Blood

Blood is a constantly circulating fluid providing the body with nutrition, oxygen, and waste removal. Blood is mostly liquid, with numerous cells and proteins suspended in it, making blood "thicker" than pure water. The average person has about 5 liters (more than a gallon) of blood. A liquid called plasma makes up about half of the content of blood. Plasma contains proteins that help blood to clot, transport substances through the blood, and perform other functions. Blood plasma also contains glucose and other dissolved nutrients. About half of blood volume is composed of blood cells: Red blood cells, which carry oxygen to the tissues White blood cells, which fight infections Platelets, smaller cells that help blood to clot Blood is conducted through blood vessels (arteries and veins). Blood is prevented from clotting in the blood vessels by their smoothness, and the finely tuned balance of clotting factors. Blood Cancers Blood cancers affect the production and function of your blood cells. Most of these cancers start in your bone marrow where blood is produced. Stem cells in your bone marrow mature and develop into three types of blood cells: red blood cells, white blood cells, or platelets. In most blood cancers, the normal blood cell development process is interrupted by uncontrolled growth of an abnormal type of blood cell. These abnormal blood cells, or cancerous cells, prevent your blood from performing many of its functions, like fighting off infections or preventing serious bleeding. There are three main types of blood cancers: Leukemia Lymphoma Myeloma

Leukemia A type of cancer found in your blood and bone marrow, is caused by the rapid production of abnormal white blood cells. The high number of abnormal white blood cells are not able to fight infection, and they impair the ability of the bone marrow to produce red blood cells and platelets. When leukemia develops, the body produces large numbers of abnormal blood cells. In most types of leukemia, the abnormal cells are white blood cells. The leukemia cells usually look different from normal blood cells, and they do not function properly. Types of leukemia There are several different types of leukemia. The types of leukemia are first divided according to the type of stem cell they developed from: Myelogenous leukemias develop from abnormal myeloid cells. Lymphocytic leukemias (also known as lymphoblastic leukemias) develop from abnormal lymphoid cells.

The types of leukemia are further grouped according to how quickly the leukemia develops and grows: Acute leukemias start suddenly, developing within days or weeks. The number of leukemia cells in the blood can rise very fast and the blood cannot do its job. Acute leukemias get worse quickly and need to be treated right away. Chronic leukemias develop slowly over months or years, and may not cause any symptoms early in the disease. Symptoms start to appear as the number of leukemia cells in the blood or bone marrow increases.

Predisposing factors The exact cause of leukemia is unknown, although many genetic and environmental factors are involved in its development. The basic mechanism involves damage to genes controlling cell growth. This damage then changes cells from a normal to a malignant (cancer) state. Analysis of bone marrow of a client with acute leukemias shows abnormal chromosomes about 50% of the time. Possible risk factors for the development of leukemia include ionizing radiation, exposure to chemicals and drugs, bone marrow hypoplasia (reduced production of blood cells), genetic factors, immunologic factors, environmental factors, and the interaction of theses factors.

Pathophysiology With leukemia, cancer occurs in the stem cells or early precursor leukocyte cell, causing excessive growth of a specific type of leukocyte. These cells are abnormal and their excessive production in the bone marrow stops normal bone marrow production of red blood cells, platelets, and mature leukocytes. Anemia, thrombocytopenia, and leukopenia result. The number of immature, abnormal white blood cells in the blood is greatly elevated. Leukemic cells can also be found in the spleen, liver, liver nodes and central nervous system. Without treatment, the client dies of infection or hemorrhage. For clients with acute leukemia, theae changes occur rapidly and, without intervention, progress to death. Chronic leukemia may be present for years before changes appear. Physical Manifestations Leukemias affects all blood cells, and blood influences the health and function of all organs and systems, thus many body areas and system cells may be affected. The following manifestations occur with the acute luekemias. Some of this findings may also be present in the client with chronic leukemia in the blast phase. Integumantary Manifestations: Ecchymoses Petechiae Open infected lesions Pallor of the conjunctiva, nail beds, palmar creases, and around the mouth. Gastrointestinal Manifestations: Bleeding gums Anorexia Weight loss Enlarged liver and spleen Renal Manifestations: Hematuria Cardiovascular Manifestations: Tachycardia at basal activity levels. Orthostatic hypotension Palpitations Respiratory Manifestations: Dyspnea on exertion. Neurologic Manifestations: Fatigue Headache Fever Musculoskeletal Manifestations: Bone pain Joint swelling and pain.

