Chapter 37 Care of pt w/ Hematologic Problems Flashcards
Exam 2
anemia
a reduction in the number of red blood cells (RBCs), the amount of hemoglobin, or the hematocrit (percentage of packed RBCs per deciliter of blood).
apheresis
the withdrawal of whole blood and removal of some of the patient’s blood components followed by reinfusion of the plasma back into the patient
blast phase cells
immature white cells that are dividing rapidly
engraftment
the successful “take” of the stem cells transplanted into the recipient
erythrocytes
red blood cells (RBCs)
glottitis
a smooth, beefy-red tongue
Hemoglobin A (HbA)
normal adult hemoglobin with two normal A chains and two normal B chains
Hemoglobin F (HbF)
the main type of hemoglobin in the fetus, having two normal A chains and two normal gamma chains that bind oxygen more tightly than does hemoglobin A or S
Hemoglobin S (HbS)
the hemoglobin of sickle cell disease in which there are two normal A chains and two abnormal beta chains that fold poorly, causing the red blood cell to assume a sickle shape under low-oxygen conditions
Hemolytic
blood destroying
hypercellularity
cellular excess in the peripheral blood
indolent
slow growing or slow to progress
intrinsic factor
a substance normally secreted by the gastric mucosa that is needed for intestinal absorption of Vitamin B12
leukemia
blood cancer that results from a loss of normal cellular regulation, leading to uncontrolled production of immature WBCs (“blast” cells) in the bone marrow
leukocytes
white blood cells (WBCs)
leukopenia
reduction in the circulating number of white blood cells (WBCs)
lymphomas
cancers of the lymphoid cells and tissues with loss of cellular regulation and abnormal overgrowth of lymphocytes
malignant
cancerous
multiple myeloma (MM)
a white blood cell cancer of mature-B lymphocytes called plasma cells that secrete antibodies
nadir
the period after chemotherapy in which bone marrow suppression is the most severe
pancytopenia
a condition of low circulating numbers of all blood cell types
perfusion
adequate arterial blood flow through the tissues (peripheral perfusion) and blood that is pumped by the heart (central perfusion) to oxygenate body tissues
m
peripheral blood stem cells (PBSCs)
stem cells that have been released from the bone marrow and circulate within the peripheral blood
pernicious anemia
anemia resulting from failure to absorb Vitamin B12, caused by a deficiency of intrinsic factor (a substance normally secreted by the gastric mucosa), which is needed for intestinal absorption of Vitamin B12
Philadelphia Chromosome
an abnormal chromosome often associated with chronic myelogenous leukemia caused by a translocation of the ABL gene from chromosome 9 onto the BCR gene of chromesome 22
Polycythemia Vera (PV)
one of the chronic myeloproliferative neoplasms (MPNs) in which there is loss of cellular regulation and excessive proliferation of specific groups of abnormal myeloid cells that have decreased function
SCD crisis
episodes of extensive cellular sickling that obstruct perfusion, causing tissue hypoxia and severe pain
Sickle Cell Disease (SCD)
a genetic disorder in which a mutation in the gene for the beta chains of hemoglobin causes chronic anemia, pain, disability, organ damage, increased risk for infection, and early death as a result of poor blood perfusion
Stomatitis
mouth sores
Teratogen
an agent that can cause birth defects
Thrombocytopenia
a reduction in the number of circulating platelets from reduced platelet production
Thrombocytopenia Purpura
the destructive reduction of circulating platelets after normal platelets production
hematologic
of or relating to blood; the dx, treatment, and prevention of disease of the blood and bone marrow as well as the immunolgic, hemostatic (blood clotting) and vascular systems
What is the function of RBCs in the body?
