Nursing Care of Patients with Hematologic Disorders

1. Nursing Care of Patients with Hematologic Disorders

2. 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.

3. 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

4. Hodgkin’s 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

5. 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)

6. 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

7. 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

8. 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.

9. Heparin Induced Thrombocytopenia“Hit 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

10. 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

11. 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