Hematology: Leukemia Assessment and Manifestations

Leukemia, as discussed in previous lectures, is a condition that results to an overproduction of white blood cells. Due to this overproduction, there is a crowding out of the other types of blood cells inside the bone marrow.

In this instruction, we’ll be going through the clinical manifestations of leukemia and how to accurately assess a client who is suffering from the disease.

Pain

Due to the crowding out of the white blood cells, the pressure is being pushed on the bone; thus, bone pain occurs, making it a crucial clinical manifestation of leukemia.

Bone pains would feel like they are bursting at the joint. The client will also experience pancytopenia which is just a fancy word that means all kinds of cells are decreasing. Back pain is another essential manifestation of leukemia.

Hemoglobin and Hematocrit

The hemoglobin and hematocrit level will go down, causing an increased heart rate.  Hemoglobin is the transporter of oxygen throughout the body. Therefore, if there is low hemoglobin and hematocrit, the heart will compensate by pumping faster. Aside from that, the client will also show signs of fatigue and shortness of breath due to low oxygen capacity carriers.

Skin

Having low hemoglobin and hematocrit will cause decreased capillary refill time, which is evidenced by a pale skin. So, if a client comes in with an increased heart rate and pale skin, there is a probability that there is insufficient blood volume.

Decreased Appetite

Low blood volume will also affect the gastrointestinal tract, leading to decreased appetite which will then result in weight loss. The weight loss is so severe that a client sheds off around 20 pounds a week.  Take note of this vital information because this is an NCLEX® test tip. Aside from weight loss, another gastrointestinal manifestation is vomiting coupled with nausea.

Headaches and Dizziness

Less blood flow means low oxygenation to the brain. Therefore, precipitating manifestations like dizziness and headaches will arise.

Bleeding

Blood workups like complete blood count will show a significant increase in WBC, whereas the hemoglobin and hematocrit are decreased as well as the platelets. As for the international normalized ratio (INR), prothrombin time (PT), and partial prothrombin time (PTT), they are bound to increase since there is not enough platelet to regulate normal clotting. Because of this, the client is bound to bleed in certain areas in the body.

Bleeding will be evident in the following:

  • Urine
  • Gastrointestinal tract
  • Feces that is dark-tinged
  • Hematomas on different parts of the body
  • Gums
  • Profuse bleeding from a simple cut

Informing the client about bleeding manifestations is important because it can abruptly cause death, especially during the acute phase of leukemia. Bleeding is the main nursing priority that should be addressed immediately.

Interventions

What are the different types of treatments given to leukemia clients?

  1. Stem cell transplant or engraftment
  2. Chemotherapy

Chemotherapy is crucial in refreshing the bone marrow to create blood cells from scratch. This procedure is a form of restart button to prompt the bone marrow to begin the process of creating normal red blood cells and white blood cells.

For the complete pathophysiology of leukemia, you can visit our Simple Nursing website and YouTube channel.

Leukemia: Nursing Considerations and Management

In today’s leukemia lecture, we’ll be talking about the basic treatments and interventions that primarily influence your client’s condition. The information that will be given here is critical in passing major nursing exams, especially the NCLEX®.

So, let’s figure out what are the things that you should focus on, especially in managing clients with leukemia.

Uncomplicated Pathophysiology

Leukemia treatment is done because the bone marrow is producing increased white blood cells (WBC), more than the usual, acceptable number. These white blood cells that are immaturely produced are pushing on the bone marrow which causes immense pain. Also, these WBCs are crowding out the other major blood components, mainly the red blood cells and the platelets.

Clinical Manifestations

Usually, hospitals would have a maximum of 10,000 WBCs for their laboratory report value. However, clients with leukemia would go as high as 30,000 WBCs. Therefore, the main clinical manifestation in terms of laboratory results is that everything else (platelets and red blood cells) would be low aside from the white blood cell count.

Nursing Management

There are a couple of nursing management and considerations that nurses have to keep in mind when taking care of a client with leukemia.

Radiation and Chemotherapy

These are primarily given to decrease the abnormally high number of white blood cells. Radiation and chemotherapy will technically restart the entire system of producing WBCs because they will wipe out the WBC population – the good and the bad ones.