they carry oxygen to tissue which helps with perfusion
RBC disorders are problems that…
impair production of RBCs (either too little or too much), impaired function (for instance with SCD not enough functional Hgb to carry enough O2), and/ or abnormal destruction of RBCs
Conditions that cause low blood oxygen/ sickling
- hypoxia
- dehydration
- infection
- venous stasis
- pregnancy
- alcohol consumption
- high altitudes
- low or high environmental or body temperatures
- acidosis
- strenuous exercise
- emotional stress
- anesthesia
is when red blood cells, which are usually round and flexible, become hard and shaped like a crescent or a “sickle”; this happens because of a change in the hemoglobin, the protein inside red blood cells that carries oxygen; a change in the hemoglobin causes RBCs to sickle
sickle cell disease
Cells that do not move through blood vessels easily
sickle-shaped cells
characteristics of sickled cells
- become hard and shaped like a crescent moon or a “sickle”
- don’t move through blood vessels easily
- get stuck and block blood flow
- break apart faster than normal cells
Sickled cells breaking apart and blocking blood flow leads to what?
leads to problems like pain, tiredness, and damage to organs because the body isn’t getting enough oxygen
A clumped masses of sickled RBCs block blood flow and perfusion is known as what?
vaso-occlusive event (VOE)
VOC
(sudden onset) weekly or even yearly, conditions causing local or systemic hypoxemia; can refer to the overall crisis involving any issues arising from the blockage of blood flow
VOE
results in impaired perfusion with long term effects to tissues and organs (organs most affected spleen, liver, heart, kidney, brain, joints, bones and retina); typically emphasizes the painful experience of sickle cell patients during an episode
VOE/ VOC
in practice- the terms are used interchangeably
:is the protein in red blood cells that carries oxygen throughout the body
hemoglobin
when oxygen levels are low, HbS causes red blood cells to change shape from their normal round form to a rigid, sickle shape; these sickle-shaped cells do not flow well through blood vessels, leading to blockages and various complications
the sickling of red blood cells
genetic risks for SCD
- family history
- ethnicity
Who is at a higher risk of having children with SCD?
individuals with a famliy history of SCD or sickle cell trait
SCD is more prevalent in which populations?
- individuals of African descent
- people from the Mediterranean region
- individuals from parts of the Middle East and India
SCD is inherited in what manner?
autosomal recessive
What is autosomal recessive?
a person must inherit 2 copies of the mutated gene (one from each parent) to have the disease
What is an individual considered if they inherit only one copy of the mutated gene but usually do not experience symptoms ?
a carrier (having sickle cell trait)
What is carrier status?
if both parents are carriers of the sickle cell trait, there is a 25% change with each pregnancy that their child will inherit two copies of the mutated gene and have sickle cell disease; a 50% chance that the child will be a carrier; and a 25% chance that the child will have normal hemoglobin
There are approximately how many people living with SCD in the US?
100,000
Repeated VOEs cause what to tissues and organs, especially the spleen?
long-term damage
the spleen acts as a what for your blood?
filter
what does spleen do?
filters the blood; recognizes & removes old, malformed, or damaged RBCs; fights infection
How does the spleen get damaged when filtering the blood?
the spleen will destroy sickled cells but in the process becomes damaged; it fights infection if it becomes damaged it can lead to infection/ risk of infection
What is the trigger for RBCs to sickle?
low oxygen conditions
Where does WBC formation occur?
in the soft tissue inside of your bones (bone marrow)
What are the 2 types of WBCs?
- T cells
- B cells
What is another name for white blood cells?
lymphocytes
What is another name for red blood cells?
erythroctye
where does t cells grow?
thymus
What does the T cells do?
- wipe out infected or cancerous cells
- direct the immune response by helping B lymphocytes to eliminate invading pathogens
What does the B cells do?
create antibodies
B cell aka?
B lymphocyte
T cell aka?
T lymphocyte
:a fist-sized organ found in the upper left side of your abdomen, next to your stomach and behind your left ribs; an important part of your immune system but you can survice without it; part of your lymphatic and immune system
spleen
What does the spleen do?
