Leukopnea

LEUKOPNEA

1. LEUKOPNEA

2. DEFINITION Leukopenia is an abnormal reduction of circulating white blood cells, especially the granulocytes. The term leukopenia is often used interchangeably with neutropenia. It may result from reduced production of white blood cells or increased utilization and destruction, or both.

3. NORMAL WBC COUNTS For normal adult the WBC counts range between 4500 and 11000 per cubic millimeter of blood. This is slightly higher in children.

4. TYPES OF WHITE BLOOD CELLS

5. TYPES OF WHITE BLOOD CELLS There are five types of white blood cells. Each helps to protect the body from a different kind of infection: Neutrophils : These make up 55 to 70% of total white blood cells. They help fight off fungal and bacterial infections. Lymphocytes : These are the second most common type of white blood cell. They protect the body from viral infections.

6. TYPES OF WHITE BLOOD CELLS Basophils : These are the least common type of the white blood cells. They are involved in inflammatory reactions to allergens. Monocytes : These are the largest of the white blood cells. They play a role in fighting off bacteria, fungi, and viruses. They also help mend tissue that has been damaged by  inflammation Eosinophils : These fight parasites and play a role in allergic reactions and conditions, such as Asthma

7. CAUSES AND RISK FACTORS APLASTIC ANEMIA  – A condition where the bone marrow doesn’t produce new blood cells CANCER OR DISEASES OF THE BONE MARROW  – Such as Multiple Myeloma, Leukemia CERTAIN MEDICATIONS  – Medicines that destroy white blood cells are bupropion , clozapine , cyclosporine CANCER TREATMENTS  – Including Chemotherapy, Radiation therapy and bone marrow transplant CONGENITAL CONDITIONS  – Kostmann’s syndrome is a congenital disorder of the bone marrow

8. CAUSES AND RISK FACTORS INFECTIOUS DISEASES   – Such as HIV/AIDS, Tuberculosis HYPERSPLENISM  – When the spleen destroys white blood cells SEVERE INFECTION   – An infection that uses white blood cells to fight infection faster than the body can produce them AUTOIMMUNE DISORDERS : Some of these kill white blood cells. Examples include  Lupus and Rheumatoid Arthritis SARCOIDOSIS : A collection of inflammatory cells in the body . This is an overreaction of the immune system. It can also affect bone marrow.

9. SYMPTOMS OF LEUKOPENIA No definite symptoms until pt becomes infected Fever 100.5˚F (38˚c) Chills Sweating

10. DIAGNOSIS History CBC with differential count Blood Culture Other investigations to find the cause

11. TREATMENT Vary depending on what is causing leukopenia. Treatments include: DISCONTINUING TREATMENT THAT CAUSES LOW WHITE BLOOD CELL COUNTS  – Can include medications, Chemotherapy or Radiation (Reduce the dose) GROWTH FACTOR THERAPY  – (G-CSF) Granulocyte Colony Stimulating Factor. It increases the neutrophil production in bone marrow LOW-BACTERIAL DIET  – A diet that minimizes exposure to bacteria -- such as raw, unwashed products or undercooked meat MEDICATIONS  – Antibiotics that fights the infection

12. DEFINITION Agranulocytosis, also known as agranulosis or granulopenia, is an acute condition involving a severe and dangerous leukopenia (lowered white blood cell count), most commonly of neutrophils causing a neutropenia in the circulating blood.

13. ETIOLOGY • The exact cause is unknown • It may be because of either Decreased production of neutrophils or Increased destruction of neutrophils DECREASED PRODUCTION OF NEUTROPHILS Aplastic anemia Cancers, lymphoma and leukemia Chemotherapy Radiation therapy

14. ETIOLOGY INCREASED DESTRUCTION OF NEUTROPHILS • Hypersplenism • Auto Immune Disorders • Bacterial or Viral Infections • Use of Drugs- Psychotropic Medicines, Anti Thyroid Agents, Anti Coagulants And Antibiotics

15. CLINICAL FEATURES EARLY SYMPTOMS ARE • Sudden Fever • Chills • Sore Throat • Weakness • Sore Mouth And Gums • Mouth Ulcers • Bleeding Gums LATE SYMPTOMS •Tachycardia • Tachypnea • Low Blood Pressure • Skin Abscesses

16. DIAGNOSIS • HISTORY COLLECTION AND PHYSICAL EXAMINATION • BLOOD STUDIES Complete Blood Count ---Neutrophil Count will be below 500, and can reach 0 cells/mm³ • CULTURE STUDIES Culture of Urine, Blood And Ulcerative Lesion in throat are positive for bacteria

17. MANAGEMENT 1. COLONY STIMULATING FACTORS: Effective in increasing neutrophil production . 2. ANTIBIOTICS/ANTIVIRAL Combination of broad spectrum antibiotics are usually administered incase of viral and bacterial infections . 3. CORTICOSTEROIDS Corticosteroids may be used if the cause is an immunological disorder

18. NURSING MANAGEMENT NURSING DIAGNOSIS • Risk for infection related to neutropenia • Knowledge deficit related to toxic agents that causes agranulocytosis

19. NURSING MANAGEMENT NURSING DIAGNOSIS Risk for infection secondary to impaired immunocompetence R/T decreased WBC NURSING INTERVENTIONS Through hand washing by everyone who enters pt’s room Allow no one with cold or sore throat to care for pt Care for neutropenic patient before caring other pt as much as possible Ensure room is cleaned daily

20. NURSING MANAGEMENT Change Water in containers -- O 2 humidifiers Provide low microbial diet Eliminate fresh salads and unpeeled fresh fruits Provide total body hygiene daily Administer antimicrobials on time Maintain meticulous IV site care

21. NURSING MANAGEMENT • Monitor patients leukocyte count regularly • Maintain strict aseptic techniques during procedures • Maintain proper isolation of the patient • Administer proper antibiotics to the patient • Provide skin care and prevent dryness of the skin • Provide psychological support to the patients • Encourage to avoid self medications

22. Kostmann syndrome  is a rare, severe, congenital neutropenia  disorder  characterized by a lack of mature neutrophils (absolute neutrophil counts less than 500 cells/mm3) associated with frequent, recurrent bacterial infections (e.g. otitis media, pneumonia, sinusitis, urinary tract infections, abscesses of skin and/or ... Growth factor therapy is a type of  regenerative medicine   that uses the body’s own growth factors to promote the healing of wounds, chronic pain, degenerative diseases such as arthritis, and other conditions. Growth factors are substances produced in the body that stimulate the growth and proliferation of cells involved with inflammation and healing, which aid in the body’s natural ability to repair itself.