Blood and Lymphatic Disorders: Past Paper PDF

12/9/2024 Unit 6 Blood and lymphatic Disorders Blood and Circulatory System Disorders Chapter 10 1 Circulatory System  The circulatory system consists of the cardiovascular syst...

12/9/2024 Unit 6 Blood and lymphatic Disorders Blood and Circulatory System Disorders Chapter 10 1 Circulatory System  The circulatory system consists of the cardiovascular system and lymphatic system  This chapter will cover the blood vessels, the blood, and associated disorders. 2 Anatomy of Major Arteries 3 1  12/9/2024 4 Blood Vessels  Arteries—arterioles Transport blood away from heart  Veins—venules Return blood back to the heart  Capillaries Microcirculation within tissues  Systemic circulation Exchange of gases, nutrients, and wastes in tissues  Pulmonary circulation Gas exchange in lungs 5 6 2  12/9/2024 Anatomy of Major Veins 7 Structural Comparison of Arteries and Veins 8 Histology of Arteries and Veins  Tunica intima—endothelium (simple squamous epithelium)  Tunica media—middle layer, mostly smooth muscle  Tunica adventitia (externa)—connective tissue with fibrocytes, collagen (type I), and elastic fibers 9 3  12/9/2024 Blood 10 Function  Transport oxygen and nutrients to all tissues  Remove waste products of cellular metabolism  Play a critical role in the body's defenses/immune system, and  Serve in maintaining body homeostasis 11 Composition of Blood  Plasma Plasma proteins  Cellular component Erythrocytes Leukocytes Thrombocytes (platelets) 12 4  12/9/2024 Components of Blood and Their Functions 13 Hematopoiesis 14 Erythrocytes (Red Blood Cells)  Biconcave flexible discs  No nucleus in mature state  Contains hemoglobin Globin portion Heme group  Life span—120 days  Erythropoietin produced in the kidney stimulates erythrocyte production. 15 5  12/9/2024 Normal Red Blood Cells 16 Normal Blood Cells 17 Breakdown of Hemoglobin 18 6  12/9/2024 Blood Clotting—Hemostasis  Three steps: Vasoconstriction or vascular spasm after injury Platelet plug Coagulation mechanism  Plasmin will eventually break down the blood clot. 19 Clot Formation  Production of prothrombin factor due to tissue damage  Prothrombin or factor II is converted into thrombin  Thrombin converts Fibrinogen (factor I) into fibrin threads  A fibrin mesh forms to trap cells  The clot gradually shrinks or retracts, pulling the edges of damaged tissue closer together and sealing the site 20 Hemostasis and Anticoagulant Drugs 21 7  12/9/2024 Blood Typing Blood typing is based on antigens in the plasma membrane of the erythrocytes.  ABO system Based on the presence or absence of specific antigens Antibodies in the blood plasma  Rh system Antigen D in plasma membrane: Rh+ Absence of antigen D: Rh− 22 ABO Blood Groups 23 Diagnostic Tests (1 of 3)  Complete blood count (CBC) Includes total red blood cells (RBCs), white blood cells (WBCs), and platelets Leukocytosis (increased WBCs) Associated with inflammation or infection Leukopenia (decreased WBCs) Associated with some viral infections, radiation, chemotherapy Increased eosinophils Common in allergic responses  Differential count for WBCs 24 8  12/9/2024 Diagnostic Tests (2 of 3)  Morphology Observed with blood smears Shows size, shape, uniformity, maturity of cells Different types of anemia can be distinguished.  Hematocrit Percent by volume of cellular elements in blood  Hemoglobin Amount of hemoglobin per unit volume of blood Mean corpuscular volume (MCV) Indicates the oxygen-carrying capacity of blood 25 Diagnostic Tests (3 of 3)  Reticulocyte count Assessment of bone marrow function  Chemical analysis Determines serum levels of components, such as iron, vitamin B12, folic acid, cholesterol, urea, glucose  Bleeding time Measures platelet function  Prothrombin time (PT) and partial thromboplastin time (PTT) Measure function of various factors in coagulation process International normalized ratio (INR) is a standardized version. 26 Blood Therapies (1 of 2)  Whole blood, packed red blood cells, packed platelets For severe anemia or thrombocytopenia  Plasma or colloid volume-expanding solutions To maintain blood volume  Artificial blood products Compatible with all blood types None of them can perform all the complex functions of normal whole blood. 