Neutropenia and Thrombocytopenia

Question 1

What is hematopoiesis, what are the three cell lineages

Answer 1

Process that generates blood cells of all lineages/ WBC, RBC, Platelets

Question 2

What are the “younger” leukocytes

Answer 2

neutrophils, eosinophils, and basophils

Question 3

What is the life span of neutrophils, platelets, RBCs

Answer 3

12 hours, 10 to 14 days, 120 days

Question 4

For while blood cells what are the top 3 cells types present in the blood

Answer 4

Neutrophils (60-70%), lymphocytes (25-33%), monocytes (2-6%)

Question 5

What are normal WBC, ANC, and platelet counts

Answer 5

3,000/mm3, 1500/mm3, 100,000/mm3

Question 6

What is myelosuppression

Answer 6

Bone marrow activity is decreased resulting in less RBCs, WBCs, and platelets

Question 7

What is the equation to find ANC

Answer 7

(%Segs + %Bands) X WBC/100 (WBC in thousands)

Question 8

What is the Nadir

Answer 8

Lowest level blood counts during chemotherapy cycle (usually utilize ANC or platelets)

Question 9

What is the usual onset for Nadier, recovery

Answer 9

10-14 days after chemotherapy administration, 21-28 days

Question 10

When is chemotherapy given

Answer 10

every 3 to 4 weeks

Question 11

What ANC reading is regarded as neutropenia

Answer 11

ANC less than 500 neutrophils/mcL OR ANC greater than 1000 neutrophils/mcl with a predicted decrease to less than or equal to 500 neutrophils/mcl over the next 48 hours

Question 12

What are the grades for neutropenia

Answer 12

Grade 1: 1500/mm3 or higher
Grade 2: Less than 1500/mm3 to 1000/mm3
Grade 3: Less than 1000 to 500/mm3
Grade 4 Less than 500/mm3
Grade 5: Death

Question 13

T/F: Chemotherapy will always be given regardless of ANC

Answer 13

False: If ANC is less than 1500 chemotherapy is not recommended

Question 14

T/F: Myelosuppresive chemotherapy is mostly associated with decreased survival

Answer 14

True

Question 15

What is febrile neutropenia

Answer 15

ANC less than 500/mm3 or 1000/mm3 that is predicted to decline to less than 500/mm3 over the next 48 hours
Patient needs a single oral termerature greater than 101F or 100.4F for one hour

Question 16

What is the link between severe neutropenia and febrile neutropenia

Answer 16

For every day of severe neutropenia there is approximately a 10% increased risk of developing FN

Question 17

T/F: Most cases of febrile neutropenia occur late into chemotherapy

Answer 17

False: Most initial febrile neutropenia events occur during the first cycle of chemotherapy

Question 18

What are methods for preventing chemotherapy-induced neutropenia

Answer 18

Postpone next cycle of chemotherapy until ANC is greater than 1500, decrease chemotherapy in the next cycle, give antibiotics prophylaxis, Myelpoid growth factors

Question 19

What are the myeloid growth factors

Answer 19

Filgrastim, pegfilgrastim, sargograstim (not tolerated well)

Question 20

What is the MOA of MGFs, filgrastim specifically

Answer 20

Stimulate proliferation and differentiation of hematopoietic progenitor cells, stimulates neutrophilica granulocytes

Question 21

What is the dose for filgrastim, pegfilgrastim

Answer 21

5-10 mcg/kg/day, 6 mg (one dose per cycle)

Question 22

What is the onset of filgrastim, pegfilgrastim

Answer 22

2-8 hours, 72 hours

Question 23

T/F: MGF need to be administered 12 hours after chemotherapy

Answer 23

FalsE: MGFs need to be administered 24 hours (up to 3 to 4 days) after chemotherapy

Question 24

MGF adverse effects

Answer 24

Bone pain, flu like symptoms, brusing, rash, sickle cell crisis

Question 25

How long must a person wait to receive chemotherapy if given pegfilgrastim

Answer 25

14 days

Question 26

What cancer patients will not recieve MGFs

Answer 26

Those with Myeloid malignancy

Question 27

What is primary prophylaxis

Answer 27

Chemotherapy regimen is expected to cause 20% FN and automatically recieve MGF on first cycle

Question 28

What is secondary prophylaxis

Answer 28

For patients who experienced a neutropenic complication on a previous cycle of chemotherapy without MGF

Question 29

What is considered high risk for FN, intermediate, low

Answer 29

Greater than 20%, 10-20%, less than 10%

Question 30

T/F: If there is a high risk of FN an MGF should be given regardless of the type of chemotherapy

Answer 30

True

Question 31

What are the patient-related risk factors for developing febrile neutropenia

Answer 31

Age greater than 65 years old, poor performance status, persistent neutropenia

Question 32

What are the treatment related risk factors for developing febrile neutropenia

Answer 32

Previous chemotherapy and previous radiation therapy

Question 33

What are the cancer related risk factors for developing febrile neutropenia

Answer 33

Bone marrow involvement with tumor or pre-existing neutropenia

Question 34

What are the comorbiditiy risk factors for developing febrile neutropenia

Answer 34

Recent surgery or open wounds, renal dysfunction (CrCl less than 50), liver dysfunction (total bilirubin greater than 2), HIV infection with low CD4 counts

Question 35

What is considered thrombocytopenia, normal amount

Answer 35

Less than 150,000/mm3 platelets (150,000 to 300,000)

Question 36

What are the grades for thrombocytopenia

Answer 36

``` Grade 1: Normal to 75/mm3 Grade 2: Less than 75 to 50/mm3 Grade 3: Less than 50 to 25/mm3 Grade 4: Less than 25/mm3 Grade 5: Death ```

Question 37

When does spontaneous bleeding occur

Answer 37

20,000 -10,000/mm3 or less

Question 38

What is the best way to treat chemotherapy-induced thrombovytopenia

Answer 38

Platelet transfusion: pooling platelets from several donors, separated from whole blood,

Question 39

When is the transfusion threshold 10K

Answer 39

Hematological malignancies, HSCT patients, solid tumors

Question 40

What is the transfusion threshold for surgical procedures, BM biopsies

Answer 40

40-50k, less than 20K