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Pediatrics > Hematology and Oncology > Flashcards

Hematology and Oncology Flashcards

1
Q

2 Components of Blood

A

Plasma and Blood Cells

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2
Q

Function of plasma

A

Liquid component

Contains coagulation factors to stop prolonged bleeding

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3
Q

Function of RBC

A

Carry oxygen

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4
Q

Function of WBC

A

Fight infection

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5
Q

Function of platelets

A

Stop immediate bleeding

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6
Q

Two ways to classify anemias

A
  1. pathophysiology
  2. size of RBCs
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7
Q

What are the pathological approaches to anemia?

A
  1. decreased production
  2. hemolysis
  3. blood loss
  4. sequestration
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8
Q

What causes decreased production of RBCs/reticulocytes? (4)

A
  1. marrow infiltration/injury
  2. nutritional deficiency
  3. erythropoietic deficiency
  4. ineffective erythropoiesis
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9
Q

Why is reticulocyte count high in hemolytic anemias/blood loss?

A

Compensatory mechanism

Responds to destruction by creating even more

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10
Q

Who is iron deficiency most prevalent in and why?

A

Children: increased iron needs for growth + picky eaters

Women: blood loss through menstruation

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11
Q

4 Factors in Iron Deficiency Anemia?

A
  1. excessive loss
  2. inadequate intake
  3. increased demand
  4. impaired absorption
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12
Q

Iron rich foods

A

Red meats, fish, eggs, tofu, lentils, green leafy, iron fortified cereals

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13
Q

Why should milk intake be limited?

A

poor iron availability, displaces iron rich foods

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14
Q

When can cow’s milk be introduced

A

3.25% cows milk should not be introduced until 12 months

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15
Q

Side effects of iron supplementation

A

constipation, tarry stool, teeth staining

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16
Q

What can iron deficiency anemia lead to?

A

long term issues in brain functioning related to decreased oxygen supply to the brain

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17
Q

Signs and Symptoms of low platelets

A
  1. excessive bruising
  2. epistaxis
  3. bleeding of gums/teeth
  4. petechiae
  5. purpura
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18
Q

Petechiae

A

Pinpoint hemorrhages occurring on the body that do not blanch to pressure

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19
Q

Purpura

A

Larger purplish areas of hemorrhage in which blood collects under the tissues

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20
Q

Causes of low/dysfunctional platelets

A
  • Infections
  • Idiopathic thrombocytopenia purpura (most common) – immune reaction causing platelets to be low
  • Disseminated intravascular coagulation (DIC)
  • Medications (NSAIDS, etc.)
  • Familial inherited platelet disorders
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21
Q

What type of bleeding characterizes coagulation disorders vs platelet disorders?

A

OOZING/PROLONGED

coagulation factors: stop prolonged bleeding
platelets: stop immediate bleedings

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22
Q

Most important nursing management points for children with coagulation disorders

A

Prevent bleeding by instructing child to avoid activities with high potential for injury

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23
Q

Bleeding times are _______ when a clotting disorder in present

A

Prolonged

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24
Q

Most common coagulation disorders

A

Von Willebrand

Hemophilia A and B

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25
Q

Neonatal pattern of bleeding

A
  1. heel poke
  2. umbilical cord
  3. circumcision
  4. CNS bleeds r/t birth trauma
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26
Q

Infant pattern of bleeding

A
  1. frenulum from feeding
  2. tongue/dental as teething
  3. soft tissue/forehead as starting to walk
  4. immunization
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27
Q

Children/adult pattern of bleeding

A
  1. hemoarthrosis
  2. muscle bleeds
  3. soft tissue bleeds
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28
Q

Neutrophil function

A

Kill bacteria, fungi, debris

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29
Q

Monocyte function

A

clean up damaged cells

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30
Q

Eosinophil function

A

Kill parasites, cancer cells, and involved in allergic response

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31
Q

Lymphocyte function

A

Fight viruses and make antibodies

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32
Q

Basophil function

A

Involved in allergic response

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33
Q

When are you most worried about low WBC levels?

A

usually would indicate no infection present but

worry when there is congenital/autoimmune/cancer reasons

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34
Q

High WBC levels can indicate

A
  • infection
  • inflammation
  • tissue damage
  • leukemia
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35
Q

Origin of pediatric vs adult cancers and difference in what it tends to effect

A

Ped: embryonic mesodermal germ layer - affect tissues

Adult: epithelial - affect organs

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36
Q

Growth and responsiveness of pediatric cancer compared to adult

A

Grow/spread more quickly but are more responsive to treatment

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37
Q

Why is childhood cancer not preventable as it is in adulthood?

