Class 19 review Flashcards
Is primary polycythemia preventable?
No
How is secondary polycythemia generated?
Any source of hypoxia, maintaining adequate oxygenation may prevent problems
Leukemia definition
A broad term given to a group of malignant diseases that affect the blood and blood-forming tissues of the bone marrow, lymph system, and spleen
Acute leukemia is characterized by…
The development of immature hematopoeitic cells
Chronic leukemias involve…
More mature forms of WBCs, and the disease onset is more gradual
The 4 types of leukemia
Acute Myelogenous Leukemia (AML)
Acute Lymphocytic Leukemia (ALL)
Chronic Myelogenous Leukemia (CML)
Chronic Lymphocytic Leukemia (CLL)
Acute Myelogenous Leukemia (AML)
- 80% acute leukemias in adults
- Abrupt and dramatic
- Serious infections can result and abnormal bleeding
- Uncontrolled proliferation of myeloblasts
- Normal hematopoeitic cells are replaced by leukemic myeloblasts - can also infiltrate other organs
Acute Lymphocytic Leukemia (ALL)
- Most common leukemia in children
- Immature small lymphocytes proliferate in bone marrow
- Most are B-cell origin
- Fever, bleeding can start abruptly
- Progressive weakness, fatigue, and bleeding can also occur over time
Chronic Myelogenous Leukemia (CML)
- Excessive development of mature neoplastic granulocytes
- Move into the blood and infiltrate liver and spleen
- These blood cells contain the Philadelphia chromosome
- Chronic stable phase → acute aggressive phase called blastic phase
Chronic Lymphocytic Leukemia (CLL)
- Most common in adults
- Production of functionally inactive but long-lived mature lymphocutes
- Usually B cells
- Lymphocytes invade liver, spleen, and bone marrow
- This invasion causes enlarged nodes, increased infection, and pressure on organs due to lymph node enlargement
Laboratory findings of acute myelogenous leukemia (AML)
- Low RBC count, Hb, Hct
- Low platelet count
- Low to high WBC count
- High LDH
- Hypercellular bone marrow
Laboratory findings of acute lymphocytic leukemia (ALL)
- Low RBC count, Hb, Hct
- Low platelet count
- Low, normal, or high WBC
- High LDH
- Hypercellular bone marrow
Laboratory findings of chronic myelogenous leukemia (CML)
- Low RBC count, Hb, Hct
- High platelet count early, lower count later
- Increased neutrophils
- Normal lymphocytes
- Normal or low monocytes
Laboratory findings of chronic lymphocytic leukemia (CLL)
- Mild anemia
- Thrombocytopenia with disease progression
- Increase WBC, lymphocytes
What is a lymphocyte?
A type of white blood cell that is part of the immune system. Two types: B and T cells. The B cells produce antibodies that are used to attack invading bacteria, viruses, and toxins.
Laboratory findings of pancytopenia
Low RBC, Low Plt, Low WBC
Symptoms of leukemia
Weight loss, chills, night sweats
Fatigue with progressive weakness
Dyspnea, cough
Nausea, vomiting
Hematuria, decreased UO
Diarrhea, dark or bloody stools
Easy bruising
Headaches, confusion
Polycythemia description
Hyperviscosity and hypervolemia
Polycythemia complications
Hypertension
Vessel distension
Impaired blood flow
Circulatory stasis
Thrombosis
Tissue hypoxia
Clinical manifestions of polycythemia
Headache, vertigo, dizziness
Pruritus exacerbated by a hot bath
Painful burning and redness of the hands and feet
Plethora - ruddy complexion
Angina, HF, intermittent claudication
Thrombo-phlebitis
Etiology of leukemia
No single causative agent
A combination of factors:
Chromosomal changes
Chemical agents
Proto-oncogenes
Regulate normal cellular processes such as promoting growth “turn on” replication in the cell
Tumour supressor genes
Suppress growth
Acute Myelogenous Leukemia (AML) Clinical Manifestations
Weight loss, malaise
Bone pain
Leukocytosis on bloodwork
Increased uric acid, potassium, LDH on bloodwork
Gout
Types of chemotherapy for leukemia
Intensification therapy
Consolidation therapy
Maintenance therapy
Why are multiple drugs used to treat leukemia?
Decrease drug resistance
Minimize drug toxicity
Interrupt cell growth at multiple points in the cell cycle
Cytotoxic agents (chemotherapy) MOA and types
Drugs that kill cells directly by damaging DNA or interrupting mitosis
Cell-cycle non-specific
Cell-cycle specific
Bone marrow suppression
Myelosuppression reduces number of neutrophils, platelets, and erythrocytes
Neutropenia definition
“weakened immune system” increases incidence and severity of infection. Typically begins a few days after dosing, and the nadir occurs 10-14 days, with neutrophils recovering about a week later
Nadir
Lowest neutrophil count (peak of the bone marrow suppression caused by cancer treatment)
Thrombocytopenia
Low platelet count increased risk for serious bleeding
Anemia
Reduced red blood cells. Less common than neutropenia or thrombocytopenia as RBCs lived for 120 days allowing erythrocytes to recover before they drop too low
Collaborative management for bone marrow suppression
Monitor lab values like neutrophil count. Must be returned to normal before next dose. Assess the need for platelet or RBC transfusions
Monitor for signs or symptoms of infection: fever is earliest
Educate on infection control
Monitor for signs and symptoms of blood loss
Avoid use of blood thinners
Hematopoietic drugs: promote the function of cells in the bone marrow
Digestive tract injury
Damages the epithelial lining of the GI tract
Stomatitis
Inflammation of the oral mucosa, typically develops a few days after chemotherapy has begun and may persist for weeks. Can cause severe pain
Diarrhea
Inflammation of intestines, rectum, and anus. Impairs absorption of fluid and other nutrients
Collaborative management for digestive tract injury
Pain management:
Mild: oral mouthwash with topical anesthetic (lidocaine) mouthwash and antihistamine (diphenhydramine)
Severe: systemic opioid
Bland, calorie dense diet
Good oral hygiene
Monitor for and treat oral yeast infection
Treat (loperamide) and support patients care with diarrhea
Monitor fluid and electrolyte imbalances
Collaborative management of nausea and vomiting
Treat with antiemetics: Ondansetron (Zofran), dimenhydrinate (Gravol)
Monitor fluid and electrolyte imbalances, treat accordingly
Encourse PO (food and fluid) intake
Other toxicities of cancer treatment
Alopecia: reversible hair loss resulting from injury to hair follicles
Reproductive toxicity: to a developing fetus, ovaries, testes and cause atrophy of the vaginal epithelium. Fetus is most impacted. Can cause irreversible sterility in males
Carcinogenesis drug induced damage to DNA. May take years for secondary cancer to appear
What does petechiae tell us?
Something has happened to the clotting of blood
LDH
Lactate dehydogenase hormone. Represents the increase in the cellular damage
