Understanding Leukemia and Bone Marrow Function

Role of bone marrow

Bone marrow acts as a factory that produces blood cells, including red blood cells (RBCs) for oxygen transport, white blood cells (WBCs) for immune defense, and platelets for blood clotting.

Leukemia effects on bone marrow

In leukemia, particularly acute lymphoblastic leukemia (ALL) or acute myeloid leukemia (AML), the white blood cell production line malfunctions, leading to the overproduction of immature cells called blasts that do not function properly, disrupting the production of RBCs and platelets.

Acute lymphoblastic leukemia (ALL)

Acute lymphoblastic leukemia (ALL) is a type of cancer that originates from the lymphoid line in the bone marrow, characterized by the rapid production of immature white blood cells.

Leukemia's impact on blood cell production

Leukemia disrupts the normal production of blood cells by overwhelming the bone marrow with immature blasts, which reduces the number of functional red blood cells and platelets, leading to anemia and increased bleeding risk.

Age group affected by leukemia

Leukemia is the most common cancer in children, particularly affecting those between the ages of 2 to 5 years old.

Demographic characteristics of leukemia in children

Leukemia primarily affects young children, with a slightly higher incidence in boys than girls, and it is most commonly observed in white children.

Common symptoms of leukemia in children

Common symptoms of leukemia in children include fatigue, paleness, frequent bruising, and recurrent infections.

Analogy for bone marrow's function

Bone marrow is likened to a giant factory with assembly lines producing red blood cells, white blood cells, and platelets, which are essential for oxygen transport, immune defense, and blood clotting, respectively.

Significance of immature blasts in leukemia

Immature blasts in leukemia are problematic because they do not function effectively as white blood cells, leading to a compromised immune system and allowing infections to proliferate.

Impact of leukemia on a child's health

Noah, a 6-year-old boy, experiences symptoms such as fatigue, paleness, and bruising, indicating that leukemia may be affecting his health by impairing his blood cell production and immune response.

Symptoms noticed by Noah's mom

Noah experiences random nosebleeds, constant sleepiness, pain when touched on his chest bone, and a swollen belly, which indicates spleen enlargement.

Significance of chest bone pain

The chest bone pain is caused by blasts clogging the marrow and pushing out, which is a symptom related to leukemia.

CBC in leukemia diagnosis

CBC stands for complete blood count, and it is crucial for diagnosing leukemia as it reveals low RBCs indicating anemia, low platelets indicating thrombocytopenia, and abnormal WBC counts.

Peripheral blood smear in leukemia diagnosis

A peripheral blood smear involves examining blood under a microscope to identify an excess of blasts, which indicates leukemia.

Bone marrow aspiration

A bone marrow aspiration involves inserting a large needle into the hip bone to extract marrow, revealing hypercellularity and a predominance of blasts, which are indicative of leukemia.

Purpose of lumbar puncture in leukemia diagnosis

A lumbar puncture is performed to determine if leukemia has spread to the brain or spinal cord by inserting a needle into the spine.

Calculating absolute neutrophil count (ANC)

ANC is calculated using the formula: ANC = WBC x (%Neutrophils + %Bands) ÷ 100.

ANC value of less than 1000

An ANC value of less than 1000 indicates neutropenia, which signifies an increased risk of infection.

Effects of anemia on Noah's body

Anemia causes Noah to appear pale, feel tired, and breathe rapidly due to insufficient oxygen transport.

Managing Noah's anemia

Nurses monitor Noah's energy and vital signs, provide blood transfusions, and plan rest times for his comfort.

Neutropenia and its implications for Noah

Neutropenia is characterized by low white blood cell counts, meaning Noah's immune system is weakened, leaving him vulnerable to infections.

Neutropenic precautions for nurses

Nurses should use masks and gloves, ensure no sick visitors are allowed, check the patient's temperature regularly, and monitor for subtle signs of infection.

