Blood Lecture Pt 3

Front 1

Sickle Cell Disease

Back 1

Genetic Disorder– RBCs become malformed during periods of hypoxia & obstruct capillaries in joints and organ. "increased hemolysis" breakdown of RBC
-genetic disease
-results in chronic anemia
-crisis is brought on by dehydration, infection, pregnancy, high altitudes, alcohol, stress, or strenuous activities.
-Pain is 1st symptom

Front 2

Treatment for Sickle Cell Crisis

Back 2

O2, analgesics to help with the pain, Hydrate (IV) and by giving them blood transfusions, replacing the RBCs.

Front 3

Polycythemia Vera

Back 3

-greater than normal abundance of rbc
-sustained increase hemoglobin & hematocyte.
-blood is supper thick, its hyper viscus
-Hemo > 18 g/dl Htc >55%,
-can be temporary or permanent,
-also excessive production of leucocytes & platelets.

Front 4

S/S Polycythemia Vera

Back 4

-Dark, flush plethoric appearance, intense itching, hypertension, poor tissue oxygenation

-high risks for clots.

Front 5

Tx Polycythemia Vera

Back 5

-Increase their hydration,
-anticoagulants
-phlebotomize them Frequently; 2-5 times a week is not unusual.

Front 6

2 white blood cell disorders.

Back 6

-Leukemia is usually a cancer of the bone marrow.
-lymphoma is a cancer of the lymphonodi tissue,

Front 7

Leukemia

Back 7

"an uncontrolled proliferation of malignant leukocytes that originate in the bone marrow"
-cancer of wbc or of cells that develop into wbc
-WBC are not functional. They invade and destroy bone marrow & can metastasize to liver, spleen, lymph nodes, testes, and brain.

Front 8

problems

Back 8

-Overgrowth of leukemic cells prevents growth of other blood components (platelets, erythrocytes,
mature leukocytes)
-metastasize to liver, spleen, lymph nodes, testes, and brain.
-w/o treatment will die from infection or hemorrhage

Front 9

Leukemias are divided into

Back 9

-acute sudden onset with a short duration
- Chronic is a slow onset and persists over years.

further classified by the type of white blood cells primarily affected.

Front 10

increased risk of developing leukemia

Back 10

-genetics (twins of parents w/ leukemia very high)
-Exposure to ionizing radiation & chemicals
-downs syndrome and trisomy 13
-hypoplasia- low production of blood cells
-immune deficiency

Front 11

blasts

Back 11

blast cells; immature WBCs

Front 12

general signs and symptoms

Back 12

-bleeding, petechia, ecchymosis, fatigue, weakness, fever, enlarged spleen/liver, anorexia, bone pain,
-platelet function is reduced= any kind of excessive bleeding on patients needs to be examined: bruises easily suffers from nose bleeds, heavy menstrual flow or bleeding from the gum, rectum and hematuria.
- Fatigue weakness is from the increased metabolism of the leukemic cells.
-fevers, prone to infection, bronchitis, flu, sore throats very easily.
-Enlarged spleen or liver is from the mature white blood cells.

Front 13

ecchymosis

Back 13

bruise

Front 14

DX

Back 14

-first with a CBC
- bone marrow exam.
-Other include lumbar puncture, MRI, or CAT scan

Front 15

CBC

Back 15

-wbc may be normal, but mostly abnormal: either very low or very high.
-WBC count differential is what is analyzed; one type of cell will be overwhelmingly predominate: Platelets, RBC count, hgb, htc, are prob low.

Front 16

- bone marrow biopsy.

Back 16

-aspirate some bone marrow
- very important diagnostic tool for leukemic
- sternum or iliac crest
- leukemic pt will have a lot of immature cells, a lot of blasts, and an absence of normal cells.

Front 17

lumbar puncture

Back 17

to test if cells have entered the central nervous system, the spinal fluid.
-We don’t’ really want to do that in the acute phase of leukemia because we might contaminate the CNS with cells. But we might do that in a later stage.

Front 18

MRI or Cat Scan

Back 18

MRI, CAT scan to see if there are other lesions or organs or bones that have been affected by the leukemia cells.
- identify presence, size, and shape of nodes, tumors

Front 19

Important point in preparation for the bone marrow aspiration

Back 19

is the patient in preparation and teaching

-Painful, teach on analgesia and the soreness they will experience afterward

Front 20

Postoperatively

Back 20

-apply pressure to the site and probably going to do a small pressure dressing with that.
-assess for bleeding, pain, and infection.

Front 21

There are 4 types of leukemias

Back 21

based upon what type of cell & rate of progression.

-AML, acute myeloid leukemia
-ALL, acute lymphocytic leukemia
-CML Chronic myeloid leukemia
-CLL Chronic Lymphocytic Leukemia

Front 22

AML

Back 22

-acute myeloid leukemia most common in adults: "adult onset leukemia"=median age is 65
-peak incidents 60-65, uncommon in children
-Prognosis is variable; age, health status, radiation exposure, chemo, other diseases
-risk of death=infection & bleeding. goal=remission.

