Hematology and Oncology Flashcards
2 Components of Blood
Plasma and Blood Cells
Function of plasma
Liquid component
Contains coagulation factors to stop prolonged bleeding
Function of RBC
Carry oxygen
Function of WBC
Fight infection
Function of platelets
Stop immediate bleeding
Two ways to classify anemias
- pathophysiology
- size of RBCs
What are the pathological approaches to anemia?
- decreased production
- hemolysis
- blood loss
- sequestration
What causes decreased production of RBCs/reticulocytes? (4)
- marrow infiltration/injury
- nutritional deficiency
- erythropoietic deficiency
- ineffective erythropoiesis
Why is reticulocyte count high in hemolytic anemias/blood loss?
Compensatory mechanism
Responds to destruction by creating even more
Who is iron deficiency most prevalent in and why?
Children: increased iron needs for growth + picky eaters
Women: blood loss through menstruation
4 Factors in Iron Deficiency Anemia?
- excessive loss
- inadequate intake
- increased demand
- impaired absorption
Iron rich foods
Red meats, fish, eggs, tofu, lentils, green leafy, iron fortified cereals
Why should milk intake be limited?
poor iron availability, displaces iron rich foods
When can cow’s milk be introduced
3.25% cows milk should not be introduced until 12 months
Side effects of iron supplementation
constipation, tarry stool, teeth staining
What can iron deficiency anemia lead to?
long term issues in brain functioning related to decreased oxygen supply to the brain
Signs and Symptoms of low platelets
- excessive bruising
- epistaxis
- bleeding of gums/teeth
- petechiae
- purpura
Petechiae
Pinpoint hemorrhages occurring on the body that do not blanch to pressure
Purpura
Larger purplish areas of hemorrhage in which blood collects under the tissues
Causes of low/dysfunctional platelets
- Infections
- Idiopathic thrombocytopenia purpura (most common) – immune reaction causing platelets to be low
- Disseminated intravascular coagulation (DIC)
- Medications (NSAIDS, etc.)
- Familial inherited platelet disorders
What type of bleeding characterizes coagulation disorders vs platelet disorders?
OOZING/PROLONGED
coagulation factors: stop prolonged bleeding
platelets: stop immediate bleedings
Most important nursing management points for children with coagulation disorders
Prevent bleeding by instructing child to avoid activities with high potential for injury
Bleeding times are _______ when a clotting disorder in present
Prolonged
Most common coagulation disorders
Von Willebrand
Hemophilia A and B
Neonatal pattern of bleeding
- heel poke
- umbilical cord
- circumcision
- CNS bleeds r/t birth trauma
Infant pattern of bleeding
- frenulum from feeding
- tongue/dental as teething
- soft tissue/forehead as starting to walk
- immunization
Children/adult pattern of bleeding
- hemoarthrosis
- muscle bleeds
- soft tissue bleeds
Neutrophil function
Kill bacteria, fungi, debris
Monocyte function
clean up damaged cells
Eosinophil function
Kill parasites, cancer cells, and involved in allergic response
Lymphocyte function
Fight viruses and make antibodies
Basophil function
Involved in allergic response
When are you most worried about low WBC levels?
usually would indicate no infection present but
worry when there is congenital/autoimmune/cancer reasons
High WBC levels can indicate
- infection
- inflammation
- tissue damage
- leukemia
Origin of pediatric vs adult cancers and difference in what it tends to effect
Ped: embryonic mesodermal germ layer - affect tissues
Adult: epithelial - affect organs
Growth and responsiveness of pediatric cancer compared to adult
Grow/spread more quickly but are more responsive to treatment
Why is childhood cancer not preventable as it is in adulthood?
Not based on lifestyle or environmental factors
Most common pediatric cancers
- leukemia
- CNS tumors
- lymphoma
Cure rate of pediatric cancer
Today cure rate is about 85% (4% in 1962)
What is the most common malignancy of childhood?
