Leukopenia Or Decreased White Blood Cells

LEUKOPENIA

LEUKOPENIA

(leukocytopenia or leucopenia) • A condition in which there are fewer leukocytes (White blood cells) than normal. • Normal WBC is 5500/mm3 • It is results from neutropenia (diminished neutrophils) or lymphopenia (diminished lymphocytes).

Neutropenia • It is a neutrophil count of less than 2,000/mm3. • It is a result from a decrease production of neutrophils or increased destruction of these cells. • A patient with neutropenia is at high risk of having infection from both exogenous and endogenous. Endogenous sources are the skin and GI tract.

Clinical Manifestations • No definite symptoms of neutropenia until the patient becomes infected.

PATHOPHYSIOLOGY of Leukopenia Precipitating Factors: 1. Exposure to Radiation and certain chemicals. 2. With leukemia 3. HIV virus

Somatic Mutations in DNA Activate oncogene/Deactivate tumor- suppressor Gene. Malignant Transformation of Lymphoid stem cells

Uncontrolled proliferation of lymphoblast in the bone marrow. Lymphoblast replace the normal marrow element. Decreased production of normal blood cells. Leukopenia (decreased leukocytes)

Infection If not treated

If treated

Septicemia

Prevention of complications

Death

Diagnostic Examination ●Culture of blood, urine, and sputum should be obtained, as well as chest x-ray.

Medical Management ●Treatment of the neutropenia varies depending on its cause and severity. Drugs that may cause neutropenia are stopped whenever possible, and exposures to suspected toxins are avoided. ●Sometimes the bone marrow recovers by itself without treatment.

►Fever, the symptom that usually indicates infection in people who have neutropenia, is an important sign that immediate medical attention is needed. ►Growth factors such as G-CSF also called (Granulocyte colony-stimulating factors) which stimulate the production of white blood cells,when the cause of neutropenia is decreased production.

►Corticosteroids may help if the neutropenia is caused by an autoimmune reaction. ►Antithymocyte globulin or other types of therapy that suppresses the activity of the Immune system may be used when a disorder such as aplastic anemia is present.

• To ensure adequate therapy against the invading infectious organisms, broadspectrum antibiotics are initiated as soon as the samples for culture are obtained, although the medications may be changed after culture and sensitivity results become available.

Nursing Management 1. Minimize the risk of infection  Sterile hand washing should be observed by all personnel entering the patients room and before any care episode  Neutropenic patients should be nursed away from infected patients  Special care should be taken during any invasive procedures

2.Observing for signs of infection >Vital signs is monitored every 4 hours if infection is present or suspected >Observed for hypotension, altered respiratory rate, tachycardia, skin inflammation, cough, sore throat 3. Provide patient education and support >Nurse should ensure that patients and their families are able to take adequate precautions to prevent infections

>Patient should be taught to record their own temperature with a 24 hour contact number for hematology unit. >Advice maintaining a low microbial diet

Lymphopenia • A lymphocytes count less than 1500/mm3. • It is can be result from ionizing radiation, long term use of corticosteroids, uremia, some neoplasms and some protein losing enteropathies (in which the lymphocytes within the intestines are lost.)

Nursing Diagnosis • Activity intolerance related to Generalized body weakness as evidenced by restlessness, fatigue, and inability to do daily activities. • Impaired physical mobility related to decreased strength and endurance secondary to chemotherapy as evidenced by limited ability to perform gross/fine motor skills. • Risk for infection related to decreased WBC