Front 23

AML s/s

Back 23

-fever, infection, and bone pain, pain from an enlarged liver or spleen.
-Fatigue & weakness
-Bleeding; bleeding gums or bruises. ef

Front 24

AML Tx

Back 24

-aggressive Induction therapy (high doses IV chemo)
-will be hospitalized during induction therapy
-Some pt may not be able to tolerate the treatment. IV therapy may kill them=palliative care
- admin blood or platelets due to thrombocyticpenia
-Bone marrow transplants, stem cell transplants
-teach friends fam on infection risks & prevention

Front 25

Tx side effects & Supportive Tx

Back 25

- isolation b/c of risk or bacteria/ fungal/viral
-Careful w/ foods esp. fruit
-antibiotics, antifungal (due to whiping WBC)
-diarrhea, anorexia from tx
-transfusions b/c tx damages platelets/clotting fact.
-daily absolute neutrophil counts; ANC can be 0
-can become severly anemic/platelets below 10,000

Front 26

ALL

Back 26

-acute lymphocytic leukemia: lymphoblasts are immature & not normal, uncontrolled proliferation of lymphoblasts from the lymphoid stem cells.
-very common in children, but adults can get it too.
-peak age 4 years old, boys more than girls
-after age 15, it’s uncommon but it can happen.
-child 5 year survival rate is very good,80%,
-adults 5 year survival rate is 40%(1/2) older the age, the more decreased the survival rate.

Front 27

ALL S/S

Tx

Back 27

-s/s similar to other leukemia.
-Methotrexate med used prophylactically b/c of high instance of cns involvement. used intrathecally (brain/spinal cord) or w/ cranial radiation
-chemotherapy and bone marrow transplant.

Front 28

CML

Back 28

-chronic myeloid leukemia: specific to a section of missing DNA from chromo. (Philadelphia), 90-95% of CML pt have missing. chromo. is trans located in chromo. 9= the 2 fuse together, producing BCR ABL gene, making abnormal the protein: trypsin kinase
-3 stages: chronic, accelerated and blast.
-median age 55-60, rare under age 20.

Front 29

CML S/S

tx

Back 29

-general malaise, anorexia, weight loss, enlarged tender spleen and liver.
-2 primary drugs used: Gleevec and Sprycel.
-chemotherapy or bone marrow transplant.
-Life expectancy is about 3-5 years.

Front 30

CLL

Back 30

-Chronic Lymphocytic Leukemia: Unlike other leukemias, these cells are mature and do not die (when cell die, make new cell)= over accumulation
-more in men that women, primarily in over 50
-survival is anywhere from 2-14 years

Front 31

CLL s/s

tx

Back 31

-swollen painful lymph nodes
-b symptoms: fevers over 101.5, drenching sweats & weight loss (unexpected over 10% body weight)
-Tx is based on s/s, if found early & symptoms
-Tx Chemo; pt may just opt to do supportive treatment b/c tx is very severe

Front 32

Lymphoma.

Back 32

WBC disorder: abnormal overgrowth of lymphocytes
-tumor in Any place that the lymphatic system: lymp. tissue, lymphoid, intestinal lymph tissue, thymus, bone marrow, secondary tissue, spleen, tonsils
-2 types, Hodgkins and Non-Hodgkins.

Front 33

Hodgkin’s lymphoma risk factors

Back 33

-cause is unknown
- 1st degree relatives
-chrono immuno suppressant therapy, (i.e. renal transplant patients)
-exposure to agent Orange
-epstein Barr virus, hx of virus

Front 34

The malignant cell or marker or Hodgkin’s lymphoma is called

Back 34

the reed Sternberg cell

Front 35

Hodgkin’s lymphoma s/s

Back 35

-painless enlarged lymph node (firm, not hard, painless) on the side of the neck. It’s unilateral. It’s Unicentric in Origen (single node beginning)
-B symptoms might be present (Fever above 101.5, drenching night sweats, and anorexia)
-painless enlarged lymph node & B symptoms= prognosis is poor. Just node enlargement good .

Front 36

Hodgkin’s lymphoma Tx

Back 36

-dependent on how early found, early most treatable
-first step is to stage it: harbor staging criteria.
-biopsy for presences of the Reid Sternberg cell.
-tx external radiation; external radiation of lymph node region, chemotherapy or both.

Front 37

Nursing interventions due to Tx of Hodgkin’s lymphoma

Back 37

-neck is burns. Burns from the radiation & swallowing is a factor we have to consider with these patients.
-Treat burns on their neck
-helping with feeding & swallowing issues
-may need tube feeding

Front 38

Non-Hodgkin’s

Back 38

-cancer that originates from the lymphoid tissue, but doesn’t have the Reid Sternberg marker cell.
-more than 12 types; generally all treated the same
-spreads throughout the lymphatic system in a less orderly way than a Hodgkin’s lymphoma.
-3% of all cancer deaths in the US
-incidence increases with age. average age 50-60

Front 39

Non-Hodgkin’s causes & tx

Back 39

-We really don’t know what causes it. may be associated w/ some viral infections, radiation, auto-immune disorders or toxic chemicals.
-prognosis varies with the type of lymphoma it is, tx determined by the type and stage
-chemo, radiation, BMT or med interferon.