- it fights any invading germs in the blood (the spleen contains infection-fighting white blood cells/ antibodies)
- it controls the level of blood cells (WBC, RBC and platelets)
:small cells that form blood clots
platelets
What screens the blood and removes any old or damaged red blood cells?
spleen
If the spleen does not work properly, it may start to remove what? What can this lead to?
health blood cells; anemia- from a reduced number of RBCs; an increased risk of infection- from a reduced number of WBCs; bleeding or bruising - from a reduced number of platelets
Sickle Cell Disease Assessment Questions
History
* ask about previous crisises, what let to the crisis, severity, and usual management
* explore recent contact with ill people and activities to determine what caused the current crisis; ask about signs and symptoms of infection
* review all activities and events during the past 24hrs, including food and fluid intake, exposure to temperature extremes, drugs taken, exercise, trauma, stress, recent airplane travel, and use of alcohol, tobacco, or other recreational drugs
* ask about changes in sleep and rest patterns, ability to climb stairs, and any activity that induces shortness of breath
* assess the patient’s perceived energy level using a scale ranging from 0 to 10 (0=not tired with plenty of energy; 10= total exhaustion) to assess the degree of fatigue
What is the most common symptom of SCD crisis?
pain
Psychosocial Assessement: SCD
- often cognitive and behavioral changes are early indications of cerebral hypoxia from poor perfusion
- assess the patient and document mental status exam results
hematocrtit of patients with SCD
is low (between 20%- 30%) because of RBC shortened lifespan and destruction; the value decreases even more during a crisis or stress (aplastic crisis)
the reticulocyte count of SCD patients is
is high, indicating anemia of long duration
the total bilirubin of a SCD patient may be
high because damaged RBCs release iron and bilirubin
a SCD patient’s WBC count is
usually high, the elevation is r/t chronic inflammation caused by tissue hypoxia and ischemia
Why would patients with SCD have bone changes?
from a result of chronically stimulated marrow and low bone oxygen levels
Why may a SCD patient’s skull on an xray look like a “crew cut”?
bone surface cell destruction and new growth giving the skull a “crew cut” appearance
What may joints show on an xray of a SCD patient?
necrosis and destruction
What may ultrasonography, CT, positron emission tomography (PET), and a MRI show of a SCD patient?
soft-tissue and organ changes from poor perfusion and chronic inflammation
What do ECG changes show in a patient with SCD? specific ECG?
changes indicating cardiac infarcts and tissue damage; related to the area of the heart damaged
Echocardiograms may show what in SCD patients?
cardiomyopathy and decreased cardiac output (low ejection fraction)
Infection prevention in SCD patients:
- spleen plays a big role in immune system
- patient with scd at risk for infection
- watch closely for sepsis
- prophylactic antibodies often given
- recommend annual flu shot and pneumonia vaccine
- strict asepsis technique for all invasic procedures
- HANDWASHING!
What procedure is helpful for SCD patients?
transfusions with RBCs; must use cautiously to avoid iron overload from repeated transfusions; will see transfusions used pretty commonly with goal being to avoid stroke
what labwork would you expect to see ordered for a SCD patient?
- CBC
- H&H
- ABGs
H.O.P. (SCD interventions)
- Hydration
- Oxygenation
- Pain relief
Pain management for patients with SCD experiencing a acute crisis usually starts with what?
at least 48 hrs of IV pain meds
What percentage of SCD patients suffer from an opioid addiction?
2%-5%
Concerns about substance abuse can lead to what?
inadequate pain treatment in SCD patients, as they are often treated as drug seekers
CHECK YOUR BIAS!
SCD patient: pain management
Morphine and Dilaudid often given as
via IV or PCA pump
Avoid what concerning pain meds with SCD patients?
PRN schedule
A SCD patient is usually dehydrated when they come in for a crisis…
hydration through both oral and IV routes
Hydration is important in SCD patients experiening a crisis, what should we encourage?
the patient to drink fluids- water, juices
Because the SCD patiet is dehydrated their blood is…
what fluids are given?
usually hypertonic; hypotonic fluids given IV (usually 1/2 NS infused, often initial bolus at 250mL/hr & then reduced to maintenance rate)
SCD
In a crisis, IV intake should be at least what rate?
