Hyperleukocytosis

Of course, these are not just symptoms of ALL and are more often caused by something other than leukemia. (p. 1)

CASE STUDY PROGRESS: The client has now received 3 cycles of combination chemotherapy for her breast cancer. Her last treatment with doxorubicin, cyclophosphamide, and 5-fluorouracil was approximately 12 days ago. She came to the emergency room with a 2-day history of fever, chills, and shortness of breath. On arrival, she is disoriented and agitated. Vital signs are 86/43, 119, 28, 39.8° C, SaO2 85% on room air. Laboratory data include WBC 1.2 thou/cmm, Hct 24.9%, Hgb 8.7 g/dl, platelets 125 thou/cmm. Differential WBC count shows 37% granulocytes, 60% lymphocytes, 3% monocytes. Chem 14 is within normal limits, with the exception of BUN 28 mg/dl, creatinine 1.6 mg/dl, and lactic acid 2.4 mg/dl. Chest x-ray demonstrates diffuse infiltrates in the left lower lung.

As listed in Wong the “cardinal symptoms of cancer in children are unusual mass or swelling, unexplained paleness and loss of energy, sudden tendency to bruise, persistent, localized pain or limping, prolonged, unexplained fever or illness, frequent headaches often with vomiting, sudden eye or vision changes and excessive, rapid weight loss.” When completing an assessment of the child the healthcare work should be able to incorporate these signs to help them complete the necessary physical assessment and also lab or diagnostic testing.

Scenario: John is a 4 year-old boy who was admitted for chemotherapy following diagnosis of acute lymphoblastic leukemia (ALL).  He had a white blood cell count of 250,000.  Clinical presentation included loss of appetite, easily bruised, gum bleeding, and fatigue.  Physical examination revealed marked splenomegaly, pale skin color, temperature of 102°F, and upper abdomen tenderness along with nonspecific arthralgia.

Acute Lymphoblastic Leukemia, is the disease that affects children the most and because of the abnormal cells that are immature white blood cells which cannot help the body fight infections cause children with the disease to often get infections and have fevers (National Cancer Institute, 2002, p. 1). The symptoms that the patient with ALL may have depend on the number of abnormal cells of the patient where exactly the cells collect. Children patients with ALL have low amounts of healthy red blood cells and platelets, which cause less oxygen to be carried through the body because of the lack of red blood cells. Patients at times may look pale, feel weak, and tired causing bleeding and bruising very easily because of their lack of enough platelets. This condition is called anemia. Anemia is very much common in patients with acute lymphoblastic leukemia. Fever, fatigue, bone or joint pain, tiny red spots under the skin called petechiae are a couple of symptoms that the disease ALL has. Headaches with, or without vomiting also may occur if patient happens to have abnormal cells collecting in the brain or spinal cord (National Cancer Institute, 2002 para. 2).

Another, interrelated concept to central line associated blood stream infections is immunity. This is defined as “The normal physiologic response to microorganisms and proteins as well as conditions associated with an inadequate or excessive immune response… which is a body wide, complex, interrelated group of cells, tissues, and organs that work within a dynamic communication network to protect the body from attacks by foreign antigens, typically proteins”(Giddens,2013). One of the greatest concerns on any oncology floor is the white blood cell count of any patients. This is a result of the chemotherapy that they are receiving, and one of various dangerous side effects of chemotherapy drugs is neutropenia. Dunbar et al, states “Neutropenia (low white blood cell count) is a common and potentially dangerous side effect in patients receiving chemotherapy treatments and may lead to higher risk of infection (2014). Further, patients who have febrile neutropenia have a 2-21% increased mortality rate, and it is estimated that 4,1000 patients die from this each year (Dunbar et al,2015).

Some symptoms of RCC are lower back pains, lumps, anemia, fatigue, fever, weight loss, and other symptoms are unusual hair growth in women, vision problems, pale skin, and swelling of the veins around one or both testicles. The treatment for stage one RCC is surgery, radiation therapy, arterial embolization, and a clinical trial. Stage 2, surgery, surgery before of after radiation therapy, radiation therapy, arterial embolization and a clinical trial. Stage 3, surgery , arterial embolization, radiation therapy, surgery, and a clinical trial of biologic therapy following surgery. Stage 5 and recurrent renal cell cancer surgery, surgery to reduce the size of the tumor. Targeted therapy, biologic therapy, radiation therapy as palliative therapy to relieve symptoms and improve the quality of life and a clinical trial of new treatment. Renal cell cancer is a cancer that has come back after it was treated. The cancer can come back many years after its has been treated correctly, in the kidney or in other parts of the body. The causes of RCC are your age, the older you are the greater risk you have, your gender, males are most likely to develop RCC. Your genes, your family history, you smoking, you being overweight, and you having high blood pressure. All of those things can cause you to have

