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CHILDRENS > EXAM 3 HEM/ONC > Flashcards

EXAM 3 HEM/ONC Flashcards

1
Q

RBC norm values and description

A

4.5-5.5

indirectly estimates Hgb and reflects function of bone marrow

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2
Q

Hgb norm values and description

A

11.5-15.5

Can tell if the RBCs are carrying a lot/a little Hgb if you compare it to RBC count.

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3
Q

Hct norm values and description

A

35-45%

Percentage of RBCs that make up whole blood. Generally is 3x Hgb content

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4
Q

WBC norm values and description

A

4.5-13.5

more important to know differentials so you can see what type of infection you’re fighting.

Ex:
Neutrophils: bacterial
Eosinophils: allergens, parasites, cancer
Basophils: Contain histamine, heparin, and serotonin to help win fight
Lymphocytes: Make antibodies
Monocytes: Infantry of immune system

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5
Q

Platelet norm values and description

A

150-400

Can tell if pt can clot well or not

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6
Q

Normal lifespan of RBCs

A

120 days

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7
Q

At what well-child check is it appropriate to check hemoglobin

A

1 year old

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8
Q

A Hgb below __ is considered too low for children

A

10-11g/dL

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9
Q

What are the 3 classifications of anemias

A

Decreased RBC production

Increased RBC loss

Increased RBC destruction

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10
Q

Examples of Decreased RBC production

A

Nutritional deficiency or bone marrow failure

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11
Q

examples of Increased RBC loss

A

epistaxis, hemophilia, hypersplenism

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12
Q

Examples of Increased RBC destruction

A

Intracorpuscular (sickle cell, thalassemia, membrane deficits)

Extra corpuscular (chemotherapy, infection, immunization)

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13
Q

Symptoms of Increased RBC destruction

A

yellow eyes, dark urine, big liver

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14
Q

Symptoms of Increased RBC loss

A

hypotension, decreased peripheral pulse

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15
Q

Symptoms of Decreased RBC production

A

pica, systolic murmur

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16
Q

Why do you check for iron deficiency at specifically 1 year of age?

A

They wean from fortified bottles/cereals that are fortified with iron. They usually start to drink too much cows milk which makes them iron deficient and fat

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17
Q

how should a child take iron supplements

A

2-3 divided doses between meals with Vit C

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18
Q

Sickle Cell Anemia is a …..

A

hemoglobinopathy

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19
Q

The cause of Sickle Cell Anemia is

A

a Autosomal recessive disorder

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20
Q

Describe pathology and symptoms of sickle cell disease

A

Sickle cells stick to each other and cause blockages at bifurcations.

Sx include stroke, paralysis, pneumonia, pulm hypertension, atelectasis, heart failure, anemia, priapism, osteomyelitis, big liver/spleen, gallstones, necrosis of tissue that lost flow d/t blockage, blindness

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21
Q

How do you manage sickle cell disease

A

Prevent sickling
Rest and minimize energy expenditure
Hydration
Electrolyte replacement
Analgesia
Blood replacement
Antibiotics

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22
Q

What causes a Sickle Cell Crisis

A

Anything that increases body’s need for oxygen or alters transport of oxygen
Trauma
Infection, fever
Physical and emotional stress
Increased blood viscosity caused by dehydration
Hypoxia

to treat:
Rest to minimize energy loss
Hydration through oral or IV therapy
Electrolyte replacement
Analgesia for pain
Blood replacement for anemia
Antibiotics for infection

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23
Q

What are the 5 types of Sickle Cell Crisis

A

vaso-occlusive, splenic-sequestration, aplastic crisis, CVA, and acute chest syndrome

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24
Q

Describe vaso-occlusive type of Sickle Cell Crisis

A

Most common crisis
Painful
Stasis of blood with clumping of cell 🡪 microcirculation 🡪 infarction
S/S; fever, pain, tissue engorgement

