Care of Patients with Hematological
(WBC) Disorders
Prepared by: Salima Shams
Reviewed by: Salima Shams,
2024
Objectives
At the end of session, students will be able to:
• Discuss the stages if the blood cell development.
• Talk about anatomy and functions of WBC.
• Define Leukemia and different types of it.
• Describe etiology, clinical manifestations and
patho physiology of different types of leukemia.
• Explain diagnostic studies and management of client
with leukemia.
• Discuss the nursing care of client with leukemia.
• Describe Lymphoma and types of it.
WBC (leukocytes)
(4,000-10,000/mm3)
Granulocytes Agranulocytes
70% of all WBC (30%)
Neutrophils monocytes (5%)
Basophils lymphocytes (25%)
Eosinophils
Functions of WBC
It protects the body from invasion by micro-organisms
(bacteria, parasites, and viruses) through various
mechanisms i.e.
• Phagocytosis.
• Production of interferon and interleukin.
• Various responses in allergic reactions
• Antibody production (B-lymphocytes).
• Neutrophils: Essential in preventing/limiting
bacterial infection; average lifespan: 2–4 hr
• Lymphocytes: Integral component of
immune system
• Monocytes: Enter tissue as macrophages;
phagocytosis
• Esinophils: Involved in allergic reactions
(neutralizes histamine); digest foreign
proteins
• Basophils: Contain histamine; integral part
of hypersensitivity reactions
Definitions
Leukocytosis: The number of circulating WBC increased in
response to the defense of the body. For e.g. (hepatitis,
measles, mumps, allergic reaction, marrow cancer -).
Leucopenia: overall decrease in total WBC count is referred as
leucopenia. Normal ranges (4,000-10,000cells/mm3).
Granulocytopenia / Neutropenia: general term to indicate
reduction in circulating granulocytes because 40-75% of
granulocytes are neutrophils.
LEUKEMIA
A disease in which there is an uncontrolled
production of immature WBC in blast form.
It’s a malignant proliferation of white blood cell/
precursors by the bone marrow. (proliferation is
prolong)
It results in uncontrolled increase in the production of
leukocytes and/ or their precursors.
LEUKEMIA
Leukemia is a malignant disease of the blood forming
organ i.e. bone marrow.
Commonly known as blood cancer.
Mainly affecting WBC proliferation and indirectly
affecting other blood cell formation.
Epidemiology:
As a group the leukemia's represent about 10% of all the
cancers.
Leukemia
Risk factor:
• exposures to radiation.
• Chemicals (benzene)
• Drugs i.e chemotherapeutic agents.
• Viral infections.
Cx: mutation
• Family history
• Genetic predisposition i.e. Down’s syndrome
Pathophysiology
Disorderly, unregulated proliferation of WBC
Bone marrow replace by immature leukocytes or blast cells (blast crisis)
Fewer production of normal cells
Immature leukocytes circulate in blood and infiltrates in lymph nodes, spleen,
and other organs
Anemia, thrombocytopenia can also occur.
Sign and symptoms
White blood cells, which are involved in fighting
pathogens are dysfunctional.
•Frequent infections. ( tonsils, sores in the mouth, flu
like symptoms, diarrhea, pneumonia & opportunistic
infections)
Lack of blood platelets.
•Bruised, bleed excessively, or develop pinprick bleeds
(petechiae), hemorrhage
Anemia
•General feeling of fatigue, feeling sick, headache
Acute leukemia
Acute leukemia is characterized by an rapid
overgrowth of very immature cells in the bone
marrow. These cells are known as blast cells.
Acute Leukemia
Symptoms:
• Abrupt onset.
• rapid increase of immature (blast) cells
• Rapid progression and accumulation of the
malignant cells.
• Organ enlargement
• Symptoms occur with in few weeks to months.
• Immediate treatment is required.
• Renal dysfunction due to increased cell
destruction---- increased uric acid formation -----
obstruction of renal tubules with urate crystals.
Chronic Leukemia
Chronic Leukemia are characterized by the abnormal growth
of relative more mature cells.
It could be myelocytes, monocytes/ lymphocytes depend on
type of leukocytes involved.
Symptoms:
• Similar symptoms but slow progression.
• Taking months or years to progress
• Excessive build up of relatively mature, but still abnormal,
white blood cells at ‘cyte’ stage.
• Chronic leukemia mostly occurs in older people but can occur
in any age.
Types of leukemia: Depend on the maturity of cells,
type of cell involved.
There are four most common types of leukemia. These
are:
• Acute myeloid leukemia (AML).
• Acute lymphoblastic leukemia (ALL)
• Chronic myeloid leukemia (CML).
• Chronic lymphocytic leukemia (CLL).
Lymphoblastic or lymphocytic leukemia: The cancerous
change takes place in a type of marrow cell that normally goes
on to form T and B lymphocytes.
Myeloid or Myelogenous leukemia: The cancerous change
takes place in a type of marrow cells that normally goes on to
form other types of white cells i.e. Granulocytes/ monocytes.
Also known as non lymphocytic leukemia
Types
Acute lymphoblastic leukemia (ALL):
Common in children under 10 years of age also
affects adults after age 40.
Survival rate: 85% in children and 50% in adults.
