Hematologic part 3

Question 1

What does Lymphoma mean?

Where does it travel to?

Answer 1

Neoplasm or cancer from lymph nodes

Travels into lymph tissue such as spleen, GI, liver, and bone marrow.

Question 2

Two categories of lymphoma:

Answer 2

Hodgkin

Non-Hodgkin

Question 3

What is Hodgkins Lymphoma?

Answer 3

Cancer of the lymph nodes due to Reed Sternberg cells

Question 4

How common is Hodgkins Lymphoma and who will we see it in?

Answer 4

Hodgkins is rare.

Will see it in those on immunosuppressants and veterans or farmers that were exposed to Agent orange.

Question 5

How does Hodgkins Lymphoma spread?

How does dx go?

Answer 5

Originates in a single node and then spreads along the lymphatic system.

It can take multiple biopsies to find those Reed sternberg cells so they’ll do a lot

Question 6

What age will you start to see Hodgkins Lymphoma?

Answer 6

Earlys 20’s. After 50

Question 7

What assessment do you want to be doing to catch Hodgkins?

Answer 7

Check the clavicular chains of the cervical, supra-clavicular, & mediastinal for enlarged lymph nodes that are painless and usually on one side of neck.

Question 8

What is the viral component associated with Hodgkins lymphoma?

Answer 8

Hodgkins patients test positive for Epstein - Barr

Question 9

What type of symptoms will be present for a patient whose hodgkins has infiltrated other parts of the body?

Answer 9

Compression in nature.

- numbness and tingling for patients with a tumor on the spine for example

Question 10

How common are B symtptoms in Hodgkins?

Answer 10

40% more common

- flu symptoms

Question 11

What do they try to eliminate when diagnosing hodkins?

Answer 11

Infectious causes

Question 12

Diagnosis of hodgkin details?

Answer 12

Lymph node biopsy of the reed-sternberg cells Xray, CT of abdomen, chest, and pelvis to see how far the cancer has gone.
Bone marrow inspection
CBC for mild anemia

Question 13

Early stage of Hodgkin Lymphoma treatment

Answer 13

Short course of chemo of 2-4 months

Followed by radiation treatment to the specific areas

Question 14

Treatment for advanced stage of Hodgkins

Answer 14

Combo chemo with ABVD

- Adrimycin, Blenoxane, Velban, DTIC

Question 15

Where is possible secondary malignancy that can develop with Hodgkins?

Answer 15

Lung and breast cancer

Acute Myeloid Leukemia (AML)*****

Question 16

What is Non-hodgkin Lymphoma?

Answer 16

New cells grow into lymph tissue from a single clone lymphocyte that is malignant

Question 17

What is the nature of infiltration or spread with Non-hodgkins?

Answer 17

Non-Hodgkins spread is unpredictable. Can go in lymph nodes and nonlymph tissue.

Question 18

What type of health history is common with Non-Hodgkins patients

Answer 18

Immunodeficiencies & autoimmune disorders
Previous cancer treatment
Organ transplant
Viral infections
Agent Orange exposure or chemicals like pesticides

Really a patient who is already sick.

Question 19

Most common symptoms of Non-hodgkins?

Answer 19

Lymphadenopathy - enlarged lymph nodes

Question 20

When is Non-hodgkins typically diagnosed?

Answer 20

Later stages bc only 1/3 of people have any flu-like symptoms or B symptoms. They walk around with it and have no clue

Question 21

What is the usual occurrence that takes people in for Non-Hodgkins?

Answer 21

CNS compression symptoms

Question 22

Diagnostic tests used for Non-hodgkins

Answer 22

CT
PET - shows metabolic activity of tumors
Bone marrow biopsy
CSF analysis if there’s CNS involvement

Question 23

Localized Non-Hodgkins treatment?

Answer 23

Radiation

Question 24

What is the aggressive combination chemo for Non-Hodgkins?

Answer 24

Monoclonal antibody

Question 25

Treatment for Non-Hodgkins patients with CNS involvement

Answer 25

Intrathecal chemo or cranial radiation

Question 26

Why are patients with cancers at risk for DIC?

Answer 26

The affect the cancer has on the blood cells and platelets

Question 27

What will platelets be like if a patient is at risk for DIC

Answer 27

Decreased platelet count

Question 28

If a patient has DIC, what happens to PT?

Answer 28

Increased PT

Question 29

If a patient has DIC, what happens to PTT?

Answer 29

Increased PTT

Question 30

What will the D-dimer lab be like if the patient has DIC?

Answer 30

Increased

Question 31

DIC labs to know

Answer 31

Decreased platelets
Increased PT
Increased PTT
Increased D-dimer

Question 32

DIC symptoms

Answer 32

Petechia
Bleeding of gums or nose - check membranes
Foley bleeding
Prolonged bleedings
Ecchymosis
Hemorrhage into subcutaneous tissues that is purple
Oozing from multiple sites

(think, what would you assess for patients on blood thinners)

Question 33

When working up for DIC, what other disease is similar?

Answer 33

Menningitis

Question 34

What is the worry with DIC?

Answer 34

Mortality from ischemic thrombosis and bleeding out from hemorrhage

Question 35

How do we treat and manage DIC?

Answer 35

Treat what caused the DIC
Oxygen
Fluids
Electrolyte management

Question 36

How can Cryoprecipitate help DIC?

What factors?

Answer 36

It replaced fibrinogen and helps clotting factors V and VII.
- if these factors are in deficit, they have increased risk of bleeding out

Question 37

What does FFP or fresh frozen plasma do for DIC?

Answer 37

The FFP can replace other factors and volume