A

Not based on lifestyle or environmental factors

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38
Q

Most common pediatric cancers

A
  1. leukemia
  2. CNS tumors
  3. lymphoma
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39
Q

Cure rate of pediatric cancer

A

Today cure rate is about 85% (4% in 1962)

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40
Q

What is the most common malignancy of childhood?

A

Leukemia - acute lymphoblastic leukemia

41
Q

Define leukemia and what organs are involved

A

WBC stem cell (BLASTS) growing out of control – do not respond to body’s stop signals

Involves the bone marrow (where blood is made), lymph nodes, and the spleen.

42
Q

When do individuals start to experience symptoms of leukemia and what are they?

A

When the immature white blood cells, called blasts, begin to crowd out other healthy cells in the bone marrow, the child experiences the symptoms of leukemia

– infections
– anemia
– bleeding

43
Q

Define lymphoma and what are the 2 categories

A

Tumors of the lymph tissues (lymph nodes, thymus and spleen)

second most common group of cancer in children.

Hodgkins and Non Hodgkins

44
Q

Duration of symptoms of leukemia/lymphomas

A

Usually a very short duration of symptoms weeks to few months

45
Q

Age of occurence of lymphomas/leukemia

A

Usually 2-6 but can be any age

46
Q

Clinical manifestations of leukemia/lymphomas are dependent on:

A

where infiltration occurs

47
Q

3 categories of clinical manifestations of leukemia/lymphomas

A
  • Constitutional symptoms (fever, chills, weight loss)
  • Extramedullary infiltration (lymphadenopathy, gums inflamed, kidney or spleen involvement)
  • Bone marrow infiltration: normal cells can’t grow
48
Q

What occurs secondary to bone marrow infiltration/marrow failure?

A

Cytopenia

49
Q

RBC cytopenia symptoms

A

Anemia!!

Weakness, fatigue and ischemia, SOB, exercise intolerance, pallor, tachycardia

50
Q

WBC cytopenia symptoms

A

Neutropenia!!

Infections, fever, sepsis, death

51
Q

Platelet cytopenia symptoms

A

Thrombocytopenia!!

Mucosal bleedings, petechiae, ecchymoses

52
Q

IV hydration and medications are given to leukemia patients to prevent tumor lysis because

A

Breakdown of leukemia cells damaging to kidney

53
Q

Signs and Symptoms of Pediatric Brain Tumors are dependent on

A

Location and size

Think ICP for symptoms

54
Q

2 Main Regions of pediatric brain tumors

A
  1. Posterior Fossa (60%) - controls movement and baseline autonomic function
  2. Cerebral hemisphere (40%) - controls intellectual function
55
Q

Pediatric Solid Tumors besides CNS in order of prevalence

A
  1. neuroblastoma
  2. wilms

3, bone (osteo and ewings)

  1. rhabdo
  2. retino
56
Q

Bone tumours are most often diagnosed in _________, whereas soft tissue tumours occur in ________

A

adolescence

younger children

57
Q

When is osteosarcoma most commonly seen

A

Often at the peak of growth (teenagers) in second decade of life when children are rapidly growing (age 10-25)

58
Q

Where in the body is osteosarcoma commonly found?

A

Usually in the long bones (humerus, femur/tibia, and pelvis

Usually near the growth plates

59
Q

Osteosarcomas usually have _______ at diagnosis to the _____ and _______

A

mets

lung

brain

60
Q

Where is Ewing Sarcoma found

A

occurs primarily in the bone or soft tissue.

can occur in any bone, but is most often found in the extremities and can involve muscle and the soft tissues around the tumor site.

61
Q

Age of occurence in Ewing Sarcoma

A

ages of 5 and 20

62
Q

Where does rhabdomyosarcoma originate and what is the most common site?

A

originates in the soft tissues of the body, including the muscles, tendons and connective tissues

Head and neck most common site

can be anywhere including bladder, vagina, arms, legs and trunk

63
Q

Rhabdomyosarcoma often occurs in ______ children

A

younger

64
Q

What is the most common soft tissue sarcoma in childhood

A

Rhabdomyocarcoma

65
Q

What is Wilm’s Tumor

A

Most common from kidney; malignant (cancerous) tumor originating from cells of the kidney

66
Q

Most common site of metastasize for Wilms

A

Lungs

67
Q

Where do neuroblastomas arise from

A

nerve tissue, often in adrenal gland, but any nerve tissue in the neck, chest or pelvis – usually centrally related.

68
Q

How do children with neuroblastomas present

A

“racoon eyes”, “dancing eyes” opsiclonus myoclonus, diarrhea, high urine catecholamines

69
Q

General treatments for pediatric cancer

A
  1. biopsy and surgery
  2. chemotherapy
  3. radiation
  4. stem cell transplant
  5. targeted therapies
70
Q

Goal of surgery as cancer treatment

A

complete resection with clean margins but this is not always possible

71
Q

Purpose of pathology and radiology following surgery as cancer treatment

A

look for residual tumour

Radiation Therapy: Often used for localized tumors or after surgery to eliminate remaining cancer cells.

