Blood Cancers and Bleeding Disorders
Leukemia, lymphoma, myeloma, hemophilia and platelet disorders
Leukemia
- Bone marrow fills with abnormal white cells → infection (few working WBCs), bleeding (low platelets), anemia (fatigue).
- ALL is the most common childhood cancer; AML, CLL and CML mostly in adults.
- Diagnosis: blood counts and bone marrow biopsy (posterior iliac crest; pressure afterward).
- Chemotherapy, targeted drugs, stem cell transplant (watch for graft-vs-host disease: rash, diarrhea, liver changes), CAR-T cell therapy (watch for cytokine release syndrome: fever, low BP; and neurotoxicity).
Lymphoma and myeloma
- Hodgkin lymphoma: painless enlarged lymph node (often neck), Reed-Sternberg cells; good cure rates.
- Non-Hodgkin lymphoma: more common, many types.
- "B symptoms": fever, drenching night sweats, weight loss.
- Multiple myeloma (plasma cells): "CRAB": high Calcium, Renal failure, Anemia, Bone pain and fractures. Fluids, fall precautions, careful moving.
Bleeding disorders
| Condition | Key points |
|---|---|
| Hemophilia A / B | Missing factor VIII (A) or IX (B); X-linked, mostly males. Bleeding into joints (hemarthrosis): factor replacement first, then rest, ice, elevation. Emicizumab prevents bleeds in hemophilia A. No IM injections, aspirin or NSAIDs; soft toothbrush; medical ID |
| Von Willebrand disease | Most common inherited bleeding disorder: nosebleeds, heavy periods. Desmopressin or factor concentrates |
| Immune thrombocytopenia (ITP) | Antibodies destroy platelets: petechiae, bruising. Steroids, IVIG, other drugs |
| Heparin-induced thrombocytopenia (HIT) | Platelets drop >50% 5–10 days after heparin; clots, not bleeding, are the danger. Stop all heparin (including flushes); use argatroban or bivalirudin |
| DIC | Widespread clotting uses up clotting factors → bleeding: ↓ platelets and fibrinogen, ↑ PT/aPTT and D-dimer. Treat the cause; blood products |
Bleeding precautions (low platelets)
Soft toothbrush; electric razor; no IM injections, rectal temperatures or enemas; gentle nose blowing; avoid aspirin and NSAIDs; apply pressure longer after needle sticks; fall prevention; watch urine, stool, gums, skin, and neuro status. Spontaneous bleeding risk rises sharply below ~20,000/mm³.
Priority
A neutropenic patient with a fever, or a patient with low platelets and a new headache or confusion (possible brain bleed), needs immediate attention.