200mL/ hr
Why is oxygen given to a SCD patient during a crisis?
a lack of oxygen is the main cause of sickling; ensure the oxygen is humidified
Complementary and altenative therapies: SCD patients/ crisis
- keep the room warm
- use distraction
- relaxation techniques
- positioning
- warm soaks
chimerism
presence of donor cells
pain specific, sudden onset
VOC
most specific to organs (spleen, liver, heart, kidney, brain,, joints, bones, and retina), causes damage, which in turn means a loss of function
VOE
a reduction or deficiency of erythrocytes (RBCs) reflected as decreased Hct, Hgb, and RBCs
anemia
basically a reduction in the number of RBCs (amount of hemoglobin & hematocrit)
anemia
What is clinical indicator, NOT a specific disease?
anemia
can occur with many health problems/ chronic conditions
anemia
anemia can result from a variety of reasons such as:
- dietary
- genetic
- bone marrow disease
- excessive bleeding
key features of anemia
- pallor
- tachycardia (heart is compensating for lack of O2 to tissues)
- intolerance to cold
- brittle nails
- orthostatic hypotension
- dyspnea on exertion
- decreased O2 sat levels
- fatigue
- headache
- irritability, difficulty concentrating
causes of anemia:
Decreased production
* Iron deficiency
* vit b12 deficiency
* folic acid deficiency
* aplastic anemia
Destruction of RBC
* SCD
the most common form of anemia worldwide
iron deficiency anemia (microcytic)
Iron Def Anemia can result from..
blood loss, poor intestinal absorption, or inadequate diet
Who might you see Iron Def Anemia in?
- Crohn’s disease
- UC
- ETOH
with which anemia is the RBCs small (microcytic)
Iron def anemia (chronic)
symptoms of iron def anemia
- weakness
- pallor
- activity intolerance
- spoon-shaped, concave brittle nails
Any adult should be evaluted for abnormal bleeding especially where?
GI tract
indications of a GI bleed
- tarry stools
- nausea
- epigastric pain
- constipation
- heartburn (if esophagus is the source of the bleed)
treatment for iron def anemia
- increasing oral intake of iron from food sources
- oral iron supplements
- IM/ IV iron solution (Venofer)
- Procrit (Epoetin) - medication that stim the body to make more RBCs
iron rich food sources
- organ meat
- egg yolks
- kidney beans, beans
- leafy green veggies
- raisins
- beef, meats
- spinach
- peanut butter
- molasses
Patient teaching- Iron Def Anemia
- eat iron rich foods with Vit C for better absorption
- oral iron can stain teeth (use a straw)
Iron- IV piggyback
over 15 mins; push over 5 slow mins.
anaphalactic shock if given too quickly
Vitamin B12
cyanocobalamin
need to absorb iron and helps to make RBCs; def leads to anemia
Vitamin B12
Vitamin B12 Def Anemia (macrocytic)
lack of Vit B12 causes improper DNA synthesis of RBCs so they increase in size
macrocytic
large cell size
Who can you see Vit B12 def anemia in?
vegan dieters, diets lacking dairy; pts with gastric trouble (small bowel resection, chronic diarrhea)
Physical assessment of a patient with VitB12 def anemia will reveal what?
glossitis = smooth, beefy, red tongue along with fatigue, pallor, jaundice, and weight loss
develops slowly; can be mild or severe; pernicious anemia
Vit B12 def anemia
a type of B12 def (resulting from failure to absorb Vit B12 from intestinal tract); caused by lack of intrinsic factor (which is needed for intestinal absorption of Vit B12); can be mild or severe
Pernicious Anemia
used to be fatal before treatment became available
pernicious anemia
Pernicious anemia can occur with…
- small bowel resection
- tapeworm
- overgrowth of intestinal bacteria
patients with this type of anemia may also have parasthesia
pernicious anemia
What used to be used to diagnose Pernicious Anemia?
