Hematology & Oncology Chapters 21-24 PDF

Hematology & Oncology Mrs. Brandi Lester, MSN, RN, NP-C Chapters 21-24 Physiolo gy Review  Hema-/Hemato- = blood Erythro- = red Neutro- = neutrophil, neutral Leuko- = white Root Thrombo = clot Word A- = absent, none, no s Lymph- = lymph Myel- = bone marro...

Hematology & Oncology Mrs. Brandi Lester, MSN, RN, NP-C Chapters 21-24 Physiolo gy Review  Hema-/Hemato- = blood Erythro- = red Neutro- = neutrophil, neutral Leuko- = white Root Thrombo = clot Word A- = absent, none, no s Lymph- = lymph Myel- = bone marrow -emia = in blood -cyte = cell -cytosis = increase in cell numbers -penia = deficiency -oma = tumor -lytic = destruction -poeisis = creation, formation  Hematopoiesis = formation of blood Erythropoietin = formation of red Erythrocyte = red blood cell Hematolog Leukocyte = white blood cell y Terms Thrombocyte = platelet (“clot” cell) Anemia = no blood Leukocytosis = increase in white blood cells Leukopenia = deficiency of white blood cells Neutropenia = deficiency of neutrophils Thrombocytopenia = deficiency of platelets Lymphoma = tumor of lymph Myeloma = bone marrow tumor Hemolytic = blood destruction Thrombolytic = clot destruction Stem Cell Differentiation Hematologic Organs  Bone Marrow  Produces all the different cells  In adults include  Kidney  Excretes Erythropoietin when hypoxia detected  Erythropoietin (hormone) that stimulates red blood cell production.  Liver  Spleen Hematologic Organs CLINICAL CONCEPT  The number of reticulocytes is a good indicator of bone marrow activity, because it represents recent production of RBCs. A high reticulocyte count indicates that the bone marrow is working hard to keep up with RBC loss. Hematologic Organs  Liver  Produces prothrombin and other clotting factors  Stores extra iron in ferritin  Spleen  Destroys red blood cells that are old or abnormal  Breaks down hemoglobin  Stores platelets  Filters antigens Laboratory Tests Complete Blood Count (CBC) Blood is examined in a smear Then the different types of cells are counted Laboratory Tests CBC Red Blood Cells (RBC) Number of circulating RBCs in 1 mm3 of blood Normal range: Women: 3.6 – 5.0 million Men: 4.2 – 5.4 million White Blood Cells (WBC) Number of WBCs present in 1 mm3 of blood Normal range: 5,000- 10,000 mm3  Laboratory Tests CBC Platelet Count Number of platelets in 1 mm3 of blood Normal: 90,000 to 450,000 per microliter of blood. Hematocrit Percentage of RBCs to total blood volume Normal: Women: 37-47% Men: 40-50% Hemoglobin Total amount of hemoglobin in blood Normal: Women: 12-15 g/dL Men: 14 – 16.5 g/dL Red Blood Cell Disorders Anemia Anemia  Anemias from Decreased  Anemias from Increased Production of Red Blood Destruction of Red Blood Cells Cells  Iron Deficiency Anemia  Sickle Cell Disease  Vitamin B12 Deficiency Anemia  Aplastic Anemia  Iron Deficiency Anemia  Iron is necessary for hemoglobin production  Causes  Decreased iron consumption  Decreased iron absorption  Increased bleeding  Causes Microcytic RBCs  Clinical Manifestations  Cyanosis to sclera  Brittle nails  Decreased appetite  Headache  Irritability  Stomatitis  Pica (eating substances that are not food)  Fatigue  Iron Deficiency Anemia  Treatment  Identify and treat the cause  Diet (increase iron intake)  Liver, clams/mussels, oysters, cooked beef, sardines, turkey, eggs  Lentils, beans, spinach, broccoli, tofu  Breakfast cereals enriched with iron  Supplementation  Vitamin B12 Deficiency Anemia  Also known as Pernicious Anemia  Causes Macrocytic RBCs  Failure to activate the enzyme that moves folic acid into precursor RBC, so that cell division and growth can occur  Causes  Vitamin B12 deficiency (lack of intrinsic factor)  Decreased Vitamin B12 intake Vitamin B12 Deficiency Anemia  Clinical Manifestations  Pallor  Jaundice  Smooth beefy red tongue  Paresthesia (numbness and tingling of extremities), unsteady gait  Loss of deep tendon reflexes  Anorexia  Interventions  Diet  Shellfish, liver, fish, tofu, red meat fortified cereals, eggs, cheese, and low fat dairy  Vitamin supplementation  Aplastic Anemia  Bone marrow depression of all blood cells (Pancytopenia)  Causes Aplastic Anemia  Autoimmune  Medications  Medical treatments  Viruses  Genes Normal Blood Aplastic Anemia  Clinical Manifestations  Anemia (fatigue, pallor, dyspnea)  Leukocytopenia (recurrent infections)  Thrombocytopenia (bleeding)  Treatment  Blood Transfusions  Bone Marrow Transplant  Sickle Cell Disease  Abnormal hemoglobin