Wk. 4 - Care of Adults with Hematology Cancer

What is neutropenia?

A condition characterized by an abnormally low number of neutrophils, increasing the risk of infection.

How is mild neutropenia classified based on ANC levels?

ANC 1,000-1,500 cells/mm³

How is moderate neutropenia classified based on ANC levels?

ANC 500-1,000 cells/mm³

How is severe neutropenia classified based on ANC levels?

ANC <500 cells/mm³

How is the Absolute Neutrophil Count (ANC) calculated?

ANC = (% Neutrophils + % Bands) x WBC/100

A patient has a WBC count of 2,000/µL, neutrophils at 40%, and bands at 5%. What is their ANC?

900 cells/mm³

Why do neutropenic patients often lack classic signs of infection?

Because they have a reduced immune response, leading to minimal inflammation.

What is the most significant indicator of infection in neutropenic patients?

Low-grade fever (>100.4°F or 38°C).

What are three other signs of infection in neutropenic patients?

Sore throat, skin infections, pain during urination

What is the first step in managing febrile neutropenia?

Administer broad-spectrum IV antibiotics within 1 hour of fever onset.

Name three additional steps in managing febrile neutropenia.

Collect samples, monitor virals, administer colony-stimulating factors

What type of isolation is required for a patient with severe neutropenia?

Protective isolation with a HEPA-filtered private room.

What dietary precautions should neutropenic patients follow?

Avoid raw meats, eggs, and unwashed fruits/vegetables, consume pasteurized dairy products.

Why should neutropenic patients avoid crowds and sick individuals?

To reduce exposure to infections due to their weakened immune system.

What is the primary pathophysiology of Acute Myeloid Leukemia (AML)?

Uncontrolled proliferation of myeloblasts (immature WBCs).

What are three clinical manifestations of AML?

Fatigue, frequent infections, bleeding/bruising

What is a key diagnostic finding in AML?

Bone marrow biopsy showing hypercellular marrow with myeloblasts.

What is the primary treatment approach for AML?

Combination chemotherapy and hematopoietic stem cell transplantation (HSCT).

How does Chronic Lymphocytic Leukemia (CLL) differ from AML?

CLL progresses slowly and involves mature but ineffective B lymphocytes.

What is a hallmark diagnostic feature of CLL on a blood smear?

Smudge cells.

How is early-stage CLL managed?

Observation if asymptomatic; chemotherapy if disease progresses.

What is the defining characteristic of Hodgkin’s Lymphoma?

Presence of Reed-Sternberg cells in lymph nodes.

What are the classic “B symptoms” of Hodgkin’s Lymphoma?

Fever, night sweats, unexplained weight loss.

What is the primary treatment for Hodgkin’s Lymphoma?

Combination chemotherapy (ABVD regimen).

How does Non-Hodgkin’s Lymphoma (NHL) differ from Hodgkin’s?

NHL lacks Reed-Sternberg cells and is more common.

What is the treatment for indolent (low-grade) NHL?

Watchful waiting, radiation, or monoclonal antibodies.

What is the treatment for aggressive (high-grade) NHL?

Combination chemotherapy and stem cell transplant.

What is the hallmark pathophysiology of multiple myeloma?

Malignant plasma cells proliferate in bone marrow, damaging bones and producing M protein.

What does the acronym "CRAB" stand for in multiple myeloma symptoms?

Calcium elevation (hypercalcemia), Renal failure, Anemia, Bone pain/fractures.

What is a key diagnostic marker of multiple myeloma found in urine?

Bence-Jones protein.

What medications are used to prevent bone breakdown in multiple myeloma?

Bisphosphonates (e.g., Pamidronate).

What is the mechanism of action of Epoetin Alfa (Epogen®)?

Stimulates RBC production in bone marrow.

What is the main side effect of Filgrastim (Neupogen®)?

Bone pain due to increased neutrophil production.