Module 09 Discussion - Overcoming Challenges Discussion Topic Activity Time: 2 hours; Additional Time for Study, Research, and Reflection: 1 hour Directions: Initial post Pick one hematological disorder covered in this module. For this disorder, identify and describe three treatment strategies for the disorder. What challenges could arise in carrying out these strategies and providing care to the patient? Reply Post What interventions could be utilized in order to overcome these challenges? Please make your initial post by midweek, and respond to at least one other student's post by the end of the week. Please check the Course Calendar RESPONSE POST 1 Hematological disorder- Leukemia  Leukemia is a type of blood cancer in which a malignant white blood cell multiplies inside the bone marrow. Acute leukemia (quick and severe) and chronic leukemia (slowly progressing) are two different types of leukemia. Treatment for your leukemia is determined by several factors. Treatment options are determined by the doctor based on the age and overall health of the patient, the type of leukemia, and whether it has spread to other areas of your body, including the central nervous system.  Radiation therapy is a type of treatment that damages leukemia cells and stops their growth by using X-rays or other high-energy beams.  Chemotherapy is the most common type of leukemia treatment. Chemicals are used to kill leukemia cells in this medicinal treatment. A single medicine or a combination of drugs is given depending on the type of leukemia. These medications can be taken as pills or injected straight into a vein.  Transplantation of bone marrow. A stem cell transplant, commonly known as a bone marrow transplant, aims to restore healthy stem cells by replacing diseased bone marrow with leukemia-free stem cells that rebuild healthy bone marrow. Doses of chemotherapy or radiation therapy are used before a bone marrow transplant to eradicate leukemia-producing bone marrow. Then you'll have a blood-forming stem cell infusion to help repair your bone marrow.  What challenges could arise in carrying out these strategies and providing care to the patient?  There is currently no cure for leukemia, as there is for other types of cancer. After diagnosis and therapy, people with leukemia may go into remission, a state in which the cancer is no longer detectable in the body. However, cancer cells that remain in the body may cause it to reoccur.  Infections occur frequently. If you have chronic lymphocytic leukemia, you may have infections regularly, which can be dangerous. Infections can occur when blood lacks sufficient germ-fighting antibodies (immunoglobulins).  People with chronic lymphocytic leukemia are more likely to develop other cancers, such as skin cancer, lung cancer, and digestive system cancer.  References.  Kliegman RM, et al. The leukemias. In: Nelson Textbook of Pediatrics. 21st ed. Elsevier; 2020. https://www.clinicalkey.com. Accessed Oct. 16, 2020.  Leukemia. American Society of Hematology. https://www.hematology.org/education/patients/blood-cancers/leukemia. Accessed Oct. 16, 2020.  Hematological DisordersHematologic SystemThe hematologic system is comprised of blood, blood cells, lymph, and organs involved in blood formation or blood storage. The hematologic system has three functions: transportation, regulation, and protection. These function aid in the removal of waste products, delivery of nutrients to tissues and organs, and the delivery of oxygen. The hematologic system regulates blood production and protects against other disease process. Disorders of the hematological system can have a minimal to significant impact on the patient. Patients that have multiple co-morbidities are at higher risk for poor outcomes.Sickle Cell DiseaseSickle cell disease is a group of inherited red blood cell disorders in which the hemoglobin blood cells are hard and sticky and resemble a “C” shape. These abnormal hemoglobin red blood cells adhere to the blood vessel and block the blood flow resulting in avaso-occlusive event. A vaso-occlusive event results in an increase in tissue hypoxia and more sickle cell formation that worsens the patient’s condition. Sickle cell disease can result in chronic anemia, pain, organ damage, increased risk for infection, and death.Risk Factors for Sickle Cell DiseaseHypoxiaDehydrationInfectionVenous stasisPregnancyAlcohol consumptionHigh altitudesLow or high environmental or body temperatureAcidosisStrenuous exerciseEmotional stressAnesthesia AnemiaAnemia is the reduction in the number of red blood cells, the amount of hemoglobin, or hematocrit. Anemia is a common condition that can occur in healthy individuals. There are many types of anemia; each type is caused by a deficiency in one of the components that make fully functioning red blood cells. Some types of anemia are caused by decreased red blood cell production, increased red blood cell destruction, or chronic loss of red blood cells. Iron deficiency anemia is the most common type of anemia worldwide (Touhy & Jett, 2016).Types of AnemiaType of AnemiaGlucose-6-phosphate dehydrogenase (G6PD) deficiency anemiaAutoimmune hemolyticIron deficiencyVitamin B12 deficiencyFolic acid deficiencyAplasticDescriptionLack of the G6PD enzyme, which stimulates glucose metabolism for energy for RBC productionAutoimmunity resulting in the destruction of the RBCsDecreased iron supply for RBC productionFailure to move folic acid into the precursor RBC due to lack of enzyme activationCaused by a deficiency in folate intakeCan progress to megaloblastic anemiaDeficiency in circulating RBCs due to impaired cellular regulationCommon CausesX-linked recessive deficiency of the enzyme G6PDAbnormal immune functionDietary deficiencyRapid metabolismDietary deficiencyDietary deficiencyExposure to myelotoxic agents Polycythemia VeraPolycythemia vera is a chronic, slow-growing blood cancer disorder in which there is an increase in red blood cell production leading to leukocytosis, thrombocytosis, and elevated hemoglobin levels above normal. These abnormal