Chapter 34

Chapter 34

Part 3

Neutropenia

Occurs when the total number of neutrophils is abnormally low, putting the patient at increased risk of infection.

What are neutrophils: Neutrophils (also known as neutrocytes or heterophils) are the most abundant type of granulocytes and make up 40% to 70% of all white blood cells in humans.

Treating Neutropenia

Classic signs of infection (redness, swelling, pain) in these patients may be absent.

Fever may be the only sign of infection.

Most common sites of infection: lung (pneumonia, blood (sepsis), and GI tract

Infections are usually caused by bacteria, may also be caused by fungi and viruses.

Treating Neutropenia cont.

Antibiotics and minimizing exposure to infections using compromised host precautions: patient should wear a mask, no flowers in hospital room, frequent vitals, keep invasive procedures to a minimum, no humidifiers or standing water, private room, etc.

Non-Hodgkin's Lymphoma

Cancer of the lymph system

More commonly seen in older people

Stages: Low grade, intermediate grade, high grade

Treatments include chemo and radtiation

Survival rate depends on grade and age at diagnosis, usually 68%

Hodgkin's Disease

Type of lymphoma characterized by Reed Sternberg cells in the lymph nodes

Reed Sternberg cells: (also known as lacunar histiocytes for certain types) are distinctive, giant cells found with light microscopy in biopsies from individuals with Hodgkin lymphoma. They are usually derived from B lymphocytes, classically considered crippled germinal center B cells.

Men are more commonly diagnosed then women, ages in their 20's and 50's

Treated with chemo or radiation, survival rate: 85%

Leukemia

Cancer of the WBCs in which the bone marrow produces too many immature WBCs leaving the patient at risk for infection.

Two main types exist: Myelogenous and Lymphocytic. Each type can be either chronic or acute. Chronic infections can last many years, are treated with chemo pills and the patient usually feels fine. Acute infections in either form come on suddenly and leave the patient at high risk for infection and bleeding. Acute forms are treated with chemotherapy as soon as possible.

Acute Leukemias

Acute Lymphocytic Leukemia

-Most often occurs in children 2-6 years old.

-WBC can skyrocket within days

-Treated with chemo

-70-80% survival rate after 5 years

Acute Myelogenous Leukemia

-Most often appears in adults

-WBC can skyrocket within days

-Treated with chemo

-20% survival rate after 5 years

Signs and Symptoms of Acute Leukemia

-infection, fatigue, tachycardia, paleness, and tachypnea

-petechiae or purpura, epistaxis, gingival bleeding, melena (blood in stool), menorrhagia (heavy menstrual periods)--due to low platelet counts

-patients may also report bone pain, weight loss, and swollen lymph nodes

Diagnosing Leukemia

CBC with very high WBC count, bone marrow biopsy

Medical Treatment for Acute Leukemia

-high doses of chemo to destroy the diseased bone marrow (called induction therapy)

-Patients with Acute Lymphocytic Leukemia then receive lower doses of chemo over 1-3 years, called maintenance therapy

-Patients with Acute Myelogenous Leukemia receive high doses over the next 2-4 months but are then finished with all treatment, treatments called intensification then consolidation

-during the high doses of chemo, patient may stay in the hospital to receive blood transfusions and antibiotics

Multiple Choice

Which problem presents the greatest risk to a patient with Acute Myelogenous Leukemia treated with high doses of chemo?

• hemorrhage

• Anemia

• Infection

• Fatigue

Multiple Select

Which are causes of neutropenia?

• Decreased bone marrow production

• Chemotherapy

• Hypersensitivity reactions

• Radiation therapy

• Autoimmune disorders

Multiple Choice

A 20-year old African American woman comes to the community clinic complaining of fatigue, fever, anorexia, joint pain & muscle pain. She has a butterfly rash on her face. These are symptoms of:

• Hodgkin's disease

• leukemia

• systemic lupus erythematosus, SLE

• multiple myeloma

Multiple Choice

The reason pus may not be seen even though infection is present in a patient with leukemia is that patients with leukemia do not have normal:

• platelets

• red blood cells

• white blood cells

• cytokines