chains (HbS) that “sickle” when stressed  Sickled cells go back to normal shape when stressor is removed  Sickle Cell Trait Less than half of RBCs are sickled  Sickle Cell Disease Almost all RBCs are sickled Sickle Cell Disease  Etiology and Genetic Risk  Genetic disorder (autosomal recessive)  1 in 500 African Americans have SCD  More common in people of African and Mediterranean descent  Sickle Cell Disease  Sickle Cell Crisis  Stressors  Hypoxia  Dehydration  Infection  Pregnancy  High altitudes  Low or high environmental or body temperatures  Strenuous exercise  Emotional stress  Anesthesia  Sickle Cell Disease  Clinical Manifestations Sickle cell crisis:  Severe Pain  Dyspnea  Tachycardia, Angina  Fatigue  Jaundice  Pallor  Priapism  Treatment  Manage pain!  Remove stressor Thalassemia  Autosomal dominant trait  Abnormal hemoglobin from a lack of one of two proteins (alpha and beta) that makes up hemoglobin  Mostly seen in Mediterranean descent (can occur in Asian, Indian, and African descent)  Clinical Manifestations  Miscarriage  Delayed growth and development  Bone deformities  Fatigue, Dyspnea  Jaundice, Hepatomegaly  Splenomegaly  Heart failure Disorder of Excess Red Blood Cells  Polycythemia Vera  Too many erythrocytes (cancer of RBC)  Rare and can be life threatening  Clinical Manifestations  Flushed, dark purple facial skin  Intense itching  Hypertension, Tachycardia  Thrombosis  Hyperkalemia  Headaches and visual changes  Polycythemia Vera  Treatment  Phlebotomy with Apheresis  Removal of blood, removal of RBCs, then transfused back into patient  Increase Hydration  Anticoagulants  Chemotherapy, Radiation White Blood Cell Disorders  Disorder of Decreased WBCs  Leukocytopenia/ Neutropenia  Leukocytopenia  Vitamin Deficiency  Decreased levels of white blood  Clinical Manifestations cells (below 5,000)  Depends on severity and cause  Neutropenia  Infections and ulcerations  Neutrophils’ normal range: 2000-  Signs and symptoms of infection 7500 cells/µL  Neutrophils < 500 cells/µL  Causes  Drug suppression  Radiation therapy  Congential conditions  Bone Marrow cancers  Spleen destruction  Neutropenic Precautions  Place in private room  No fresh flowers or potted plants  Use good handwashing technique  No standing water  For severely neutropenic, wear gown, mask,  Instruct patient and gloves  Bathe daily  Do to use supplies from common areas for  Avoid eating raw meat or vegetables neutropenic patients  Use condom during intercourse  Limit amount of people entering the  Do not change pet litter boxes patient’s room  Avoid crowds  Inspect mouth and skin and mucuous membranes every 8 hours  Inspect open areas (such as wounds and IV) for infection  Change wound dressing daily  Keep frequently used equipment in the room for use of patient  Avoid indwelling catheter Disorders of Excess WBCs Infectious Mononucleosis  Also known as “Mono” and “Kissing Disease”  Caused by Epstein-Barr virus in the herpes family  Spread through saliva  Self-limiting  Usually occurs in adolescents and young adults  Insidious onset  Incubation is 4-8 weeks  Acute illness lasts 2-3 weeks  May not fully recover for 2-3 months Leukemia  Pathophysiology  Leukemia  Cancer of leukocytes  Leukemia cells abnormally reproduce, crowding out normal blood cells  Four types of Leukemia Chronic Acute Myeloid CML AML Lymphoid CLL ALL Types of Leukemia Leukemia Population Response to Prognosis Type Affected Chemotherap y ALL Children Responds well Good AML Adults Responds fairly Worse than well that of ALL CLL Adults Responds Most live many poorly years after diagnosis CML Adults Responds Poor poorly Leukemia  Clinical Manifestations  Diagnosis  Pantocytopenia  Bone marrow biopsy Leukemia  Treatment  Chemotherapy  Hematopoietic Stem Cell Transplant Lymphoma Hodgkin’s Lymphoma Non-Hodgkin’s Lymphoma  Hodgkin’s Lymphoma  Cancer that affects the lymphatic system  Least common of two lymphomas  Solid tumors that contain Reed- Sternberg Cells  Usually originate in the lymph nodes of the upper body  Commonly seen in teens and young adults and adult men in their 50-60s  Spreads predictably from one set of lymph nodes to the next  Hodgkin’s Lymphoma  Clinical Manifestations  Fever, Heavy Night Sweats, Unplanned Weight Loss  Large, painless lymph nodes  Pain in lymph nodes after alcohol consumption Hodgkin’s Lymphoma Staging Stage I Located one site Stage II Located in two sites Stage III Sites in the lymph nodes above and below the diaphragm Stage IV Sites in