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25
Q

Describe splenic-sequestration type of Sickle Cell Crisis

A

Life threatening: death can occur within a few hours
Blood pools in spleen
S/S: profound anemia, hypovolemia, and shock

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26
Q

Describe aplastic crisis type of Sickle Cell Crisis

A

Diminished production and increased destruction of RBCs
Triggered by viral illness or depletion of folic acid
S/S: profound anemia, pallor

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27
Q

Describe CVA type of Sickle Cell Crisis

A

Severe, unrelieved HA
Severe vomiting
Seizures
Behavioral changes
Weakness or inability to move
Unsteady gait
Slurred speech
Vision changes

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28
Q

Describe acute chest syndrome type of Sickle Cell Crisis

A

Severe chest, back or abd pain
Fever
Very congested cough
Dyspnea, tachypnea
Retractions
Declining O2 sats

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29
Q

What is Thalassemia

A

Anemia from defective synthesis of Hgb, structural impairment of RBCs, and shortened life of RBCs

Dx by visualizing Overabundance of erythrocytes found in the bone marrow

Affects mainly descendants of people living near the Mediterranean sea. Infants become symptomatic at 6 weeks (anemia/growth failure) and have low hgb and hct.

Bone marrow transplantation is potential cure

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30
Q

What are the 4 types of Thalassemia

A

Thalassemia minor: asymptomatic silent carrier

Thalassemia trait: mild microcytic anemia

Thalassemia intermediate: moderate-to-severe anemia plus splenomegaly

Thalassemia major (also known as “Cooley’s anemia”): severe anemia necessitating transfusions to survive

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31
Q

What is Hemosiderosis

A

excessive iron deposits- esp lungs and kidneys- r/t chronic transfusions

s/s: chronic fatigue, severe exercise limitation, growth failure

Treat with iron-chelating drugs such as deferoxamine (Desferal). Drugs bind excess iron for excretion by kidney

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32
Q

Hemosiderosis is a common complication of

A

Therapeutic Management of Thalassemia through excessive blood transfusions

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33
Q

What are the 2 types of Aplastic Anemia

A

Pancytopenia: simultaneous depression of all formed elements of the blood
-Profound anemia
-Leukopenia
-Thrombocytopenia

Hypoplastic anemia: profound depression of RBCs but normal white blood cells (WBCs) and platelets

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34
Q

What is the difference between primary and secondary aplastic anemia

A

Primary (congenital)
Secondary (acquired)

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35
Q

How do you treat aplastic anemia

A

Immunosuppressive therapy
Bone marrow transplantation

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36
Q

What is Hemophilia

A

A group of hereditary bleeding disorders that result from deficiencies of specific clotting factors

Mom carries gene (x-linked recessive)

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37
Q

What is the difference between Hemophilia A and B

A

Hemophilia A
“Classic hemophilia”
Deficiency of factor VIII

Hemophilia B
Also known as “Christmas disease”
Caused by deficiency of factor IX

Von Willebrand disease
Deficiency of von Willebrand factor and factor VIII

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38
Q

How do you Dx Hemophilia

A

History of bleeding episodes
Overt prolonged bleeding
Hemarthrosis (bleed into joint)
Ecchymosis
X-linked inheritance

Laboratory findings
Low levels of factor VIII or IX, prolonged partial thromboplastin time
Normal: platelet count, parathormone level, and fibrinogen level

39
Q

Therapeutic Management of Hemophilia

A

Replace missing clotting factors
Aggressive replacement therapy with factor concentrate
Home infusion

Desmopressin (DDAVP)
IV administration or nasal spray
Causes two to four times’ increase in factor VIII activity
Used for mild hemophilia

Aminocaproic acid
Prevents clot destruction

40
Q

Care Management of Hemophilia

A

Prevent bleeding
Safe environment
Dental hygiene
Recognize and control bleeding
RICE
Prevent the crippling effects of bleeding
Support the family and home care
Genetic counseling

41
Q

What is Immune Thrombocytopenia

A

An acquired hemorrhagic disorder characterized by:

