Stem Cell and Bone Marrow Transplant

Question 1

Where does hematopoiesis occur in adults?

Answer 1

bone marrow and lymphatic tissues

Question 2

What types of blood cells are derived from stem cells?

Answer 2

RBCs, WBCs, and platelets

Question 3

What is leukemia?

Answer 3

malignant disorder in leukocytes

Question 4

What are the 4 types of leukemia?

Answer 4

acute myeloid leukemia, chronic myeloid leukemia, acute lymphoid leukemia, and chronic lymphoid leukemia

Question 5

What types of cells does myeloid leukemia affect? (6)

Answer 5

erythrocytes, platelets, basophils, neutrophils, eosinophils, and monocytes

Question 6

What types of cells does lymphoid leukemia affect?

Answer 6

Natural killer cells, T lymphocytes, and B lymphocytes

Question 7

What is the difference between acute leukemia versus chronic leukemia?

Answer 7

In acute leukemia, immature leukemia cells will continue to reproduce and build up and without treatment, patients typically live only a few months
In chronic leukemia, the cells that build up can mature partly. These leukemia cells can build up and outlive normal cells and they will progress over a long period of time, and patients can live for years with this

Question 8

What is the pathophysiology of leukemia?

Answer 8

lack of normal regulatory mechanisms of bone marrow cell proliferation and maturation

Question 9

What are general symptoms that will be seen in a patient with leukemia?

Answer 9

FEVER, fatigue, night sweats, headaches, SOB, bruising, petechiae, and bone/joint pain

Question 10

What are secondary symptoms that may be experienced by a patient with leukemia?

Answer 10

anemia, leukopenia, thrombocytopenia, swollen lymph nodes, and enlarged liver/spleen

Question 11

How is the type of leukemia diagnosed?

Answer 11

WBC count with differential

Question 12

What will a patient’s MRI/CT show if they have leukemia?

Answer 12

infiltrates and sites of infection

Question 13

How is neutropenia determined?

Answer 13

Absolute Neutrophil Count (ANC) =
[(bands+segs) x WBC count] / 100

Question 14

What is a normal absolute neutrophil count? What would the count be for someone with leukemia?

Answer 14

Normal ANC= 2,500-5,000
ANC <500

Question 15

Why is having a low absolute neutrophil count very detrimental to a patient’s health?

Answer 15

it will severely increase the risk for infection

Question 16

What are the 3 types of bone marrow transplants?

Answer 16

autologous, syngeneic, and allogenic

Question 17

What is a syngeneic bone marrow transplant?

Answer 17

patient receive stem cells from their identical twin

Question 18

What is an allogenic bone marrow transplant?

Answer 18

patient receives stem cells from their brother, sister, or parent. An unrelated donor may also be used

Question 19

What are examples of supportive care for leukemia?

Answer 19

anti-infectives, antipyretics, transfusions, fluids and electrolytes, symptom management, psychological, and spiritual support

Question 20

What are the priority diagnoses for patients with leukemia?

Answer 20

infection, injury: bleeding, altered thought processes, anemia-related diagnoses (Fatigue), and ineffective individual/family coping

Question 21

What are the 4 types of stem cell transplants?

Answer 21

Haploidentical, autologous, syngeneic, and allogenic

Question 22

What is the nursing care management for a patient that is receiving an autologous stem cell transplant?

Answer 22

Place the patient on a cardiac monitor as the dimethyl sulfoxide may cause heart block or bradycardia. Additionally, premedicate the patient with steroids and antiemetics

Question 23

How long can autologous stem cells are cord cells be stored?

Answer 23

up to several years

Question 24

Can allogenic stem cells be stored/frozen?

Answer 24

No. It is administered following processing and is used within 48 hours of collection

Question 25

what is the temperature for a warm bath for thawing frozen stem cells?

Answer 25

38-40 degrees celsius

Question 26

What is a systemic side effect that does not occur in autologous infusions that may occur in allogenic stem cell transfusions?

Answer 26

hemolytic transfusion reaction

Question 27

Renal side effects of an autologous stem cell transfusion

Answer 27

Hemaglobinuria Hypertension Fluid overload Renal failure

Question 28

How often should vital signs be assessed on Day 0 of a stem cell transplant?

Answer 28

Q15 min for 1 hour, Q30 min for 2 hours, and then Q1H for 4 hours

Question 29

How long should a patient be wearing a cardiac monitor when getting a stem cell transfusion?

Answer 29

during the transfusion and for 4 hours after completion of infusion

Question 30

What should urine be assessed for during the 4 hours post transplant?

Answer 30

heme

Question 31

What can be given to promote engraftment?

Answer 31

GCSF/GMCSF (Sargramostin)

Question 32

What lab values are evidence of engraftment?

Answer 32

ANC>500 and Platelets greater than or equal to 20,000 without a platelet transfusion

Question 33

When might capillary leak syndrome occur following a transfusion?

Answer 33

7-14 days post transfusion is the higher risk period

Question 34

What happens with capillary leak syndrome?

Answer 34

increased capillary permeability, which leads to fluid retention/weight gain and can lead to ascites/pulmonary edema

Question 35

How should a nurse assess for capillary leak syndrome?

Answer 35

Monitor Is and Os (Q4H), weight, BP, lung sounds

Question 36

What complications of a stem cell infusion may require the need for CRRT?

Answer 36

Hemorrhagic cystitis

Question 37

If a patient begins to have hematuria, dysuria, urgency, and bladder spams, what complication of stem cell infusions may this patient be experiencing?

Answer 37

hemorrhagic cystitis

Question 38

When might a patient experience veno-occlusive disease?

Answer 38

7-12 days after stem cell infusion

Question 39

What happens in veno-occlusive disease?

Answer 39

Hepatic obstruction manifested by Liver enlargement/ascites ↑ bilirubin/LFTs/jaundice 10% weight gain/RUQ pain Occurs about 7-12 days after transplant

Question 40

What is first line management of veno-occlusive disease?

Answer 40

diuretics/fluid restriction

Question 41

When does primary graft failure occur?

Answer 41

within 1st 2 months

Question 42

If a patient has a graft failure at 6 months, what kind of failure are they experiencing?

Answer 42

secondary graft failure

Question 43

Which 3 organs are damaged with acute graft versus host disease?

Answer 43

Skin, GI, and Liver

Question 44

If a patient is 75 days post stem cell transplant reporting green/watery diarrhea, erythema on palms and soles of feet, and RUQ pain, what is suspected to be occurring? What labs would you anticipate to verify this?

Answer 44

Acute graft versus host disease. LFTs should be assessed

Question 45

If a patient is suspected to have chronic GVHD, what labs would you expect to be ordered, why?

Answer 45

CBC as this can cause thrombocytopenia BMP as this can cause malabsorption and dehydration

Question 46

What is the most common cause of death following a stem cell transplant?

Answer 46

chronic GVHD