Leukemia/Lymphoma and Bleeding Disorders Flashcards
What does leukemia mean?
- white blood
Myeloid leukemia originates?
- in the bone marrow
Lymphoid leukemia orginates?
- in the lymphatic tissue
acute means?
- sudden onset: death can occur rapidly.
* BE AGGRESSIVE with treatment.
chronic means?
- developed over the years: the patient can live for years development is slow.
Leukemia is when WBC’s accumulate in the tissue where they originate until there is no more room, and then they?
- spill out lymphocytes into the lymphatic tissue
- spill out granulocytes into the bone marrow.
- *this crowds out other cell such as RBCs and platelets,
Name this leukemia:
- affects all ages
- > 65yrs poor prognosis
- most common nonlymphocytic leukemia
- induction therapy > consolidation tx
- acute myeloid leukemia
Name this leukemia:
- most common in children to 15yrs
- chemo tx
- acute lymphocytic leukemia
Name this leukemia:
- median onset varies with race
- caucasian 75yrs; af. american 40-75yrs
- 5yr survival rate is 80%
- oral chemo; leukapheresis; stem cell transplant
- chronic myeloid leukemia
Name this leukemia:
- 81% of patients >60yrs
- most common form of leukemia
- 2-20yr survival rate
- no treatment at first; later chemo
- chronic lymphocytic leukemia
What are the different types of lymphoma?
- hodgkins
- nonhodgkins
Which lymphoma is this:
- originates in single node
- affect men > women
- 2 peaks of onset: 20yr and after 50yr
- chemo tx/radiation tx
- hodgkins
Which lymphoma is this:
- more common/more fatal
- 50 to 60 yrs
- chemo tx/radiation tx
- nonhodgkins
What is the pathophysiology for non-hodgkins lymphoma?
- uncontrolled proliferation of B lymphocytes
Which lymphoma has the presence of Reed-Sternberg cell - fragments of Epstein-Barr virus have been found in RS cell.
- hodgkins
What are neoplasms of lymphoid tissue, usually begin in one lymph node, then spread throughout the lymphatic system and into organs?
lymphoma
What are these manifestations of?
- anemia, pallor, dyspnea d/t decreased RBC’s
- ecchymoses d/t decreased platelets
- infections d/t WBC’s
- bone pain d/t expansion of marrow
- lymphadenopathy
- hepatomegaly or splenomegaly
- abdominal pain, weight loss, nausea, fatigue, anorexia
leukemia
What are these manifestations of?
- painless progressive enlargement of lymph nodes, spleen, lymphoid tissues.
- cervical lymph node is usually the 1st
- night sweats, sweating, fever, itching, weight loss
Hodgkins
What are these manifestations of?
- may find location of tumor I/e abdominal or pelvic mass.
non-hodgkins
What are the diagnostics for leukemia?
- CBC
- bone marrow biopsy
- CSF analysis
What are the diagnostics for lymphoma?
- lymph node biopsy
- CT image of lymph nodes
How long are you NPO for a CT if contrast is being used? How many hours prior to the Ct is contrast given?
What should you encourage after a CT?
What should you monitor after Ct?
- at least 8 hours
- 1-2 hrs
- fluids
- monitor BM’s
Treatment for leukemia & lymphoma is?
- chemo/radiation
- platelets to prevent bleeding
- PRBC’s to prevent anemia and resulting activity intolerance
- VTE prophylaxis if hospitalized
What do you monitor when getting PRBC’s?
- CBC: Hgb/Hct
When caring for a patient with leukemia/lymphoma assess for?
- infection
- bleeding
- anemia
- daily weights
- activity intolerance
- fall risks
- coping skills
- pain management
- daily intake and output
- monitor diet
- CAREFUL NERUO ASSESSMENT**
Teach patients with leukemia and lymphoma:
- what to expect with each diagnostic
- medications and what they do along with adverse effects
- danger signs to report FEVER
- how to monitor for bleeding
- to use stool softener and soft toothbrushes
- blood in urine
- coffee-ground emesis
What is it called when your body has deficient number of circulating platelets?
- Thrombocytopenia
What is a complication of thrombocytopenia?
- hemorrhage
What disease is hereditary deficiency of vWF coal protein and platelet dysfunction and Factor VIII deficiency?
- vonWillebrand’s Disease
- also known as pseudohemophilia
What is it called when your body has a deficiency of platelets that occurs when the immune system destroys the body own platelets?
- immune thrombocytopenic purpura (ITP)
What is the most common cause of hemorrhagic d/o?
- Thrombocytopenia
What are the four mechanisms that could be responsible for thrombocytopenia?
- decreased platelet production
- decreased platelet survival
- pooling of blood in the spleen
- intravascular dilation of circulating platelets
What are common causes of thrombocytopenia?
- defective platelet production in the bone marrow
- increased platelet destruction outside the bone marrow
EX: cirrhosis, DIC, severe infection or sepsis
Massive blood loss from trauma treated with fluid resuscitation can cause?
dilution thrombocytopenia
What are some drugs that can cause thrombocytopenia?
- ReoPro
- cordarone
- ampicillin
- Tegretol
- gold salts
- heparin
- ibuprofen
- naproxen (NSAIDS)
- dilantin
- zosyn
- duinine
- zantac
- rifampin
- zocor
- Bactrim
- vancomycin
Can congenital or acquired viral infections cause thrombocytopenia?
- YES
Can hypersplenism and hypothermia cause thrombocytopenia?
- YES
Risk factors for thrombocytopenia:
- leukemia
- aplastic anemia
- HIV
- hep C
- Epstein-Barr
- rubella
- mumps
- varicella
- bacterial infection
- sepsis
- coagulopathy problems
- pregnancy
- malignancy
- rheumatologic/autoimmune d/o
- ETOH abuse
What is the most common type of bleeding d/o?
- vonWillebrands Disease
What are the common causes of vonWillebrands disorder?
- acquired cancer
- non-hodgkins
- leukemia
- drugs
- immune d/o (ex: lupus)
- it can also be inherted*
Normal platelets last ___ to ____ days but in ITP ____ to ____ days or less.
- 7 to 10
- 1 to 3
With ITP that is caused by acute virus prognosis is?
- excellent
With ITP that is caused by chronic essential or autoimmune disorders prognosis is?
- good remission lasts weeks to years.
What do these manifestations represent? - sudden onset perechiae/ecchymoses - bleeding from mucous membranes - fatigue/malaise - general weakness - menorrhagia - splenomegaly LABS: plts: <140,000 prolonged PT; aPTT is normal or increased
- Thrombocytopenia
What do these manifestations represent? - ecchymoses - neuro signs: pain, lack of sensation in limb - paralysis - epistaxis - hemarthrosis or joint deformities LABS: NL plt count aPTT increased Factor VIII absent or reduced
- vonWillebrands
What do these manifestations represent? - epistaxis - mennorhagia - prolonged bleeding -petechiae/ecchymoses - bleeding from mucous membranes - absence of splenomegaly LABS: plt count is <75,000 NL PT and PTT
- ITP
What can you administer to a patient with von willebrands for dental procedures that is short acting?
- DDAVP: its a nasal spray that will increase factor VIII or vWF
What treatment is used for ITP?
- prednisone and if the patient is unresponsive to prednisone then IV immune globulin
- if all medication therapy fails splenectomy surgery
