1 / 34

Living with Chronic Neutropenia

Living with Chronic Neutropenia. “Poly” and me. Mary Ann Bonilla, M.D. “Living with chronic illness is a search for quality of life”. Need to be well informed in order to manage the physical symptoms

xadrian
Download Presentation

Living with Chronic Neutropenia

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Living with Chronic Neutropenia “Poly” and me Mary Ann Bonilla, M.D.

  2. “Living with chronic illness is a search for quality of life” • Need to be well informed in order to manage the physical symptoms • Need to learn to live with the emotional challenge to accept limitations and appreciate life’s gifts.

  3. Neutropenia • Decrease in the absolute neutrophil count in the blood (ANC) • Neutrophils are the primary defense against bacteria and fungus • Maintain Intact Surface Barriers • Skin • Mucous membranes of mouth and sinuses • Lungs • GI Tract

  4. Neutrophil Function

  5. Calculating ANC • ANC = WBC x (% segs + % bands) • Total WBC 5000 cells/mm3 Band Neutrophils 5% Segmented Neutrophils 55% ANC = 3000 cells/mm3

  6. Severity = Infection • Mild = 1000-1500 cells/mm3 commonly asymptomatic • Moderate = 500-1000 cells/mm3 gingivitis, impetigo, otitis • Severe = < 500 cells/mm3 bacteremia, peritonitis, pneumonia

  7. Risk Factors for Infections • Severity of neutropenia • <500 cells/mm3 • Neutrophil reserve in BM • Mouth disease • Chronic gingivitis • recurrent mouth sores

  8. “What is the most important thing I can do to prevent getting sick and spreading germs to others?”

  9. Wash Your Hands

  10. Clean is Key • Basic Hygiene • Daily bathing • Hand and nail care • Before food handling • Teach children good habits early • toilet training • Hand Sanitizers or wipes

  11. Mouth Care • Dental Cleanings-2 to 4 times/year • Regular Brushings • Flossing • Mouth Wash -Biotene, Closys -Peroxide based cleanser -Fluoride Rinses

  12. Infants • Good care of diaper area • Prompt attention to rashes • May need anti-fungal cream, Nystatin • No rectal suppositories or thermometers

  13. Gastrointestinal • Proper care and handling of food • Cook poultry and meats thoroughly • Bottled water if unsure of safety • Pasteurized milk and juice • No need for neutropenic diet

  14. Protecting your Lungs • Avoid sick or coughing individuals • Mask if necessary • Immunizations • including Flu vaccine • Stop smoking and avoid second smoke

  15. Fever • Discuss a medical plan with your doctor prior to the episode: • Day vs. Night/weekends • Seek medical attention for temp> 101O • Work-up: CBC, Cultures • Antibiotics

  16. Lifestyles- Travel • Use of public transportation to engage in a normal lifestyle. • Pediatric Blood Cancer 2008 • 82% school; 90% holidays • Travel letter from MD/RN • Summary/ Contact numbers • Guidelines for fever • Permission for needles • Appropriate packaging for medications • cold pack, sharps • Research hospital/physician near your vacation site for emergencies.

  17. Lifestyles-Pets • Good hygiene practice • Good veterinary care • Overall benefits of human-animal bond • ? Reptiles-increased risk of Salmonella Eur J Oncol Nurs 2006

  18. Partners in Health Care • Keep medical records • Be compliant… • Ask questions… and Ask Again! • Schedule Family Conferences • Keep informed

  19. Relieving Pain Topical anesthetics • EMLA -Blood tests -IV catheters -G-CSF injections

  20. Intravenous Conscious Sedation for Painful Procedures

  21. Relieving Stress • Child Life Specialist • Medical play • Psychologist/ Social Work Counseling -Individual, Family • Support Groups • Relaxation Techniques -Yoga, Meditation

  22. Integrative Therapies • Group of diverse medical and health care systems, practices, and products that are not presently considered to be a part of conventional medicine National Center Complementary and Alternative Medicine www.nccam.nih.gov • Combine conventional medical therapy and Complementary and Alternative Medicine (CAM) therapies that have some high quality scientific evidence of safety and efficacy

  23. Aromatherapy • Use of essential oils from plants to support and balance the mind, body, and spirit • Therapeutic grade • Routes • Inhalation-diffuser or placing drops of oil near pt • Topical-massage, lotions or bath water

  24. Essential Oil • Anti-septic, Anti-bacterial • “Thieves”, Clove, Lemon, Cinnamon, Eucalyptus, Rosemary • Anxiety, Depression • Ylang Ylang, Rose, Lavender • Pain • “Wood Lock”, Camphor, winter green, eucalyptus • Insomnia/ Nausea • Lavender, Lemon

  25. Massage Therapy • Manipulation of the muscles and soft tissues of the body • To relax and increase delivery of blood and oxygen to the massaged areas • To increase warmth and decrease pain

  26. Acupuncture • Stimulation of trigger points on the body with sterile fine needles, (0.22 to 0.25 mm) • Used in postoperative and chemotherapy related nausea, pain

  27. Accupressure L4 trigger point for lower back pain

  28. Helpful Vocabulary ANC,absolute neutrophil count Anemia, too few red blood cells. Antibodies, proteins made by a subgroup of white blood cells, the lymphocytes that are responsible for the body's defense Bands, young neutrophils. Bone marrow, the spongy material located in the centre of our bones. It is the home of our stem cells, which reproduce to create our blood, including white blood cells, red blood cells, platelets, B- and T lymphocytes and macrophages

  29. CBC (Complete blood count),a summary of the numbers of various types of cells present in the blood at the time of the blood draws. Cytogenetics, a method by which chromosomes can be analysed. Erythrocytes, red blood cells. Fever, temperature above 101o G-CSF, granulocyte-colony stimulating factor. Leukocytes, white blood cells consisting of granulocytes, monocytes and lymphocytes.

  30. Hemoglobin (Hb)- reflects capacity of red blood cells to transportoxygen and nutrition to the tissues Hematopoiesis - the formation of blood cells Leucopenia- low white cells in blood Lymphocytes, subgroup of leukocytes, which are responsible for the body's defense against viruses (T lymphocytes) and the production of antibodies (B lymphocytes). Neutrophils, a subgroup of granulocytes defending the body against bacteria and fungus. Also known as segs, polys or segmented neutrophils.

  31. Neutropenia- low number of neutrophils in the blood. Osteopenia, mildly demineralized bone substance. Osteoporosis, severely demineralized bone substance. Platelets, a subgroup of blood cells responsible for clotting, which are also called thrombocytes. RBC-Red blood cells (RBC) Stem cells, the most immature cell in the bone marrow, which are able to reproduce themselves and develop into different types of blood cells.

  32. Subcutaneous (SQ), under the skin. Retic-Reticulocyte. Young RBC’s. Splenomegaly, the enlargement of the spleen.  Thrombocytopenia, the decreased number of platelets in the blood White blood cells, a subgroup of blood cells consisting of monocytes, granulocytes and lymphocytes, which together build the immune system and defend the body against infection.

More Related