Significance of thrombocytopenia

Thrombocytopenia is characterized by low platelet counts, leading to easy bruising, bleeding from minor bumps, nosebleeds, petechiae, and bleeding gums.

Managing a patient with thrombocytopenia

Nurses should avoid IM injections and rectal temperatures, use a soft toothbrush, and prevent bumping limbs.

Platelet transfusions

Platelet transfusions may be necessary.

Four phases of chemotherapy treatment

The four phases are: Induction (to achieve remission), CNS prophylaxis (to prevent leukemia from entering the brain), Intensification (to eliminate remaining cells), and Maintenance (to prevent recurrence).

Routes of chemotherapy administration

Chemotherapy can be administered via IV, Port-a-Cath, orally (PO), and intrathecally (into the spine).

Cell cycle-specific chemotherapy agents

Cell cycle-specific agents, like Methotrexate and Vincristine, work only when cells are dividing.

Non-specific chemotherapy agents

Non-specific agents, like Cyclophosphamide, kill cells at any stage.

Role of targeted therapy in leukemia treatment

Targeted therapy, such as Imatinib and Dasatinib, attacks specific proteins associated with leukemia, aiming to be more effective with fewer side effects.

Common side effects of chemotherapy

Common side effects include myelosuppression (leading to anemia, infection, and bleeding), nausea, vomiting, mouth sores, hair loss, neuropathy, bladder irritation, and delayed puberty.

Blood transfusions for low blood counts

Blood transfusions provide PRBCs for anemia and platelets for bleeding, helping the body recover and maintain necessary blood levels.

Nurse monitoring during blood transfusion

The nurse should monitor for fever, hives, trouble breathing, and back pain during the first 15 minutes of the transfusion.

Importance of monitoring for infection in neutropenic patients

Neutropenic patients have weakened immune systems, making them more susceptible to infections that may not present with obvious symptoms, thus requiring careful monitoring.

Side effects of steroids in chemotherapy

Steroids like Prednisone and Dexamethasone can cause side effects such as moon face, mood swings, and elevated blood sugar and blood pressure.

Myelosuppression

Myelosuppression is the shutdown of bone marrow function, leading to anemia, increased risk of infection, and bleeding complications.

Chemotherapy and hair growth

Chemotherapy can cause hair loss (alopecia), which is typically temporary, with hair regrowth occurring after treatment ends.

Purpose of CNS prophylaxis in leukemia treatment

CNS prophylaxis involves special treatment to prevent leukemia from spreading to the brain, ensuring comprehensive management of the disease.

Immediate actions for transfusion reaction

Stop transfusion immediately, flush IV with normal saline, notify the doctor, send the blood bag and tubing to the lab, collect urine and blood samples, and document everything.

Purpose of Stem Cell Transplant (HSCT)

HSCT is used to wipe out old marrow with high-dose chemotherapy and then transfuse new healthy stem cells to rebuild a brand-new immune system.

Graft-vs-Host Disease

Graft-vs-Host Disease occurs when new immune cells from the donor attack the recipient's organs.

Main types of leukemia

The main types of leukemia are Acute Lymphoblastic Leukemia (ALL) and Acute Myeloid Leukemia (AML).

Common signs of leukemia

Common signs of leukemia include bruising, fatigue, fever, and bone pain.

Blood tests in diagnosing leukemia

Blood tests in leukemia typically show high white blood cell counts with blasts, low red blood cells, low platelets, and low absolute neutrophil counts.

Treatment phases for leukemia

The treatment phases for leukemia include four phases of chemotherapy, steroids, transfusions, and potentially stem cell transplant.

Nursing responsibilities for leukemia patients

Nursing responsibilities include preventing infection, monitoring for bleeding, and supporting the patient's energy levels.

Potential sources of stem cells for transplantation

Potential sources of stem cells for transplantation include matched siblings, cord blood, and unrelated donors.

Ablative therapy in stem cell transplants

Ablative therapy involves destroying the old marrow with high-dose chemotherapy before transfusing new healthy stem cells.