Nursing Care of Patients with Hematologic Disorders

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Nursing Care of Patients with Hematologic
Disorders
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Bone Marrow Transplant

• Autologous Bone Marrow Transplant
• Allogenic Bone Marrow Transplant
• Sources
• Bone marrow harvest Collecting stem cells by
  taking them directly out of the bone.
• Apheresis Collecting stem cells by filtering the
  blood for peripheral (circulating) blood cells
• Umbilical cord blood Stem cells are filtered
  from blood in the umbilical cord after a baby is
  born.

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Stem Cell Transplant

• Replaces dysfunctional bone marrow
• Destroy unhealthy bone marrow that may contain
  cancer cells.
• Complications that can arise with a stem cell
  transplant include
• Graft-versus-host disease
• Stem cell (graft) failure
• Organ damage
• Cataracts
• Secondary cancers
• Death

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Hodgkins Lymphoma

• Signs Symptoms
• Painless swelling of lymph nodes in the neck
• Armpits or groin
• Persistent fatigue
• Fever and chills
• Night sweats
• One of the most treatable types of cancer
• Chemotherapy
• Combination radiation and chemotherapy
• Stem cell transplant

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Non-Hodkins Lymphoma

• Signs Symptoms
• Swollen lymph nodes in neck, armpit or groin
• Abdominal pain or swelling
• Chest pain, coughing or trouble breathing
• Fatigue, fever, night sweats
• Occult blood
• Intervention
• Wait
• Chemotherapy, Radiation, Stem cell transplant
• Medications
• Rituximab (Rituxan), Ibritumomab (Zevalin),
  Tositumomab (Bexxar)

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Multiple Myeloma

• White blood cell cancer that involves a more
  mature lymphocyte - plasma cell
• Signs Symptoms
• Bone pain, particularly in back, pelvis, ribs and
  skull.
• Presence of abnormal proteins which can be
  produced by myeloma cells in blood or urine.
• Hypercalcemia Bence Jones
• Interventions
• Chemotherapy
• Autologous stem cell transplant
• Bisphosphonates

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Neutropenia

• Neutropenia may be caused by
• Congenital disorders characterized by poor bone
  marrow function
• Cancer or other diseases that damage bone marrow.
  (filgrastim)
• Viral infections that disrupt bone marrow
  function
• Autoimmune disorders that destroy neutrophils or
  bone marrow cells
• Overwhelming infections that use up neutrophils
  faster than they can be produced
• Drugs that destroy neutrophils or damage bone
  marrow

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Thrombocytopenia

• Idiopathic thrombocytopenic purpura (ITP)
• ITP is a disease in which antibodies form and
  destroy the body's platelets.
• Thrombotic thrombocytopenic purpura (TTP)
• TTP is a rare disease in which small blood clots
  form suddenly throughout the body.
• Hemolytic-uremic syndrome (HUS)
• abnormal premature destruction of red blood cells.

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Heparin Induced ThrombocytopeniaHit Happens

• Serious immune-mediated syndrome where heparin
  administration is associated with
• Thrombocytopenia
• The generation of heparin-dependent antibodies
  (typically IgG)
• A high risk for thrombosis causing significant
  morbidity and mortality

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Hemophilia

• Hemophilia A is deficiency of factor VIII and
  accounts for 80 of cases.
• Hemophilia B is deficiency of factor IX and
  accounts for 20 of cases.
• Symptoms of bleeding may include
• Many large or deep bruises
• Joint pain and swelling caused by internal
  bleeding
• Unexplained bleeding or bruising
• Blood in urine or stool
• Prolonged bleeding from cuts or injuries, or
  after surgery or tooth extraction
• Nosebleeds with no obvious cause
• Tightness in your joints

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Disseminated Intravascular Coagulation (DIC)

• Signs Symptoms
• Microvasculature thrombosis
• Thrombi spread to affect the organs
• Decreased consciousness
• Abdominal pain GI tract occlusion
• Decreased urinary output
• Chest pain, respiratory difficulty
• Therapeutic management complex
• Must remove underlying injury
• Stop damage from thrombosis or bleeding
• Anticoagulant therapy
• Replacement therapy
• Restore anticoagulant pathways