Thrombocytopenia: excessive destruction of platelets

Purpura: discoloration caused by petechiae beneath the skin

Normal bone marrow with increased number of immature platelets or eosinophils

Usually acute but can become chronic if it lasts over 12 mo

Often follows upper respiratory or other infection

42
Q

What are the clinical manifestations of Immune Thrombocytopenia

A

Easy Bruising
-petechiae
-ecchymoses
-most often over bony prominences

Bleeding from Mucous Membranes
-epistaxis
-bleeding gums
-internal hemorrhage evidenced by the following:
-hematuria
-hematemesis
-melena
-hemarthrosis
-menorrhagia
-hematomas over lower extremities

43
Q

Management of Immune Thrombocytopenia

A

Primarily supportive:
IV immuno-globulin
Anti-D antibody

44
Q

What can Recurrent or severe episodes of nosebleeds mean

A

Vascular abnormalities, leukemia, thrombocytopenia, clotting factor deficiency diseases (von Willebrand disease and hemophilia)

45
Q

____ therapy prevents perinatal transmission of HIV

A

HAART

46
Q

HIV Virus takes over ______ lymphocytes

A

CD4+T

47
Q

Therapeutic management of HIV/AIDS

A

Antiretroviral drugs:
Slow virus growth
Prevent/treat opportunistic infections
Nutritional support
Symptomatic treatment

48
Q

What are clinical manifestations of HIV

A

Malnutrition, short stature, cardiomyopathy

49
Q

Name some acute reactions to blood transfusion

A

Hemolytic: the most severe, but rare

Sudden severe HA, chills, shaking, fever, N/V, red or black urine, tight chest

Febrile reactions: fever, chills

Allergic reaction: urticaria, pruritus, laryngeal edema

Air emboli: may occur when blood is transfused under pressure

Difficulty breathing, sharp pain in chest, apprehension

Hypothermia
Chills, decreased temp, irregular HR, possible cardiac arrest, Nausea diarrhea

50
Q

Name some delayed reactions to blood transfusion

A

-transmission of infection (jaundice, etc)
-hepatitis
-HIV
-Malaria
-Syphilis
-Bacterial or viral infection

51
Q

When both parents have sickle cell trait, what is the chance that each of their children will have sickle cell anemia?

A

25%

52
Q

What are some early signs of cancer in children

A

Fever and pain common in childhood, leading to easily missed problem
Unexplained loss of energy
Sudden vision changes
Excessive, rapid weight loss
anemia, firm and enlarged lymph nodes
ecchymosis, petechiae, spontaneous bleeding

53
Q

What Laboratory tests can help confirm the presence of cancer

A

CBC, LFTs, coagulation studies, urinalysis, Lumbar puncture, bone marrow aspiration, CT, MRI, PET, MIBG

54
Q

What are some ways to get ahead of side effects of cancer treatment

A

monitor neutrophil count to make sure it doesn’t go lower than 500/mm3

Keep in mind that Usual signs of infection and inflammatory response are limited

Prevention of infection is a priority so use prophylactic antibiotics and use

55
Q

When would you give a platelet transfusion to a cancer pt

A

Platelet transfusions generally reserved for active bleeding not responding to basic treatment measures

Repeated transfusions increase risk of sensitization and antigen formation

Teach to avoid activities that may cause injury, bike, skate boards, contact sports

56
Q

Name some Side Effects of Cancer Treatment

A

Hemorrhage, Anemia, N/V, Altered nutrition, mucosal ulceration, neurological problem’s, Hemorrhagic cystitis

57
Q

How do you decrease nausea and vomiting during cancer tx

A

Synthetic cannabinoids are being used in children

Administer antiemetic 30 minutes before chemotherapy begins and routinely for 24 hours after chemotherapy

