Jacked up WBC Flashcards
pancytopenia will result in what 4 assessment findings/symptoms?
Fatigue, infection, bruising, bleeding
type of cancer:
Uncontrolled production of immature WBC’s in bone marrow that enter blood stream +decrease production of normal blood cell types =
leukemia
leukemia findings
-infections
-anemia
-bleeding
-shitty perfusion
-tachycardia/pnea
-liver/spleen enlargement
-n/v/weigh loss
-loc
-fatigue/pain
leukemia findings
-infections
-anemia
-bleeding
-shitty perfusion
-tachycardia/pnea
-liver/spleen enlargement
-n/v/weigh loss
-loc
-fatigue/pain
match with acute or chronic leukemia:
-sudden onset with severe symptoms
-slow growing with milder symptoms
acute = sudden onset with severe symptoms
chronic = sudden onset with severe symptoms (chronic can become acute)
is a prolonged aptt indicative of good or bad clotting? what will you see with leukemia?
bad! slow clotting with leukemia
diagnostic tests for leukemia (2)
- Bone Marrow Aspiration and Biopsy
- Chromosome analysis (AKA cytogenic studies)
leukemia teaching:
patient with leukemia has temp increase in 1 degree- okay or not okay?
not okay! call provider for 1 degree temp increase with leukemia
what kind of precautions do we put someone on with leukemia?
neutropenic
- Neutropenic diet
- Handwashing, Hand Sanitizing
- Bathe daily
- Vaccinate
- Avoid contact with trash
- Avoid contact with animals
- Avoid houseplants, cut flowers, gardens
- Avoid Humidifiers
- Avoid using Denture cups
- Avoid crowds
3 phases of leukemia treatment
- Induction
- Consolidation
- Maintenance
during the induction phase of leukemia treatment they will do combination therapy- what is it?
7 plus 3
* 7 days of IV cytosine arabinoside
* 3 days anthracycline
- Complications: INFECTION; Liver/Kidney/Cardiac Toxicity; n/v/d/; stomatitis; alopecia
- Infection related deaths more common during this period
what are the consolidation and maintenance phases of leukemia treatment?
conoslidation = chemo early in remission
maintenance = months to years of chemo after consolidation
re leukemia: what is this drug and why do it care- Imatinib mesylate (Gleevac)
First line drug for leukemia
true or false we can treat leukemia with a allogenein hempatopoietic stem cell transplants?
true
- Option increased survival or possible cure
- Risk for mortality
top 2 chemo complications with leukemia
- infection
- poor clotting
what platelet count occurs with which thing:
< ? = risk for *bleeding *
< ? = risk for spontaneous bleeding
< ? = platelet *transfusion *
- < 50,000 High risk for bleeding
- < 20,000 Risk for spontaneous bleed
- < 10,000 Platelet* transfusion*
what platelet count occurs with which thing:
< ? = risk for *bleeding *
< ? = risk for spontaneous bleeding
< ? = platelet *transfusion *
- < 50,000 High risk for bleeding
- < 20,000 Risk for spontaneous bleed
- < 10,000 Platelet transfusion
what is nadir?
Period of greatest bone marrow suppression during chemo
what are the defining charcteristics of multiple myeloma
cancer of mature B lymphocytes (plasma cells) causing :
* excess antibodies
* excess cytokines
* pancytopenia
a cancerous plasma cell is called a ____ cell
myeloma cell
this cancer is specifically linked to herpes virus 8 but also largely unknown causes like all the cancers
multiple myeloma
you will see elevated ____ levels with multiple myeloma but you have to rule out ______
find: urine protein or paraprotein levels
rule out: MGUS
MGUS vs MM
- MM =10% of bone marrow is infiltrated, paraprotein in blood or urine, osteolytic bone lesions (bone changes)
- MGUS = + paraprotein in blood and urine, can turn into MM
top 3 MM findings
bonus question: all the protein will damage what organ down the line?
- Fatigue
- Bone pain
- Bruising
kidneys! glomerulus not happy about all the protein
diagnostics for MM
- immunoglobulin and plasma protein levels high
- bence jones protein in peepee
- > 10% bones marrow infiltrated (biopsy)
- Xray (swiss cheese bones)
top intervention for MM
bone pain management
–> biophosphonates (denosumab)
do we do bone marrow stem cell translpant for MM patients?
sure fucking do but not that many people do it
also chemo, steroids, protease inhibitors, immunomodulators
patient education for MM
watch for fatigue, infection, bleeding
this cancer is characterized by:
- uncontrolled growth of lymphocytes accumulate in lymph tissue
lymphoma
common for solid tumors in lymph node and spleen
*Less likely in bone marrow!!
hodgkins vs non hodgkins lymphoma
who has reed sternberg cells?
who is predictable?
who starts in a single place?
who is easier to treat?
Hodkins
- yes reed sternberg
- yes predictable
- yes single starting place
- yes easier to treat
Non Hodgkins
- no reed sternberg
- no predictable
- no easy treatment
NOn hodgkins is a NO
assessment findings for all the lymphomas
-large painless lymph node
-b symptoms: night sweats, weight loss w/o trying, perpetuating fever
how do we know if you have reed sternberg cells or not?
biopsy
what system do they use to stage hodgkins lymphoma
Lugano Modification of the Ann Arbor Staging System
Not sure if we need to know the hodgkins lymphoma stages but this card is for the borad strokes on the differences in the 4 stages
I: single lymph node
II: 2 or more lymph nodes on same side of diaphragm
III: lymph nodes on both sides of diaphragm
IV: shits all over - liver, lung, skin, marrow
what is the system they use to categroize and stage Non Hodgkins lymphoma?
WHO classification
Hodgkins- whats the treatment? prognosis?
chemo , radiation
yes good prognosis but late complications can occur
idk how much of this we need to know so I made it a food note:
“Late effects” / Complications
Can occur years to decades after tx with radiation and chemo.
* Cardiovascular disease
* Secondary malignancies
* Restrictive lung disease
* Endocrine dysfunction
* Hypothyroidism
* Infertility
* Premature menopause
non-hodgkins treatment?
chemo, MABS, radiation, radiolabeled antibodies, Chimeric Antigen Receptor (CAR) T cells , novel therapies
(a lot more different things they try than hodgkins)
tell me about Chimeric Antigen Receptor (CAR) T Cells - what does it treat? what does it do? is it chill- biggest side effect?
- Treats Non Hodgkins Lymphoma
- Charges up the immune system, releasing lots of inflammatory cytokines.
- Side effectL cytokine storm!!
cytkine storm:
* Last 5-7 days
* Flu like symptoms
* Fever
* Fatigue
* Body aches
* Hypotension
* Edema
* Decreased UOP
iggy pages per harrell
looks at these if you will but I ain’t cracking no damn textbook
- Chapter 37; pages 802-815, page 818-819.
- Chapter 20; pages 377-393
