the autologous bone marrow transplant where the patient (recipient) themselves are the donor and allogenic bone marrow transplant is when the donor is another person and their tissue has matching genetic type as the recipient. The donated bone marrow must match the patients’ cell, ideal donor is an identical twin because there HLA (human leucocyte antigen) combination is identical with that of the patient most often patient’s brother or sister serves since inheriting their parents genes meaning matching genetic type stem cells. If Mrs Brown doesn’t have any sibling it is more likely that a donor could come from family member or who comes from the same racial or ethnic group because the recipient has higher match tissue character and/or matching genetic type. Transplant surgery can be dangerous if not carried out safely it can cause a deadly infection from toxic bacteria by contamination in the tissue before it gets harvest into the recipient.
(Montague S.E. 2004 el al)
3) What tests would be carried out on the donated tissue and recipient tissue
Explain how these tests work the cells that are involved(8 marks)
The test that would be carried out on the donated tissue and recipient are ABO blood type, Human leukocyte antigen typing (HLA-typing) and lastly cross-matching transfusion test. A blood type also knows as blood group is a process which accurately exhibits the type of blood group for individual humans. Blood group is recognized by the antigens protein molecules (such as carbohydrates and glycoprotein) that are found on the outer part of the red blood cell (RBC)and antibodies present in plasma. Antibodies and antigens are the natural defense against every foreign antigen however a person’s body normally doesn’t make antibodies against its own antigens. Blood typing system are used to provide confirmation of tissue compatibility for bone marrow transfusion, it divides to four categories type A, type B, type AB and type O. Blood type are inherited antigenic substances from both parents. Blood type is important during blood transfusion or an organ transplant, in the case of organ transplants the donors’ organ tissue has to necessity match the recipients blood type, without a positive match the transplant can not be performed because a mismatch can cause negative response.
([v]Yashon & Cummings 2009)
Human Leukocyte Antigens (HLA) creates each person’s tissue unique by proteins on white blood cells. The antigens expressed on the external of the lymphocytes of the donor are matched against the recipient. Human leukocyte antigen typing (HLA-typing) is executed by bone marrow or blood stem cell transplant, it is tested by comparing the persons HLA tissue which are HLA, A, B, C, and DR proteins. The HLA-typing test is used to provide evidence of tissue compatibility and the transplant tolerates by the recipient, siblings are the ideal donor match given that they may have inherited the same HLA type. ([vi] Hoffbrand . 2006 et al)
Cross-matching is the concluding stage in the transfusion testing. The blood of the donor with the same ABO and Rh type as the recipient is elected. The procedure of cross-matching involves the patient’s serum having antibodies mixed with donor’s red blood cells (RBCs) containing a particular blood type antigen. If clumping or agglutination occurs the blood is not compatible indicates unwanted antigen-antibody reaction meaning that the serum’s antibodies attacked and attached on the donor’s RBCs antigen. If agglutination does not occur the blood is compatible indicates compatibility between the donor’s blood and the recipient’s blood.
([vii] Brandeau 2004 et al)
4) What drugs and treatment might be prescribed to Mrs Brown after the
The first step in treating the cancerous white blood cells, is chemotherapy followed after a bone marrow transplant and finishing off with after care drug treatments. Treatment of leukaemia options bases on the type and level of disease and overall health and age of the patient. Chemotherapy is used to kill cancer cells such as chronic leukaemia destroying the patient’s bone marrow a high dose completely destroys the remaining cancer cells in the body. Chemotherapy for leukaemia can involve a single drug or a combination is this is because different drugs show attack to the leukaemia cells in different ways. Example of combination drugs are cyclophosphamide, vincristine, and prednisone. The drug combination also avoids chronic leukaemia cells from becoming resistant to any one drug.
([viii]Norworthy 2011 et al)
When the chemotherapy stage is complete the patient’s blood cell level is low, the requirement of blood and stem cell transfusion is next. In between these two procedures antibiotic drugs are provided this is vital because of a lack of white blood cells in the recipient tissue. Bone marrow transplant or also know as stem cell transplant, is the replacement of the recipient’s diseased bone marrow with donor’s healthy bone marrow. The procedure involves an injection into the bone marrow receiving a mixture of blood forming stem cells that travel to the bone marrow where they originate to produce new red blood cells, white blood cells and platelets.
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