Question

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.

Answer 1

12)she need allogenic bone marrow transplantation.

Bone marrow transplantation is the process of replacing unhealthy bone marrow with healthy one. This transplantation used for various cancerous condition like leukemia, lymphoma, multiple myeloma and myelodisplacia. Non cancerous condition like a plastic anemia, hemoglobinopatheis and immunodeficiency disorder

Types of bone marrow transplantation

:autologous transplantation _in this type transplant own cell after the treatment period

:allogenic transplantation _in this transplant donor's stem cell is infused to patient

Bone marrow transplant process

1)conditioning phase

The duration is last from 7 to 10days. Purpose of these phase to suppress the immunity with chemotherapy or radiation therapy and create space to new cell .

2)stem cell processing and infusion

Duration is 20min to 1 hour. Pretty medication is used to suppress immunity to prevent rejection. Depletion of T-cell prevent graft versus host disease.then cryoprecipitated stem cell is infused via central venous line.

3)Neutropenic phase

Duration is 2 to 4 week. In this period patient have no immune system he is more vulnerable to infection. Provide supportive care and antibiotic therapy. Healing is poor in this period .

4)Engraftment process

This is healing phase. Fever subside, prevent the occrance of GVHD and prevent viral infection like cytomegalo virus.

5)post engagement phase

Last for months to years. Develop gradual development of tolerance.

13)the main problem of bone marrow transplantation is:,

:risk for infection _the low blood cell count lead to more risk for infection.

:Graft versus host disease _this is a major problem of allegiance transplantation .

:bleeding_bleeding occur due to decreased platelet count.

:veno occlusive disorders _occurred due to blockage of small vein near to the liver.

14)answer is option b ,monitoring for signs of infection and bleeding, because post transplant patient have law blood count it will lead to anemia, bleeding and infection, so monitor for these symptom is very important.

15)the patient need strict isolation. Isolation maintaining in personal room except for diagnostic or therapeutic procedure. Provide N95 respirator while exit from the room.

:maintaining hand hygiene

The patient room should be well sealed one, appropriate ventilation are there, self control door for rooms, maintain back up ventilation equipment, no carpeting on the room ,avoid dusting method, no flowers or plants in the room

16)provide emotional support by explaining about transplantation process.educate them about usual length of hospital stay, benefits and side effects of transplant and promote them to participate in decition making.

17)complication of transplantation

:graft versus host disease

:hepato venous occlusive disorders

:graft failure

18)Graft versus host disease

GVHD is a condition in which donor bone marrow or stem cell attacked by recipient body. It is commonly occurring in allogenic bone marrow transplantation .

Types of GVHD

:acute graft versus host disease _it occurred with in a week. symptoms include skin rash, yellow discoloration, nausea, vomiting ,diarrhea and abdominal cramps .

Chronic graft versus host disease _it is occurring after several months to years .Main symptoms include diaphragmatic, shortness of breath, fatigue, skin rash, abdominal distension, decrease range of motion

19)if one bone marrow transplantation is fail the other way is to use another stem cell from other donor or from umbilical cord .This may helpfully to treat condition. if transplantation will not work we can treat condition with chemotherapy and radiation therapy, above statement is false.