clonal stem cells interfere with normal cell growth. This uncontrollable growth results in abnormally viscous blood that impedes circulation and increases the risk of intravascular thrombosis formation.Causes of Polycythemia VeraUnknownPossible geneticHereditary HemochromatosisHereditary hemochromatosis is a hereditary disorder that causes the body to absorb too much iron. Excess iron is stored in the liver, spleen, heart, joints, skin, and pancreas. These iron deposits can result in organ failure.Causes of Hereditary HemochromatosisGeneticsMyelodysplastic SyndromesMyelodysplastic syndromes are a group of disorders caused by the formation of abnormal cells in the bone marrow. The abnormal cell production is due to a loss of normal cellular regulation. These abnormal cells are destroyed once they are released into the blood resulting in a reduction of white blood cells and platelets.Causes of Myelodysplastic SyndromesAge greater than 65 yearsChemical exposureSmokingExposure to radiation or chemotherapyLeukemiaLeukemia is blood cancer that results from a loss of cellular regulation, leading to an overproduction of immature white blood cells, also known as “blast” cells, in the bone marrow. Due to the increased production of immature cells, the bone marrow is unable to produce normal blood cells. Leukemia can be acute or chronic. Acute leukemia has a sudden onset; chronic leukemia has a slow onset and persists for years. Leukemia is classified based on cell type. There are also several subtypes for each disease that are based on degree of maturity of abnormal cells and specific cell type.Lymphocyctic or Lymphoblastic leukemias are cells produced in the lymphoid pathways.Myelocytic or Myelogenous leukemias are cells produced in the myeloid pathway. Malignant LymphomasMalignant lymphomas are cancers of the lymphoid tissue caused by an overproduction of lymphocytes. The cancer cells grow in the lymph system throughout the body as a solid tumor. There are two major forms of lymphoma: Hodgkin’s and non-Hodgkin’s. Hodgkin’s Lymphoma (HL) – the cancer starts in a single lymph node or single chain of nodes. The specific cancer cells are the Reed-Sternberg cells.Risk Factors for Hodgkin’s LymphomaViral infectionHuman T-cell leukemiaLymphoma virusHuman immune deficiency virus (HIV)Exposure to chemicalsNon-Hodgkin’s Lymphoma (NHL) – includes all lymphoid cancers divided into indolent or aggressive. It spreads randomly through the lymphatic system. NHL is a group of diseases. Subgroups of this disease are based on histology, immunophenotyping by flow cytometry, and genetics.Risk Factors for Non-Hodgkin’s LymphomaSolid organ transplantImmunosuppressive drugs therapyHuman immune deficiency virus (HIV)Chronic infection from Helicobacter pyloriMultiple MyelomaMultiple myeloma is a cancer of the bone marrow plasma cells, specifically the B-lymphocytes. These cells produce antibodies called gamma globulins and fewer WBCs. RBCs and platelets are produced, resulting in anemia and increasing the patient’s risk of infection.Causes of Multiple MyelomaGeneticsEnvironmental and occupational hazardsAutoimmune Thrombocytopenic PurpuraAutoimmune thrombocytopenic purpura is also called idiopathic thrombocytopenic purpura (ITP). This condition results in a decrease in the number of circulating platelets. Antibodies are produced and coat the surface of the platelets making the platelets non-functional, resulting in clotting impairments.Causes of Autoimmune Thrombocytopenic PurpuraViral infectionAutoimmune disordersThrombotic Thrombocytopenic PurpuraThrombotic thrombocytopenic purpura (TTP) is a condition in which platelets clump together abnormally in the capillaries resulting in a reduction of circulating platelets. Due to a decrease in the number of circulating platelets, clotting is impaired.Causes of Thrombotic Thrombocytopenic PurpuraAutoimmune disorderHemophiliaHemophilia is an incurable hereditary bleeding disorder characterized by prolonged bleeding times. Hemophilia A results from a deficiency of factor VIII and is the most common type of hemophilia. Hemophilia B results from a deficiency in factor IX and is less common.Causes of HemophiliaGeneticHeparin-induced ThrombocytopeniaHeparin-induced thrombocytopenia (HIT) is an immune-mediated drug reaction in which the patient experiences a decrease in the platelet count while being treated by heparin. Heparin therapy is utilized in order to prevent the platelets from clumping together. HIT occurs when the body’s immune system identifies heparin as a foreign body and begins to develop antibodies.Transfusion TherapyTransfusion therapy is utilized for any blood product that is removed from a donor and transfused to a recipient. Types of products that can be transfused are whole blood, packed red blood cells, frozen plasma, cryoprecipitate, and platelets. Selection of blood product is based on the patient’s lab results and clinical condition.Prior to blood or blood product transfusion, the patient must have a type and screen performed in order to ensure the patient receives the compatible product. The chart below outlines the compatibility between the donor and recipient.RECIPIENTABABODONORAXXBXXABXOXXXXType of Blood ProductFresh Whole BloodPacked Red Blood cellsFresh Frozen PlasmaCryoprecipitatePlateletsReasons to TransfuseHemorrhageIncrease oxygen carrying capacity and restore volumeVolume expander and coagulation deficienciesTreat fibrinogen deficiencyReplenish low platelet countsCare of the patient during transfusion includes monitoring of the vital signs 15 minutes after the start of the transfusion and post transfusion. Monitor the patient for signs and symptoms of transfusion reaction such as:ChillsShortness of breathHivesItchingBack painChanges in vital signsIf the patient is experiencing a transfusion reaction, immediately discontinue the transfusion, flush the IV line, and notify the physician. Blood products must be returned to the lab for analysis.ReferenceTouhy, T. & Jett, K. (2016). Ebersole and Hess' toward healthy aging. 9th ed. Mosby: St. Louis.