Aplastic Anemia: 6 Flashcards
What is Aplastic Anemia?
What blood cells? 3
bone marrow is unable to produce enough blood cells
* White blood cells (leukopenia)
* Red blood cells (anemia)
* Platelets (thrombocytopenia)
Aplastic Anemia
What cells are involved?
What do they do?
AA can be? but most are?
What can trigger it?
Usually autoimmune involving T lymphocytes
The T cells target and destroy the patient’s own stem cells.
This results in a decrease in RBC, WBC, and platelets.
Can be congenital or acquired, but most cases are idiopathic
Infections and pregnancy can trigger it,
OR
it may be caused by:
* Drugs (e.g., chemotherapy, antibiotics, etc))
* Chemicals / Radiation damage
What blood cells are affected by aplastic anemia?
How are these blood cells affected?
Red blood cells (anemia)
White blood cells (leukopenia)
Platelets (thrombocytopenia)
They are significantly decreased
What is the primary cause of aplastic anemia?
What branch of the immune system is primarily responsible?
damage to stem cells in the bone marrow
T-cell–mediated autoimmunity.
With low RBC, patients may present with symptoms of?
Symptoms of Anemia? 6
Anemia or bleeding.
Anemia = low o2 in the blood
Symptoms of anemia:
* Fatigue
* Pallor
* Shortness of breath
* Tachycardia
* Decreased activity tolerance
* Glossitis
With low WBC, patients are at risk for?
What kind of infections?
Patients will be at risk for developing an infection due to the leukopenia.
Patients are at risk for ALL TYPES OF INFECTION
Symptoms of low platelets (Thrombocytopenia)? 6
Thrombocytopenia
* Increased risk for bleeding
* Petechiae
* Bruising
* Nosebleeds
* Hematuria
* Bleeding from injection sites, etc.
What diagnostic changes would be expected in AA?
Decreased
RBCs
Hemoglobin
Hematocrit
WBC
Platelets
What is the diagnostic test that is definitive for the diagnosis of aplastic anemia?
Bone marrow biopsy!!!
The marrow in aplastic anemia is high in fat instead of cells.
Based on the age of 55, how will treatment be determined?
Under 55?
Over 55?
In patients under 55 years of age, a sibling donor who matches, stem cell transplant is the best treatment!!!
In patients over 55 years of age or those with no matched sibling, immunosuppressive therapy (IST) is the primary treatment.
What is a stem cell transplant and what would the RN teach the patient about this method of treatment?
Stem cells are the “building blocks” for the cells your body is breaking down, a transplant provides more oppurtunities for new cells to form.
The cells can be collected from your own blood or bone marrow, or from a donor.
What is ATG?
Target?
Used in preventing?
ATG is used for?
Anti-thymocyte globulin (ATG)
Immunosuppressant therapy
horse or rabbit-derived antibodies that target and destroy T cells
Rejection of organ transplant
ATG is used in autoimmune
What is serum sickness?
Symptoms?
How does it go away?
Serum sickness is a hypersensitivity (allergy) reaction from foreign protein (ATG)
Fever / Rash / Joint pain
Goes away on its own after stopping ATG
What type of drug is cyclosporine?
What does it do?
Immunosuppressant
Used to prevent transplant rejection.
TEST QUESTION!!!!
What are the side effects of cyclosporine?
Many patients on cyclosporine require?
Hypertension!!! (Increases BP)
Hirsutism
Gingival hyperplasia
Nephrotoxicity
Many patients on cyclosporine require
initiation of antihypertensive therapy
What type of drugs are corticosteroids?
immunosuppressive agents
What are the LONG TERM side effects of corticosteroids? 5
How to stop them?
Is long term use recommended?
Fluid retention
Hyperglycemia
Hypernatremia
Hypertension/Elevated BP levels
Osteoporosis
DO NOT STOP ABRUPTLY!!!
Long-term use of steroids is not recommended, but may be necessary
Why are growth factors given to treat AA?
To stimulate the bone marrow to produce more blood cells.
-Erythropoetin
-Thrombopoetin
TEST QUESTION!
What is the significance of aspirin and AA?
Aspirin is avoided in patients with thrombocytopenia because of its antiplatelet effect
Why would they be prescribed antifungal drugs?
Patients with neutropenia that receive IST, are at higher risk for mold (fungal) infections
These types of infections are associated with high mortality rates.
Therefore, antifungal prophylaxis with antifungals are recommended for patients with severe AA and should continue as long as the patient is neutropenic
TEST QUESTION
Death in AA is commonly caused by?
Death in this population is commonly caused
by hemorrhage or/and infection
