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Heme/Onc/BMT > The Basics > Flashcards

The Basics Flashcards

1
Q

Stem cells

A

Cells found in bone marrow that can turn into 3 main types of blood cells: RBCs, WBCs, platelets
Hematopoeitic stem cells are precursors to all blood cells

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2
Q

Red blood cells

A

Carry oxygen around the body

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3
Q

White blood cells

A

fight infection

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4
Q

Platelets

A

stop bleeding by clotting

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5
Q

Pluriopotent stem cells (and renewal and differentiation)

A

most primitive form of cells, they can lead to renewal and differentiation
Renewal- reproduce another cell identical to itself
Differentiation- generate one or more subsets of mature cells

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6
Q

Bone marrow transplant RESCUE

A

replace bone marrow and restore its normal function after high doses of chemotherapy or radiation are given to treat a malignancy

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7
Q

Plasma cells

A

plasma B cells, are white blood cells that originate in the lymphoid organs as B lymphocytes
plays a role in adaptive immunity and secreting antibodies

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8
Q

Aphresis

A

a centrifuge separates blood into it’s components: RBC, WBC, platelets and plasma

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9
Q

Bone marrow harvest

A

collects stem cells w/ a needle placed in the bone marrow (soft tissue of bones); usually from hip or sternum

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10
Q

Cytokines

A

any of a number of substances, such as interferon, interleukin, and growth factors, which are secreted by certain cells of the immune system and have an effect on other cells.
Play a roll in immunity including maturation, defense, inflammatory responses

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11
Q

Graft vs Host Disease

A

Donor marrow or stem cells attack the recipient, can occur at any time but more common after marrow has started to make healthy cells
Usually occurs in skin, GI tract, liver
Symptoms include rash, jaundice, n/v/d, abdominal pain

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12
Q

Cytokine Release Storm

A

an acute systemic inflammatory syndrome characterized by fever and multiple organ dysfunction;Immune system activation leads to endothelial activation leading to systemic inflammation

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13
Q

When does CRS commonly occur (ex: with CAR T cell therapy)

A

3-14 days after infusion (possibility of late CRS is why we keep patients nearby for first 2 weeks)

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14
Q

Symptoms of CRS

A

Fever, flu-like symptoms, n/v/d/a, rash, tachypnea, hypoxia, pulmonary edema, cardiovascular (tachycardia, hypotension, capillary leak), hepatic dysfunction (transaminitis, increased bili), renal dysfunction

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15
Q

Markers to check if concerns for CRS

A

inflammatory markers, interleukins

IL-6, IFNy, IL-10, GM-CSF

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16
Q

Risk factors for CRS

A
  1. High disease burden in bone marrow
  2. Rapidly increasing blast count following lymphodepletion
  3. Active infections
  4. Other inflammatory processes
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17
Q

CRS Grading system (5)

A
  1. Fever
  2. Fever and hypotension
  3. Fever and hypotension requiring I pressor, hypoxia
  4. Fever, requires ventilatory support, requires multiple pressors
  5. Death
18
Q

Vasopressors

A

a group of medications that contract (tighten) blood vessels and raise blood pressure

19
Q

Graft rejection or relapse

A

Recipient’s immune system attacks the donor graft and destroys transplanted tissue organ, usually due to donor’s HLA proteins)

20
Q

Average time to engraftment with peripheral blood (aphresis) & risk for GVHD

A

10-14 days, higher risk for GVHD

21
Q

Average time to engraftment with bone marrow harvest & risk for GVHD

A

14-21 days, intermediate GVHD risk

22
Q

Average time to engraftment with cord blood & risk for GVHD

A

21-28 days, low GVHD risk

23
Q

Neutrophil engraftment

A

ANC > 500 for 3 consecutive days

24
Q

anti-diuretic hormone

A

helps regulate the amount of water in your body.

It works to control the amount of water your kidneys reabsorb as they filter out waste from your blood.

25
Q

Immunotherapy

A

directed against recipient’s circulating T-lymphs to decrease risk of graft rejection, it is also directed against donor T-lymphs infused @ the time of transplant to decrease risk of GVHD

26
Q

Corticosteroids in the setting of BMT

A

prevent IL-1 and IL-6 production by macrophages and inhibit all stages of T cell activation

27
Q

Prep for DAY 0 BMT (4)

A
  1. TPN should be stopped at midnight (may restart TPN four hours after)
  2. Cardiac monitor and pulse oximeter 30 min before
  3. Pre meds administered 3 hours before (Tylenol, Benadryl, Hydrocortisone ) * no hydrocort if CAR T or haplo
  4. Do not give blood the night before
28
Q

Infusion rate for autologous transplants

A

5-30 minutes (fastest)

29
Q

Infusion rate for allogenic BMT/PBSC transplants

A

60-120 minutes

30
Q

Infusion rate for allogenic cord blood transplants

A

30-60 minutes

31
Q

Infusion rate for allogenic donor lymphocyte transplants

A

30-60 minutes

32
Q

Oral care for BMT patients

A

Chlorhexidine 4x/day and Nystatin 4x/day

Discontinue CHX if patient gets mucositis - will be painful

33
Q

Lactate dehydrogenase

A

Enzyme that helps convert glucose/sugar into energy for cells - levels can help to assess tissue damage in body
LDH is highest in muscles, liver, kidneys and red blood cells
If your LDH blood or fluid levels are elevated, it may indicate that certain tissues in your body have been damaged

34
Q

Refractory illness

A

a disease or condition that does not respond to treatment

35
Q

When to not give steroids

A
  1. CAR T cell
  2. Haplo transplant
  3. If getting post-transfusion Cytoxan
36
Q

DMSO

A

A preservative in transplant cells that can cause hypersensitivity reaction, so be cautions on day 0 and 24h post-transplant

37
Q

Fibrinogen

A

a protein produced by the liver. This protein helps stop bleeding by helping blood clots to form.
High levels = increased risk of clot formation

38
Q

High vs Low INR

A

INR= international normalized ratio
High INR: Increased risk of bleeding (b/c blood is clotting more slowly)
Low INR: Increased risk of clotting (b/c blood clots more quickly)

39
Q

Prothrombin time (PT)

A

How long it takes for blood to clot

Prothrombin is a protein made by the liver

40
Q

Low vs high clotting factors

A

Clotting factor levels that are too low can cause you to bleed too much after an injury.
Levels that are too high can cause dangerous clots to form in your arteries or veins.

41
Q

High vs low platelets

A

Platelets react to bleeding by initiating blood clot
High platelets: increased risk of clotting
Low platelets: increased risk of bleeding

42
Q

Platelet engraftment

A

Plt >20 w/o plt infusion for 10 days, then engraftment date is day #7

Heme/Onc/BMT (4 decks)

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