Download Acute Lymphocytic Leukemia - Objectives

Acute Lymphocytic Leukemia - Objectives
1. Using the Case Study Workbook, discuss functions and properties of blood to include:
a. three general functions
Transport O2 and nutrients, regulation of homeostatis, protection with through immune function
b. components of blood including plasma and formed elements
Plasma—liquid portion (mostly water, some proteins); Formed elements—RBCs, WBCs, platelets
c. five primary types of WBCs and their function
Neutrophils—first responders in bacterial infections (elevated in bacterial infections); phagocytic;
makes up the majority of circulating WBCs
Macrophages—phagocytic
Monocytes—elevated in viral infections
Eosinophils—elevated in allergic responses
Basophils—elevated in allergic responses
Lymphocytes—main cells in immune responses; elevated in viral infections; make up about 20-25% of
circulating WBCs
d. differentiate between granular and agranular WBCs
Granulocytes—neutrophils, eosinophils, basophils
Agranulocytes—lymphocytes, monocytes
e. describe the origin and development of blood cells
Blood cells develop in a process called hematopoiesis in the red bone marrow. Blood cells arise from
stem cells. They differentiate either as myeloid or lymphoid cells. Blasts are early cells in the
developmental line.
f. define hemopoesis (hematopoiesis)
Production of blood cells, occurs in the red bone marrow
g. define key cells involved in blood cell formation including pluipotent stem cells, myeloid and lymphoid
stem cells, blasts.
Pluripotent stem cells—stem cells that differentiate into many different types of cells
h. define cell types that come from the myeloid line and those that come from the lymphoid line.
Myeloid—RBCs, platelets, monocytes, neutrophils, eosinophils, basophils
Lymphoid cells—lymphocytes (T cells and B cells)
i. Describe pathological conditions in which each WBC type may be elevated or decreased (See table
19.2).
See letter c. above
j. Define the percentage of each type of WBC in the blood (See table 19.3).
See letter c. above
2. Define the following terms: anemia, leukopenia, leukocytosis, lymphoblast, thrombocyte, blasts, blood-brain
barrier, hypercellularity, meninges, pneumonia, pus, petechiae, remission, upper-lobe infiltrate, transfusion.
Anemia—decreased number of circulating red blood cells
Leukopenia—decreased number of circulating white blood cells
Leukocytosis—increased number of circulating white blood cells
Lymphoblasts—early cells of the lymphocytic line usually found only in the bone marrow
Thrombocyte—platelet; helps blood to clot
Blasts—another term for lymphoblasts; found at high levels in acute lymphocytic leukemia
Blood-brain barrier—barrier that separates the blood from the brain and spinal cord; acts as protection
Hypercellularity—increased number of cells in the bone marrow
Meninges—three layers that cover the brain and spinal cord
Pneumonia—infection of one or both lungs; diagnosed using CBC, Chest x-ray, gram stain, and
sputum culture (chest x-ray would be most definitive)
Pus—accumulation of cells and fluid indicating an infection
Petechiae—pinpoint hemorrhages under the skin resulting from blood leaking from capillaries
Remission—patient’s blood and bone marrow no longer shows any abnormalities after cancer
treatments
Upper-lobe infiltrate—presence of infectious material in the superior portion of the lung
Transfusion—administration of donor blood that can be used as a treatment of anemia (specifically
transfusion of packed red blood cells
3. Discuss a CBC
a. Define CBC, WBC, RBC, Hb, Hct, and platelets.
CBC—complete blood count; blood test used to measure several components of the blood (RBCs,
WBCs, platelets, etc)
WBC—leukocytes; differential of WBCs will indicate if blood stem cells are differentiating correctly
RBCs—erythrocytes; transport oxygen throughout the body using hemoglobin
Hg—hemoglobin; portion of the RBCs that carries O2 and gives blood its red color
Hct—hematocrit; percentage of red blood cells in the total blood volume
Platelets—thrombocytes; important part of blood clotting
b. List 5 pathological conditions that may cause an elevation in the WBC count.
Infection; inflammation; allergic reaction; malignancy (specifically leukemia); hereditary disorders
4. Discuss the diagnostic testing used to diagnose leukemia to including throat culture, bone marrow aspirate,
lumbar puncture, and chest x-ray.
