name it
Erythrocytes, leukocytes and platelets
used for ALL, and ACL.. blocks signals in leukemic cells that express BCR-ABL protein; chemotherapy, HSCT
MUST ADHERE TO REGIMEN!
Imatinib mestylate (Gleevec)
tx aggressive chemo, HSCT
Leukemic cell infiltration is more common with this leukemia, with symptoms of meningeal involvement (spinal cord and brain) and liver, spleen, and bone marrow pain
Treatment
Cranial irradiation of brain, chemotherapy, imatinib mestylate, HSCT, monoclonal antibody therapy
CNS involvement → headache and vomiting
Acute Lymphocytic Leukemia (ALL)
Primary or secondary (platelets < 20,000)
Normal platelets 150,000 - 450,000
Primary occurs in isolation, by itself for no reason
Secondary: autoimmune or after viral illness, Sulfa drugs or pregnancy
Antiplatelet antibodies develop in blood and bind to patients platelets
Symptoms: bruising or petechiae
Dry purpura - when patients have bruising on extremities
Wet purpura - bruising on mucosal membranes
Hemoptysis
Medical Management
Platelet transfusions DON’t WORK BECAUSE OF ANTIPLATELETS
Discontinue Sulfa drugs
Corticosteroid treatment Imuran
IVIG
MoAb Rituximab
Splenectomy
Nursing Management
Assess lifestyle
Determine risk for bleeding
Check medications - Sulfa, OTC medications, Herbal medications
Avoid ALL drugs with aspirin or NSAIDS
Avoid constipation
No vigorous flossing
No vaginal intercourse
If on corticosteroids - check for osteoporosis
Immune Thrombocytopenic Purpura
the stem cells for T or B cells are
Can be due to medications, chemicals, benzine
MDS → cells are not functioning normally and there is dysplasia of cells
Bone Marrow Failure (Aplastic, MDS)
maybe asymptomatic or present with fatigue or illness. Discovered when CBC is done for other purposes. Overtime pt can develop pancytopenia (all of the levels are down - RBC, WBC, platelets). Watch for altered mental status, if pt develops aml, they are very resistant to treatment.
only cure stem cell transplant; otherwise treat with bone marrow stimulating agents
Malignant B lymphocytes, most of which are mature, may escape apoptosis, resulting in excessive accumulation of cells Survival varies from 2-4 years to > 20 years depending upon stage
Accidental diagnosis
Increased lymphocyte count and bacterial infections
s/s Lymphadenopathy, hepatomegaly, splenomegaly
“B symptoms” include fever, sweats, weight loss
Treatment
Early stage may require no treatment (watchful waiting), chemotherapy (Fludara, Cytoxan) monoclonal antibody therapy rituximab
Chronic Lymphocytic Leukemia (CLL)
Low platelet count
Result from decreased production of platelets (leukemia), increased destruction (sepsis), increased consumption of platelets (DIC - disseminated intravascular coagulation) - clotting, then when platelets are used up massive bleeding will occur (bleeding from eyes, nose, ears, IV site - EVERYWHERE)
S/S
Platelet count < 20,000 → petechiae, nasal and gingival bleeding, excessive bleeding with menstruation, dental extractions or surgery
Medical Management
Treat the underlying cause
May need platelet transfusion
Nursing Management
Severe HA → cerebral bleeding
Thrombocytopenia
arrive to the scene first
Band cells: less mature cells (shift to the left - an increased number of band cells, usually during infection)
Take on an empty stomach one hour before or two hours after a meal with OJ or some other Vitamin C
Iron absorption is reduced with foods - especially with dairy and antacids
Gradually increase dose to prevent GI distress
To allow body to adjust to iron
Increase Vitamin C intake to enhance absorption
Citrus fruits and juices, strawberries, tomatoes, broccoli
Eat foods high in fiber to prevent constipation
Stools will become dark
If taking liquid prep, drink through a straw or use a spoon in the back of the mouth
Rinse mouth afterwards
IT WILL STAIN THE TEETH
Patient will experience cramping and N/V
Noncompliance is seen because of this
Needs to be taken for as long as prescribed even though the patient may not be feeling fatigued
If patient must take with food - the absorption will be decreased by 50%
May need increased doses or longer prescription time
s/s ruddy complexion and splenomegaly from increased blood volume and viscosity of blood. HCT >60, normal o2, enlarged spleen. Risks include thrombosis complications (CVA, MI) and bleeding from dysfunctional platelets Bleeding can be in the form of nosebleeds, ulcers, GI bleeding, hematuria and intracranial hemorrhage
POLYCYTHEMIA VERA
tx. phlebotomy 500 ml 1, or 2x a week. chemotherapeutic agents(hydroxyurea - suppress marrow function, controlling blood counts), platelet aggregation inhibitors(anagrelide - AGRYLIN), interferon, and antihistamines, promote leg exercises and ambulation