58
Q

How do you monitor nutritional status of cancer patients

A

Monitor height, weight routinely, monitor prealbumin, transferrin and albumin

59
Q

What should a cancer patient try to eat

A

High protein, high calorie, full-fat rather than reduced fat options

60
Q

How do you prevent Hemorrhagic cystitis

A

Prevented with at least 1 ½ times recommended daily fluid needs
Encourage frequent voiding
Watch for dysuria or hematuria

61
Q

how long does it take hair to regrow after cancer treatment is complete

A

3 to 6 months

62
Q

Steroid use during cancer treatment can result in

A

Cushingoid appearance (moon face) so Avoid salt intake to reduce fluid retention and wear Loose-fitting clothes

63
Q

T/F: Cancer kids should still get their vaccines on time

A

F: Only the inactivated vaccines, not the Varicella/MMR

64
Q

What is the most common form of childhood cancer

A

Acute lymphoid leukemia (ALL)

more often in hispanic boys. might begin prenatally

65
Q

What is Leukemia

A

A broad group of malignant diseases of bone marrow and lymphatic system

Unrestricted proliferation of immature WBCs in the blood-forming tissues of the body

Liver and spleen are the most severely affected organs

Leukemia demonstrates the same neoplastic properties as solid tumors

Classifications are increasingly complex

66
Q

Describe the onset of leukemia

A

Can be acute or insidious onset
Well child incidental, or illness that they don’t seem to recover from, or could be presenting like other conditions (RA)

67
Q

Name the most common characteristic of leukemia

A

Although leukemia is an overproduction of WBCs, often acute form causes low leukocyte count

Greatly elevated immature cells, or blasts

Immature cells do not attack and destroy normal blood cells

Cellular destruction takes place by infiltration and subsequent competition for metabolic elements

68
Q

Describe the cycle of leukemia

A

Bone marrow makes too many WBC blasts (babies) which never mature and become helpful but compete for the same resources other cells need. Eventually the baby WBCs take up so much nutrition that the bone marrow can’t make cells anymore d/t lack of nutrients necessary to manufacture. This results in:
-anemia (No RBCs)
-infection (no mature WBCs)
-bleeding (no platelets)
Then your bones weaken and start to fracture. This results in
-bone pain
-fever
-pallor
-fatigue
-hemorrhage
-joint pain

69
Q

Name the sites of disturbance for leukemia pts.

A

Spleen, liver, and lymph glands demonstrate infiltration, enlargement, and fibrosis

CNS all messed up:
Cranial nerves
Spinal nerves

70
Q

How do you definitively Dx Leukemia

A

Bone marrow aspiration or biopsy.

Once Dx, do a lumbar puncture to evaluate central nervous system (CNS) involvement

71
Q

What places in the body are considered “sanctuaries” for leukemic cells?

A

CNS and testes

72
Q

What factors influence the prognosis of a child with leukemia

A

Age and WBC count at diagnosis, CNS involvement, testicular involvement, Down syndrome, sex, race and ethnicity, and nutritional status; cell characteristics; response to initial treatment

73
Q

What are the Four types of standard treatment for leukemia

A

Chemotherapy, radiation therapy, chemotherapy w/stem cell transplant, and targeted therapy (TKIs, monoclonal antibodies, proteasome inhibitor therapy)

74
Q

What are the Three phases of therapy

A

remission induction (4-5 weeks), consolidation/intensification, maintenance

75
Q

What are the four standard treatments for cancer

A

chemotherapy, radiation therapy, chemo w/ stem cell transplant, and targeted therapy (tyrosine kinase inhibitors/TKI)

76
Q

How do you determine complete remission

A

presence of less than 5% blast cells in the bone marrow and no detectable abnormal blood cells in the extramedullary sites

77
Q

Describe CNS prophylactic therapy

A

Used in high risk children to reduce the risk of leukemic cells taking over the CNS

78
Q

Describe Reinduction after relapse

A

Each relapse means poorer prognosis

Testes are resistant to chemotherapy and may lead to relapse

Relapse in testes leads to intensive chemotherapy and irradiation

79
Q

Describe Bone marrow transplantation

A

Used in both ALL and AML

80
Q

What are the two types of lymphomas

A

Hodgkin disease
More prevalent among children 15 to 19 years of age

Non-Hodgkin Lymphoma
More prevalent among children <14 years of age

81
Q

Describe HODGKIN DISEASE

A

Affects LYMPH NODES more than lymph itself.

