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N361 Hematology

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by

Elizabeth Goss

on 19 March 2013

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Transcript of N361 Hematology

Hematology Counteracting the "Lethal Triad" Functional Genomics in
Hematological Malignancies Article One Hematological cancers include leukemia, lymphoma and myeloma
Treatment usually non-specific
highly toxic
incomplete response
long-lasting effects RNAi screens
RNA inhibitor
Type of Synthetic Lethal Screen
RNAi introduced to cancer cells
RNAi travels into cell, cuts cell's RNA into small fragments
RNAi identifies RNA fragment programmed to identify
follows it to corresponding location on cell's mRNA
section of mRNA destroyed
corresponding gene is shut off These screens potentially allow for the identification of...
genes that (when shut off) increase tumor cell’s sensitivity to medications
new genes to target with medications
Personal Screening...still a long way off
Research currently working on making "library" of RNAi to be used for screening
hope to one day be able to screen every diagnosed patient Why can't treatment be targeted?
Tumor Cell Heterogeneity -
too much variation
Drug Resistance -
intrinsic
acquired
mutations
non-specific - below 35.5 °C (96 °F) TRAUMA - leading cause of death in people < 40 years
- major COD within first 24 hrs is
hemorrhage
BUT...if detected early, at risk patients can have a much different outcome - decreases perfusion of tissue & prevents clotting
hypothermia
acidosis
coagulopathy in the past: focus was on acidosis & hypothermia
trauma patients compensated
- "normal" vital signs despite
hemorrhage
masked severity of injuries "Lethal Triad" 3+ met? Hemoglobin Base deficit International Normalized Ratio Temperature Systolic Blood Pressure Trigger Points identifying variables that are easy to obtain, rapidly available, and accurate Take Home Message ... for Nurses Patients who have suffered from trauma may be at risk for hemorrhage
Hemorrhage within a hospital is preventable
If you work in ED or trauma, know the red flags to alert the provider of possible coagulopathy and hemorrhage risk < 11 g/dL > 1.5 < 90-110 mm Hg > 6 < 36 °C (96.5 °F) Abuse or Blood Disorder? Ernine Lopez: convicted of rape & abuse of 6 month old Isis Vas






After 10 years in prison, pro-bono group discovered
Disseminated Intervascular Coagulation
After 11 years, released from jail
Now a new district attorney re-prosecuting him NEED for
MASSIVE
TRANSFUSION Bleeding disorders affect 1% of the population.
Due to under-reporting, clinicians have a tendency to hastily report unfounded child abuse

von Willebrand disease and Hemophilia A and B mimic child abuse by causing bruises
Von Willebrand affects approximately 1% to 2% of the population
Hemophilia A and B affect approximately 1 in 10,000 individuals “Idiopathic thrombocytopenic purpura, thrombocytopenia with lymphoblastic leukemia, vitamin K deficiency, purpura fulminans, meningitis with disseminated intravascular coagulation
(DIC), hemorrhagic disease of the newborn, Henoch-Schönlein purpura, and ruptured subarachnoid vascular malformation also appear in the literature .” misdiagnosed as child abuse Scary Truth... Von Willebrand:
3 month old brought to hospital after 2 days of observation from a fall
Presented with seizures, bilateral retinal hemorrhages, subdural and subarachnoid hematomas, a history of easy bruising
No apparent bruising at the time of admission anywhere on the trunk, back, or arms
Initial blood work completed, but “negative for Willebrand disease, thrombocytopenia, and disorders associated with a prolonged prothrombin time (PT) and prolonged partial thromboplastin time (PTT).” more REAL cases... Physician did not know trauma from the fall could result in Father arrested for shaking baby - Mother charged with neglect
Child placed in foster care, continued bruising
Caused clinicians to conduct blood tests
Confirmed von Willebrand disease.
Yet, the prosecutor was not familiar with von Willebrand and insisted that shaking baby syndrome caused the injuries and Father was incarcerated. Nursing Diagnosis Increased nutrition less that body requirements r/t hyper metabolism of cancer aeb anorexia

Risk for injury (hemorrhage) r/t decreased platelet count secondary to ALL Case Study pg. 268 in your text Emily Basile, Elizabeth Goss, Kelly Kennedy, Alyssa Mackenzie, Adria Spinelli, Galina Podolyak, Sissy Winstead values for von Willebrand. normal Citations
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