Schilling test (text)
What is used to diagnose Pernicious Anemia?
serum B12 test
s/s of paresthesia (neuro)
- numbness
- tingling
s/s of Pernicious Anemia
- paresthesia
- poor balance
- glossitis
- fatigue
- pallor
- jaundice
How is Vit B12 def anemia and Pernicious anemia managed?
increasing intake of foods with B12
Vit B12 rich foods
- animal proteins
- fish
- eggs
- nuts
- dairy
- dried beans
- leafy green veggies
Where do you most likely give a B12 injection due to its thick, viscousness?
ventralgluteal
Patients using begin B12 injections, how often?
weekly
folic acid def anemia s/s
- glossitis
- fatigue
- pallor
- jaundice
- weight loss
BUT NERVOUS SYSTEM functions remain NORMAL because folic acid def does not affect nerve function and wont result in PARESTHESIA
common causes of folic acid def anemia
- poor nutrition (malnutrition- chronic alcohol abuse)
- malabsorption (Crohn’s disease)
- drugs
what is the most common cause of folic acid def anemia?
poor nutrition
Which patient (folic acid def) has increased demands for folate, interactions with meds, poor intake?
elderly patients
diet for folic acid def anemia
- dark green leafy veggies
- liver
- yeast
- citrus fruits
- dried beans
- nuts
- breakfast cereals
- peas
- folic acid supplementation
aplastic anemia
is a deficiency of circulating RBCs because of the failure of the bone marrow to produce these cells
Aplastic Anemia results from:
- injury to the pluripotent cell/ master cells- injury r/t toxic agents, drugs, or viral infection
s/s of Aplastic Anemia
- severe anemia
- infection is a huge threat and common
Aplastic anemia often occurs with..
- leukopena
- thrombocytopenia
- when both happen together = pancytopenia
pancytopenia
- decreased RBCs
- decreased WBCs
- decreased platelets
treatment for aplastic anemia
- blood transfusions (only used if nec because if used unnec it increases risk of adverse reactin to blood)
- immunosuppressive therapy
- splenectomy (needed if spleen is enlarged- splenomegaly, that is either destroying normal RBCs or suppressing their development)
- stem cell transplant (most successful method of treatment; that doesnt respond to other treatments)
immunohemolytic anemia aka?
autoimmune hemolytic anemia
immunohemolytic anemia/ autoimmune hemolytic anemia
an abnormal immunity that results in the excessive destruction of RBCs membrane followed by accelerated RBC production. (basically, RBCs recongnized by the immune system as non-self and are attacked and destroyed)
Why does immunohemolytic anemia/ autoimmune hemolytic anemia happen?
unknown; idiopathic
s/s of immunohemolytic anemia/ autoimmune hemolytic anemia
pallor and extreme fatigue
immunohemolytic anemia/ autoimmune hemolytic anemia treatment
- steroids are 1st line of treatment (prednisone, dexamethasone)
- immunosuppressive chemo agents
- plasma exchange to remove antibodies
- possibly splenectomy
- balance rest and activity
Polycythemia Vera
too much of everything! / RED
type of blood cancer that causes the bone marrow to make too many/ excessive RBCs, leukocytes, and platelets; these excess cells thicken the blood causing flow to slow which causes a lot of problems (blood clots)
* technically defined as sustained increase in blood hemoglobin and hematocrit
* very rare
Polycythemia Vera- thick blood leads to..
stasis leading to thrombosis, leading to tissue hypoxia, leading to infact and necrosis, leading to damage to organs such as the heart, kidneys, other organs and tissues
s/s of Polycythemia Vera
- hypertension
- dark purple facial skin and mucus membranes
- distended veins
- intense itching
a malignant disease that progresses in severity over time
Polycythemia Vera (PV)
treatment of PV
apheresis or intermittent phlebotomy (where blood is removed from the patient and RBCs are removed/ decreased to decrease viscosity of the blood and then plasma is returned to the patient
how much should a PV patient drink in a day?
