Acute Lymphocytic Leukemia | Pathologies of Blood, heart and circulation

• Also called: Acute lymphoblastic leukemia, ALL
• Acute lymphoblastic leukemia (ALL)
• After chemotherapy - discharge
• B and T cell screen
• Bone marrow biopsy
• Bone marrow transplant
• Bone marrow transplant - discharge
• Bone-marrow transplant - series
• Cryoglobulins
• Fibrinopeptide A
• T-cell count

Also called: Acute lymphoblastic leukemia, ALL

Leukemia is cancer of the white blood cells. White blood cells help your body fight infection. Your blood cells form in your bone marrow. In leukemia, however, the bone marrow produces abnormal white blood cells. These cells crowd out the healthy blood cells, making it hard for blood to do its work. In acute lymphocytic leukemia (ALL), also called acute lymphoblastic leukemia, there are too many of specific types of white blood cells called lymphocytes or lymphoblasts. ALL is the most common type of cancer in children.
Possible risk factors for ALL include being male, being white, previous chemotherapy treatment, exposure to radiation, and for adults, being older than 70.
Symptoms of ALL include:
• Weakness or feeling tired
• Fever
• Easy bruising or bleeding
• Bleeding under the skin
• Shortness of breath
• Weight loss or loss of appetite
• Pain in the bones or stomach
• Pain or a feeling of fullness below the ribs
• Painless lumps in the neck, underarm, stomach, or groin
Tests that examine the blood and bone marrow diagnose ALL. Treatments include chemotherapy, radiation therapy, stem cell transplants, and targeted therapy. Targeted therapy uses substances that attack cancer cells without harming normal cells. Once the leukemia is in remission, you need additional treatment to make sure that it does not come back.
NIH: National Cancer Institute

Acute lymphoblastic leukemia (ALL)

Acute lymphoblastic leukemia (ALL) is a fast-growing cancer of a type of white blood cell called a lymphoblast.
ALL occurs when the bone marrow produces a large number of immature lymphoblasts. Bone marrow is the soft tissue in the center of bones that helps form all blood cells. The abnormal lymphoblasts grow quickly and replace normal cells in the bone marrow. ALL prevents healthy blood cells from being made. Life-threatening symptoms can occur as normal blood counts drop.

Causes

Most of the time, no clear cause can be found for ALL.
The following factors may play a role in the development of all types of leukemia:
• Certain chromosome problems
• Exposure to radiation, including x-rays before birth
• Past treatment with chemotherapy drugs
• Receiving a bone marrow transplant
• Toxins, such as benzene
The following factors are known to increase the risk of ALL:
• Down syndrome or other genetic disorders
• A brother or sister with leukemia
This type of leukemia usually affects children ages 3 to 7. ALL is the most common childhood cancer, but it can also occur in adults.

Symptoms

ALL makes a person more likely to bleed and develop infections. Symptoms include:
• Bone and joint pain
• Easy bruising and bleeding (such as bleeding gums, skin bleeding, nosebleeds, abnormal periods)
• Feeling weak or tired
• Fever
• Loss of appetite and weight loss
• Paleness
• Pain or feeling of fullness below the ribs
• Pinpoint red spots on the skin (petechiae)
• Swollen glands (lymphadenopathy) in the neck, under arms, and groin
• Night sweats
These symptoms can occur with other conditions. Talk to the doctor about the meaning of specific symptoms.

Exams and Tests

A physical exam may reveal the following:
• Bruising
• Enlarged liver, lymph nodes, and spleen
• Signs of bleeding (petechiae, purpura)
Blood tests may include:
• Complete blood count (CBC), including white blood cell (WBC) count
• Platelet count
• Bone marrow biopsy
• Lumbar puncture (spinal tap) to check for leukemia cells in the spinal fluid
Tests are also done to look for changes in the DNA inside the abnormal white cells. Certain DNA changes may determine how well a person does (prognosis), and what kind of treatment is recommended.