White blood cells are considered as the soldiers or police officers of the body, and their main objective is to fight off illnesses and infections. Wiping out white blood cells through radiation and chemotherapy would mean that there will be no elements to protect the body from opportunistic viruses and bacteria that could immediately harm the system.

What to expect:

  1. White blood cell count can be less than one or two, resulting in a neutropenic client.
  2. A bone marrow transplant can be given to re-infuse stem cells that can reproduce adequate white blood cells to sustain and maintain the body’s immunity.
  3. Neutropenic precaution will be activated due to increased risk for infection.
    • Prophylactic antibiotics will be given.
    • Hand washing is a must for people who will come in contact with the client, especially families, and
    • Wearing of a mask is required to prevent transport of communicable diseases.
    • Limit visitation privileges.

NCLEX® Question

One favorite NCLEX® question regarding neutropenic precaution would be:

Are flowers and fruits allowed inside the room of a client with leukemia?

Answer: No, flowers and fruits are not allowed.

But, why?

Flowers and fruits go through a process that makes sure sanitation is maintained. This sanitation process sometimes involves chemicals and other harmful elements that, when exposed to a client with leukemia, would cause sickness.

Chemotherapy Reminders

A client who undergoes chemotherapy is technically killing off immature and healthy white blood cells. Some of the side effects of this procedure are:

  1. Alopecia or hair loss
  2. Non-production of epithelial cells inside the mouth that can cause sores and ports of entry
  3. The gastrointestinal lining will be compromised; therefore, inserting rectal thermometers are contraindicated.

That’s it for our leukemia lecture. Check out our other nursing topics on SimpleNursing website and YouTube channel.

Hematology Lymphomas: Hodgkin’s & Non-Hodgkin’s

After going through leukemias, we will discuss lymphomas.

Somehow, it can get quite overwhelming when figuring out the differences between lymphomas, leukemias, and myelomas. Yes, it’s confusing, but the significant difference is their origin or where cancer started.

In all types of leukemia – whether acute myelogenous, chronic myelogenous, acute lymphocytic, or chronic lymphocytic – they have the same clinical manifestation which is increased production of white blood cells that crowd out red blood cells. The hemoglobin and hematocrit will drop, including the platelets. Technically, the only difference is where cancer originated.

For leukemia, the conditions start in the myeloid and lymphoid stem cells. As for lymphomas, they begin in the B-cells and T-cells.

Cellular Progression

As a quick recap, cells are made initially in the blood stem which is either the lymphoid or myeloid cell. Then, it becomes lymphoblast cell that then produces the T-cells and B-cells. So, this is how cells progress and where lymphomas come to life.

Physical Manifestations and Major Stages

Your clients will start developing prominent lymph nodes, pain in the spleen, and swollen tonsils. The signs and symptoms of lymphomas will either be painless or non-symptomatic. Lymphomas usually happen with clients aged 20 to 30 years old.

There are four main stages of lymph node enlargement:

  • Stage 1 – The client will manifest just one enlarged lymph node.
  • Stage 2 – Enlarged lymph node above the diaphragm.
  • Stage 3 – Three sites have enlarged lymph nodes.
  • Stage 4 – Four sites have enlarged, swollen lymph nodes.

Remember, lymph nodes are the body’s agents for sucking up anything from the blood to be pushed out of the system. Lymph nodes are activated and become swollen when people get sick; it is the body’s defense mechanism against illnesses.

Hodgkin’s versus Non-Hodgkin’s Lymphoma

The main thing that you have to take note of when differentiating Hodgkin’s from non-Hodgkin’s lymphoma is the presence of Reed-Sternberg cells. Between the two, it is the Hodgkin’s lymphoma that has the Reed-Sternberg cells.

A biopsy is done to determine if the lymphoma is with or without Reed-Sternberg cells. Once these cells show up, it’s an automatic Hodgkin’s lymphoma. On the other hand, there will be no immediate diagnosis if the results show negative for non-Hodgkin’s lymphoma.

Non-Hodgkin’s lymphoma has about 12 variations and is considered as the more severe condition than Hodgkin’s lymphoma.