Rare, more common in men
And patients receiving immunosuppressive therapy and veterans exposed to Agent Orange
Reed-Sternberg cell, initiates in a single node
Suspected viral etiology, familial pattern, incidence early 20’s and again after age 55
Excellent cure rate with treatment
Manifestations
Painless lymph node enlargement, pruritus (itching); fever, drenching sweats, weight loss, mild anemia
Treatment is determined by stage of the disease and may include chemotherapy and/or radiation therapy
Are at VERY HIGH RISK for infection
Long-term complications and 18-26% develop secondary malignancy
Patients complain of QOL problems r/t fatigue
Hodgkin Lymphoma
Can be seen in those who follow vegetarian diet
In people who are bleeding (always suspect a GI malignancy) → in pt who is generally healthy with anemia
Smooth, glossy red tongue, brittle, rigid nails, fatigue, sore tongue, tachy, SOB dizziness
PICA - craving ice, starch, dirt
Iron Deficiency - hypoproliferative
defect in production of RBCs
Due to iron, vitamin B12, or folate deficiency, erythropoietin production, cancer
May also result from marrow damage due to medications (chloramphenicol) or chemicals (benzine)
Hypoproliferative anemia
chemotherapy (Fludara, Cytoxan) monoclonal antibody therapy rituximab
meds for Chronic Lymphocytic Leukemia (CLL)
this condition is a secondary condition..s/s excessive production of RBC's REDUCED amounts of o2
causes : Excessive production of erythropoietin from reduced amounts of oxygen, cyanotic heart disease,
Esp. renal cancer
Very heavy smokers, COPD
Patients living at high altitudes
mild cases do not require treatment
tx. treat underlying cause, and therapeutic phlebotomy
Lymphoid tissues become infiltrated with malignant cells, spread is unpredictable and localized disease is rare
Incidence increases with age, with average age being 50 to 60
Lymphadenopathy, fever, night sweats, weight loss
Prognosis varies with type of NHL
Treatment is determined by type and stage of disease, and may include interferon, chemotherapy, and/or radiation therapy
If caught in early stages, watchful waiting may also be used
Patients most at risk - autoimmune disease, prior cancer treatment, organ transplant patients, viral infections (may precipitate - Epstein Barr and HIV), exposure to dyes, solvents and pesticides
Non-Hodgkin Lymphoma
Due to absence of intrinsic factor (gastric resection)
Very strict vegetarian diet (no milk or dairy)
Crohn’s disease
Megaloblastic tongue - beefy red
Pernicious Anemia (Vitamin B12 Deficiency)
excess destruction of RBCs
Due to altered erythropoiesis, or other causes such as hypersplenism, drug-induced or autoimmune process, mechanical heart valves
Erythrocyte destruction leads to tissue hypoxia, which in turn stimulates erythropoietin production
Corticosteroid treatment Imuran
IVIG
MoAb Rituximab
Immune Thrombocytopenic Purpura
s/s Initially asymptomatic, malaise, anorexia, weight loss, confusion or shortness of breath due to leukostasis, enlarged tender spleen or enlarged liver
Patients often do not know they have CML
Diagnosis is made while looking for something else
Leukocyte count is > 1000
Imatinib mestylate (Gleevec) blocks signals in leukemic cells that express BCR-ABL protein; chemotherapy, HSCT
MUST ADHERE TO REGIMEN!
Chronic Myeloid Leukemia (CML
Malignant disease of plasma cells in the bone marrow with destruction of the bone
Monoclonal (M) protein → myeloma cells
Median survival 3 to 5 years, no cure
Manifestations
Bone pain (typically in the ribs), osteoporosis, pathological fractures, elevated serum protein, hypercalcemia, renal failure, symptoms of anemia, fatigue, weakness, increased serum viscosity, and increased risk for bleeding and infection CRAB
Bone pain increases with movement and decreases with rest - this treatment is a priority
Excessive thirst, dehydration, constipation, AMS, coma due to hypercalcemia
Treatment may include chemotherapy, corticosteroids, radiation therapy, bisphosphonates and maintaining a HIGH URINE OUTPUT (3L/day of urine) → prevent stones and stasis
Smouldering stage - may need watchful waiting
C- Calcium (high)
R - evidence of RENAL disease (BUN & Creatinine)
A - Anemia
B - Bone lesions (seen with bone density)
High risk of infection
Encourage them to do weight bearing exercises
Careful that patients do not fall and injure themselves
Multiple Myeloma
Seen in ETOH abuse, liver disease, celiac etc
Diet low in green veggies
Pregnancy
Megaloblastic tongue - beefy red
Folic Acid Deficiency