Treatment

The first goal of treatment is to get blood counts back to normal. If this occurs and the bone marrow looks healthy under the microscope, the cancer is said to be in remission.
Chemotherapy is the first treatment tried with the goal of achieving a remission.
• The person may need to stay in the hospital for chemotherapy. Or it can be given at a clinic and the patient goes home afterward.
• Chemotherapy is given into the veins (by IV) and sometimes into the fluid around the brain (the spinal fluid).
After a remission is achieved, more treatment is given to achieve a cure. This treatment can include more IV chemotherapy or radiation to the brain. Stem cell or bone marrow transplant from another person may also be done. Further treatment depends on:
• Age and health of the person
• Genetic changes in the leukemia cells
• How many courses of chemotherapy it took to achieve remission
• If abnormal cells are still detected under the microscope
• Availability of donors for stem cell transplant

Support Groups

You can ease the stress of illness by joining a cancer support group. Sharing with others who have common experiences and problems can help you not feel alone.

Outlook (Prognosis)

Those who respond to treatment right away tend to do better. Most children with ALL can be cured. Children often have a better outcome than adults.

Possible Complications

Both leukemia itself and the treatment can lead to many problems such as bleeding, weight loss, and infections.

When to Contact a Medical Professional

Call your health care provider if you or your child develops symptoms of ALL.

Prevention

The risk of developing ALL may be reduced by avoiding contact with certain toxins, radiation, and chemicals.

Alternative Names

ALL; Acute lymphoblastic leukemia; Acute lymphoid leukemia; Acute childhood leukemia; Cancer - acute childhood leukemia (ALL); Leukemia - acute childhood (ALL)

References

Jeha S, Pui CH. Clinical manifestations and treatment of acute lymphoblastic leukemia in children. In: Hoffman R, Benz EJ Jr, Silberstein LE, Weitz JI, Anastasi J, eds.Hematology: Basic Principles and Practice.
National Cancer Institute: PDQ Adult Acute Lymphoblastic Leukemia Treatment. Bethesda, Md: National Cancer Institute. Date last modified January 13, 2015. Available at: www.cancer.gov/cancertopics/pdq/treatment/adultALL/HealthProfessional. Accessed: February 26, 2015.
National Cancer Institute: PDQ Childhood Acute Lymphoblastic Leukemia Treatment. Bethesda, Md: National Cancer Institute. Date last modified January 28, 2015. Available at: cancer.gov/cancertopics/pdq/treatment/childALL/HealthProfessional. Accessed: February 26, 2015.
National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Acute Lymphoblastic Leukemia. Version 2.2014. Available at: /www.nccn.org/professionals/physician_gls/pdf/all.pdf. Accessed: February 26, 2015.

After chemotherapy - discharge

You had chemotherapy treatment for your cancer. Your risk of infection, bleeding, and skin problems may be high. You may have mouth sores, an upset stomach, and diarrhea.
You will probably get tired easily. Your appetite may be poor, but you should be able to drink and eat.

Oral care

• Brush your teeth and gums 2 to 3 times a day for 2 to 3 minutes each time. Use a toothbrush with soft bristles.
• Let your toothbrush air dry between brushings.
• Use a toothpaste with fluoride.
• Floss gently once a day.
Rinse your mouth 4 times a day with a salt and baking soda solution. (Mix one half teaspoon of salt and one half teaspoon of baking soda in 8 ounces of water.)
Your doctor may prescribe a mouth rinse. Do not use mouth rinses with alcohol in them.
Use your regular lip care products to keep your lips from drying and cracking. Tell your doctor if you develop new mouth sores or pain.
Do not eat foods and drinks that have a lot of sugar in them. Chew sugarless gums or suck on sugar-free popsicles or sugar-free hard candies.
Take care of your dentures, braces, or other dental products.
• If you wear dentures, put them in only when you are eating. Do this for the first 3 to 4 weeks after your chemotherapy. Do not wear them at other times during the first 3 to 4 weeks.
• Brush your dentures 2 times a day. Rinse them well.
• To kill germs, soak your dentures in an antibacterial solution when you are not wearing them.

