Hematologic part 3 Flashcards
What does Lymphoma mean?
Where does it travel to?
Neoplasm or cancer from lymph nodes
Travels into lymph tissue such as spleen, GI, liver, and bone marrow.
Two categories of lymphoma:
Hodgkin
Non-Hodgkin
What is Hodgkins Lymphoma?
Cancer of the lymph nodes due to Reed Sternberg cells
How common is Hodgkins Lymphoma and who will we see it in?
Hodgkins is rare.
Will see it in those on immunosuppressants and veterans or farmers that were exposed to Agent orange.
How does Hodgkins Lymphoma spread?
How does dx go?
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
What age will you start to see Hodgkins Lymphoma?
Earlys 20’s. After 50
What assessment do you want to be doing to catch Hodgkins?
Check the clavicular chains of the cervical, supra-clavicular, & mediastinal for enlarged lymph nodes that are painless and usually on one side of neck.
What is the viral component associated with Hodgkins lymphoma?
Hodgkins patients test positive for Epstein - Barr
What type of symptoms will be present for a patient whose hodgkins has infiltrated other parts of the body?
Compression in nature.
- numbness and tingling for patients with a tumor on the spine for example
How common are B symtptoms in Hodgkins?
40% more common
- flu symptoms
What do they try to eliminate when diagnosing hodkins?
Infectious causes
Diagnosis of hodgkin details?
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
Early stage of Hodgkin Lymphoma treatment
Short course of chemo of 2-4 months
Followed by radiation treatment to the specific areas
Treatment for advanced stage of Hodgkins
Combo chemo with ABVD
- Adrimycin, Blenoxane, Velban, DTIC
Where is possible secondary malignancy that can develop with Hodgkins?
Lung and breast cancer
Acute Myeloid Leukemia (AML)*****
What is Non-hodgkin Lymphoma?
New cells grow into lymph tissue from a single clone lymphocyte that is malignant
What is the nature of infiltration or spread with Non-hodgkins?
Non-Hodgkins spread is unpredictable. Can go in lymph nodes and nonlymph tissue.
What type of health history is common with Non-Hodgkins patients
Immunodeficiencies & autoimmune disorders
Previous cancer treatment
Organ transplant
Viral infections
Agent Orange exposure or chemicals like pesticides
Really a patient who is already sick.
Most common symptoms of Non-hodgkins?
Lymphadenopathy - enlarged lymph nodes
When is Non-hodgkins typically diagnosed?
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
What is the usual occurrence that takes people in for Non-Hodgkins?
CNS compression symptoms
Diagnostic tests used for Non-hodgkins
CT
PET - shows metabolic activity of tumors
Bone marrow biopsy
CSF analysis if there’s CNS involvement
Localized Non-Hodgkins treatment?
Radiation
What is the aggressive combination chemo for Non-Hodgkins?
Monoclonal antibody
Treatment for Non-Hodgkins patients with CNS involvement
Intrathecal chemo or cranial radiation
Why are patients with cancers at risk for DIC?
The affect the cancer has on the blood cells and platelets
What will platelets be like if a patient is at risk for DIC
Decreased platelet count
If a patient has DIC, what happens to PT?
Increased PT
If a patient has DIC, what happens to PTT?
Increased PTT
What will the D-dimer lab be like if the patient has DIC?
Increased
DIC labs to know
Decreased platelets
Increased PT
Increased PTT
Increased D-dimer
DIC symptoms
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)
When working up for DIC, what other disease is similar?
Menningitis
What is the worry with DIC?
Mortality from ischemic thrombosis and bleeding out from hemorrhage
How do we treat and manage DIC?
Treat what caused the DIC
Oxygen
Fluids
Electrolyte management
How can Cryoprecipitate help DIC?
What factors?
It replaced fibrinogen and helps clotting factors V and VII.
- if these factors are in deficit, they have increased risk of bleeding out
What does FFP or fresh frozen plasma do for DIC?
The FFP can replace other factors and volume