> 3L fluids daily
what meds are used for PV patients due to their thick blood?
anticoagulants/ blood thinners
what gauge needle would be used for a PV patient?
large bore, #14
another term for white blood cells?
leukocytes
WBCs
provide protection from infection and cancer developement
white blood cell disorder
leukemia
when WBCs are present in abnormal amounts (too much or too little) what is altered in some degree, placing the patient at risk for complications?
- immunity
- gas exchange
- clotting
leukemia
a type of cancer with uncontrolled production of immature WBCs in the bone marrow; as a result bone marrow becomes crowded with immature, nonfunctional cells and production of normal blood cells is greatly reduced
leukemia can be acute with sudden onset OR
chronic with a slow onset and symptoms that persist for years
How are leukemias classified?
by how quickly they progress and by the type of cell involved
Myeloid Leukemias
develop in WBCs known as neutrophils and monocytes that help fight bacteria or fungal infections
Lymphocytic Leukemias
develop in B lymphocytes, T lymphocytes or natural killer cells that produce antibodies or other substances to fight infections
4 main types of leukemias
- AML Acute myelogenous leukemia
- ALL Acute Lymphocytic Leukemia
- CML Chronic Myelogenous Leukemia
- CLL Chronic Lymphphocytic leukemia
Acute Myelogenous Leukemia (AML)
most common form in adult onset
Acute Lymphocytic Leukemia (ALL)
most common in children onset
Chronic Myelogenous Leukemia (CML)
often in people 50 or older
Chronic Lymphocytic Leukemia (CLL)
most common chronic type
the exact cause of leukemia?
is unknown
What are involved in the development of leukemia?
many genetic and environmental factors
possible risk factors of leukemia
ionizing radiation (occupational exposure or previous radiation therapy), viral infection, exposure to chemicals (spas, pools, hairdressers, aerosals) and drug exposure, smoking and family history
ANT pneumonic to remember the 3 main problems or symptoms associated with leukemia
THINK: leukemia= numerous immature WBCs like ants in an ant colony
- Anemia r/t decreased hemoglobin
- Neutropenia leading to increased risk of infection
- Thrombocytopenia increases risk for bleeding
Risk for infection is ___ in leukemia.
HUGE
What is a major cause of death in the patient with leukemia?
infection
Death results from not only the disease condition (leukemia) itself, but what also?
the drugs used to treat leukemia like chemotherapy (which often leaves the patient neutropenic)
neutropenia
when a person has low level of neutrophils, which means the patient has trouble fighting off infections
neutrophils
a type of white blood cell; fight infection by destroying harmful bacteria and fungi (yeast) that invades the body; made in the bone marrow
drug therapy leaves cancer patients what? Often on what type meds?
neutropenic; antibacterial, antiviral, and antifungal drugs
What should neutropenic patients avoid?
- unpeeled fresh fruits and veggies
- raw or rare-cooked meat, fish and eggs
- fresh flowers or plants
- standing water
- contaminants (reverse isolations for patients, staff/ visitors mask up to protect patient)
Limit what with neutropenic patients?
visitors (no sick visitors or large crowds)
put a sign on the door of a neutropenic patient stating what?
Neutropenic Precautions (usually gloves and mask at minimum- for patient’s protection); protective isolation; aseptic technique; good handwashing
patients may be on what med to decrease yeast growth?
Fluconazole (Diflucan)
Continually assess Neutropenic patient for:
s/s of infection
* daily CBC with differential
* inspect mouth every shift for lesions or breakdown
* assess lung sounds for adventitous breath sounds
* assess urine for cloudiness
Neupogen
- given SubQ or IV- if needed
- a bone marrow stimulant that helps the body make WBCs
What is the earliest sign of infection in a neutropenic patient?
an elevated temperature
What standing orders should you have on a neutropenic patient?
blood culture at first onset of any temperature
HSCT
hematopoietic stem cell transplant/ bone marrow transplant
is a standard treatment for the patient with leukemia (also lymphoma, multiple myeloma, aplastic anemia, sickle cell disease and many solid tumors) who has a closely matched donor (tissue match not blood type) and who is in temporary remission after induction therapy
Hematopoietic Stem Cell Transplant/ bone marrow transplant (HSCT)
The process of a bone marrow transpant (HSCT) can take how long?
longer process- can take up to 36 days or longer
the process of HSCT/ bone marrow transplant goes like this… admission then what?
patient will go through chemo and radiation to wipe out their own bone marrow and then receive transplant
Why is the process of HSCT/ bone marrow transplant a time of great risk for infection?
they have no immune system
after how many days will engraftment occur?
