NU 350 Malignant Blood Disorders

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What are the basic characteristics of leukemia?

Malignant problem with the white blood cells

Affects the bone marrow, lymph system, and spleen. WBCs get trapped in all three of these places.

Affects all age groups

Changes normal cells to malignant cells


What is the etiology of leukemia?

No single cause. Exposure to chemicals, radiation, chemotherapy, and smoking and genetic problems (Philadelphia chromosome) increase the risk.


What is acute myelogenous leukemia (AML)?

AML is most often going to affect adults. It's sudden onset, pt will come in with an infection that won't go away. Platelets, RBCs, and normal WBCs will be decreased. But WBC count will skyrocket because of immature blast cells. End up with anemia. Platelets will be 25-50, normally 150-400. WBC count could be over 100.

Bleeding is a major issue. Many pts complain of nosebleeds or bruising all over.


What is acute lymphocytic leukemia (ALL)?

More common in children. Most often meningitis is common for these children.


What is chronic myelogenous leukemia (CML)?

Comes on more slowly. May not habe symptoms for years. Philadelphia chromosome abnormality. Usually at the end of it, starts acting like acute leukemia, rapid stage. After it kicks in, the pt doesn't usually live long.


What is chronic lymphocytic leukemia (CLL)?

Again, usually no symptoms until late stage. Comes with enlarged lymph nodes.


What are the clinical manifestations of leukemia?

Depends on type, but common are:

Increased # of infections

Bleeding and bruising easily

Bone/joint pain

Weight loss

Swollen lymph nodes without pain

May have sores break out on the gums


What are the diagnostic studies used to diagnose leukemia?

Bone marrow aspiration

Lumbar puncture

CT scan

Peripheral blood smear if pt is having CNS symptoms.


What is the initial goal of therapy?

Attaining remission


What are the common pharmacological treatments for leukemia?

Very high dose of chemotherapy

Combination drug therapy decreases drug resistance, minimizes drug tolerance, and interrupts cell growth


What are the non-pharmacological treatments for leukemia?

Stem cell transplants. Autologous stem cells to try to save the good parts of their own blood, Syngenic stem cells (when an identical twin gives stem cells), and allogenic (from another donor, could be parent, sibling, or volunteer who's a match).


What does a nurse need to know about management of leukemia?

Assess hx, specifically exposure, occupation, smoking, medications. S/s like fatigue, bleeding, bruising, or family hx of leukemia.

Goals: Remain free from infection.



What are the characteristics of Hodgkin's lymphoma?

  • 11% of all lymphomas
  • Reed-Sternberg cells
  • 90% originate in lymph nodes
  • Cause unknown-factors include Epstein-Barr virus, occupational toxins, genetic predisposition
  • Above the diaphragm-confined to lymph nodes
  • Most of the time, going to be cervical, axillary, or inguinal lymph nodes that are enlarged
  • Not painful

What are the clinical manifestations of Hodgkin's lymphoma?

Swollen nodes that aren't painful, fatigue, weight loss.


How is Hodgkin's lymphoma diagnosed?

Lymph node biopsy. Looks at width and thickness of lymph node.


What is the prognosis of Hodgkin's lymphoma?

if found early in stage 1 or 2, 80% chance of survival for 5 years.


What are the characteristics of non-Hodgkin's lymphoma?

  • Most common cancer of the blood
  • Affects all ages
  • B-cell or T-cell origin
  • 60,000 new cases diagnosed each year
  • 20,000 deaths each year

What are the clinical manifestations of non-Hodgkin's lymphoma and how is it diagnosed?

Primary is lymph node enlargement without pain, often times, the disease is already advanced without the patient's knowledge. Can go outside of the lymph node. Pancytopenia is another symptom.

Diagnosed by lymph node biopsy.


Describe the 3 types of non-Hodgkin's lymphoma.

1. Low-grade or indolent - Very slow growing. Can sit for years.

2. Intermittent - aggressive

3. High grade - Very aggressive


What is the treatment and prognosis for non-Hodgkin's lymphoma?

Treatment is based around controlling symptoms.

Some pts never go into remission.

Prognosis is not as good as Hodgkin's.


What are the characteristics of multiple myeloma?

  • Malignant plasma cells attack bone marrow and destroy bone
  • Develops after 40 years of age
  • More common in men
  • More common in African Americans

What is the etiology of multiple myeloma?

Cause is unknown. Exposure to radiation, chemicals such as benzene, smoking, chemo, herbicides, insecticides.

Bence-Jones proteins are present in the urine. Kidneys are affected bc of the high protein level being excreted. They can go into renal failure once advanced.


What are clinical manifestations of multiple myeloma?

Slow onset, skeletal pain, hurting in the ribs, back, legs. Osteoporosis develops, calcium's lost from the bone, calcium level in blood becomes too high bc it can't get into the bone. Anemia, pancytopenia.


Prognosis for multiple myeloma?

Can live a couple years or 10-12 years depending on when you're diagnosed. But many pts hit the advanced stage before diagnosis.


What are some nursing interventions in the management of multiple myeloma?

Manage bone pain, increase fluids, plenty of hydration, ambulation to help, absorb calcium in the bones, ROM.


What are characteristics of myelodysplastic syndrome?

Called pre-leukemia or "smoldering" leukemia.

Bone marrow doesn't function normally.

Not enough normal blood cells are made.

Occurs most often in old people.

A myelodysplastic syndrome may develop following treatment with drugs or radiation therapy for other diseases, or it may develop without any known cause. The myelodysplastic syndromes may change into acute myeloid leukemia.


What are the s/s of myelodysplastic syndrome and how is it diagnosed?

Most common sign is anemia, may manifest as infection and bleeding.

Diagnosed by bone marrow biopsy to identify the disease and the specific type.