Chronic lymphocytic leukemia (CLL):
Most often affects adults over the age of 55 yrs.
Two-thirds of affected people are men.
The five-year survival rate is 75%.
Types
Enlarged lymph nodes and hyper plasia of lymphoid
tissues.
Lymphocytes count would be high.
With it, anemia and thrombocytopenia.
Acute myelogenous leukemia (AML):
Occur at any age but common in adults.
More common in men than women.
five-year survival rate in 40% clients.
Types
Chronic myelogenous leukemia (CML):
Gradual increase in the number of immature
granulocytes in the blood.
Occurs mainly in Adults.
Commonly occur because of chromosal abnormality.
The five-year survival rate is 90%.
Video on ALL
https://www.youtube.com/watch?
v=7nCvItKbEns
Diagnostic Test:
• CBC
• Lymph node aspiration & Biopsy
• BM aspiration & Biopsy
Treatment goal:
• Suppressing the abnormal cell proliferation.
• Preventing from disease progression and
complications.
• Supporting patient physiologically and
psychologically.
• Remission.
Treatment (vary with type)
• Chemotherapy (care during chemotherapy
administration)
• Give antiemetic, antibiotics, supportive treatment
• Blood and blood product.
• Bone marrow transplant
Nsg Diagnosis
• High risk for infection r/t low immunity secondary to
leukemia.
• Fatigue r/t low hemoglobin secondary to anemia or side
effect of tx
• High risk for injury r/t low platelet counts.
• Imbalanced nutrition i .e less than body requirement r/t
anorexia, mouth ulcer, and pain.
• Disturbed body image r/t hair loss, wt loss .
• High risk for sexual dysfunction r/t fatigue secondary
to side effect of chemotherapy/ radiation therapy.
Nursing Intervention
Lymphomas
Lymphomas: Tumor originating in lymphatic system.
Lymphatic system consist of lymph, lymph vessels and
lymphoid tissues.
Most lymphomas are cancer of lymphoid tissues and
involve mostly thymus, lymph nodes, the spleen,
tonsils and intestinal lymphoid tissue.
They are of two type Hodgkin (HD) and Non
Hodgkin Lymphoma (NHL)
• HD seems commonly in young adults.
T and B cell Development and
Maturation
• Both T and B cells begin their development in the bone
marrow
• B lymphocytes leave the bone marrow, differentiate into
plasma cells, and then move to the lymph nodes, spleen,
lymphoid tissue where they continue to proliferate and
produce antibodies
• T lymphocytes leave the bone marrow as precursor T
lymphocytes travel to the thymus, where they differentiate
into CD4+ helper T cells and CD8+ cytotoxic T cells. Then
they move to lymph node.
• The alimentary canal, respiratory passages, and
genitourinarysystems are guarded by accumulations of
Immune System
Lymph nodes: bean-sized collections of lymphocytes. There are about 600
lymph nodes found throughout the body – in the neck, armpits, chest, abdomen,
groin and some other parts of the body. Lymphatic vessels connect the lymph
nodes. They contain lymph, a fluid that carries lymphocytes.
Spleen is an organ found on the left side of the body, near the stomach. It
contains lymphocytes and removes worn-out cells from the blood.
Hodgkin Lymphoma (HL)
Hodgkin lymphoma (HL) is one of the most curable forms of cancer.
Signs and Symptoms The most common sign of Hodgkin lymphoma is one or more
enlarged (swollen) lymph nodes. The enlarged lymph node may be in the neck, upper
chest, armpit, abdomen or groin. It is usually painless.
Diagnosis is by finding Hodgkin cells such as multinucleated Reed Sternberg Cell (RS
cells) in lymph nodes.
Signs and symptoms of Hodgkin lymphoma may also include:
Swollen lymph nodes , Cough and shortness of breath , Fever
Night sweats, Tiredness, Weight loss
Non-Hodgkin Lymphoma (NHL)
A type of cancer that generally develops in the lymph nodes and lymphatic tissue
found in organs such as the stomach, intestines or skin. In some cases, NHL
involves bone marrow and blood.
Lymphoma cells may develop in just one place or in many sites in the body.
NHL has many different subtypes which are either indolent (slow growing) or
aggressive (fast growing).
About 85-90 percent of NHL cases start in the B cells. Can be caused by Epstein–Barr
virus (EBV)
Symptoms almost same as HL
Videos on Lymphoma
• https://www.youtube.com/watch?
v=Du2G3XoaCEE
• https://www.youtube.com/watch?
v=H0OtQlQYwrQ
• https://www.youtube.com/watch?
v=ApMZMRTqi2w
• https://www.youtube.com/watch?
v=JD0EZMeFwB8
Etiology:
o Unknown
o Viral cause i.e EPS (Epstein Barr Virus) in 30-50% clients with
HD.
o Genetic factors
o Family history
S/S:
• Fever
• Weight loss
• lymphadenopathy (swollen lymph node)
• Sore throat
• Appearance in the blood of atypical lymphocytes
Biopsy: distant large, giant cell called Reed sternberg cells of the
HD lymphoma
A typical lymphocytes
Management
• Excision of lymph node
• Radiation therapy
• Chemotherapy/ immunotherapy/ targeted
therapy
