Hematological Disorders Flashcards
- Focusing on leukemia and lymphoma.
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Is cancer of the lymph node tissue
Lymphoma
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Are usually cancers of the bone marrow
Is an uncontrolled proliferation of malignant lymphocytes that originate in the bone marrow. Is a type of cancer associated with mass production of immature WBCs, or blasts, in the bone marrow
Leukemia
Factors Associated with Leukemia
- Genetics
- Exposure to ionizing radiation/chemicals
- Congenital abnormalities
- Acute (sudden onset with short duration) and chronic (slower onset, persistent for years)
Signs & Symptoms
- Bleeding
- Petechiae/ecchymosis
- Fatigue, weakness
- Fever
- Flu-like symptoms
- Enlarged liver/spleen, anorexia, bone pain
Diagnostics
- CBC
- Bone marrow examination
> Bone marrow biopsy/aspiration (from sternum or iliac crest) - Lumbar puncture (LP) [have cells entered the CNS or spinal fluid?]
- MRI/CT
Bone Marrow Aspiration
- In a bone marrow aspiration, an MD uses a thin needle to remove a small amount of liquid bone marrow, usually from a spot in the posterior iliac crest. A bone marrow biopsy is often taken at the same time. The second procedure (the biopsy) removes a small piece of bone tissue and the enclosed marrow
Nursing Considerations
- Assess for pain, bleeding, and infection at the site
- Apply pressure to the site post-op and a pressure dressing
4 Types of Leukemias
- Acute Myelogenous (AML)
- Acute Lymphocytic (ALL)
- Chronic Myelogenous (CML)
- Chronic Lymphocytic (CLL)
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Is the most common type of leukemia in people 50+ and may have a hereditary component
CLL (Chronic Lymphocytic)
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Is a leukemia common in children with median age of 10 years old
ALL (Acute Lymphocytic)
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Is a leukemia that doesn’t usually occur in children; rather uncommon in that age group
- Typically affects older adults and is caused by a chromosomal mutation that happens spontaneously
CML (Chronic Myelogenous)
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Is the most common leukemia occurring in adults; “adult onset”
> Median age of 65
AML (Acute Myelogenous)
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An uncontrolled proliferation of lymphoblasts from lymphoid stem cells
* Most common in children
- Fever, fatigue, bleeding
- Treatment - chemotherapy (methotrexate [MXT]), BMT (bone marrow transplant)
> MXT used prophylactically due to CNS involvement; given intrathecally or used with cranial radiation
ALL
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- Most common adult onset leukemia; peak incidence is age 60
- Prognosis variable
- Fever, infection, fatigue/weakness, bleeding, bone pain [ ! biggest risk from death is from infection or bleeding]
- Chemotherapy, BMT; supportive treatment = blood transfusions, antibiotics
! Isolation Precautions due to risk of infection
AML
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- More common in older adults (M>F; >50 y.o.); survival 2-14 years
- Malignant B lymphocytes
> Cells are mature, immature, do not die so there is an overaccumulation happening - “B” symptoms, swollen lymph nodes
> Fever >101.5°, drenching sweats, weight loss
> If found early and symptoms are mild, may be no treatment; may just do supportive - Chemotherapy (for late-stage cases)
CLL
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Philadelphia chromosome; BCR-ABL gene
> Specific to section of DNA missing from chromosome 22 - missing in 90-95% of patients
- General malaise, anorexia, weight loss, and enlarged and tender, painful spleen and liver
> Median age 55-60; uncommon in those <20
> Life expectancy 3-5 years
Tyrosine kinase protein
* 3 stages (chronic/accelerated/blast)
- Treatment = Gleevec (Imatinib) or Dasatinib (Sprycel); chemotherapy (MXT) combo or BMT
CML
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Is an abnormal overgrowth of lymphocytes
- Primarily tumors of lymphatic system
What are the 2 types of?
Lymphoma
Hodgkin’s; non-Hodgkin’s lymphoma (NHL)
Lymphomas are tumors of the lymphoid tissue, thymus, bone marrow, or secondary tissue lymphoid, spleen, tonsils, intestinal lymph tissue
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Consists of all other cancers originating from lymphoid tissue
- Any lymphoid cancer that does NOT have Reed Sternberg cells
- Causes unknown; may be associated with viral infections, radiation, autoimmune disorders and toxic chemicals
- Incidence increases with age and average age is 50-60
Non-Hodgkin’s lymphoma
- There are more than 12 types but generally treated all the same
- Spreads throughout lymphatic in a less orderly way than Hodgkin’s; represents 3% of cancer deaths in the US
- Treatment determined by type and stage of disease and can include chemotherapy, radiation, BMT, or Interferon
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Is a cancer that starts in a single lymph node or a single chain of lymph nodes
> Has a relatively rare malignancy and pretty high cure rate; M>F; in teens and young adults there’s peak incidence; exact cause unknown
> Higher incidence in someone with a first-degree relative that have the disease or people who have chronic immunosuppressive therapy
- i.e., patient with a renal transplant; veterans exposed to agent orange or someone with a h/o EBV (are going to have a higher risk)
! Reed Sternberg cell
! s/s painless enlarged lymph node on neck; “B” symptoms
Hodgkin’s lymphoma
- First sign is a painless, enlarged lymph node on the side of the neck; unilateral. Is a single node in the beginning; node is firm, but not hard and painless
- If you have B symptoms and a painless lymph node, your prognosis is poorer than if you just had lymph node enlargement
- Is 1 of the most treatable types of cancers if found early
- First step is staging = Arbor staging criteria
- For diagnosis, a lymph node biopsy is performed; looking for presence of Reed-Sternberg cells
- Treatment will involve external radiation; radiation of the involved lymph node region, chemotherapy, or a combination of both
> One of the complications of radiation to this region is burns on the neck (can impact swallowing = consider feeding tube)
Hodgkin’s Lymphoma = Treatment
- Staging
- Chemotherapy
- Radiation
! Diagnosis = lymph node biopsy - presence of Reed Sternberg cells
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Is a reduced # of platelets below the average range of 150,000 to 450,000/mm3
> A count <150,000 puts the patient at risk for excessive bleeding (consider safety and institute fall precautions)
- Not a disease but rather a complication of other disorders
- Occurs as a result of decreased platelet production in the bone marrow or increased platelet destruction
> Antibodies that increase platelet destruction may be genetic, acquired, or medication-induced
Thrombocytopenia
Thrombocytopenia - Disorders
- Acute ___ may occur between ages __-__
- Chronic ___ occurs most often in women between ages __-__
ITP; 2-6
ITP; 15-40
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Is a hereditary disorder carried by females on the X chromosome and is the body’s inability to appropriately clot; leads to excessive bleeding as well
Hemophilia
___ usually follows a viral infection or immunization in children
Clinical manifestations = easy bruising and petechiae; bleeding from nose, gums, GI/GU tract; severe cases = bleeding in vital organs like brain (! fatal)
Management = treatment depends on the level of thrombocytopenia present
ITP
In adults, ITP can be medication-induced or secondary to an autoimmune disorder
In all cases, there is some sort of immune system dysfunction where anti-platelet antibodies are formed which increases platelet destruction rather than having the typical 7-day lifespan (may be destroyed in a matter of hours)
! If thrombocytopenia becomes more profound, treatment is with ___
glucocorticoids
- Risk of hemorrhage is a major complication with any condition that results in thrombocytopenia
- Severity of thrombocytopenia determines whether there’s a risk of spontaneous bleed; although the clinical manifestations initially are ecchymosis and petechiae as the platelet count decreases, normal activities like brushing your teeth or sneezing may induce spontaneous bleeding