Leukemia - acute lymphoblastic leukemia
Define leukemia and what organs are involved
WBC stem cell (BLASTS) growing out of control – do not respond to body’s stop signals
Involves the bone marrow (where blood is made), lymph nodes, and the spleen.
When do individuals start to experience symptoms of leukemia and what are they?
When the immature white blood cells, called blasts, begin to crowd out other healthy cells in the bone marrow, the child experiences the symptoms of leukemia
– infections
– anemia
– bleeding
Define lymphoma and what are the 2 categories
Tumors of the lymph tissues (lymph nodes, thymus and spleen)
second most common group of cancer in children.
Hodgkins and Non Hodgkins
Duration of symptoms of leukemia/lymphomas
Usually a very short duration of symptoms weeks to few months
Age of occurence of lymphomas/leukemia
Usually 2-6 but can be any age
Clinical manifestations of leukemia/lymphomas are dependent on:
where infiltration occurs
3 categories of clinical manifestations of leukemia/lymphomas
- Constitutional symptoms (fever, chills, weight loss)
- Extramedullary infiltration (lymphadenopathy, gums inflamed, kidney or spleen involvement)
- Bone marrow infiltration: normal cells can’t grow
What occurs secondary to bone marrow infiltration/marrow failure?
Cytopenia
RBC cytopenia symptoms
Anemia!!
Weakness, fatigue and ischemia, SOB, exercise intolerance, pallor, tachycardia
WBC cytopenia symptoms
Neutropenia!!
Infections, fever, sepsis, death
Platelet cytopenia symptoms
Thrombocytopenia!!
Mucosal bleedings, petechiae, ecchymoses
IV hydration and medications are given to leukemia patients to prevent tumor lysis because
Breakdown of leukemia cells damaging to kidney
Signs and Symptoms of Pediatric Brain Tumors are dependent on
Location and size
Think ICP for symptoms
2 Main Regions of pediatric brain tumors
- Posterior Fossa (60%) - controls movement and baseline autonomic function
- Cerebral hemisphere (40%) - controls intellectual function
Pediatric Solid Tumors besides CNS in order of prevalence
- neuroblastoma
- wilms
3, bone (osteo and ewings)
- rhabdo
- retino
Bone tumours are most often diagnosed in _________, whereas soft tissue tumours occur in ________
adolescence
younger children
When is osteosarcoma most commonly seen
Often at the peak of growth (teenagers) in second decade of life when children are rapidly growing (age 10-25)
Where in the body is osteosarcoma commonly found?
Usually in the long bones (humerus, femur/tibia, and pelvis
Usually near the growth plates
Osteosarcomas usually have _______ at diagnosis to the _____ and _______
mets
lung
brain
Where is Ewing Sarcoma found
occurs primarily in the bone or soft tissue.
can occur in any bone, but is most often found in the extremities and can involve muscle and the soft tissues around the tumor site.
Age of occurence in Ewing Sarcoma
ages of 5 and 20
Where does rhabdomyosarcoma originate and what is the most common site?
originates in the soft tissues of the body, including the muscles, tendons and connective tissues
Head and neck most common site
can be anywhere including bladder, vagina, arms, legs and trunk
Rhabdomyosarcoma often occurs in ______ children
younger
What is the most common soft tissue sarcoma in childhood
Rhabdomyocarcoma
What is Wilm’s Tumor
Most common from kidney; malignant (cancerous) tumor originating from cells of the kidney
Most common site of metastasize for Wilms
Lungs
Where do neuroblastomas arise from
nerve tissue, often in adrenal gland, but any nerve tissue in the neck, chest or pelvis – usually centrally related.
How do children with neuroblastomas present
“racoon eyes”, “dancing eyes” opsiclonus myoclonus, diarrhea, high urine catecholamines
General treatments for pediatric cancer
- biopsy and surgery
- chemotherapy
- radiation
- stem cell transplant
- targeted therapies
Goal of surgery as cancer treatment
complete resection with clean margins but this is not always possible
Purpose of pathology and radiology following surgery as cancer treatment
look for residual tumour
Radiation Therapy: Often used for localized tumors or after surgery to eliminate remaining cancer cells.