27 9  12/9/2024 Blood Therapies (2 of 2)  Epoetin alpha Artificial form of erythropoietin Before certain surgical procedures Anemia related to cancer Chronic renal failure  Bone marrow or stem cell transplantation Close tissue match necessary Treatment of some cancers Severe immunodeficiency Severe blood cell diseases  Drug treatment Aids in the clotting process 28 Blood Dyscrasias 29 The Anemias (1 of 2)  Anemia causes a reduction in oxygen transport.  Basic problem is hemoglobin deficit  Oxygen deficit leads to: Less energy production in all cells Cell metabolism and reproduction diminished Compensation mechanisms Tachycardia and peripheral vasoconstriction General signs of anemia Fatigue, pallor (pale face), dyspnea, tachycardia 30 10  12/9/2024 The Anemias (2 of 2)  Oxygen deficit leads to: Decreased regeneration of epithelial cells Digestive tract becomes inflamed and ulcerated, leading to stomatitis Inflamed and cracked lips Dysphasia Hair and skin may show degenerative changes. Severe anemia may lead to angina or congestive heart failure (CHF). 31 Iron Deficiency Anemia  Insufficient iron impairs hemoglobin synthesis. Microcytic, hypochromic RBCs Result of low hemoglobin concentration in cells  Very common Ranges from mild to severe Occurs in all age groups, but more common in women of childbearing age Estimated that one in five women is affected Proportion increases for pregnant women  Frequently sign of an underlying problem 32 Iron Deficiency Anemia—Blood Smear 33 11  12/9/2024 Causes  Dietary intake of iron below minimum requirement  Chronic blood loss As from bleeding, ulcer, hemorrhoids, cancer  Impaired duodenal absorption of iron In many disorders, malabsorption syndromes  Severe liver disease May affect iron absorption as well as storage 34 Signs and Symptoms  Pallor of skin and mucous membranes  Fatigue, lethargy, cold intolerance  Irritability  Degenerative changes  Stomatitis and glossitis  Menstrual irregularities  Delayed healing  Tachycardia, heart palpitations, dyspnea, syncope 35 Pernicious Anemia: Vitamin B12 Deficiency (1 of 2)  Basic problem is lack of absorption of vitamin B12 because of lack of intrinsic factor Intrinsic factor secreted by gastric mucosa Required for intestinal absorption of vitamin B 12  Characterized by very large, immature, nucleated erythrocytes Carry less hemoglobin Shorter life span 36 12  12/9/2024 Pernicious Anemia: Vitamin B12 Deficiency (2 of 2)  Dietary insufficiency is very rarely a cause.  Genetic factors have been implicated. More common in light-skinned women of northern European ancestry  Often accompanies chronic gastritis  May also be an outcome of gastric surgery 37 Development of Pernicious Anemia 38 Vitamin B12 and Nerve Cells  Vitamin B12 is needed for the function and maintenance of neurons.  Significant deficit of the vitamin will cause symptoms in the peripheral nerves.  These may be reversible. 39 13  12/9/2024 Vitamin B12 Deficiency 40 Additional Manifestations  Tongue is typically enlarged, red, sore, and shiny  Digestive discomfort, often with nausea and diarrhea  Feeling of pins and needles, tingling in limbs 41 Diagnostic Test  Microscopic examination (erythrocytes)  Bone marrow examination (hyperactive)  Vitamin B12 serum levels below normal  Presence of hypochlorhydria or achlorhydria  Presence of gastric atrophy 42 14  12/9/2024 Aplastic Anemia (1 of 2)  Impairment or failure of bone marrow  May be temporary or permanent  Often idiopathic but possible causes include: Myelotoxins Radiation, industrial chemicals, drugs Viruses Particularly hepatitis C Genetic abnormalities Myelodysplastic syndrome Fanconi’s anemia 43 Aplastic Anemia (2 of 2)  Blood counts indicate pancytopenia. Anemia, leukopenia, thrombocytopenia Bone marrow biopsy may be required. Erythrocytes often appear normal.  Identification of cause and prompt treatment needed for bone marrow recovery Removal of any bone marrow suppressants Failure to identify cause and treat effectively is life-threatening! 44 Hemolytic Anemia  Results from excessive destruction of RBCs  Causes Genetic defects Immune reactions Changes in blood chemistry Infections such as malaria Toxins in the blood Antigen-antibody reactions Incompatible blood transfusion Erythroblastosis fetalis 45 15  12/9/2024 Sickle Cell Anemia (1 of 6)  Genetic condition Autosomal Incomplete dominance Anemia occurs in homozygous recessive. Diagnostic testing is available. More common in individuals of African ancestry Heterozygous condition is somewhat protective against malaria. One in ten African Americans is heterozygous for the trait. 