Leucopenia & Neutropenia

Tayyeba Syeddain Instructor RNC 21/12/2012

LEUCOPENIA

Definition: Leucopenia, a condition in which there are fewer WBCs than normal, results from neutropenia (diminished neutrophils) or lymphopenia(diminished lymphocytes).

Even if other types of WBCs (eg, monocytes, basophils) are diminished, their numbers are too few to reduce the total WBC count significantly

LYMPHOPENIA

LYMPHOCYTES

Lymphocytes less than 1500/mm3: Can result from ionizing radiation, a. Long-term use of corticosteroids, b. Uremia, c. Neoplasms (e.g, breast and lung cancers, advanced Hodgkins disease), and d. Some protein-losing enteropathies (in which the lymphocytes within the intestines are lost).

NEUTROPENIA-

NEUTROPHILS

Neutrophils less than 2000/mm3 Causes: 1.Decreased Production of Neutrophils Aplastic anemia, due to medications or toxins Metastatic cancer, lymphoma, leukemia Myelodysplastic syndromes Chemotherapy Radiation therapy

NEUTROPENIA-CAUSES
2.Increased Destruction of Neutrophils Hypersplenism Medication-induced* Immunologic disease (e.g, systemic lupus erythematosus [SLE]) Viral disease (eg, infectious hepatitis) Bacterial infections

NEUTROPENIA-RISK FOR INFECTION

A patient with neutropenia is at increased risk for infection, both exogenous and endogenous. The risk for infection is increases proportionately with the decrease in neutrophil count. The risk for infection Significant risk= ANC < 1000, High risk=ANC < 500, Almost certain infection= ANC < 100..

NEUTROPENIA

No definite symptoms of neutropenia until the patient becomes infected.

MEDICAL MANAGEMENT
Management varies depending upon its cause. If neutropenia is medication induced, the offending agent needs to be stopped, if possible. The use of growth factors such as G-CSF or granulocyte/macrophage colony-stimulating factor (GM-CSF) can be effective in increasing neutrophil production when the cause of the neutropenia is decreased production. Corticosteroids may be used if the cause is an immunologic disorder.

MEDICAL MANAGEMENT
Withholding or reducing the dose of chemotherapy or radiation therapy may be required when the neutropenia is caused by these treatments; however, in the case of potentially curative therapy, administration of growth factor is considered to be preferable, so that the maximum antitumor effect can be achieved. Broad-spectrum antibiotics

NURSING MANAGEMENT
Preventing and managing infectious and complications. Patient teaching. Patients at risk for neutropenia should have blood drawn for CBCs Nurses need to be able to calculate the ANC and to assess the severity of neutropenia and the risk for infection

HOME CARE TEACHING

At the completion of the home care instruction, the patient or caregiver will be able to: 1. Describe consequences of alterations in neutrophils, lymphocytes, immunoglobulins, or their sources. 2. Verbalize the rationale for being at risk for infection. 3. Identify signs and symptoms of infection. 4.Demonstrate how to monitor for signs of infection 5. Describe to whom, how, and when to report signs of infection

6.Identify appropriate behaviors to take to prevent infection Maintain good hand hygiene technique, total body hygiene, and skin integrity. Avoid fresh flowers, plants, garden work (soil), bird cages, and litter boxes. Avoid fresh salads and unpeeled fruits or vegetables. Maintain a high-calorie, high-protein diet, with fluid intake of 3000 mL (unless fluids are restricted). Avoid people with infections, crowds. Perform deep breathing, use incentive spirometer every 4 hr while awake. Provide adequate lubrication with gentle vaginal manipulation during sexual intercourse.