Allison lecture 3 Study Notes on Neutropenia and Leukemia

Skills Lab Sign Ups

  • Initial testing sign-ups posted (not for practice).

  • If first attempt not touched, need to come for next step.

Neutropenia Overview

  • Caused by autoimmune disorders, drug reactions, hematologic disorders, and severe sepsis.

  • Neutropenic level: below 2500 neutrophils.

  • Diagnostics: CBC, bone marrow biopsy, possible chest X-ray.

Symptoms and Presentation

  • Normal temperature in neutropenic patients; do not always meet SIRS criteria.

  • Potential for sepsis despite normal vitals.

Treatment and Management

  • Identify root cause of neutropenia.

  • Initiate early antibiotic therapy.

  • Use hematopoietic growth factors post-chemotherapy for patients.

  • Neutropenic precautions: hand hygiene, no fresh produce, monitor visitors.

Important Medications

  • Filgotinib and Pegfilgrastim: Promote granulocyte production and reduce infection rates.

  • Erythropoietin: Aids red blood cell synthesis, minimal side effects.

Myelodysplastic Syndrome (MDS)

  • Ineffective blood cell production, risk of progression to acute myeloid leukemia (AML).

  • Diagnosed via blood tests and bone marrow biopsy.

Leukemia Overview

  • Group of cancers affecting blood and bone marrow; can occur at any age.

  • Cannot pinpoint exact cause; may involve genetic and environmental factors.

Diagnosis and Treatment of Leukemia

  • Diagnose via CBC, bone marrow biopsy, flow cytometry.

  • Treatment includes chemotherapy, radiation, and potential stem cell transplants.

Patient Management

  • Monitor for infection, thrombocytopenia, fluid/electrolyte balance, and signs of tumor lysis syndrome.

  • Continuous assessment and interprofessional collaboration are crucial for successful treatment outcomes.

Key Points for Nursing Practice

  • Perform thorough patient assessments, focusing on symptom history.

  • Collaborate with multidisciplinary teams for effective patient care.

Leukemia

Etiology

  • No single identifiable cause in most cases

  • Often appears suddenly

  • Genetic factors may play a role

  • Chromosomal abnormalities can sometimes be identified in leukemic cells

  • Higher risk in:

    • Identical twins

    • Individuals with genetic conditions (e.g., Down syndrome)

  • Environmental factors:

    • Ionizing radiation exposure

    • Alkylating agents (chemotherapy-related)

    • Possible association with pesticides and industrial chemicals

  • May originate from clonal stem cell disorders

Pathophysiology

Leukemia begins when genetic mutations cause the bone marrow to produce abnormal immature white blood cells (blasts).

These blasts:

  • Multiply rapidly

  • Do not mature properly

  • Do not function normally

As blasts accumulate, they crowd the bone marrow, interfering with normal hematopoiesis.

This results in:

  • ↓ Red blood cell production → anemia

  • ↓ Platelet production → bleeding/bruising

  • ↓ Functional white blood cells → increased infection risk

Blasts then enter the bloodstream and infiltrate other organs, including:

  • Lymph nodes

  • Spleen

  • Liver

  • Central nervous system

🔑 Key Points – Pathophysiology

  • Leukemia is a bone marrow disorder

  • Abnormal blast cells invade and crowd out normal cells

  • Leads to pancytopenia

  • Symptoms reflect loss of normal blood cell function, not just excess WBCs

Assessment

Subjective Findings

  • Persistent or unexplained fatigue

  • Recurrent or frequent infections

  • Fever (may be intermittent)

  • Easy bruising or bleeding

Patients often do not recognize the pattern — the nurse must connect the findings.

Objective Findings

  • Pallor

  • Petechiae

  • Ecchymosis

  • Enlarged lymph nodes (often firm, non-tender)

  • Possible hepatosplenomegaly

🔑 Key Points – Assessment

  • Frequent infections without clear cause are a red flag

  • Bruising without trauma is significant

  • Pallor + fatigue + petechiae should prompt further evaluation

  • Always assess trends, not isolated findings

Diagnostics

  • CBC with differential

    • Abnormal WBC count

    • ↓ Hemoglobin / hematocrit

    • ↓ Platelets

  • Peripheral blood smear

    • Presence of leukemic blast cells

  • Bone marrow biopsy

    • Confirms diagnosis

    • Normal blasts: < 5%

    • Leukemia: often 80–100% blasts

  • Imaging (CT, MRI, PET) to assess organ involvement

🔑 Key Points – Diagnostics

  • Bone marrow biopsy is diagnostic

  • Peripheral smear supports suspicion

  • CBC often shows abnormalities in all three cell lines