Living with Chronic Neutropenia Poly and me Mary Ann

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Living with Chronic Neutropenia
Poly and me
Mary Ann Bonilla, M.D.
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Living with chronic illness is a search for
quality of life

• Need to be well informed in order to manage the
  physical symptoms
• Need to learn to live with the emotional
  challenge to accept limitations and appreciate
  lifes gifts.

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Neutropenia

• Decrease in the absolute neutrophil count in the
  blood (ANC)
• Neutrophils are the primary defense against
  bacteria and fungus
• Maintain Intact Surface Barriers
• Skin
• Mucous membranes of mouth and sinuses
• Lungs
• GI Tract

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Neutrophil Function
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Calculating ANC

• ANC WBC x ( segs bands)
• Total WBC 5000 cells/mm3
• Band Neutrophils 5
• Segmented Neutrophils 55
• ANC 3000 cells/mm3

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Severity Infection

• Mild 1000-1500 cells/mm3 commonly
  asymptomatic
• Moderate 500-1000 cells/mm3 gingivitis,
  impetigo, otitis
• Severe lt 500 cells/mm3 bacteremia,
  peritonitis, pneumonia

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Risk Factors for Infections

• Severity of neutropenia
• lt500 cells/mm3
• Neutrophil reserve in BM
• Mouth disease
• Chronic gingivitis
• recurrent mouth sores

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What is the most important thing I can do to
prevent getting sick and spreading germs to
others?
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Wash Your Hands
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Clean is Key

• Basic Hygiene
• Daily bathing
• Hand and nail care
• Before food handling
• Teach children good habits early
• toilet training
• Hand Sanitizers or wipes

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Mouth Care

• Dental Cleanings-2 to 4 times/year
• Regular Brushings
• Flossing
• Mouth Wash
• -Biotene, Closys
• -Peroxide based cleanser
• -Fluoride Rinses

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Infants

• Good care of diaper area
• Prompt attention to rashes
• May need anti-fungal cream, Nystatin
• No rectal suppositories or thermometers

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Gastrointestinal

• Proper care and handling of food
• Cook poultry and meats thoroughly
• Bottled water if unsure of safety
• Pasteurized milk and juice
• No need for neutropenic diet

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Protecting your Lungs

• Avoid sick or coughing individuals
• Mask if necessary
• Immunizations
• including Flu vaccine
• Stop smoking and avoid second smoke

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Fever

• Discuss a medical plan with your doctor prior to
  the episode
• Day vs. Night/weekends
• Seek medical attention for tempgt 101O
• Work-up CBC, Cultures
• Antibiotics

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Lifestyles- Travel

• Use of public transportation to engage in a
  normal lifestyle.
• Pediatric Blood Cancer 2008
• 82 school 90 holidays
• Travel letter from MD/RN
• Summary/ Contact numbers
• Guidelines for fever
• Permission for needles
• Appropriate packaging for medications
• cold pack, sharps
• Research hospital/physician near your vacation
  site for emergencies.

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Lifestyles-Pets

• Good hygiene practice
• Good veterinary care
• Overall benefits of human-animal bond
• ? Reptiles-increased risk of Salmonella
• Eur J Oncol Nurs 2006

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Partners in Health Care

• Keep medical records
• Be compliant
• Ask questions and Ask Again!
• Schedule Family Conferences
• Keep informed

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Relieving Pain

• Topical anesthetics
• EMLA
• -Blood tests
• -IV catheters
• -G-CSF injections

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• Intravenous Conscious Sedation for Painful
  Procedures

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Relieving Stress

• Child Life Specialist
• Medical play
• Psychologist/ Social Work Counseling
• -Individual, Family
• Support Groups
• Relaxation Techniques
• -Yoga, Meditation

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Integrative Therapies

• Group of diverse medical and health care systems,
  practices, and products that are not presently
  considered to be a part of conventional medicine
• National Center Complementary and Alternative
  Medicine www.nccam.nih.gov
• Combine conventional medical therapy and
  Complementary and Alternative Medicine (CAM)
  therapies that have some high quality scientific
  evidence of safety and efficacy

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Aromatherapy

• Use of essential oils from plants to support and
  balance the mind, body, and spirit
• Therapeutic grade
• Routes
• Inhalation-diffuser or placing drops of oil near
  pt
• Topical-massage, lotions or bath water

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Essential Oil

• Anti-septic, Anti-bacterial
• Thieves, Clove, Lemon, Cinnamon, Eucalyptus,
  Rosemary
• Anxiety, Depression
• Ylang Ylang, Rose, Lavender
• Pain
• Wood Lock, Camphor, winter green, eucalyptus
• Insomnia/ Nausea
• Lavender, Lemon

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Massage Therapy

• Manipulation of the muscles and soft tissues of
  the body
• To relax and increase delivery of blood and
  oxygen to the massaged areas
• To increase warmth and decrease pain

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Acupuncture

• Stimulation of trigger points on the body with
  sterile fine needles, (0.22 to 0.25 mm)
• Used in postoperative and chemotherapy related
  nausea, pain

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Accupressure

• L4 trigger point for lower back pain

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Helpful Vocabulary

• ANC,absolute neutrophil count
• Anemia, too few red blood cells.
• Antibodies, proteins made by a subgroup of white
  blood cells, the lymphocytes that are responsible
  for the body's defense
• Bands, young neutrophils.
• Bone marrow, the spongy material located in the
  centre of our bones. It is the home of our stem
  cells, which reproduce to create our blood,
  including white blood cells, red blood cells,
  platelets, B- and T lymphocytes and macrophages

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• CBC (Complete blood count), a summary of the
  numbers of various types of cells present in the
  blood at the time of the blood draws.
• Cytogenetics, a method by which chromosomes can
  be analysed.
• Erythrocytes, red blood cells.
• Fever, temperature above 101o
• G-CSF, granulocyte-colony stimulating factor.
• Leukocytes, white blood cells consisting of
  granulocytes, monocytes and lymphocytes. 
•  

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• Hemoglobin (Hb)- reflects capacity of red blood
  cells to transport oxygen and nutrition to the
  tissues
• Hematopoiesis - the formation of blood cells
• Leucopenia- low white cells in blood
• Lymphocytes, subgroup of leukocytes, which are
  responsible for the body's defense against
  viruses (T lymphocytes) and the production of
  antibodies (B lymphocytes).
• Neutrophils, a subgroup of granulocytes defending
  the body against bacteria and fungus. Also known
  as segs, polys or segmented neutrophils.

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• Neutropenia- low number of neutrophils in the
  blood.
• Osteopenia, mildly demineralized bone substance.
• Osteoporosis, severely demineralized bone
  substance.
• Platelets, a subgroup of blood cells responsible
  for clotting, which are also called thrombocytes.
• RBC-Red blood cells (RBC)
• Stem cells, the most immature cell in the bone
  marrow, which are able to reproduce themselves
  and develop into different types of blood cells.

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• Subcutaneous (SQ), under the skin.
• Retic-Reticulocyte. Young RBCs.
• Splenomegaly, the enlargement of the spleen. 
• Thrombocytopenia, the decreased number of
  platelets in the blood
• White blood cells, a subgroup of blood cells
  consisting of monocytes, granulocytes and
  lymphocytes, which together build the immune
  system and defend the body against infection.