46 Sickle Cell Anemia (2 of 6) 47 Sickle Cell Anemia (3 of 6)  Abnormal hemoglobin (HbS)  Sickle cell crisis occurs whenever oxygen levels are lowered.  Altered hemoglobin is unstable and changes shape in hypoxemia.  Sickle-shaped cells are too large to pass through the microcirculation.  Obstruction leads to multiple infarctions and areas of necrosis. 48 16  12/9/2024 Sickle Cell Anemia (4 of 6) 49 Sickle Cell Anemia (5 of 6) 50 Sickle Cell Anemia (6 of 6)  Multiple infarctions affect brain, bones, organs  In addition to basic anemia: Hyperbilirubinemia, jaundice, gallstones Caused by high rate of hemolysis  Clinical signs Do not usually appear until the child is about 12 months old 51 17  12/9/2024 Signs and Symptoms  Severe pain because of ischemia of tissues and infarction  Pallor, weakness, tachycardia, dyspnea  Hyperbilirubinemia—jaundice  Splenomegaly  Vascular occlusions and infarctions In lungs Acute chest syndrome Smaller blood vessels Hand-foot syndrome  Delay of growth and development  Congestive heart failure 52 Diagnostic Tests  Blood test- determine abnormal RBC morphology  Hemoglobin electrophoresis  Prenatal DNA analysis 53 Treatment  Hydroxyurea has reduced the frequency of this crisis  Dietary supplementation with folic acid  Bone marrow transplantation  Immunization in children Against pneumonia, influenza, meningitis 54 18  12/9/2024 Comparison of Selected Anemias 55 Thalassemia  Genetic defect in which one or more genes for hemoglobin are missing or variant.  When two genes are involved the condition is moderate to severe.  Abnormal production of the globin chains and therefore the amount of hemoglobin produced And the # of RBC’s are reduced. 56 Signs & symptoms  The usual signs of anemia and increased hemolysis are present  Also includes the child's growth and development are impaired directly by hypoxia and indirectly by the fatigue and inactivity  Hyperactivity in the bone marrow leads to invasion of bone and impairs normal skeletal development  Heart failure develops as a result of the increasing cardiac workload. 57 19  12/9/2024 Treatment  Blood transfusions are the only treatment available at this time.  Iron chelation therapy may be necessary to remove excess iron from numerous transfusions  Bone marrow transplants have been curative in some children 58 Indications of Blood-Clotting Disorders  Persistent bleeding from gums  Repeated epistaxis  Petechiae Pinpoint, flat, red spots on skin and mucous membrane  Frequent purpura and ecchymosis  More than normal bleeding in trauma  Bleeding into joint—hemarthroses Swollen, red, painful  Hemoptysis 59 Blood-Clotting Disorders  Hematemesis Coarse brown particles (coffee ground emesis)in vomit  Blood in feces Black or occult  Anemia  Feeling faint and anxious  Low blood pressure  Rapid pulse 60 20  12/9/2024 Petechiae 61 Hemophilia A (1 of 2)  Classic hemophilia Deficit or abnormality of factor VIII  Most common inherited clotting disorder X-linked recessive trait Manifested in men, carried by women  Varying degrees of severity  Prolonged bleeding after minor tissue trauma  Spontaneous bleeding into joints  Possible hematuria or blood in feces 62 Hemophilia A (2 of 2)  Diagnostic tests Bleeding time and PT normal PTT, activated PTT (aPTT), coagulation time prolonged Serum levels of factor VIII are low.  Treatment Desmopressin (DDAVP) Replacement therapy for factor VIII 63 21  12/9/2024 Von Willebrand’s Disease  Most common hereditary clotting disorder  Three major types  Signs and symptoms include: Skin rashes Frequent nosebleeds Easy bruising Bleeding of gums Abnormal menstrual bleeding  Treatment based on type and severity 64 Disseminated Intravascular Coagulation (DIC) (1 of 2)  Involves both excessive bleeding and clotting  Excessive clotting in circulation Thrombi and infarcts occur.  Clotting factors are reduced to a dangerous level.  Widespread, uncontrollable hemorrhage results.  