Preventing infections

Take care not to get infections for up to 1 year or more after your chemotherapy.
Practice safe eating and drinking during cancer treatment.
• Do not eat or drink anything that may be undercooked or spoiled.
• Make sure your water is safe.
• Know how to cook and store foods safely.
• Be careful when you eat out. Do not eat raw vegetables, meat, fish, or anything else you are not sure is safe.
Wash your hands with soap and water often:, including:
• After being outdoors
• After touching body fluids, such as mucus or blood
• After changing a diaper
• Before handling food
• After using the telephone
• After doing housework
• After going to the bathroom
Keep your house clean. Stay away from crowds. Ask visitors who have a cold to wear a mask, or not to visit. Do not do yard work or handle flowers and plants.
Be careful with pets and animals.
• If you have a cat, keep it inside.
• Have someone else change your cat's litter box every day.
• Do not play rough with cats. Scratches and bites can get infected.
• Stay away from puppies, kittens, and other very young animals.
Ask your doctor what vaccines you may need and when to get them.

Other self-care

• If you have a central venous line or PICC line, know how to take care of it.
• If your doctor or nurse tells you your platelet count is still low, learn how to prevent bleeding during cancer treatment.
• Stay active by walking. Slowly increase how far you go based on how much energy you have.
• Eat enough protein and calories to keep your weight up.
• Ask your doctor about liquid food supplements that can help you get enough calories and nutrients.
• Be careful when you are in the sun. Wear a hat with a wide brim. Use sunscreen with SPF 30 or higher on any exposed skin.
• Do not smoke.

Follow-up

You will need close follow-up care with your cancer doctor and nurse. Be sure to keep all your appointments.

When to call the doctor

Call your doctor if you have any of these symptoms:
• Signs of infection, such as fever, chills, or sweats
• Diarrhea that does not go away or is bloody
• Severe nausea and vomiting
• Inability to eat or drink
• Extreme weakness
• Redness, swelling, or drainage from any place where you have an IV line inserted
• A new skin rash or blisters
• Jaundice (your skin or the white part of your eyes looks yellow)
• Pain in your abdomen
• A very bad headache or one that does not go away
• A cough that is getting worse
• Trouble breathing when you are at rest or when you are doing simple tasks
• Burning when you urinate

References

Freifeld AG, Kaul DR. Infection in the patient with cancer. In: Niederhuber JE, Armitage JO, Doroshow JH, et al., eds.Abeloff's Clinical Oncology
National Cancer Institute. Chemotherapy and you: support for people with cancer. http://www.cancer.gov/cancertopics/coping/chemotherapy-and-you.Accessed May 7, 2014.
Perry MC. Approach to the patient with cancer. In: Goldman L, Schafer AI.Goldman's Cecil Medicine
Sideras K, Hallemeier CL, Loprinzi CL. Oral complications. In: Niederhuber JE, Armitage JO, Doroshow JH, et al., eds.Abeloff's Clinical Oncology

B and T cell screen

A B and T cell screen is a laboratory test to determine the amount of T and B cells (lymphocytes) in the blood.

How the Test is Performed

A blood sample is needed.
Blood could also be obtained by capillary sample (fingerstick, or heelstick in infants).
After the blood is drawn it goes through a two-step process. First, the lymphocytes are separated from other blood parts. Once the cells are separated, identifiers are added to distinguish between T and B cells. The E-rosetting test identifies T cells and direct immunofluorescence is used to identify B cells.

How to Prepare for the Test

Tell your health care provider if you have had any of the following, which might affect your T and B cell count:
• Chemotherapy
• HIV
• Radiation therapy
• Recent or current infection
• Steroid therapy
• Stress
• Surgery

How the Test Will Feel

When the needle is inserted to draw blood, some people feel moderate pain, while others feel only a prick or stinging sensation. Afterward, there may be some throbbing.

Why the Test is Performed

Your doctor may order this test if you have signs of certain diseases that weaken the immune system. It may also be used to distinguish between cancerous and noncancerous disease, especially cancers that involve the blood and bone marrow.
The test may also be used to determine how well treatment for certain conditions is working.

