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Questions and Answers
Which symptom is NOT associated with anemia?
Immature WBCs are effective in responding to pathogens.
False
What causes increased bleeding risk in thrombocytopenia?
Decreased platelets and reduced coagulation factors
Increased ____________ levels may lead to renal insufficiency.
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Match the symptoms to the corresponding condition:
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Which clinical therapy is NOT recommended for infection management?
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Weight loss is a symptom of increased metabolism.
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List one symptom of leukemic cell infiltration in the kidneys.
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Patients with _________ may experience bruising and bleeding gums.
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Which therapy is primarily aimed at improving hydration and nutrition for anemia management?
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What is a primary objective of leukemia treatment?
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Chemotherapy should be administered during the induction phase to sustain remission.
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Name one intervention to manage infection in leukemia patients.
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Patients at risk of bleeding due to low platelet count may undergo a __________ to manage symptoms.
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Which of the following is a method of treatment for leukemia?
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Match the following therapies with their purpose:
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Hydration and nutrition are not important in anemia treatment for leukemia patients.
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Which of the following symptoms is commonly associated with the neurologic effects of leukemia?
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Thrombocytopenia is characterized by an increased platelet count.
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Name a common respiratory symptom in patients with leukemia.
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Patients with leukemia may experience __________ due to compromised immune function.
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Match the symptoms with their respective systems affected by leukemia:
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In the context of leukemia, what does a high platelet count in early CML indicate?
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Bone marrow exams evaluate the maturity of cells within the marrow.
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What is a common hematologic finding in patients with leukemia?
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Leukemia may lead to __________ in the gastrointestinal system, affecting nutrition.
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What type of bone marrow transplant uses the patient's own marrow after remission?
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Graft-versus-host disease (GVHD) only occurs in the case of autologous stem cell transplants.
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Name one potential complication of bone marrow or stem cell transplants.
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Before an allogeneic BMT, high doses of __________ are used to destroy leukemic cells.
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Match the transplant types to their definitions:
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What procedure is used to remove and filter bone marrow from a donor?
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Patients undergoing autologous BMT do not require chemotherapy before the transplant.
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What treatment may be given to manage graft-versus-host disease?
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The filtered bone marrow is __________ and infused intravenously.
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What is the role of GM-CSF/G-CSF before harvesting stem cells?
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Study Notes
Anemia
- Symptoms: Pallor, Fatigue, Tachycardia, Malaise, Lethargy, Dyspnea on exertion.
- Cause: Overproduction of white blood cells (WBCs) reduces red blood cell (RBC) availability.
- Clinical Therapies: Improve hydration and nutrition, stimulate RBC production with Epoetin, blood transfusions, rest, monitor vital signs and complete blood count (CBC).
Infection
- Symptoms: Fever, Night sweats, Oral ulcerations, Frequent/recurrent infections in respiratory, integumentary, urinary, and other systems.
- Cause: Immature WBCs fail to respond effectively to pathogens.
- Clinical Therapies: Teach hand hygiene and cough etiquette, avoid crowds, teach symptom reporting, administer antimicrobials, monitor vital signs and CBC.
Bleeding (Thrombocytopenia)
- Symptoms: Petechiae, Bruising, Bleeding gums, Hematuria, Hematemesis, Rectal bleeding.
- Cause: Decreased platelets and reduced coagulation factors lead to increased bleeding risk.
- Clinical Therapies: Monitor coagulation studies, patient education to reduce injury, administer platelets and clotting factors, monitor CBC, blood transfusions.
Leukemic Cell Infiltration
- Meningeal Infiltration: Increased intracranial pressure → headache, altered level of consciousness (LOC), cranial nerve impairment, nausea/vomiting.
- Lymph Nodes, Liver, Spleen, Bone Marrow: Pain and swelling in affected tissues.
- Kidneys: Reduced urine output, Increased blood urea nitrogen (BUN) and creatinine levels.
Increased Metabolism
- Symptoms: Weight loss, Heat intolerance, Dyspnea on exertion, Tachycardia.
Uric Acid Accumulation
- Cause: Destruction of WBCs releases large amounts of uric acid, potentially causing renal insufficiency by obstructing renal tubules.
Anemia Treatment
- Improve hydration and nutrition to support red blood cell production.
- Use medications like epoetin to stimulate red blood cell production.
- Perform blood transfusions to increase red blood cell count.
- Encourage rest to reduce energy expenditure.
- Monitor vital signs and complete blood count (CBC) to assess effectiveness and adjust treatment.
Infection Prevention & Management
- Teach infection prevention techniques, including hand hygiene, cough etiquette, and limiting exposure to crowds.
- Educate patients on recognizing and reporting potential infection symptoms.
- Administer antimicrobial medications as needed to treat existing infections.
- Monitor vital signs and CBC for signs of infection.
Management of Bleeding (Thrombocytopenia)
- Monitor coagulation studies to assess blood clotting ability.
- Educate patients on minimizing injury risk and preventing bleeding.
- Administer platelets or clotting factors to address low platelet counts.
- Monitor CBC for evidence of blood loss and assess need for transfusions.
Treatment Overview
- The primary aims of leukemia treatment are to alleviate symptoms, achieve remission, and potentially cure the disease.
- Treatment methods include chemotherapy, targeted therapy, radiation therapy, and bone marrow or stem cell transplantation.
- Chemotherapy consists of induction and consolidation phases. Induction aims to induce remission, while consolidation maintains remission.
- Prognosis varies depending on the specific type and subtype of leukemia. While cure is more common in children, long-term remission is achievable for adults.