Diagnostic Evaluation 1. CBC and blood smear peripheral WBC count varies widely from 1,000 to 100,000/mm3 and may include significant numbers of abnormal immature (blast) cells, anemia may be profound; platelet count may be abnormal and coagulopathies may exist. 2. Bone marrow aspiration and biopsy cells also studied for chromosomal abnormalities (cytogenetics) and immunologic markers to classify type of leukemia further. 3. Lymph node biopsy to detect the spread. 4. Lumbar puncture and examination of cerebrospinal fluid for leukemic cells Treatment To eradicate leukemic cells and allow restoration of normal hematopoiesis. 1. High-dose chemotherapy given as an induction course to obtain a remission (disappearance of abnormal cells in bone marrow and blood) and then in cycles as consolidation or maintenance therapy to prevent recurrence of disease. 2. Leukapheresis (or exchange transfusion to infants) may be used when abnormally high numbers of white cells are present to reduce the risk of leukostasis and tumor burden before chemotherapy. 3. Radiation particularly of central nervous system (CNS) 4. Autologous or allogeneic bone marrow or stem cell transplantation. Complications 1. Leukostasis; in setting of high numbers (greater than 50,000/mm3) of circulating leukemic cells (blasts), blood vessel walls are infiltrated and weakened, with high risk of rupture and bleeding, including intracranial hemorrhage. 2. Disseminated intravascular coagulation(DIC). 3. Tumor lysis syndrome: rapid destruction of large numbers of malignant cells leads to alteration in electrolytes (hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia). 4. May lead to renal failure and other complications. 5. Infection, bleeding, and organ damage.

Nursing Interventions Preventing infection: Frequently monitor the client for pneumonia, pharyngitis, esophagitis, perianal cellulitis, urinary tract infection, and cellulitis, which are common in leukemia and which carry significant morbidity and mortality. Monitor for fever, flushed appearance, chills, tachycardia; appearance of white patches in the mouth; redness, swelling, heat or pain in the eyes, ears, throat, skin, joints, abdomen, rectal and perineal areas; cough, changes in sputum; skin rash. Check results of granulocyte counts. Concentrations less than 500/mm3 put the patient at serious risk for infection. Avoid invasive procedures and trauma to skin or mucous membrane to prevent entry of microorganisms. Use the following rectal precautions to prevent infections: Avoid diarrhea and constipation, which can irritate the rectal mucosa, avoid the use of rectal thermometers, and keep perineal are clean. Care for the patient in private room with strict handwashing practice. Encourage and assist patient with personal hygiene, bathing, and oral care. Obtain cultures and administer antimicrobials promptly as directed. Preventing and Managing bleeding: Watch for signs of minor bleeding, such as petechiae, ecchymosis, conjunctival hemorrhage, epistaxis, bleeding gums, bleeding at puncture sites, vaginal spotting, heavy menses. Be alert for signs of serious bleeding, such as headache with change in responsiveness, blurred vision, hemoptysis, hematemesis, melena, hypotension, tachycardia, dizziness. Test all urine, stool, emesis for gross and occult blood.

Monitor platelet counts daily. Administer blood components as directed. Keep patient on bed rest during bleeding episodes.

