Anemia+and+neutropenia

= Anemia, Neutropenia, Thrombocytopenia, & Pancytopenia in Oncology  = = =

** __Anemia__**
= = // **What is anemia? ** //

Anemia is a condition in which the red blood cell (RBC) count in your blood is lower than normal. This is usually detected in a test called a complete blood count (CBC). This condition means that your blood also has a low amount of hemoglobin, which is part of the RBC, which is the part of the cell that carries the oxygen to the different parts of the body. Most of the time, most people do not feel any symptoms until their hemoglobin level is below normal levels (less than 11 g/dL).

__**These symptoms include:** __
 * **Fast heartbeat**
 * **Shortness of breath**
 * **Trouble breathing when doing things like walking, climbing stairs, or even talking**
 * **Dizziness**
 * **Chest pain**
 * **Swelling in the hands and/or feet**
 * **Pale skin, nail beds, mouth and gums**
 * **Extreme tiredness (fatigue)**

// **What causes anemia in cancer patients? ** //

__**The most common causes of anemia in cancer patients and people in general include:** __
 * **Cancer development/ cellular dysfunction**
 * **Cancer treatment (chemotherapy, radiation, others)**
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 110%;">**Blood loss (this can be slow constant bleeding such as from the intestine or bladder; or fast bleeding, like heavy menstruation or bleeding from a stomach ulcer)**
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 110%;">**Vitamins and minerals that the person is not eating in their diet.**
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 110%;">**Major organ problems (including severe heart, lung, kidney, or liver disease)**
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 110%;">**Red blood cells (RBCs) being destroyed by the body before they're replaced**
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 110%;">**The body making a lower amount of RBCs.**
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 110%;">**Inherited diseases such as Sickle cell disease or thalassemia**
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 110%;">**A combination of factors mentioned above.**

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 110%;">In addition, if a patient is on platinum-based chemotherapy, certain tumors (like ovarian or lung tumors), and having a low hemoglobin prior to the cancer, makes them at risk to becoming anemic.

// **<span style="font-family: 'Times New Roman','serif'; font-size: 19px;">How does anemia affect cancer? ** //

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 14px;">If your doctor or nurse suspects that you may be at risk for anemia, they will be observing your signs and symptoms, as well as monitoring your hemoglobin levels. Other things that they will look at to figure out your risk for getting this condition includes your hemoglobin levels and other lab results, past cancer treatments, blood transfusions in the past 6 months, any lung, heart, or circulation problems, and your age. If you have severe anemia, it may delay your cancer treatment or make the dose of your treatment have to be reduced. It can also cause them not to work as well as they are expected to.

// **<span style="font-family: 'Times New Roman','serif'; font-size: 19px;">How is anemia treated? ** //

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 110%;">Depending on the cause, the treatment can be different. __<span style="font-family: Arial,Helvetica,sans-serif; font-size: 110%;">**Treatments include:** __
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 110%;">**Eating nutrient-rich foods**
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 110%;">**Taking iron and folic acid supplements**
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 110%;">**RBC transfusion**
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 110%;">**Take medications that will make your body create more RBCs (Epoetin and Darbepoetin)**

= <span style="color: #0000ff; font-family: Impact,Charcoal,sans-serif; font-size: 180%;">__Neutropenia__ <span style="color: #0000ff; font-family: Impact,Charcoal,sans-serif; font-size: 180%;">  =

// **<span style="font-family: 'Times New Roman','serif'; font-size: 19px;">What is Neutropenia? ** //

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 110%;">Neutrophils are a type of white blood cell (WBC) that flows through your blood stream, and helps fight off infection. Neutropenia is an abnormally low amount of these kinds of cells. People that have this kind of condition have a higher risk of infection since they do not have as many cells fighting off harmful microorganisms. __<span style="font-family: Arial,Helvetica,sans-serif; font-size: 110%;">**Symptoms that a person with this condition may feel include:** __


 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 110%;">**Fever**
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 110%;">**Chills/ sweating**
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 110%;">**Sore throat or mouth sores**
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 110%;">**Pain in the abdomen**
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 110%;">**Diarrhea (sores around the anus as well)**
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 110%;">**Painful, burning, or frequent urination**
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 110%;">**Cough**
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 110%;">**Shortness of breath**
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 110%;">**Signs of infection around a cut, wound, or IV site**
 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 110%;">**Unusual vaginal discharge or itching**

// **<span style="font-family: 'Times New Roman','serif'; font-size: 19px;">What are the causes of Neutropenia in cancer patients? ** //

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 110%;">Cancer and cancer treatment can cause neutropenia in many ways. Some kinds of chemotherapy effect the bone marrow, making it produce lower amounts of neutrophils. Also, different kinds of cancers (leukemia, lymphoma, and myeloma, or metastatic cancer) that make the bone marrow produce abnormal amounts of blood cells and crowd the bone marrow’s normal cells. Radiation therapy can also affect the bone marrow of a cancer patient. Also, if the patient is older, they run the risk of getting this condition since their immune system is already weakened.

