13.5 Neutropenia and Hematopoietic Stem Cell Transplantation (HSCT)

Question 1

Neutropenia

Answer 1

• Side-effect of chemotherapy. Decreased number of neutrophils (first line of defense against infection)
• Extremely worried about infection due to immunosuppression
• Typically occurs with hematologic cancers (lymphoma, leukemia, myeloma)
• DETERMINED WITH ANC (ABSOLUTE NEUTROPHIL COUNT)

Precautions To Take
- Reverse isolation
- Neutropenic diet (no fresh fruits or vegetables that can be contaminated)
- No fresh flowers from visitors
- VS for signals of infection
- Antimicrobial soaps
- Avoid invasive procedures (including IM)
- Limit visitors
- Private Room
- Prophylactic antibiotics
- Change open water containers every few hours

Question 2

Hematopoietic Stem Cell Transplant (HSCT)

Answer 2

• Stem cells can grow into new body cells used to treat hematologic cancers.
• This is a bone marrow transplant

Allogenic Transplant
- Donor with compatible HLA (proteins on your cells responsible for regulating immune function)

Isogenic
- Marrow taken from genetically identical twin

Autologous
- Child’s own bone marrow is used

Question 3

HSCT Phases

Answer 3

Pre-transplant Phase
- Child receives high dose of chemotherapy and total body irradiation to wipe out the immune system so the body can accept the transplant.
- SEVERE RISK OF INFECTION

Transplant Phase
- Child receives infusion of donor stem cells, and if successful, donor cells will implant in the hosts bone marrow and produce normal blood cells within 2-4 weeks.

Post-Transplant Phase
- Protect from infection
- GVHD is a major threat here
- Watch signs of rejection

Question 4

Psychosocial Needs

Answer 4

Anxiety, fear, PTSD, depression
- Children may not understand why they don’t feel good, why their hair is falling out, why they need surgeries.

• There may be fear of cancer coming back or another cancer developing
• Coping mechanisms and resources they may need

Question 5

Cognition Effects of Cancer

Answer 5

• Even if cancer goes into remission there may still be long term effects
• Learning and memory difficulties
• Concentration, attention span, memory
• IQ
• Visual motor integration
• Speed of processing
• Spelling/Vocabulary
• Handwriting
• Social skills
• Problem solving skills
• Educate families that patient may experience these issues.

Question 6

Definitions

Answer 6

Polycythemia
- Significant increase in RBCs

Leukocytosis
- Significant increase in WBCs

Neutropenia
- Absolute neutrophil count less than 1500

Thrombocytopenia
- Platelets less than 50,000

Blast Cells
- Immature WBCs found in bone marrow

Absolute Neutrophil Count (ANC)
- Measure of bodies ability to fight an infection that uses neutrophils as an index