Blood Disorders Quicksheet

Leukemia

● group of malignant disorders affecting the blood and blood-forming tissues - where

are blood components made? bone marrow, spleen, and lymph system

● classifications:

acute = immature hematopoietic stem cells are proliferated

chronic = mature forms of WBC , gradual onset

o acute lymphocytic leukemia

▪ most common type in kiddos. b cell in origin

▪ s/s are abrupt (fever, bleeding) or insidious (progressive weakness,

fatigue, pain, bleeding tendencies). CNS manifestations common

o acute myelogenous leukemia

▪ abrupt, dramatic onset - serious infection or abnormal bleeding

▪ uncontrolled proliferation of myeloblasts - hyperplasia of bone

marrow and spleen

o chronic myelogenous leukemia

▪ excessive mature neoplastic granulocytes

▪ philadelphia chromosome (genetic marker) sets it apart

▪ chronic, stable phase followed by acute, aggressive (blastic) phase

o chronic lymphocytic leukemia

▪ most common type in adults

mature-appearing lymphocytes

● b cells involved + lymphadenopathy all around

o clinical manifestations of leukemia

▪ varied but related to

● bone marrow failure - overcrowding by abnormal cells

● Formation of leukemic infiltrates → leukostasis (life-

threatening complication. caused by high levels, >100,000, of

leukemic wbc in peripheral blood vessels. blood thickens and

blocks circulatory pathways)

▪ inadequate marrow levels lead to … anemia, thrombocytopenia, ↓ #

and function of WBCs

o treatment

▪ chemotherapy

● induction aggressive treatment attempting to bring about

remission

● post-induction / post-remission given to eliminate any

remaining cells

● maintenance lower doses of same drugs used for induction

given q 3-4 wks for a prolonged time

o nursing assessment

▪ signs of infection
 ● fever, chills/sweating, persistent cough, crackles/decreased

lung sounds, pain on urination, abdominal pain

▪ signs of anemia

● fatigue, SOB, weakness, dizziness/fainting, pallor, insomnia,

tachycardia

▪ signs of bleeding

● bruising (purpura, petechiae), epistaxis, blood in urine or stool,

tachycardia, hypotension, headache, confusion, or other neuro

symptoms may indicate brain bleed

▪ other symptoms

● weight loss, dehydration, mood changes, stomatitis (mouth

sores), jaundice, hepatomegaly, splenomegaly, paresthesia,

reduced UO

o nursing interventions (most unique, IMO)

▪ Limit visitors as indicated

▪ Prohibit live plants/flowers

▪ Require good hand hygiene by all visitors, clinicians, and patients

▪ Chance IV tubing according to hospital quality, usually q 72 hrs

▪ Encourage foods high in protein

Lymphoma
● malignant neoplasms originating in bone marrow and lymphatic structures

● hodgkin’s lymphoma

o proliferation of abnormal giant, multinucleated cells

▪ reed sternberg cells !!!!! located in the lymph nodes

o cause unknown. 2x more in males

o key factors: infection w Epstein-Barr virus (mono), genetic predisposition,

exposure to occupational toxins

o clinical manifestations

▪ insidious onset - enlargement of cervical, axillary, or inguinal lymph

nodes

▪ nodes are movable, nontender, and painless unless nodes exert

pressure on nerves nearby

▪ b symptoms !

● Night Sweats (drenching)

● Fever (>100.4)

● Weight loss (exceeding 10% in 6 months)

● non-hodgkin’s lymphoma

o heterogenous group of malignant neoplasms of the immune system affecting

all ages. primarily b, t, or nk cell origin

o cause unknown. most common in those that are immunodeficient. no

hallmark feature

o prognosis is not as good as Hodgkin’s (based on histopathology) (change of

tissue caused by disease)

▪ ALSO b symptoms

● treatment for both

o chemo & radiation therapy

o hematopoietic stem cell transplant is the goal

Disseminated Intravascular Coagulation (DIC)

● acquired hemorrhagic syndrome. clotting + bleeding

● causes: trauma, malignancy, burns, shock, abruptio placentae

● widespread clotting in small vessels

● diagnostic testing

o cbc will show thrombocytopenia

o ↑ PT, PTT, d-dimer

o blood smear

● treatment

o treat underlying cause

o give heparin, plt infusions, fresh frozen plasma, antibiotics, fluid

replacement, electrolyte replacement

● nursing management
 o use soft toothbrush, electric razor, avoid aspirin, avoid risk for injury, like

contact sports, examine urine for blood, examine stool (black tarry stool …

emergency!)

Thrombocytopenia

● reduction of platelets, results in abnormal hemostasis (prolonged or spontaneous

bleeding

● causes:

inherited

acquired:

o immune thrombocytopenia purpura (ITP)

▪ most common. syndrome of abnormal destruction of circulating plts

▪ primarily an autoimmune disease

▪ clinical syndrome manifests as

● acute condition in children

● chronic in adults

▪ treated w multiple therapies

● corticosteroids

● IVIG and anti-Rh in high doses

● rituximab

▪ may need plt transfusion

▪ NOT an emergency
o thrombotic thrombocytopenic purpura (TTP)

▪ uncommon syndrome w a variety of features that are not always

present

▪ most commonly associated w hemolytic-uremic syndrome. TTP-HUS

▪ associated w enhanced aggregation of plts that form into micro-

thrombi

▪ caused by plasma enzyme deficiency

▪ medical emergency !

▪ Treatment:

● treat underlying disease or cause

● plasmapheresis is used to aggressively reverse platelet

consumption

● Rituximab (a monoclonal antibody drug)

o heparin-induced thrombocytopenia (HIT)

▪ life-threatening

▪ two major responses:

● plt destruction & vascular endothelial injury

▪ develops 5-10 days after heparin therapy is started

● plt counts drop 50% below baseline

● venous thrombosis is the major clinical problem. DVT and PE

often result

▪ treatment: STOP heparin permanently.

are still at risk for PE) (to decrease clot formation)