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Haemotology - Coggle Diagram

- - - - -pernicious is a subtype. lack of intrinsic factors to absorb B12
  - - - -inherited autosomal recessive disorder
        -cell represents a sickle shape
        -suckling events are triggered by low oxygenation in infection, high altitude, stress etc.
        -sickle cells cannot easily pass through capillary walls, leading to vascular occlusion, more hypoxia and more sickling. Vicious cycle
- - - - -blood tests
        -fine needle aspirate
        -lymph node and bone marrow biopsy
        -positron emission tomography scan (PET)
        -CT scan
    - - -fast onset, start treatment quickly
        -education regarding CVAD (central venous access devices)
        -chemotherapy. long hospital stays and multiple readmissions
        -supportive therapy=?
        -drugs have significant toxicities
        -significant pain if lymph node involvement
        -parenteral nutrition if gut involvement
        -high risk of tumour lysis syndrome if heavy disease burden=proteins and electrolytes from lysis of tumour needs to be excreted, can cause other problems i.e. renal due to e.g. hypercalcaemia. Give allopurinol for gout and high fluids to excrete
  - - - Pathophysiology
        
        -very rapid onset, treat ASAP
        -caused by rapid production of abnormal immature blood cells (blasts), which are useless in fighting infection
        -impacts bone marrow production of other normal cells
        AML (myeloid) - develops in myeloid lineage (the phils, macrophages and thrombocytes)
        ALL (lymphoblast) - more prevalent in children. lymphocytes and plasma cells
      - Diagnostic studies
        
        -blood tests - FBC, U&E (elecrolytes), coags
        -bone marrow trephine biopsy
        -cytogenetic testing
      - Nursing considerations
        
        -immune system dysfunction and neutropenia
        -sepsis
        -thrombocytopenia
        -anaemia
        -pancytopenia (everything)
        -DIC
        -hyperleukocytosis, clog up vessels
        -psychosocial support for pt and family, children and parents can be split up for months due to isolation precautions
  - - - -bone scan
        -bone marrow biopsy
        -24/24 urine collection
    - - -increase is osteoclast activity=hypercalcaemia requiring bisphosphonate therapy
        -acute and chornic renal failure
        -often elderly
        -loss of self care abilities
        -chonicity of disease
- - - - -cytotoxic
        -most come from natural products/metals
        -IV, oral, intrathecally (spine)
      - Nursing considerations
        
        -tumour lysis syndrome
        -bone marrow fialure
        -nadir 7-10 days post administration
        -high risk of neutropenic sepsis
        -AKI
        -cardiotoxicity, hepatotoxicity, CNS toxicities
        -haemorrhagic cystitis
        -mucositis - nausea, vomitting, diarrhoea
        -cytotoxic waste management
    - - -interfere with specific molecules
      - Nursing considerations
        
        -high risk of anaphylaxis
        -cardio and skin toicities
    - - -manipulate the immune system to kill cancer cells
        -can cause damage to normal cells
      - Nursing consideration
        
        -cytokine release syndrome
        -inflammations
    - - -autologous (from self)
        -allogenetic from another person (sibling or unrelated donor), conditioned using extremely high doses of chemo and total body irradiation with complete of ablation of bone marrow. Chimeric changes ensue
      - Nursing considerations
        
        -extreme risk of sepsis
        -electrolyte imbalance for long time
        -'graft vs host' disease
        -long term immunosuppression
    - - -gives patient choices