Care of Patients with Hematological

(WBC) Disorders

Prepared by: Salima Shams

 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)

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.
• Production of interleukin.
• Various responses in allergic reactions
• Antibody production (B-lymphocytes).
 Definitions

Leukocytosis: The number of circulating WBC increased in

response to the defense of the body. For e.g. (hepatitis,
measles, mumps, allergic reaction).

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.

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.
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. immuno suppressives, Cx: mutation of DNA
chemotherapeutic agents. and genes

• Viral infections.
• Family history
• Genetic predisposition i.e. Down’s syndrome
• Chromosomal abnormality (90% of CML has
chromosomal abnormality).
 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

Lack of blood platelets.

• Bruised, bleed excessively, or develop pinprick
bleeds (petechiae).
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)
 Sign and symptoms

Anemia
• General feeling of fatigue, feeling sick,headache

• Feeling of fullness due to an enlarged liver and spleen.

 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.
• 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).
 Myeloid/ lymphoblastic/lymphocytic

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.
 The five-year survival rate is 90%.
• http://www.cancercenter.com/video/cancer
-types/medanim/acute-lymphocytic-
leukemia/
• http://www.cancercenter.com/video/cancer
-types/medanim/acute-myeloid-leukemia/
• http://www.cancercenter.com/video/cancer
-types/medanim/chronic-lymphocytic-
leukemia/
• http://www.cancercenter.com/video/cancer
-types/medanim/chronic-myeloid-
leukemia/
Diagnostic Test:
• CBC
• 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 (Phases: induction, consolidation,
maintenance). (side effect: tumor lysis syndrome)
• Give antiemetic, antibiotics
• Blood and blood product.
• Bone marrow transplant (challenges associated with
transplant?)
 Nsg Diagnosis
• High risk for infection r/t low immunity.
• Fatigue r/t side effect of tx and anemia.
• 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 alopecia, wt loss and
fatigue.
• High risk for sexual dysfunction r/t fatigue and effect
of chemotherapy/ radiation therapy.
Nursing Intervention
 Lymphomas
Lymphomas: Tumor originating in lymphatic system.

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)
 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, 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
lymphoid tissue that are not enclosed in a capsule.
 Hodgkin Lymphoma
o Usually enlarged lymph nodes
o Biopsy: distant large, giant cell called Reed sternberg cells of
the HD lymphoma.
o Increase in young adults.

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
• Generalized lymphadenopathy (swollen
lymph node)
• Sore throat
• Appearance in the blood of atypical
lymphocytes and several antibodies
• https://www.youtube.com/watch?v=L5Egm
twvK68
• https://www.youtube.com/watch?v=saYsSI
sBObw
• https://www.youtube.com/watch?v=x3c9dy
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 Management
• Excision of lymph node
• Chemotherapy
• Radiation therapy