Neutropenia and Thrombocytopenia Flashcards
What is hematopoiesis, what are the three cell lineages
Process that generates blood cells of all lineages/ WBC, RBC, Platelets
What are the “younger” leukocytes
neutrophils, eosinophils, and basophils
What is the life span of neutrophils, platelets, RBCs
12 hours, 10 to 14 days, 120 days
For while blood cells what are the top 3 cells types present in the blood
Neutrophils (60-70%), lymphocytes (25-33%), monocytes (2-6%)
What are normal WBC, ANC, and platelet counts
3,000/mm3, 1500/mm3, 100,000/mm3
What is myelosuppression
Bone marrow activity is decreased resulting in less RBCs, WBCs, and platelets
What is the equation to find ANC
(%Segs + %Bands) X WBC/100 (WBC in thousands)
What is the Nadir
Lowest level blood counts during chemotherapy cycle (usually utilize ANC or platelets)
What is the usual onset for Nadier, recovery
10-14 days after chemotherapy administration, 21-28 days
When is chemotherapy given
every 3 to 4 weeks
What ANC reading is regarded as neutropenia
ANC less than 500 neutrophils/mcL OR ANC greater than 1000 neutrophils/mcl with a predicted decrease to less than or equal to 500 neutrophils/mcl over the next 48 hours
What are the grades for neutropenia
Grade 1: 1500/mm3 or higher Grade 2: Less than 1500/mm3 to 1000/mm3 Grade 3: Less than 1000 to 500/mm3 Grade 4 Less than 500/mm3 Grade 5: Death
T/F: Chemotherapy will always be given regardless of ANC
False: If ANC is less than 1500 chemotherapy is not recommended
T/F: Myelosuppresive chemotherapy is mostly associated with decreased survival
True
What is febrile neutropenia
ANC less than 500/mm3 or 1000/mm3 that is predicted to decline to less than 500/mm3 over the next 48 hours
Patient needs a single oral termerature greater than 101F or 100.4F for one hour
What is the link between severe neutropenia and febrile neutropenia
For every day of severe neutropenia there is approximately a 10% increased risk of developing FN
T/F: Most cases of febrile neutropenia occur late into chemotherapy
False: Most initial febrile neutropenia events occur during the first cycle of chemotherapy
What are methods for preventing chemotherapy-induced neutropenia
Postpone next cycle of chemotherapy until ANC is greater than 1500, decrease chemotherapy in the next cycle, give antibiotics prophylaxis, Myelpoid growth factors
What are the myeloid growth factors
Filgrastim, pegfilgrastim, sargograstim (not tolerated well)
What is the MOA of MGFs, filgrastim specifically
Stimulate proliferation and differentiation of hematopoietic progenitor cells, stimulates neutrophilica granulocytes
What is the dose for filgrastim, pegfilgrastim
5-10 mcg/kg/day, 6 mg (one dose per cycle)
What is the onset of filgrastim, pegfilgrastim
2-8 hours, 72 hours
T/F: MGF need to be administered 12 hours after chemotherapy
FalsE: MGFs need to be administered 24 hours (up to 3 to 4 days) after chemotherapy
MGF adverse effects
Bone pain, flu like symptoms, brusing, rash, sickle cell crisis
How long must a person wait to receive chemotherapy if given pegfilgrastim
14 days
What cancer patients will not recieve MGFs
Those with Myeloid malignancy
What is primary prophylaxis
Chemotherapy regimen is expected to cause 20% FN and automatically recieve MGF on first cycle
What is secondary prophylaxis
For patients who experienced a neutropenic complication on a previous cycle of chemotherapy without MGF
What is considered high risk for FN, intermediate, low
Greater than 20%, 10-20%, less than 10%
T/F: If there is a high risk of FN an MGF should be given regardless of the type of chemotherapy
True
What are the patient-related risk factors for developing febrile neutropenia
Age greater than 65 years old, poor performance status, persistent neutropenia
What are the treatment related risk factors for developing febrile neutropenia
Previous chemotherapy and previous radiation therapy
What are the cancer related risk factors for developing febrile neutropenia
Bone marrow involvement with tumor or pre-existing neutropenia
What are the comorbiditiy risk factors for developing febrile neutropenia
Recent surgery or open wounds, renal dysfunction (CrCl less than 50), liver dysfunction (total bilirubin greater than 2), HIV infection with low CD4 counts
What is considered thrombocytopenia, normal amount
Less than 150,000/mm3 platelets (150,000 to 300,000)
What are the grades for thrombocytopenia
Grade 1: Normal to 75/mm3 Grade 2: Less than 75 to 50/mm3 Grade 3: Less than 50 to 25/mm3 Grade 4: Less than 25/mm3 Grade 5: Death
When does spontaneous bleeding occur
20,000 -10,000/mm3 or less
What is the best way to treat chemotherapy-induced thrombovytopenia
Platelet transfusion: pooling platelets from several donors, separated from whole blood,
When is the transfusion threshold 10K
Hematological malignancies, HSCT patients, solid tumors
What is the transfusion threshold for surgical procedures, BM biopsies
40-50k, less than 20K