// **<span style="font-family: 'Times New Roman','serif'; font-size: 19px;">How can neutropenia in cancer patients be treated? ** //

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 14px;">If the patient’s bone marrow does not return to developing normal levels of neutrophils after chemotherapy, the doctor may delay the next round of chemotherapy, or lower the next dose. Also, the doctor may prescribe some antibiotics if the patient is going to be experiencing long periods of time with neutropenia, so that their risk for infection can be decreased. If chemotherapy causes neutropenia and the patient has a fever, the doctor may decide to prescribe medications that increase the neutrophils and other WBC production, which includes Filgrastim, Pegfilgrastim, or Sargramostim. = <span style="color: #ff00ff; font-family: Impact,Charcoal,sans-serif; font-size: 170%;">__**Thrombocytopenia**__ = = = = // What is thrombocytopenia? // =

Thrombocytopenia is a bleeding disorder in which the body contains a lower than normal number of functional platelets. It is the most common cause of bleeding in cancer patients. __ **Platelet levels may decline as a result of:** __

** - Insufficient bone marrow production of platelets ** ** - Increased consumption of platelets ** ** - Abnormal platelet removal from the blood by the spleen **

Platelets play an important role in the clotting mechanism of blood, which allows the body to control bleeding at the site of injury. When tissue injury occurs, the blood vessel slows bloodflow past the site of the wound. Platelets then collect at at the site of injury to form a plug. This platelet plug is then replaced by a coagulation protein called fibrin, which forms a clot and allows for healing of the wound to take place.

Platelets are produced in the bone marrow and are removed from the blood by the spleen. These two organs must work together to regulate platelet levels in the blood. Due to platelet cell fragility, they are easily damaged in many disorders, and especially vulnerable in bone marrow diseases. **//In cancer patients, thrombocytopenia may result from the presence of the tumor or may occur in response to the chemotherapy or radiation used in treatment//.** Generally, symptoms do not occur until platelets are very low.

__ **Signs & symptoms include:** __

**- Unexpected bruising** **- Petechiae, which are small, red-purple pinpoint hemorrhages on the surface of skin** **- Bleeding from the nose or gums** **- Heavy menstrual periods in women** **- Black or bloody stools** **- Hematuria** **- Severe headaches** **- Dizziness** **- Painful joints or muscles** **- Weakness**

//** What are the causes of thrombocytopenia in cancer patients? **//

Thrombocytopenia may be due to insufficient platelet production or to platelet destruction in the blood or spleen. Platelet production in the bone marrow may be suppressed by leukemia, aplastic anemia, burns, cancer chemotherapy, exposure to radiation used in cancer treatment, HIV virus, and nutritional deficiencies, among others. More relative to oncology patients, thrombocytopenia can result due to:

**- Some types of chemotherapy can damage bone marrow, resulting in decreased ability to make a sufficient number of platelets.** **- Autoimmune processes; production of antibodies by the person's body, resulting in platelet destruction.** **- Cancer cells (such as leukemia or lymphoma cells) crowd normal bone marrow cells.** **- Cancer mestasis to the bone marrow (i.e. Breast cancer)** **- Cancer of the spleen (although uncommon) can cause increased platelet destruction, by the invasion of cancer cells into the organ, disrupting normal platelet activity.** //** How is thrombocytopenia in cancer patients treated? **//

The first step to treatment of thrombocytopenia is determination of the underlying cause for the low platelet count. Routine blood draws will be done to diagnose and manage care. A reduction in the chemotherapy or radiation dose/frequency may require adjustment to allow for platelet level to return to normal. Any scheduled surgeries are delayed until platelets are restored to a normal level. Patient may require a platelet transfusion. However, those receiving chemotherapy may be prescribed certain drugs to prevent severe thrombocytopenia, in addition to reducing the need for platelet transfusions.

__ **Nursing Precautions:** __ **- Routinely monitor client for evidence of hemorrhage.** **- Institute fall precautions in those who are at increased risk for falls to reduce injuries.** **- Elevate client HOB at least 30 degrees and maintain client on bedrest during thrombocytic episode.** **- Observe patient for chills, rigors, fever, or allergic reactions.** **- Treat patient with acetaminophen or diphenhydramine to prevent platelet transfusion reactions.** **- Apply pressure to sites of venipuncture/IV access for 20 minutes.** **- Have patient use soft toothbrush or spongestick for oral care, blade-less electric razor.** **- Discourage patient from straining/coughing; treat symptoms as needed with PRN antiemetics, cough suppressants, etc.** **- Avoid aspirin and NSAIDS. (Also certain herbs; feverfew, gingko, ginseng, kava)** **- Corticosteroids, immunoglobulin, or gamma globulin therapy may be prescribed to decrease platelet destruction in immune-mediated thrombocytopenia.** **- Folate may stimulate bone marrow production of platelets in those with folate deficiency** **- Pt may undergo splenectomy to decrease platelet destruction in some cases**

//** Where can I find more information on managing my thrombocytopenia? **//

<span style="color: #00ff00; font-family: Impact,Charcoal,sans-serif; font-size: 170%;">__ Pancytopenia__
<span style="color: #00ff00; font-family: Impact,Charcoal,sans-serif; font-size: 170%;"> <span style="color: #00ff00; font-family: Impact,Charcoal,sans-serif; font-size: 170%;"> //<span style="color: #09ae6f; font-family: Arial,Helvetica,sans-serif; font-size: 140%;">What is pancytopenia? // <span style="color: #000000; font-family: Arial,Helvetica,sans-serif; font-size: 110%;">Pancytopenia is a reduction in __ALL__ types of cellular elements of the blood at one time; whereas, solitary cell-type deficiencies occurring individually are classified accordingly.