several parts of one or more organs or tissues Recurrent The disease returns after treatment  Non-Hodgkin’s Lymphoma  All lymphoid cancers that DO NOT have Reed-Sternberg cells  More common than Hodgkin’s Lymphoma  Poorer prognosis  Spreads in a less orderly fashion than Hodgkin’s lymphoma  Common in men and older adults  Suspected causes  H. pylori  Epstein Barr virus  Similar to Hodgkin’s manifestations, staging, and treatment  Multiple Myeloma  Plasma cell cancer  Excessive numbers of abnormal plasma cells in the bone marrow  Causes Bence Jones proteins to be excreted in the urine  Clinical Manifestations  Often, No Symptoms  Elevation of Serum Total Protein  Multiple Myeloma  Other Manifestations  Pantocytopenia  Bone Pain  Decreased Bone density  Pathological Fractures  Hypercalcemia  Recurrent Bacterial Infections  Kidney Dysfunction  Interventions  Watchful waiting  Chemotherapy  Stem Cell Transplant Coagulation disorders Hemostasis  Stopping of flow of blood  Normal when it seals a blood vessel to prevent blood loss  Abnormal when it causes inappropriate clotting or clotting is insufficient to stop blood flow  Hemostasis Stages  Vessel Spasm  Formation of Platelet Plug  Blood Coagulation  Clot Retraction  Clot Dissolution  Bleeding Precautions  Handle patient gently  Make sure dental devices fit properly  Use lift sheet when moving and positioning patient in bed  Instruct patient  Avoid IM injections and venipunctures  Avoid blowing nose or inserting objects  Use smallest gauge needle for task  Wear firm sole shoes when ambulating  Apply firm pressure to needle sticks for 10 minutes  Do not participate in contact sports  Apply ice to areas of trauma  Avoid anal intercourse or trauma with intercourse  Observe IV site for signs of bleeding every 4 hours  Do not strain during bowel movement  Do not administer enemas, administer  Avoid playing musical instruments that raise suppositories with caution the pressure inside your head (ie brass wind or reed instruments)  Use electric shaver  Use soft-bristled toothbrush or tooth sponges Platelet disorders  Idiopathic Thrombocytopenia Purpura (ITP)  Thrombotic Thrombocytopenia Purpura (TTP)  Idiopathic Thrombocytopenia Purpura  AKA Autoimmune Thrombocytopenia Purpura  Circulating platelets are decreased although platelet production is normal  Usually affects 20-50 year old women who have other autoimmune disorders  Maybe due to viral infection  Clinical Manifestations  Large Ecchymoses, Petechiae, Purpura  Mucosal Bleeding  Anemia  Hemorrhage  Diagnosis  Low Platelet Count and Increased Megakaryocytes  Idiopathic Thrombocytopenia Purpura  Treatment  Drug Therapy  Drugs to reduce the body’s reaction against platelets  Platelet Transfusions  Splenectomy  Thrombotic Thrombocytopenia Purpura (TTP)  Hypercoagulation depletes platelet levels  Deficiency of enzyme necessary for cleaving von Willebrand’s factor (vWF)  Most common in 40-50 year old women  Clinical Manifestations  Failure to Clot during Trauma  Fever  Renal Failure  Transient Neurologic Abnormalities Thrombotic Thrombocytopenia Purpura  Complications  Kidney Failure  Stroke  Myocardial infarction  Causes  Idiopathic, hereditary, bone marrow transplants, cancer, medications, pregnancy, and HIV  Treatment  Plasma Removal  Infusion of Fresh Frozen Plasma (FFP)  Drug therapy Clotting Factor Disorders  Hemophilia  von Willebrand Disease  Disseminated Intravascular Coagulation (DIC)  Hemophilia  Hemophilia A : deficiency of factor VIII  Hemophilia B (Christmas Disease): deficiency of factor IX (not as common)  X-linked recessive trait  Clinical Manifestations  Excessive Bleeding with Minor Injuries  Joint and Muscle Hemorrhages  Tendency to Bruise Easily  Prolonged Hemorrhage after Surgery  Treatment  Hemophilia A: Synthetic Form of Factor VIII  Blood Transfusions von Willebrand Disease  Most common hereditary bleeding disorder  Decreased platelet adhesion and aggregation  Clinical Manifestations  Bleeding or indications of bleeding  Treatment  Bleeding precautions  Measures to control bleeding  FFP  von Willebrand Disease Type 1 Type 2 Type 3 Genetics Autosomal Autosomal Autosomal dominant dominant or recessive recessive Patho Reduces vWF vWF building No measurable levels blocks are vWF or factor abnormal or VIII dysfunctional CM Usually mild, Causes Causes the but causes moderate most severe significant bleeding with bleeding bleeding after occasional problems surgery or severe trauma manifestation % vWD 75% 15-25%