Heme Flashcards
what is thrombocytosis
too many platelets.
Thrombocyte range
thrombocytopenia
When prolonged bleeding
Spontaneous hem
Infusion
Cancer patients infusion?
150000-400000
Less than 150000
50,000
20,000
10,000
20,000
What are the mature and immature WBC called
Bands Segs
About
Neutrophils
Lymphocytes
Monocytes
Eosinophils
Basophils
N- Acute inflam, bacteria, phagocytosis mature/immature shift to the left
L- B and T cells
M- Macrophages eat big like RBC
E- Phagocytes, eat A/A some cancers
B-Inflam response
Absolute Neutrophil count
Determines if a pt is neutropenic or not
WBC count x % of neutrophils
Change percent to decimal
Neutropenic= <1000
<500 is severe
Thrombocytopenia precautions 12
No asprin
watch for petechia or nose bleed
nose bleed is hard to see how much
use small needles or no
black stool/vomit
dont blow nose hard
dont bend down with head lower than waist
prevent straining
shave only with electric razor
dont tweeze hair
soft tooth brush
ask about dental/mani/pedi
Leukopenia
granulocytopenia
White blood cell decrease
Neutrophils, eosinophils, basophils
What are reticulocytes range?
Immature RBC means someone has had a lot of bleeding. 0.5-2.5
Hem Range
M
F
Hct Range
M
F
RBC
M
F
HGB
m-14-18
F12-16
Hct
M-42-52
F-37-47
RBC
M-4.7-6.1X 10^6
F 4.2-5.4x10^6
Whats the anemia rule?
30 and 10
Less than 30 Hct
and 10Hgb we need to start watching
What is DIC 4
Abnormal response of clotting cascade
Not a diseases but caused by them
Must tx underlying issue
Accelerated clotting uses up clotting factors and platelets so we can’t clot anymore.
S/s of thrombus 9
Delirium, coma, integ, ischemia, ganggreen, oliguria, azotemia, ARDS, ileus
Lab results for DIC
Pt PTT aPTT thrombin time all increased
Fibrinogen and platelets all decreased
Antithrombin reduced
Fibrin split increased
Schistocytes present
Plasminogen reduced
Prot c and s reduced
How to tx DIC
Clots-Hep, hemody
RBC transfusion
TX THE CAUSE IS NUMBER 1
What is Myelodysplastic Syndrome 3
Hematopoiesis in ineffective
Clonal disorder- Abnormal clone of stem cell in bone marrow-have issues and take up space
Can progress to AML
How to diagnose Myelodysp
how to tx-4
Bone marrow biopsy
Tx depends on severity
Tx anemia, Thrombocyotopenia, Neutropenia, pain
What are the top 3 complications of cancer
Infection, Pain, malnut
Bone marrow suppression and cancer
Common complication of cancer because of proliferation. we need to watch for anemia, infection, bleeding, Fever in cancer pt is EMERGENT
Bone marrow suppression is more common with chemo but can happen with radiation if over a large area of bone.
What is Nadir
Lowest blood cell count during chemo
usually happens w/i 7-10 days of tx Measured with a CBC
How will bone suppression look over time with the blood cells
Neutropenia 1-2 weeks
Platelets-2-3 weeks
RBC-3-4 months
How to combat fatigue with cancer
Identify when they have energy and plan care
Walk
GI issues with Cancer
Highly mitotic cells cause N/V/D
increase fluids no matter what
watch fiber
Small frequent meals high prot high cal add spices for lack of taste but not for Mucositis
Mucositis-Inflam of mucas in GI tract Can cause legions, very painful-Soft bland food, frequent rinses, no smoking or Alcohol=Irritating
Skin problems with cancer
Alopecia,
Raditation skin changes-gental, no freg, baby shampoo, lotion, no ice or heating
Chemo skin changes-Hyperpig, photosensitivity
Extravasation-Whats IV sites, Why central lines,
Risk for infection from skin breakdown
Side effects of immunotherapy
flu-like symptoms, Tachy ortho, capillary leak-pulmonary edema, Skin rashes
Give ty before therapy to help with s/s
What are the three oncologic emergencies
Obstructive, Metabolic, Infiltrative
What is HSCT
risks
Hint-One risk effects which three areas
Bone marrow transplant with high doses of chemotherapy and radiation then healthy stem cells infused. Intense procedure
Risks=Infection, graft vs host (Skin Liver, GI), bleeding, can be fatal
can come from peripheral blood of donor
What is Multiple Myeloma
More common in 3
Cancerous plasma cells that proliferate in bone marrow and destroy bone. There is an overproduction of plasma cells that don’t make antibodies like they should. Instead they make Monoclonal antibodies that are undifferentiated and ineffective. They produce cytokines and infiltrate bone marrow a Decrease in antibodies= an increased risk of infection. pancytopenia.