<span style="color: #000000; font-family: Arial,Helvetica,sans-serif; font-size: 110%;">- //**Red Blood Cells:**// Anemia (Hemoglobin < 13.5 g/dL in males, or < 12 g/dL in females) <span style="color: #000000; font-family: Arial,Helvetica,sans-serif; font-size: 110%;">- //**White Blood Cells:**// Neutropenia (Absolute Neutrophil Count < 1.5 ×103/microliter) <span style="color: #000000; font-family: Arial,Helvetica,sans-serif; font-size: 110%;">- //**Platelets:**// Thrombocytopenia (Platelet count < 150×109/L)
 * __<span style="color: #000000; font-family: Arial,Helvetica,sans-serif; font-size: 110%;">These cellular components include: __**

<span style="color: #000000; font-family: Arial,Helvetica,sans-serif; font-size: 110%;">Pancytopenia occurs when your body cannot produce enough blood cells due to dysfunction of the bone marrow stem cells, which form RBC, WBC, & platelets. This condition has widespread effects on the entire body as a whole, including complications of decreased oxygen, as well as dysfunction of the immune system. //**<span style="color: #000000; font-family: Arial,Helvetica,sans-serif; font-size: 110%;">Aplastic Anemia **//<span style="color: #000000; font-family: Arial,Helvetica,sans-serif; font-size: 110%;">is a medical term that refers to the decrease in production of all types of blood cells. <span style="color: #000000; font-family: Arial,Helvetica,sans-serif; font-size: 110%;"> <span style="color: #000000; font-family: Arial,Helvetica,sans-serif; font-size: 110%;">Pancytopenia occurs in two forms: <span style="color: #000000; font-family: Arial,Helvetica,sans-serif; font-size: 110%;">//**- Idiopathic/Autoimmune:** (Most common) Body attacks it's own tissues, recognizing them as foreign invaders// <span style="color: #000000; font-family: Arial,Helvetica,sans-serif; font-size: 110%;">//**- Secondary:** Caused by environmental factors// <span style="font-family: Arial,Helvetica,sans-serif; font-size: 110%;">*Pancytopenia can also be caused by viral infections, //**radiation or chemotherapy treatments**//, drug reactions, and exposure to toxins.

<span style="font-family: Arial,Helvetica,sans-serif; font-size: 110%;">**__Signs & Symptoms are related to the functions of each deficient cellular element collectively:__** <span style="font-family: Arial,Helvetica,sans-serif; font-size: 110%;"> <span style="font-family: Arial,Helvetica,sans-serif; font-size: 110%;">**- Bleeding, easy bruising, fatigue, shortness of breath, and weakness (r/t low RBC & platelet levels)** <span style="font-family: Arial,Helvetica,sans-serif; font-size: 110%;">**- Increased risk of infection (r/t low WBC counts)**

__** Some causes of pancytopenia (in oncology): **__
 * // What are some causes of pancytopenia in cancer patients? // **
 * - Leukemia **
 * - Treatments, such as chemotherapy and radiation **

//How is pancytopenia in cancer patients typically treated?//
Treatment of pancytopenia is dependent upon the cause of the deficiencies. =<span style="color: #09ae6f; font-family: Arial,Helvetica,sans-serif; font-size: 80%;"> __Some treatment options include:__ = - **Immunosuppressant drugs: Prevents destruction of these cells by the immune system.** ** - Bone marrow stimulants: Encourages increased activity of bone marrow to create more RBC, WBC, & platelets. ** **  - Blood transfusions: Replaces the severe deficiencies in any particular blood component. ** **  - Bone marrow transplant: Functioning marrow from a donor, to correct deficiencies. ** **  - Stem cell replacement therapy: Restores function of bone marrow stem cells in production of cellular elements  **

** //Are there any up-to-date informative articles available on this topic?// **

__ **Article:** __ [] **Journal of the American Society of Hematology. "Blood: Leading the World in Reporting Basic and Applied Hematology"** (research doi: 10.1182/blood.V99.7.2599 Blood April 1, 2002 vol. 99 no. 7 2599-2602)
 * "Development of Pancytopenia with Neutralizing Antibodies to Thrombopoietin After Multicycle Chemotherapy Supported by Megakaryocyte Growth and Development Factor"**

**<span style="font-family: 'Times New Roman','serif';">Resources: ** <span style="font-family: 'Times New Roman','serif'; font-size: 16px;">[]

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[|www.nlm.nih.gov/medlineplus/] (U.S. National Library of Medicine)

[|www.cancer.org] (American Cancer Society)