14-21 days
14 days
engraftment
the successful take of transplanted cells
when successful engraftment occurs what will be present in the patient?
only donor cells
day zero
the day of transplant (T-0)
autologous transplant
use own stem cells; collect blood stem cells through process called apheresis
allogeneic transplant
use stem cells from a donor (such as a sibling); or from umbilical cord (parents choose to donate umbilical cord blood after birth)
bone marrow harvesting
procedure occurs in OR where marrow removed through multiple aspirations from the iliac crests; donors marrow will regrow within few weeks
bone marrow transplant occurs when?
after you complete the conditioning process
day zero the stem cells are infused into the patient’s body through what?
central line
the patient is — and the transfusion is —
awake, painless
It usually take a how many weeks before the number of blood cells in the body return to normal?
several weeks (14 days)
What are some possible complications of a bone marrow transplant (HSCT)?
- graft-versus-host disease (allogeneic transplant only)
- stem cell (graft) failure
- organ damage
- infections
- cataracts
- inferitility
- new cancers
- death
graft-versus-host disease
:condition occurs when the donor stem cells that make up your new immune system see your body’s tissues and organs as something foreign and attack them
malignant lymphomas
cancers of the lymphoid tissue with abnormal overgrowth of lymphocytes
growth occurs as solid tumors in lymphoid tissues scattered throughout the body, especially the lymph nodes and spleen, rather than in the bone marrow
malignant lymphomas
2 main types of malignant lymphomas
- Hodgkin’s Lymphoma
- Non-Hodgkin’s Lymphoma
Hodgkin’s Lymphoma
- can affect any age group, however more often seen in 2 age groups: teens/ young adults and adults in their 50-60’s
- cause is unknown
- one of the most treatable forms of cancer
- Reed-Sternberg cells are present
usually starts in a single lymph or in a single chain of nodes; nodes contain a certain type of cell called Reed-Sternberg cells
Hodgkin’s Lymphoma
marker for Hodgkin’s Lymphoma
Reed-Sternberg cells
Reed-Sternberg cells
:a specific type of cancer cell; marker for Hodgkin’s Lymphoma
s/s of Hodgkin’s Lymphoma
- painless swelling of lymph nodes in neck, armpits, or groin
- nodes do become painful after drinking alcohol
- persistent fever
- drenching night sweats
- unexplained weight loss
- itching
Dx of Hodgkin’s Lymphoma
biopsy of lymph nodes and Reed-Sternberg cells found
After dx of Hodgkin’s Lymphoma, staging is performed to determine what?
extent of the disease
Treatment regimen for Hodgkin’s Lymphoma
determined by extent of disease; staging process is very detailed/ thorough
Staging of Hodgkin’s Lymphoma usually includes?
- H&P exam, CBC, electrolyte panel, kidney and liver function tests, ESR, bone marrow aspiration and biopsy, CT of head and neck, and PET scan
treatment of stage 1 and 2 Hodgkin’s Lymphoma
external radiation of involved lymph node regions
-with more extensive diease, radiation and chemotherapy treatment of choice (chemp precautions- single use bathrooms…)
-if radiation to the pelvic area- leading to steriliity in males; possible sperm banking before treament
increased risks regarding treatment of stage 1 & 2 Hodgkin’s Lymphoma
infection, anemia, bleeding, severe n/v, skin problems at the site of radiation, constipation or diarrhea, steriliity, development of secondary cancer/ antoher form of cancer
Non-Hodgkin’s Lymphoma
includes all lymphoid cancers that do not have the Reed-Sternberg cell; cause is unknown but associated with H. pylori and Epstein Barr virus; incidence higher in patients with organ transplantation & HIV disease
Non-Hodgkin’s Lymphoma is not a single disease, but rather..