Patient Education and Health Maintenance: Teach signs and symptoms of infection and advise whom to notify. Encourage adequate nutrition to prevent emaciation from chemotherapy. Teach avoidance of constipation with increased fluid and fiber, and good perineal care. Teach bleeding precautions. Encourage regular dental visits to detect and treat dental infections and disease. Lymphoma Is a type of blood cancer that affects the lymphatic system, which removes excess fluids from your body and produces immune cells? Lymphocytes are a type of white blood cell that fight infection. Abnormal lymphocytes become lymphoma cells, which multiply and collect in your lymph nodes and other tissues. Over time, these cancerous cells impair your immune system. 2 Types of Lymphoma Hodgkins and non-Hodgkin's lymphoma (NHL) Hodgkin's lymphoma is characterized by the orderly spread of disease from one lymph node group to another and by the development of systemic symptoms with advanced disease The non-Hodgkin lymphomas (NHLs) are a diverse group of blood cancers that include any kind of lymphoma except Hodgkin's lymphomas. Physical Manifestation Most of the time, this cancer is detected as painless lumps in the neck, armpits or groin. Several other warning signs and symptoms of lymphoma include fever, weight loss and sweating at night. Lymphoma can also affect other organs of the body (besides lymph nodes) and give rise to a variety of symptoms that bring an individual to a doctor. Predisposing Factor Chemical Exposure Chronic Infection Depressed Immunity Family History Genotypes Viral Exposure Age

Diagnostic Evaluation CBC Lymph Node Aspiration FNA CT Scan PET Scan or Positron Emission Tomography Treatment Chemotherapy Radiation Therapy Stem Cell Transplant Monoclonal Antibodies

Nursing Intervention Administer pain medications as ordered. Provide rest periods if the patient tires easily. Offer the patient such fluids as orange juice or ginger ale to counteract nausea. Provide the patient with plenty of fluids to help flush out the cells that are destroyed during Provide a well balanced, high calorie, high protein diet. If the patient cant tolerate oral feeding, administer I.V. fluids. Listen to the patients fears and concerns. Involve the patient and his family in his care whenever possible. Monitor the effectiveness of administered analgesics and other medications. Monitor the patients CBC, uric acid level, and serum calcium level for abnormalities. Make sure the patient receives thorough explanations about all treatment.

treatment.

Myeloma Is a type of blood cancer that specifically targets your plasma cells. Plasma cells are white blood cells that produce disease- and infection-fighting antibodies in your body. Myeloma cells prevent the normal production of antibodies, leaving your bodys immune system weakened and susceptible to infection.

Physical Manifestation Myeloma does not always cause symptoms in its early stages. But if it does, these symptoms happen because you have a lot of abnormal plasma cells. The abnormal plasma cells damage the bones and crowd out the normal blood cells. So you may also have too few white cells, red cells andplatelets. If you have an infection, you may find it is difficult to shake it off. This is because you do not have enough healthy white blood cells to fight the bacteria or viruses that have caused the infection. Abnormal bruising and bleeding can happen in myeloma because the large numbers of plasma cells in your bone marrow have stopped the platelets from being made. Breathlessness and tiredness can happen because you do not have enough red blood cells. Another symptoms are: Bone pain/ Bone Damage Swollen Ankles

Predisposing Factors Family history Lowered Immunity Body, Weight and height Medicines/ Medical Condition Past Exposure to Radiation

Diagnostic Test Blood Test Urine Test Bone Marrow test CXR Treatment

Chemotherapy, steroids and biological therapies are the main treatments for myeloma. Radiotherapy is also used to help control pain. You may also have bisphosphonates to help prevent bone damage and relieve pain. If you are fit enough, your specialist may suggest intensive treatment using high dose chemotherapy with a bone marrow or stem cell transplant Nursing Intervention A diagnosis of myeloma is devastating and often worsened because many patients have not heard of the disease . Nurses contribute to all aspects of care of a patient with myeloma - most importantly, in the prevention and management of complications of the disease and its treatments, and in providing information and support. Key goals for effective management include: pain assessment and control; educating patients on the need for adequate hydration; prompt recognition of the signs of spinal-cord compression and hypercalcaemia; management of fatigue; psychosocial support of the patient and family; and provision of relevant, high-quality, up-to-date information at all stages of their disease

Precious Anne T.Madreo SN