Question

1. In the pediatric cancer patient, which cells are affected by myelosuppression? Why does myelosuppression occur?
2. Name and describe the clinical manifestations of the complication of a stem cell transplant
3. Identify 3 organs that are negatively affected by a sickle cell crisis. Describe how these organs are affected by the crisis.
4. Besides prevention of bleeding, what is the therapeutic management of hemophilia?
5. Describe 4 items that must be included when teaching parents about iron supplement administration

Answer 1

*In paediatric cancer patient,the cells which are affected by myelosuppression-

1)Red blood cells(RBC's)-thus anaemia occurs

2)White blood cells (WBC's)-Leukopenia occurs

3) Platelets-thus thrombocytopenia occurs

*Myelosuppression may be caused by active suppression of haematopoiesis by myeloma cells

It is also a common and expected side effects of many treatment for the cancers including Thalidomide,Valcade,Revlimid, Cyclophosphamide and Melphalan

*Clinical manifestation of complications of a stem cell transplant-

1)Graft versus Host diseases-if you received a transplant that uses stem cells from a donor(allogenic transplant),you may be at risk of developing graft versus Host diseases(GHVD).There are two kind of GHVD acute and chronic.

•Acute GHVD-Happens earlier,first month after transplant,it typically affects skin, digestive tract and liver.

•Chronic GHVD-Develops later,can affect many organs.signs and symptoms include-joint and muscle pain,shortness of breath, persistent cough,vision changes such as dry eyes,rash,dry mouth, diarrhea etc

2)Stem cell(graft) failure

3)Organ damage

4) Infection

5)Cataract

6) Infertility

7)New cancer

8)Death

*The organs which are negetively affected by a sickle cell crisis and cause of it-

1)Lungs-there occurs sickle chest syndrome,This may follow a vaso-occlusive crisis and is the most common cause of death in adult sickle cell disease.Bone marrow infarction results in fat emboli to the lungs,which cause further sickling and infarction,leading to ventilatory failure if not treated.

2)Spleen-massive splenic enlargement occur due to thrombosis of venous outflow from this.resulting anaemia, circulatory collapse and death.

3)Heart-Stroke due to sickle myocardium,cardiomegaly,and transfusional iron overload.

*Besides prevention of bleeding,the therapeutic management of haemophilia-

1)Desmopressin-This hormone can stimulate the body to release more clotting factors.it can be injected slowly into a vein or provided as a nasal spray.

2)Clot preserving medication-these medication help prevent clots from breaking down.

3)Fibrin sealants-these medication can be applied directly to wound sites to promote clotting and healing.

4) Physical therapy

5)First aid for minor cuts

6) Vaccination-Consider receiving immunization against hep-A and B

*4 items that must be included when teaching parents about iron supplements administration-

1)Take iron with a small amount of food because though iron is best absorbed on an empty stomach but it causes stomach cramps,nausea and diarrhea.

2)Should not be taken with milk, calcium and antacid because those hampers it's absorption.

3)Drinking 8 ounces(240 milliliters)of fluid with an iron pills is ok

4)Taking a vitamin supplements or drinking orange juice which increase it's absorption.

5)Food that should not eat at the time of iron supplementation-High fibre food such as whole grain,raw vegetables and bran or food or drinks with caffeine.