What is Chemotherapy
Systemic drug treatment that works on different part of the cell cycle to kill cells or stop them from dividing
What causes the side effects of chemotherapy?
Affect rapidly growing cells like cancer cells AND normal cells that rapidly grow
SYSTEMIC
3 routes of chemotherapy administration
IV
Oral
Intrathecal
What is intrathecal chemotherapy used for
may be used to treat childhood ALL that has spread, or may spread, to the brain and spinal cord.
When used to prevent cancer from spreading to the brain and spinal cord, it is called central nervous system (CNS) sanctuary therapy or CNS prophylaxis.
Intrathecal chemotherapy is given in addition to chemotherapy by mouth or vein
Penetrate blood brain barrier to treat any disease of CNS
In preparation for chemo treatment, what is ordered in anticipation of toxicity?
– Cardiac: echocardiogram
– Renal: creatinine clearance (many medications are nephrotoxic)
– Pulmonary: CXR, CT Chest
– Tumor lysis and Blood counts: BW q4-24h
– Liver: LFTs
What monitoring is done for chemo treatment in anticipation of toxicity?
– Watching for tumor lysis (as chemotherapy kill cancer cells release contents into blood that can damage kidneys)
– SVC syndrome or mediastinal syndrome
Chemotherapy adverse effects + when can they be seen
- Bone marrow suppression (anemia, infection, bleeding) (day 7-10)
- mouth sores (day 2-3)
- nausea vomiting (immediate_
- decreased appetite
- weight loss
- constipation/diarrhea
- immunosuppression
- alopecia
- organ dysfunction
- infusion reaction
What is radiation therapy?
The use of ionizing radiation to break apart bonds within a cell causing cell damage and death – stops reproduction .
Can be more targeted than chemo
Problems with radiation therapy
cannot distinguish between malignant cells and healthy cells so effect on surrounding normal tissues too
once an area has been radiated, that area will no longer:
grow to develop
try not to radiate kids younger than 2-3
Radiation side effects are dependent on:
Which area you radiate
Radiation side effects
- lack of growth/development in radiation field afterwords
- increased risk of secondary cancer
- Fatigue, memory loss, developmental delay
- Nausea, vomiting, oral mucositis
- Myelosuppression
- Decreased bone and tissue growth
- Skin burn / loss of integrity at the site of irradiation.
- Organ dysfunction
How do newer targeted cancer therapies work?
Targeted therapies for certain genetic mutations or markers present in the tumour cells and not on other cells
Manipulation of patients own cells to target their own cancer cells
What are blasts and what do they indicate?
abnormal immature white blood cells (called blasts) multiply uncontrollably, filling up the bone marrow, and preventing production of other cells important for survival, namely red blood cells and platelets. This leads to infections, anemia and abnormal bleeding.
When do leukemia patients begin to experience symptoms and what are they?
When blasts begin to crowd out healthy cells in the bone marrow
- infections
- anemia
- bleeding
Immediate chemo side effects
nausea, vomiting, fatigue
Short Term Chemo Side Effects (first days to weeks)
hair loss, mouth sores, bone marrow suppression, changes in appetite/taste/smell
Mid Term Chemo Side Effects (weeks to months)
skin/nail changes, neuropathy, constipation/diarrhea
Long Term Side Effects of Chemo
fatigue, cognitive effects, emotional/psychological effects
What nutritional deficiencies lead to decreased EPO production?
iron, folate, B12
WBC count at Leukemia Diagnosis
HIGH
Everything else is suppressed
WBC Count looks at TOTAL WBC (mature and blasts) - if you look at differential mature would be low and blasts would be high
Normal hemoglobin
110-145
Normal platelets
140-440
Normal reticulocytes
19-73
Normal ferritin
4-20
Normal iron
10-29
Normal WBC
5-17.5