Very poor prognosis, with high fatality rate  Complication of many primary problems Obstetrical complications, such as abruptio placentae Infections Carcinomas Major trauma 65 Disseminated Intravascular Coagulation (2 of 2) 66 22  12/9/2024 Thrombophilia  Group of inherited or acquired disorders  Risk of abnormal clots in veins or arteries  Blood testing for clotting factor levels and abnormal antibody levels  Causative condition should be treated. 67 Myelodysplastic Syndromes  Diseases that involve inadequate production of cells by the bone marrow  Signs and symptoms include anemia; dependent on type of deficiencies that occur  May be idiopathic or occur after chemotherapy or radiation treatment  Treatment depends on deficiency type. Transfusion replacement Chelation therapy to reduce iron overload Bone marrow transplantation 68 Polycythemia  Primary polycythemia—polycythemia vera Increased production of erythrocytes and other cells in the bone marrow Neoplastic disorder Serum erythropoietin levels are low.  Secondary polycythemia—erythrocytosis Increase in RBCs in response to prolonged hypoxia Increased erythropoietin secretion Compensation mechanism to provide increased oxygen transport 69 23  12/9/2024 Signs and Symptoms  Distended blood vessels, sluggish blood flow  Increased blood pressure  Hypertrophied heart  Hepatomegaly  Splenomegaly  Dyspnea  Headaches  Visual disturbances  Thromboses and infarctions 70 Diagnostic Tests Tests to determine:  Increased cell counts  Increased hemoglobin and hematocrit values  Hypercellular bone marrow  Hyperuricemia 71 Treatment  Identify specific cause  Drugs or radiation  Suppression of bone marrow activity  Periodic phlebotomy 72 24  12/9/2024 The Leukemias (1 of 3)  Group of neoplastic disorders involving white blood cells  Uncontrolled WBC production in bone or lymph nodes  Other hemopoietic tissues are reduced.  One or more types of leukocytes are undifferentiated, immature, and nonfunctional.  Large numbers released into general circulation  Infiltrate lymph nodes, spleen, liver, brain, other organs 73 The Leukemias (2 of 3)  Acute leukemias (ALL and AML) High proportion of immature nonfunctional cells in bone marrow and peripheral circulation Onset usually abrupt , marked signs of complications Occurs primarily in children and younger adults  Chronic leukemias (CLL and CML) Higher proportion of mature cells but with reduced function Insidious onset Mild signs and better prognosis Common in older adults 74 75 25  12/9/2024 Acute Lymphocytic Leukemia 76 Signs and Symptoms of Acute Leukemia  Usual signs at onset Frequent or uncontrolled infections Petechiae and purpura Signs of anemia  Severe and steady bone pain  Weight loss, fatigue, possible fever  Enlarged lymph nodes, spleen, liver  Headache, visual disturbances, drowsiness, vomiting 77 The Leukemias (3 of 3)  Diagnostic tests Peripheral blood smears Immature leukocytes and altered numbers of WBCs Numbers of RBCs and platelets decreased Bone marrow biopsy for confirmation  Treatment Chemotherapy ALL in young children responds well to drugs Biological therapy (interferon) May be used to stimulate the immune system 78 26  12/9/2024 Complications of Leukemia  Opportunistic infections, including pneumonia  Sepsis  Congestive heart failure  Hemorrhage  Liver failure  Renal failure  CNS depression and coma 79 Arteriosclerosis and Atherosclerosis  Arteriosclerosis General term for all types of arterial changes Degenerative changes in small arteries and arterioles Loss of elasticity Lumen gradually narrows and may become obstructed Cause of increased BP  Atherosclerosis Presence of atheroma's (plaques) in large arteries Plaques consisting of lipids, calcium, and possible clots Related to diet, exercise, and stress 80 Normal (top) Versus Atherosclerotic Aorta (bottom) 81 27  12/9/2024 Lipid Transport  Lipids are transported in combination with proteins.  