Throat culture:
a. Define the principle of the test—test for pathogens in the respiratory tract
b. Describe when the test is indicated—suspected strep throat, other conditions causing sore
throat
c. Describe how the test is performed—swab of back of the throat, sample analyzed in lab
d. Summarize the diseases that can be diagnosed by the test—strep throat, other throat
infections
Bone marrow aspirate:
a. Define the principle of the test—sample of bone marrow is obtained from bone to diagnose
various conditions or to obtain donor marrow
b. Describe when the test is indicated—for diagnosis of conditions such as leukemia or as
donation
c. Describe how the test is performed—needle is inserted into the bone marrow and is
extracted through the needle. Marrow is then examined under a microscope
d. Summarize the diseases that can be diagnosed by the test—Leukemia, other blood
disorders, blood/bone infections
Lumbar puncture:
a. Define the principle of the test—used to obtain cerebral spinal fluid for examination
b. Describe when the test is indicated—suspected infection of meninges and nervous tissue;
making sure cancer cells have not spread to meninges; can be used to administer antibiotics or
chemotherapy; used to check for cells, glucose, and protein in spinal fluid; can reduce spinal
fluid pressure
c. Describe how the test is performed—needle inserted into the meninges and CSF is extracted
d. Summarize the diseases that can be diagnosed by the test—spread of
lymphoblasts/leukemic cells into meninges, meningitis, disorders of the nervous system
Chest x-ray:
a. Define the principle of the test—radiologic test to view structures of the body
b. Describe when the test is indicated—suspected pneumonia or other lung conditions, to view
size/shape of structures, look for abnormalities
c. Describe how the test is performed—x-rays are sent through structure and bounce back to
create a 2-D black and white picture
d. Summarize the diseases that can be diagnosed by the test—pneumonia, broken bones,
abnormalities in anatomy, structural problems, fluid around heart/in lungs, asthma, bronchitis
5. Discuss a gram stain:
a. Define the two groups of bacteria differentiated by a gram stain.
Gram positive bacteria; gram negative bacteria
b. Discuss why the gram stain is an important first step in the identification of a pathogen.
Allows for immediate antibiotic treatment of bacterial infections without having to wait for cultures to
get back
6. Discuss leukemia:
a. List the 4 major types of leukemia.
Acute lymphocytic leukemia (ALL) is the most common type of leukemia in young children. This
disease also affects adults, especially those age 65 and older.
Acute myeloid leukemia (AML) occurs in both adults and children.
Chronic lymphocytic leukemia (CLL) most often affects adults over the age of 55. It sometimes occurs
in younger adults, but it almost never affects children.
Chronic myeloid leukemia (CML) occurs mainly in adults. A very small number of children also
develop this disease.
b. Define the predominant age group of each type of leukemia.
See above
c. Describe the difference between a lymphocytic and a myeloid leukemia.
Lymphocytic Leukemia affects lymphocytic cell lines
Myeloid leukemia affects myeloid cell lines
d. Describe the difference between an acute and chronic leukemia.
Acute leukemia progresses quickly
Chronic leukemia progresses slowly at first and primarily affects adults
e. Describe how an acute leukemia is treated differently than a chronic leukemia.
Acute leukemia is much faster so must be treated immediately; chronic leukemia is treated based on
severity and symptoms
f. List possible risk factors of leukemia.
Exposure to high energy radiation
Genetic factors
Toxic chemical exposure
Viruses
g. Describe the clinical symptoms of leukemia.
Fever, chills, and other flu-like symptoms;
Weakness and fatigue;
Frequent infections;
Loss of appetite and/or weight;
Swollen or tender lymph nodes, liver, or spleen;
Easy bleeding or bruising;
Tiny red spots (called petechiae) under the skin;
Swollen or bleeding gums;
Sweating, especially at night; and/or
Bone or joint pain
h. Describe the procedures used to diagnose leukemia.
Bone marrow aspirate
CBC
Cytochemical stains—done to differentiate the types of leukemia
Immunological markers—done to differentiate the types of leukemia
7. Review the following treatments for leukemia: chemotherapy, radiation, bone marrow transplant.
Chemotherapy:
a. Define the principle of the treatment—systemic, anticancer drugs that target rapidly dividing
cells
b. Describe how the treatment is given—IV, IM, or orally (can even be given intrathecally—in the
epidural space)
c. Discuss the benefits and side affects of treatment—can kill off non-functional, rapidly
dividing cancer cells; side effects include fatigue, bleeding or bruising, loss of appetite, nausea
and vomiting, hair loss, or mouth sores
Radiation:
a. Define the principle of the treatment—targets tumor or cancer cells
b. Describe how the treatment is given— Radiation in high doses is aimed at tumors or specific
areas of the body containing disease
c. Discuss the benefits and side affects of treatment—can shrink tumors and destroy any
lingering cancer cells; can be used with chemotherapy to improve overall results; side effects
include skin dryness, itching, blistering, or peeling; fatigue
8. Discuss the role of the following health care professionals in diagnosing and/or treating a patient with
leukemia:
a. physician to include the following physician specialties: pediatrician, oncologist, radiation oncologist,
pathologist, and radiologist.
Pediatrician—doctor specializing in children
Pediatric oncologist—doctor who specializes in cancers in children; diagnosed Noah’s leukemia;
ordered treatments for leukemia
Hematology oncologist—diagnosis and treats diseases of the blood (neoplastic and hematologic
diseases)
Pathologist—analyzes and diagnoses all tissues removed from patients (such as bone marrow in this
case)
b. medical laboratory technologist
Also call clinical laboratory scientist; runs and evaluates the following tests: CBC, Gram stain, throat
culture, urinalysis, blood smear
c. registered nurse
Administers medications, can obtain sputum samples, administering and monitoring IV medications,
maintaining patient comfort, monitoring vital signs
d. radiology technician
Takes chest x-rays (and other radiologic test)
e. respiratory therapist
Measure lung capacity, measure oxygen, carbon dioxide, and pH levels of the blood (ABG); monitor
oxygen therapy, perform chest physiotherapy to expand and clear lungs