Pt is positive for STERNBERG-REED CELLS in lymph nodes

Sx: giant neck lymph nodes, recurrent cough

Not as common in children. Herpes (EBV) thought to play a part. Often metastasizes to spleen, liver, bone marrow, lungs, and other tissues. STAGING IS IMPORTANT

82
Q

Describe NON-HODGKIN LYMPHOMA

A

Occurs more frequently in children than Hodgkin disease

Disease usually diffuse rather than nodular. Cell type undifferentiated or poorly differentiated. Occurs early, often, and rapidly

STAGING NOT AS IMPORTANT.

Sx more like leukemia

Use aggressive chemo to fix

83
Q

What is the Most common solid tumor in children

A

brain tumor

84
Q

Name some clinical manifestations of a brain tumor

A

Hydrocephalus
Headache
Vomiting
Nystagmus
Ataxia
Dysarthria
Diabetes insipidus
Growth failure

85
Q

What 3 things do you need to asses after surgery to remove a brain tumor

A

assess pupils = ICP changes

Bleeding – assess dressing and mark

Colorless= CSF and needs to be reported immediately

86
Q

What is the most common cancer diagnosed in infancy

A

NEUROBLASTOMA

87
Q

Describe a NEUROBLASTOMA

A

Originate from embryonic neural crest cells

Primary site is in abdomen
(Firm, nontender, irregular mass in the abdomen)
BUT CAUSES
Neurological impairment
Respiratory obstruction
Paralysis
Periorbital edema
Exophthalmos
Supraorbital ecchymosis

To treat you remove as much as you can surgically, cover the cavity in radiation, and finish with chemo.

88
Q

most common type of bone tumor

A

Osteosarcoma

89
Q

Describe Osteosarcomas

A

Most are curable

Sx: localized bone pain, palpable mass on bone, limping/can’t hold heavy objects

Likely arises from bone-forming mesenchyme
Found mostly in lower extremities near growth plate

Usually remove affected area for biopsy, remove affected bone and replace with prosthetic, use chemo to reduce tumor size. If they can’t salvage an entire bone, they’ll amputate.

90
Q

Describe a EWING SARCOMA

A

Arise in marrow spaces

Originates in shaft of long and trunk bones
Ex: Pelvis, femur, tibia, fibula, humerous, ulna, vertebrae, scapula, ribs, skull

Therapeutic management
Limb salvage or amputation depending on situation
Radiotherapy
Chemotherapy

91
Q

If a limb is irradiated to treat bone cancer, you should…

A

Wear loose fitting clothes over irradiated area

Protect irradiated area from sunlight and sudden temperature changes

92
Q

Most common kidney tumor of childhood

A

WILMS’ TUMOR

Painless swelling or mass in abdomen
Firm, nontender, confined to one side, deep within flank area
Often discovered during routine hygiene cares

Surgery usually occurs within 24 to 48 hours of diagnosis. DO NOT PALPATE THE TUMOR. Handle infants carefully. Manipulation may disseminate the cancer

If unfavorable histology, prognosis is poorer
Survival rates highest among all childhood cancers

93
Q

Describe a RETINOBLASTOMA

A

Whitish “glow” in the pupil

Staging done with ophthalmoscope and then surgically removed AND/OR Surgical implantation of iodine-125 for radiation
Photocoagulation

Long-term concern is secondary tumors

94
Q

Describe some long-term effects of cancer treatment

A

Radiotherapy can decrease growth in bones or reproductive organs

Treatments may cause hormonal dysfunction

Growth and Tanner stages are important to document

Assess all body areas for abnormalities based on treatment used

CHILDRENS (8 decks)

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