Low-density lipoprotein (LDL) Transports cholesterol from liver to cells Major factor contributing to atheroma formation  High-density lipoprotein (HDL) Transports cholesterol away from the peripheral cells to liver—“good” lipoprotein Catabolism in liver and excretion 82 Lipoproteins Composition and Transport 83 Risk Factors for Atherosclerosis  Nonmodifiable Age Gender Genetic or familial factors  Modifiable Obesity Sedentary lifestyle Cigarette smoking Diabetes mellitus Poorly controlled hypertension Combination of oral contraceptives and smoking 84 28  12/9/2024 Diagnostic Tests  Serum lipid levels LDL, HDL  Exercise stress testing Screening for arterial obstruction  Nuclear medicine studies Determine the degree of tissue perfusion 85 Consequences of Atherosclerosis 86 Treatment  Treatment  Weight loss  Increase exercise  Dietary modification  Reduction of sodium intake  Control hypertension  Control of primary disorder  Cessation of smoking  Antilipidemic drugs  Surgical intervention coronary artery bypass grafting 87 29  12/9/2024 Coronary Artery Bypass 88 Peripheral Vascular Disease: Atherosclerosis  Disease in arteries outside the heart  Increased incidence with diabetes  Most common sites Abdominal aorta Carotid arteries Femoral and iliac arteries  Diagnostic tests Blood flow assessed by Doppler studies and arteriography Plethysmography measures the size of limbs and blood volume in organs or tissues. 89 Signs and Symptoms  Increasing fatigue and weakness in the legs  Intermittent claudication (leg pain)  Associated with exercise caused by muscle ischemia  Sensory impairment Tingling, burning, numbness  Peripheral pulses distal to occlusion become weak  Appearance of the skin Marked pallor or cyanosis Skin dry and hairless Toenails thick and hard 90 30  12/9/2024 Treatment  Maintain control of blood glucose level  Reduce body mass index  Reduce serum cholesterol leve  Platelet inhibitors or anticoagulant medication  Cessation of smoking  Increase activity and exercise  Maintain dependent position for legs  Peripheral vasodilators  Observe skin for breakdown and treat promptly. If gangrene develops, amputation is required. 91 Aortic Aneurysm  Localized dilation and weakening of arterial wall  Develops from a defect in the medial layer  Different shapes Saccular Bulging wall on the side Fusiform Circumferential dilation along a section of artery Dissecting aneurysm Develops when there is a tear in the intima of the wall and blood continues to dissect or separate tissues 92 Types of Aortic Aneurysms 93 31  12/9/2024 Etiology  Atherosclerosis  Trauma  Syphilis and other infections  Congenital defects 94 Signs and Symptoms  Bruit may be heard on auscultation  Pulse may be felt on palpation of abdomen  Frequently asymptomatic until they become large or rupture  Rupture may lead to moderate bleeding but usually causes severe hemorrhage and death 95 Diagnostic Tests  Radiography  Ultrasound  CT scanning  MRI 96 32  12/9/2024 Treatment  Maintain blood pressure at normal level  Prevent sudden elevations caused by exertion  Prevent stress, coughing, constipation  Surgical repair 97 Venous Disorders 98 Varicose Veins  Irregular, dilated, tortuous areas of superficial veins  Familial tendency  Increased body mass index, parity, and weight lifting are risks.  In the legs May develop from defect or weakness in vein walls or valves Appear as irregular, purplish, bulging structures  Treatment Keep legs elevated, support stockings Restricted clothing, crossing legs to be avoided 99 33  12/9/2024 Varicose Veins 100 Thrombophlebitis and Phlebothrombosis (1 of 2)  Thrombophlebitis Thrombus development in inflamed vein (e.g., IV site)  Phlebothrombosis Thrombus forms spontaneously without prior inflammation; attached loosely  Factors for thrombus development Stasis of blood or sluggish blood flow Endothelial injury Increased blood coagulability 101 Thrombophlebitis and Phlebothrombosis (2 of 2)  Signs and symptoms Often unnoticed Aching, burning, tenderness in affected legs Systemic signs—fever, malaise, leukocytosis  Complication—pulmonary embolism  Treatment Preventive measures Exercise, elevating legs Anticoagulant therapy Surgical intervention 102 34  12/9/2024 Chapter 11 Lymphatic System Disorders 103 Review of the Lymphatic System 104 Structures  Lymphatic vessels  Lymphoid tissue  Lymphatic nodules  Tonsils  Lymph nodes  Spleen  Thymus gland  Red bone marrow 105 35  12/9/2024 Overview of the Lymphatic System 106 Function  Return of excess interstitial fluid to the cardiovascular system Vessels empty into the subclavian veins.  