Men, blacks, 65-74
S/s of Multiple Myeloma 8
Slow and insidious, skeletal pain in pelvis Ribs, Spine
Osteoporosis
Osteolytic lesions from osteoclasts
can compress spine
Hypercalcemia-Seizures, AMS, Confusion, Cardiac dysR,
Kidneys renal stones, obstruction, fail, nephrosis,
Hyper-viscosity syndrome-Worse on kidneys, and organs from M prots
Bone marrow dysfunction-Pancytopenia
Diagnosis of Multiple Myeloma 7
M prots in blood and urine
Hyperca+
Increased creatinine
pancytopenia
Bence-Jones Prots
Bone marrow examiniation,
Imaging-porosis or lesions
Tx for Multiple Myeloma goal?
5 tx- regular
No cure no remission we tx s/s goal is to Decrease pain and prevent fractures.
Corticosteroids, chemo, immunotherapy, targeted therapy, HSCT
Other tx for Multiple Myeloma
Kyphoplasty, furisemide, bisohosphonates, plasmapheresis, Weight baring, NSAID/OPS together
Nursing considerations for Multiple Myeloma 5
No falls, No quick movements, Is and 0s for hyperca
increase fluids
braces
What are reed-sternberg cells a sign for
Hodgkin’s Lymphoma
What are the clinical manifestations of Hodgkins 5
Gradual onset, Enlargement of cervical, axillary or inguinal nodes, B symptoms, alcohol induced pain
What are B symptoms
Fever weight loss, night sweats
How do we diagnose Hodgekins?
CBC-But not diagnostic just looking for abnormalities.
Lymph node biopsy-Diagnostic
Radiologic studies to find where the spread is
How do we classify hodg and nonhodg
stages
1-one site
2 two sites on same side of diaphragm
3-both sides of D
4-in organs
then A- no b symptoms and B-b symptoms are present
How do we tx hodgekins?
Combination chemotherapy
ABVD-Early and Interm
BEACOPP-Advanced
Early stage-2-4 cycles
Intermediate 4-6
Advanced 6-8 cycles
What are the nursing considerations for Hodg?
Can recieve HSCT after remission, Maintenance chemo not recommended, secondary toxicities, secondary malignancies-10yrs lung and breast most common.
What is Non-Hodg lymp
and one risk factor
Group of cancers of B, T, and natural killers that occurs in all age groups most common heme cancer with no halmark signs
chromosomal translocation-mutation
What are the clinical manifestations of Non H L 8
Variety of presentation
Indolent, Rapid, Spread is unpredictable, advanced disease at diagnosis, painless lymph enlargement, Lymphadenopathy and B symptoms
Diagnostic for non-hodg
Same as hodg,
MRI, Lumbar puncture is worried about neuro, endoscopy
WHat are the other stages for non hodg
Indolent-Low grade
Aggressive-High grade
Highly Aggressive
Leukemia
malignant disorders of blood, bone marrow, lymph and spleen with loss of cell regulation in cell division occurs in all age groups cells are not dividing faster but no apoptosis
How do we classify leukemia
Acute vs Chronic-
Myelogenous-Myeloblast granulocytes vs lymphocytic- B, T NK
Four types ALL, AML, CLL, CML
Look at chart on leukemia
and table 30.24
What is the most common type of child cancer
Acute Lymphocytic leukemia
What is ALL
Most common?
Manifestations 7
Most common peds
Immature Lymphocytes- Mostly B
Abrupt, Insidious, CNA-ICP from mengie infiltration
Fever, Bleeding-spontaneous bleeding
Bone and joint pain, fatigue
AML
! fact
about
Manifestations 4
1/3 of all leukemias
Uncontrolled proliferation of myeloblasts effects all blood cells because it is in the bone marrow. so shift to left is diagnostic
Hyperplasia of bone marrow-Actually starts destroying bonemarrow
Abrupt, Infection, Bleeding
CLL
Most common adult Leukemia in older adults so lots of comfort care and quality of life.
Mature appearing lymphocytes but they don’t do anything. Can be in marrow, spleen, lymph, liver
Swollen lyphnodes, accumulate in bone marrow no tx or s/s in early stages
CML
Excessive neoplastic granulocytes in all stages of development. Chronic stage can last for years, can move into blood stream and infiltrate liver and spleen. the blastic phase is treated like acute it has the Philadelphia chromosome we treat during chronic stage and chronic stage does’t usually have symptoms
One thing to remember about leukemia
Can have pancytopenia with a high WBC because cells don’t go through apoptosis
What are the most common sites for leukemia to spread
Brain, testis, Lymph, liver, spleen, Joints
How do we diagnose leukemia?
Blood tests but need differential,
Peripheral smear-see abnormal cells
Bone marrow biopsy in post illiac crest- painful local anestethtic
Chemo terms three and about
one problem
Induction-Severely deplete bone marrow big high doses 70 percent remission after first but need to continue
Postinduction-1intensification-2 x after few months
consolidation-a few more times
Matienance
Lower dose for weeks or years
For ALL
Pancytopenia
Four other cancer tx
Corticosteroids-Destroys leukemia
Radiation-
immunotherapy-T cells targer-asprin
Hematopoietic stem cell transplant-Goal
