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Leukemia Case Study C.O. is a 43-year-old woman who noted a nonpruritic nodular rash on her...

Leukemia Case Study C.O. is a 43-year-old woman who noted a nonpruritic nodular rash on her neck and chest about 6 weeks ago. The rash became generalized, spreading to her head, abdomen, and arms, and was accompanied by polyarticular joint pain and back pain. About 2 weeks ago, she experienced three episodes of epistaxis in 1 day. Over the past week, her gums became swollen and tender and she was severely fatigued. Because of the progression of symptoms, she sought medical attention. Lab work was done, and C.O. was directly admitted to the hematology/oncology unit under the care of a hematologist for diagnostic evaluation. Skin biopsy showed cutaneous leukemic infiltrates, and bone marrow biopsy showed moderately hypercellular marrow and collections of monoblasts. Her lumbar puncture specimen was free of blast cells. The final diagnosis was acute myeloblastic leukemia. C.O. is to begin remission induction therapy with cytarabine 100 mg/m2/day as a continuous infusion for 7 days and idarubicin 12 mg/m2/day IV push for 3 days. She is scheduled in angiography for placement of a triple-lumen subclavian catheter before beginning her therapy. Laboratory Test Results Complete Blood Count (CBC) White blood cells (WBCs) 39,000/mm3 (39 x 109/L) Monocytes 64% Lymphocytes 15% Neutrophils 4% Blasts 17% Hemoglobin (Hgb) 10.4 g/dL (104 g/L) Hematocrit (Hct) 28.7% Platelets 49,000/mm3 (49 x 109/L)

12. What type of bone marrow transplant will she have? Briefly describe this transplant process.

13. Name 4 priority problems C.O. will face in undergoing a bone marrow transplant. Put a star next to the most important priority

14. What is the most important intervention post-transplant?

A. Giving analgesics for postprocedural pain

B. Monitoring for signs of infection and bleeding

C. Weighing her daily and offering small, frequent meals

D. Offering emotional support to C.O. and her family during recovery

15. What type of isolation will C.O. need? Outline the guidelines for maintaining this type of isolation.

16. Undergoing a bone marrow transplant is challenging. Describe how you would provide emotional support to C.O. and her family.

17. Name 3 complications C.O. will be at risk for after the transplant.

18. Describe graft-versus-host disease.

19. True or false. If the transplanted cells do not engraft, C.O. will die unless another transplant is tried and successful. Defend your response.

Solutions

Expert Solution

Answer:-

I her case, allogenic bone marrow transplant is the option. The most The most common type  of transplant for AML ( acute myeloblastic lauekaemia) is an allogeneic transplant . This type of transplant uses healthy blood-forming cells donated by someone else to replace the unhealthy ones. These healthy cells can come from a family member, unrelated donor or umbilical cord blood.A bone marrow transplant  takes a donor's healthy blood-forming cells and puts them into the patient's bloodstream, where they begin to grow and make healthy red blood cells, white blood cells and platelets. Patients receive high doses of chemotherapy to prepare their body for the transplant.

13.Afterward, undergoing a bone marrow transplant she will feel more tired than usual. She may feel weak, too, and you might not be hungry. She might notice changes in the way things smell and how food tastes. None of that is unusual.

Possible complications from a bone marrow transplant include:

  • Graft-versus-host disease (allogeneic transplant only)
  • Stem cell (graft) failure
  • Organ damage
  • Infections
  • Cataracts
  • Infertility
  • New cancers
  • Death

14. B.Monitoring for signs of infection and bleeding

Infection is one of the biggest concerns after a bone marrow transplant. Bacteria, viruses, and funguses can all cause it. It most likely to get one during the first 6 weeks. After that, the new stem cells will probably start making white blood cells that can help the body defend itself. But it can take up to a year for your immune system to fully recover.

Infection is a source of significant morbidity and mortality in BMT patient. Infection prevention is the crucial during the immediate phase post-transplant. All efforts by health care providers are directed towards prevention, vigilant assessment for sign and symptoms of infection.and prompt intervention at the first sign of infection.

15.After BMT the patient should be placed in protective isolation . The degree of potential isolation is varies, depending on the transplant centre and transplant type. The patient should be placed in a laminar air flow room, which provide sterile environment or the patients should be placed in a reverse isolation room.

16.The patient need help coping with your emotions after transplant, confiding in a loved one or religious counselor may provide some relief. Others find talking with a professional counselor helps them understand and manage their concerns.

Your BMT transplant center may offer counseling services, or you may find a counselor at a local hospital, cancer center or though the American Psychosocial Oncology Society.

Talking one-on-one with another transplant survivor or caregiver can also help. BMT InfoNet's Caring Connections Program can put you in touch with others who have been through transplant and have experienced the same emotional highs and lows you now face.

Support groups are often a good way to get support and to learn how others are coping with their recovery. Most support groups are organized around a particular disease, so contacting organizations such as the International Myeloma Foundation or The Leukemia & Lymphoma Society can help the patient for sspeedy emotional recovery.

17.

Complications after BMT includes,

  • Nausea, Vomiting, Diarrhea. Nausea, vomiting and diarrhea may occur with chemotherapy, radiation and/or gastrointestinal (GI) irritation. ...
  • Mucositis and Pain. ...
  • Low Platelet and Red Cell Counts. ...
  • Infections. ...
  • Fluid Overload. ...
  • Veno-occlusive Disease (VOD) ...
  • Respiratory Distress. ...
  • Graft-versus-host Disease (GVHD

18.Graft-versus-host disease (GVHD) is a potentially serious complication of allogeneic stem cell transplantation and reduced-intensity allogeneic stem cell transplantation. During allogeneic stem cell transplantation, a patient receives stem cells from a donor or donated umbilical cord blood.

19.yes.

Graft failure happens when  the new cell don't make the new white bloodcells, red blood cells, and platelets you need. This is also called “failure toengraft  or “non-engraftment” This is serious but uncommon. The most common treatment for graft failure is another transplant .


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