I was diagnosed with VCD in seventh grade. It occurs when the vocal cords do not open correctly making it difficult to breath. It is induced by physical activity

Sickness can leave many adults unable to function unlike a child with boundless energy. Also, diagnosing a child with cancer is even more difficult when the child is unable to explain how they feel. Infants to young children are unable to communicate with the parent of symptoms, which could slow down or delay diagnosis. Each child’s reaction to chemotherapy is uniquely different. The treatment used differ from child to child, and from one type of cancer to another type of cancer. Also, certain things can affect a child’s risk of effects from the treatment, such as: the type of cancer, where the cancer is found, how old the child is, the child’s overall health,, and the child’s genetic makeup (inherited risk for a certain health problem) (Late Effects). Most treatments side effects appear during or just after treatment, but some problems may continue on or may not show up until months or possibly even years after the treatment is given. These problems are known as late effects. Due to more and more children with cancer now surviving into adulthood, their long-term health and these late effects have become more of a specific focus of care and research. Late effects are caused by the damage that cancer treatment does to healthy cells in the body. Most late effects are caused by the drug chemotherapy and the treatment radiation. Cancer treatments like radiation therapy or chemotherapy kill cells that grow quickly, such as the cancer cells. Treatment can damage

Burkitt’s lymphoma is a very aggressive malignancy and one of the fastest growing amongst human malignancies. It requires immediate and aggressive intervention. Fortunately it does respond to aggressive chemotherapy regardless of it being a very rapidly growing malignancy, chemotherapy being the gold standard treatment for it. Tumor lysis syndrome which is a complication of rapid, massive and acute destruction of the tumor cells can occur during initial chemotherapy and one should remain wary of that fact. The more extended the disease, the more the chances it will get complicated and thus harder to treat.

The greatest challenge I personally faced while abroad was being diagnosed with mononucleosis. I was only two weeks into my travels but I chose not to return home. I had to practice caution when interacting in with people. Luckily, it's not an airborne contagion, however, it had great ability to set me back physically and socially. I did everything possible to keep healthy and keep moving and making the most of my time.

“I really don’t want to say things such as ‘I want to go back as how things were before. I recognize how I am right now, and I will continue to live on “ –Aya kito 1

5yrs old male child presented to emergency department with complaints of hoarseness of voice for 2 yrs, dyspnea for 1 week and cyanotic spells since last night. The vitals on admission were HR 140/min, BP 122/90mm Hg, O2 saturation 95% on room air with respiratory rate of 38/min. On examination, subcostal recessions were present. Decreased bilateral air entry and wheeze with tracheal tug was found on chest auscultation. CT scan head and neck showed laryngeal stenosis due to presence of papillomas on left vocal cord (Fig. 1). He was rushed

According to the case study the patient has responded well to the G-CSF treatment, but the count of his Neutrophils became reduced again. Even though the bacterial infection was gone, the patient is facing a Sever Neutropenia. Studies have shown that patients with Sever Congenital Neutropenia Can respond to G-CSF treatment and the neutropenia can come back again after the treatment. Because of this I would say the neutropenia in our case study might be caused as a result of Congenital Effect, but I also believe that further investigation have to be done. The doctors have to figure out what caused the Neutropenia because Neutropenia can be caused by many other ways including Leukemia, Myelofibrosis, Viral infections and Vitamin Deficiencies. The only thing the doctors proved at this point is that the bacteria didn’t cause the neutropenia because Michael’s Neutrophil count should have gone up, if the bacteria was the cause.

Metachromatic Leukodystrophy is an inherited disorder in which cells accumulate fat. This accumulation of fat in the cells is called ‘sulfatides.’ When this occurs, it makes it difficult for the nervous system to produce myelin which is a protection around the nerve cells. When myelin protects a cell, it can produce white matter throughout the nervous system. However, the sulfatide in the cells makes I difficult to produce white matter because it will either destroy or damage white matter. Resulting in a deterioration of intellectual function, motor skills and the ability to walk.