Causes of Lymphomas

Lymphomas are idiopathic; meaning, the cause of the illness is not known. What we do know are the clinical manifestations but not the leading reasons why lymphomas happen. Currently, medical experts are still figuring out how lymphomas begin, but until such time, lymphomas are considered idiopathic.

Scientists, however, think that there are a few predisposing factors of why lymphomas occur, namely:

  • Viruses
  • Carcinogens – Breathing in cancer-causing pollutants like smoke and metallic substances
  • Genetics – family members are immunocompromised

So, unlike other diseases like that of liver cirrhosis wherein you know that the client might have been an alcoholic, lymphomas are more complicated.

Interventions

Hodgkin’s lymphomas are more treatable than non-Hodgkin’s lymphoma. Hodgkin’s lymphoma can be treated with the following:

  • Radiation therapy – burns the cancer cells and the other surrounding healthy, non-cancer cells; alopecia is a common side effect.
  • Chemotherapy – taking pills to decrease immune system; kills off white blood cells.

With chemotherapy, it’s like hitting the restart button by killing off the cancer cells.

On our next discussion, we’ll be focusing on myelomas. You can visit SimpleNursing.com for more nursing resources.

See you there!

Hematology for Leukemia and Blood-Related Cancers – Part 1

Hello. We will be discussing leukemia and its pathophysiology with its different types.

What is leukemia?

Leukemia is cancer in the blood. “Leuk” came from the immature white blood cells known as blasts; while “-emia” means condition. Basically, what happens with leukemia is that there is an increased production of blood which caused crowding inside the bones.

Normally, the stem cells in the bones are mainly responsible for creating blood cells – red and white blood cells and platelets.  In leukemia, there is an overproduction of white blood cells (WBC). You can think of it as having too many policemen inside a restaurant, causing overcrowding and disproportion with other blood cells.

What should you watch out for with clients that have leukemia?

  1. Elevated WBC count, extremely high
  2. Bone pain due to the pressure of overcrowding inside your bones
  3. Decreased numbers in the other blood cells (platelets, red blood cells, hemoglobin, hematocrit)

What are the different kinds of leukemia?

There are technically four classes of leukemia – the acute and chronic myelogenous leukemia and the acute or chronic lymphoid leukemia. These types mainly depend on how fast the production of white blood cells is in the body.

AML and CML

In a person’s blood stem, there are also different types of white blood cells, one of which is the myeloid stem cells.

Overproduction of the myeloid stem cells causes acute and chronic myelogenous leukemia. Acute myelogenous leukemia (AML) is the rapid production of white blood cells in a course of a few days. On the other hand, chronic myelogenous leukemia (CML) took weeks or months for the white blood cells to increase.

ALL and CLL

Much like AML and CML, if the problem started with the lymphoid cells, it progresses into either an acute or chronic leukemia – basically known as your acute lymphoma or lymphocyte leukemia (ALL) and chronic lymphoid leukemia (CLL).

Signs and Symptoms 

Regardless of leukemia type, whether it originated form the myeloid stem cells or the lymphoid cells, the client is going to exhibit the following signs and symptsoms:

  1. Decreased hemoglobin and hematocrit levels
  2. Low platelet count
  3. High white blood cell count
  4. Bone pain
  5. Paleness
  6. Presence of hematomas

Test question tip

Nursing exams love to put in a particular question regarding your chronic myeloid leukemia (CML). There is a specific kind of test that primarily indicates the abnormality in leukemia cancer cells that pertains to CML. It’s called the Philadelphia Chromosome. And the main demographic that this affects are pediatric clients for some unknown reason.

Remember: If a particular disease cannot be explained or there are no specific reasons why the disease happened in the first place, it’s called as idiopathic; being idiots in the pathophysiology.

So, if you encounter nursing questions that states a client came in showing signs and symptoms stated above yet it’s idiopathic, the answer would most likely be chronic myeloid leukemia (CML).

On the next part, we tackle the main clinical manifestations of leukemia. We’ve already mentioned some but we’ll break it down further for you to properly understand what’s really causing all those manifestations when a person has leukemia.

See you on part 2!