72
Q

What is Chemotherapy

A

Systemic drug treatment that works on different part of the cell cycle to kill cells or stop them from dividing

73
Q

What causes the side effects of chemotherapy?

A

Affect rapidly growing cells like cancer cells AND normal cells that rapidly grow

SYSTEMIC

74
Q

3 routes of chemotherapy administration

A

IV
Oral
Intrathecal

75
Q

What is intrathecal chemotherapy used for

A

may be used to treat childhood ALL that has spread, or may spread, to the brain and spinal cord.

When used to prevent cancer from spreading to the brain and spinal cord, it is called central nervous system (CNS) sanctuary therapy or CNS prophylaxis.

Intrathecal chemotherapy is given in addition to chemotherapy by mouth or vein

Penetrate blood brain barrier to treat any disease of CNS

76
Q

In preparation for chemo treatment, what is ordered in anticipation of toxicity?

A

– Cardiac: echocardiogram
– Renal: creatinine clearance (many medications are nephrotoxic)
– Pulmonary: CXR, CT Chest
– Tumor lysis and Blood counts: BW q4-24h
– Liver: LFTs

77
Q

What monitoring is done for chemo treatment in anticipation of toxicity?

A

– Watching for tumor lysis (as chemotherapy kill cancer cells release contents into blood that can damage kidneys)
– SVC syndrome or mediastinal syndrome

78
Q

Chemotherapy adverse effects + when can they be seen

A
  1. Bone marrow suppression (anemia, infection, bleeding) (day 7-10)
  2. mouth sores (day 2-3)
  3. nausea vomiting (immediate_
  4. decreased appetite
  5. weight loss
  6. constipation/diarrhea
  7. immunosuppression
  8. alopecia
  9. organ dysfunction
  10. infusion reaction
79
Q

What is radiation therapy?

A

The use of ionizing radiation to break apart bonds within a cell causing cell damage and death – stops reproduction .

Can be more targeted than chemo

80
Q

Problems with radiation therapy

A

cannot distinguish between malignant cells and healthy cells so effect on surrounding normal tissues too

81
Q

once an area has been radiated, that area will no longer:

A

grow to develop

try not to radiate kids younger than 2-3

82
Q

Radiation side effects are dependent on:

A

Which area you radiate

83
Q

Radiation side effects

A
  1. lack of growth/development in radiation field afterwords
  2. increased risk of secondary cancer
  3. Fatigue, memory loss, developmental delay
  4. Nausea, vomiting, oral mucositis
  5. Myelosuppression
  6. Decreased bone and tissue growth
  7. Skin burn / loss of integrity at the site of irradiation.
  8. Organ dysfunction
84
Q

How do newer targeted cancer therapies work?

A

Targeted therapies for certain genetic mutations or markers present in the tumour cells and not on other cells

Manipulation of patients own cells to target their own cancer cells

85
Q

What are blasts and what do they indicate?

A

abnormal immature white blood cells (called blasts) multiply uncontrollably, filling up the bone marrow, and preventing production of other cells important for survival, namely red blood cells and platelets. This leads to infections, anemia and abnormal bleeding.

86
Q

When do leukemia patients begin to experience symptoms and what are they?

A

When blasts begin to crowd out healthy cells in the bone marrow

  • infections
  • anemia
  • bleeding
87
Q

Immediate chemo side effects

A

nausea, vomiting, fatigue

88
Q

Short Term Chemo Side Effects (first days to weeks)

A

hair loss, mouth sores, bone marrow suppression, changes in appetite/taste/smell

89
Q

Mid Term Chemo Side Effects (weeks to months)

A

skin/nail changes, neuropathy, constipation/diarrhea

90
Q

Long Term Side Effects of Chemo

A

fatigue, cognitive effects, emotional/psychological effects

91
Q

What nutritional deficiencies lead to decreased EPO production?

A

iron, folate, B12

92
Q

WBC count at Leukemia Diagnosis

A

HIGH

Everything else is suppressed

WBC Count looks at TOTAL WBC (mature and blasts) - if you look at differential mature would be low and blasts would be high

93
Q

Normal hemoglobin

A

110-145

94
Q

Normal platelets

A

140-440

95
Q

Normal reticulocytes

A

19-73

96
Q

Normal ferritin

A

4-20

97
Q

Normal iron

A

10-29

98
Q

Normal WBC

A

5-17.5

Pediatrics (12 decks)

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