a group of diseases (divided into 30 types)
When is Non-Hodgkin’s Lymphoma diagnosed?
usually not dx until it has reached a more advanced stage
symptoms of Non-Hodgkin’s Lymphoma
several swollen glands (slow growing) to metastatic disease
Treatment options for Non-Hodgkin’s Lymphoma depend on?
type and stage of the lymphoma and other factors
treatment options for Non-Hodgkin’s Lymphoma
- chemo= main treatment
- immunotherapy includes monoclonal antibodies to attack a certain target
- radiation- external beam radiation/ localized radiation therapy
- a stem cell transplant (also known as a bone marrow transplant) lets doctos give higher doses of chemotherapy, sometimes along with radiation therapy
multiple myeloma
a cancer of plasma cells; it is a WBC cancer where plasma cells become cancerous and grow out of control
when myeloma cells are overproduced…
fewer RBCs, WBCs and platelets are produced (pancytopenia); leading to anemia and increased risk for infection and bleeding; also interferes with cells that help keep bones strong (tells osteoclasts to speed up dissolving bones)
multiple myeloma is more common in whom?
adults over age 65 and is more prevalent in African Americans
cause of multiple myeloma
unknown but possible risk factors include radiation exposure, chemical exposure and infection with specific strains of herpes virus
at time of dx of multiple myeloma, patient’s symptoms are?
asymptomatic but may describe having fatigue, bone pain, easy bruising, pathological fractures
blood work in patients with multiple myeloma
- increase in serum total protein
- kidney dysfunction
- increased calcium levels
dx for multiple myeloma made how?
by xray findings- bone will show that they look like swiss cheese
treatment for multiple myeloma
varies; depends on if patient is a candidate for stem cell transplant; can also see steroids, standard chemo; analgesics for pain/ bone pain
remains largely incurable even with treatment
multiple myeloma
hemophilia
- hereditary (x-linked recessive)
- 2 forms
hemophilia A
hemophilia B - no cure
a hereditary bleeding disorder with 2 forms; defect or absence in certain blood clotting factors
hemophilia
hemophilia A
classic hemophilia; deficiency of factor VIII; accounts for 80% of cases
hemophilia B
christmas disease; deficiency of factor IX; accounts for 20% of cases; named for 5 yr old boy 1st pt described
sometimes referred to as “the royal disease” because it affected the royal families of England, Germany, Russia, and Spain in the 19th and 20th centruries. Queen Victoria of England is believed to have been the carrier of Hemo B or factor IX. She passed the trait on to 3 of her 9 children. Hemo was carried through various royal families members for 3 generations after Victoria, then disappeared.
hemophilia
someone with hemophilia does not bleed —- than someone without hemophilia. However, the person with hemophilia will bleed —.
faster; longer
What should be monitored in patient with hemophilia?
excessive bleeding from minor cuts, bruises, or abrasions
joint and muscle hemorrhages can lead to ?
disabling long-term problems- may need joint replacement
patient with hemophilia may what easily?
bruise
what is a hemophilia patient at risk of after surgery?
prolonged and potentially fatal hemorrhage
of hemophiliac patients do not get medical attention in time/ factor medication, what are they at risk for?
compartment syndrome
What should a nurse educate a patient with hemophilia on?
- avoid injury as much as possible
- no contact sports
- avoid meds that promote bleeding
- avoid use of enemas
- maintain good nutrition
- maintain good dental hygiene
- teach how to apply direct pressure if bleeding does occur
what are hemophilia patients at risk for?
- intracranial hemorrhage
- prolonged nosebleeds
- bruises easily
- warm painful joints with decreased movement/ mobility
- GI bleed
- compartment syndrome