Multisystem Effects of Leukemia
- Neurologic: Headaches, altered level of consciousness, cranial nerve impairment, seizures, coma, retinal hemorrhage, subarachnoid hemorrhage can occur due to leukemia.
- Respiratory: Dyspnea (difficulty breathing), pharyngitis (sore throat), frequent infections, and pulmonary bleeding can be seen in leukemia patients.
- Gastrointestinal: Anorexia (loss of appetite), nausea, oral ulcerations, bleeding gums, abdominal pain, hepatomegaly (enlarged liver), and gastrointestinal bleeding are common gastrointestinal effects.
- Urinary: Patients with leukemia may experience urinary tract infections (UTIs), hematuria (blood in urine), and renal insufficiency or failure.
- Musculoskeletal: Weakness, bone and joint pain, and tenderness are common musculoskeletal manifestations of leukemia.
- Metabolic: Malaise (general discomfort), heat intolerance, fever, weight loss, and night sweats can occur due to metabolic changes caused by leukemia.
- Cardiovascular: Tachycardia (rapid heart rate), orthostatic hypotension (low blood pressure upon standing), murmurs, hematomas (bruises), edema (swelling), and hemorrhage can be observed in the cardiovascular system.
- Hematologic: Anemia (low red blood cell count), thrombocytopenia (low platelet count), leukopenia (low white blood cell count), epistaxis (nosebleeds), and disseminated intravascular coagulation (DIC) are common hematologic effects.
- Immunologic: Recurrent infections, lymphadenopathy (swollen lymph nodes), abscesses, and septicemia (blood poisoning) can occur due to immune system impairment.
- Integumentary: Pallor (pale skin), petechiae (small red spots), bruising, ulcerations, and chloromas (greenish tumors) can be seen on the skin.
Diagnostic Tests
- Complete Blood Count (CBC) with Differential: Measures red blood cells (RBCs), white blood cells (WBCs), platelets, hemoglobin, hematocrit, and the morphology of WBCs.
- Bone Marrow Exam: Evaluates erythropoiesis (red blood cell production) and leukopoiesis (white blood cell production). Assesses the maturity of cells within the marrow.
Leukemia Types and Diagnostic Test Results
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Acute Myeloid Leukemia (AML):
- Low RBC count, hemoglobin, hematocrit, and platelet count.
- Variable WBC count.
- Presence of myeloblasts.
- Decreased neutrophils.
- Hypercellular bone marrow.
- Presence of blasts.
-
Chronic Myeloid Leukemia (CML):
- Low RBC count, hemoglobin, hematocrit, and platelet count (late stage).
- Increased WBC count (early stage).
- Increased neutrophils.
- Hypercellular bone marrow.
- Presence of blasts (crisis).
-
Acute Lymphoblastic Leukemia (ALL):
- Low RBC count, hemoglobin, hematocrit, and platelet count.
- Variable WBC count.
- Decreased neutrophils.
- Normal lymphocytes.
- Hypercellular bone marrow.
- Presence of blasts.
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Chronic Lymphocytic Leukemia (CLL):
- Low RBC count, hemoglobin, hematocrit, and platelet count.
- Increased WBC count.
- Normal neutrophils.
- Increased lymphocytes.
- Hypercellular bone marrow.
Bone Marrow Transplant (BMT)
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Allogeneic BMT: Uses bone marrow from a matched donor (sibling or unrelated)
- Requires high doses of chemotherapy and radiation to destroy cancerous cells in the bone marrow before transplant.
- Bone marrow is extracted from the donor and infused into the recipient through a central venous line.
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Autologous BMT: Uses the patient's own bone marrow after achieving remission.
- One liter of bone marrow is extracted from the iliac crest during remission.
- Bone marrow is frozen and stored for later use if needed (e.g., after lethal doses of chemotherapy or radiation).
- Later, the frozen bone marrow is thawed and infused intravenously through a central line.
- Neutrophil count and normal hematopoiesis (blood cell production) should increase after the transplant.
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Complications:
- Infection
- Bleeding
- Malnutrition
Stem Cell Transplant (SCT)
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Allogeneic SCT:
- An alternative to BMT, involves replacing the recipient's blood cell lines completely.
- Recipient undergoes similar pre-transplant treatment as BMT (chemotherapy and radiation).
- Donor receives GM-CSF/G-CSF for 4-5 days to increase stem cell concentration in blood.
- Blood is then harvested, WBCs (white blood cells) are separated, and administered through a large central venous catheter.
- Umbilical cord blood: Can be used as a source of stem cells in certain cases.
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Complications:
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Graft-versus-host disease (GVHD): T lymphocytes in the donated marrow or blood attack the recipient's tissues.
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Acute GVHD: Usually develops within days to six months after the transplant.
- Symptoms: Pruritic, maculopapular rash (starting on palms and soles, spreading), jaundice, diarrhea, nausea/vomiting, dry eyes.
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Chronic GVHD: Develops more than three months after the transplant and can persist indefinitely.
- Symptoms: Chronic pain, fatigue, weakness, shortness of breath due to lung injury.
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Acute GVHD: Usually develops within days to six months after the transplant.
- Treatment for GVHD: Antibiotics and corticosteroids.
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Graft-versus-host disease (GVHD): T lymphocytes in the donated marrow or blood attack the recipient's tissues.
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Description
This quiz covers crucial aspects of anemia and infection, highlighting symptoms, causes, and clinical therapies. Learn about the mechanisms behind these conditions and their management strategies. Ideal for students in health sciences or medical courses.