Filter and destroy foreign material Initiate the immune response  Absorb lipids from the GI tract 107 Lymphatic Vessels  Originate as capillaries in contact with blood capillary bed in tissues  Lymph collected by lymphatic trunks  Lymphatic trunks empty into ducts  Ducts empty into the subclavian veins 108 36  12/9/2024 Lymph Capillaries 109 Lymph  Clear, watery, isotonic fluid  Circulates in lymphatic vessels  Resembles blood plasma, with a lower protein content  Returned to the cardiovascular system 110 Lymphatic Circulation  Blind-ending capillaries in tissues  Larger vessels  Lymphatic vessels are interrupted periodically by lymph nodes  Lymphatic ducts Right lymphatic duct Drains into right subclavian vein Thoracic duct Drains into left subclavian vein 111 37  12/9/2024 Principal Organs of the Lymphatic System 112 Lymphatic Disorders 113 Lymphadenopathy Inflammation or infection of lymph nodes Infections caused by both bacteria and viruses Cancer can cause severe inflammation of nodes 114 38  12/9/2024 Lymphadenopathy Pathophysiology/Etiology Caused by another disease (eg. cold, AIDS, toxoplasmosis) Typically manifested as swollen lymph nodes Often self-limiting- resolves when underlying cause is resolved 115 Lymphadenopathy Diagnosis/Treatment Physical examination- palpation or visual Ultrasound Fine needle aspiration cytology Positron Emission Tomography- Computed Tomography(PET-CT Treatment varies based on the cause and severity. 116 Lymphomas  Malignant neoplasms involving lymphocyte proliferation in lymph nodes  Specific causes not identified Higher risk in adults who received radiation during childhood  Two main disorders Hodgkin’s lymphoma Non-Hodgkin’s lymphoma Distinguished by multiple node involvement Nonorganized, with widespread metastases 117 39  12/9/2024 Hodgkin’s Lymphoma (1 of 3)  Initially involves a single lymph node  Cancer spreads to adjacent nodes To organs via lymphatics T lymphocytes seem to be defective; lymphocyte count decreased Presence of Reed-Sternberg cells Giant cells present in lymph node Four subtypes Based on cell found at biopsy 118 Reed-Sternberg Cell 119 Hodgkin’s Lymphoma (2 of 3)  Symptoms First indicator—usually a painless enlarged lymph node Later—splenomegaly and enlarged lymph nodes General signs of cancer Weight loss, anemia, low-grade fever, night sweats; fatigue may develop. Generalized pruritis is common Recurrent infections  Treatment Radiation, chemotherapy, surgery 120 40  12/9/2024 Spread of Hodgkin’s Lymphoma 121 Hodgkin’s Lymphoma (3 of 3)  Staging and prognosis dependent on: Number of nodes involved Location of nodes involved 122 Non-Hodgkin’s Lymphoma  Increasing in incidence Partially caused by HIV infection  Similar to Hodgkin’s lymphoma Clinical signs and symptoms are similar. More difficult to treat when tumors are not localized  Initial manifestation—enlarged, painless lymph node 123 41  12/9/2024 Multiple Myeloma  Neoplastic disease that involves increased production of plasma cells in bone marrow  Sometimes also considered a circulatory/blood disorder  Unknown cause  Occurs in older adults  Production of other blood cells is impaired  Multiple tumors in bone Loss of bone Severe bone pain  Prognosis poor, with short life expectancy 124 Multiple Myeloma 125 Signs and Symptoms  Onset usually insidious  Malignancy well advanced before diagnosis  Pain caused by bone involvement  Anemia and bleeding tendency  Impaired kidney function and eventually failure  Chemotherapy to encourage remission Median survival, 3 years 126 42  12/9/2024 Lymphedema  Obstruction of lymphatic vessels  Most common form is congenital  Extremities swell because of lymph accumulation  Treatment: Diuretics Bed rest Massage of affected area Elevation of affected extremity If edema severe and infection present –surgery may be needed to remove affected tissue. 127 Elephantiasis  Lymphedema Caused by blockage because of parasitic infection  Significant swelling of affected extremity Extreme swelling of legs, breast, and/or genitalia Thickening of subcutaneous tissue Frequent infections Skin ulcerations Fever  Treatment—medication regimen to kill parasite 128 Elephantiasis 129 43  12/9/2024 Castleman’s Disease  Rare illness Involves overgrowth of lymphoid tissue  Two types Unicentric form Affects a single lymph node Multicentric form Affects multiple lymph nodes and tissue—may have severe effects on the immune system  Signs, symptoms, and treatment depend on the type of the disease 130 44