Normal Results

Normal value ranges may vary slightly among different laboratories. Some labs use different measurements or test different samples. Talk to your doctor about the meaning of your specific test results.

What Abnormal Results Mean

Abnormal T and B cell counts suggest a possible disease. Further testing is needed to confirm a diagnosis.
An increased T cell count may be due to:
• Acute lymphoblastic leukemia
• Chronic lymphocytic leukemia
• Infectious mononucleosis
• Multiple myeloma
• Syphilis
• Toxoplasmosis
• Tuberculosis
An increased B cell count may be due to:
• Chronic lymphocytic leukemia
• DiGeorge syndrome
• Multiple myeloma
• Waldenstrom macroglobulinemia
A decreased T cell count may be due to:
• Congenital T-cell deficiency disease, such as Nezelof syndrome, DiGeorge syndrome, or Wiskott-Aldrich syndrome
• Acquired T-cell deficiency states, such as HIV infection or HTLV-1 infection
• B cell proliferative disorders, such as chronic lymphocytic leukemia or Waldenstrom macroglobulinemia
A decreased B cell count may be due to:
• Acquired immunodeficiency syndrome
• Acute lymphoblastic leukemia
• Congenital immunoglobulin deficiency disorders
• Acquired immunoglobulin deficiency disorders

Risks

Veins and arteries vary in size from one patient to another and from one side of the body to the other. Obtaining a blood sample from some people may be more difficult than from others.
Other risks associated with having blood drawn are slight but may include:
• Excessive bleeding
• Fainting or feeling light-headed
• Hematoma (blood accumulating under the skin)
• Infection (a slight risk any time the skin is broken)

Alternative Names

Direct immunofluorescence; E-rosetting; T and B lymphocyte assays; B and T lymphocyte assays

References

Soff GA, Green DL, Gardner LB. Hematologic manifestations of systemic disease: cancer. In: Hoffman R, Benz EJ, Silberstein LE, et al, eds.Hoffman Hematology: Basic Principles and Practice

Bone marrow biopsy

A bone marrow biopsy is the removal of marrow from inside bone. Bone marrow is the soft tissue inside bones that helps form blood cells. It is found in the hollow part of most bones.

How the Test is Performed

A bone marrow biopsy may be done in the health care provider's office or in a hospital. The sample may be taken from the pelvic or breast bone. Sometimes, other areas are used.
Marrow is removed in the following steps:
• If needed, you are given medicine to help you relax.
• The health care provider cleans the skin and injects numbing medicine into the area and surface of the bone.
• A biopsy needle is inserted into the bone. The center of the needle is removed and the hollowed needle is moved deeper into the bone. This captures a tiny sample, or core, of bone marrow within the needle.
• The sample and needle are removed.
• Pressure and then a bandage are applied to the skin.
A bone marrow aspiration may also be done, usually before the biopsy is taken. After the skin is numbed, the needle is inserted into the bone, and a syringe is used to withdraw the liquid bone marrow. If this is done, the needle will be removed and repositioned. Or, another needle may be used for the biopsy.

How to Prepare for the Test

Tell the health care provider:
• If you are allergic to any medications
• What medications you are taking
• If you have bleeding problems
• If you are pregnant
You must sign a consent form.

How the Test will Feel

You will feel a sharp sting when the numbing medicine is injected.The biopsy needle may also cause a brief, usually dull, pain. Since the inside of the bone cannot be numbed, this test may cause some discomfort.
If a bone marrow aspiration is also done, you may feel a brief, sharp pain as the bone marrow liquid is removed.

Why the Test is Performed

Your doctor may order this test if you have abnormal types or numbers of red or white blood cells or platelets on a complete blood count (CBC).
This test is used to diagnose leukemia, infections, some types of anemia, and other blood disorders. It may also be used to help determine if a cancer has spread or responded to treatment.

Normal Results

A normal result means the bone marrow contains the proper number and types of blood-forming (hematopoietic) cells, fat cells, and connective tissues.

What Abnormal Results Mean

Abnormal results may be due to cancers of the bone marrow (leukemia, lymphoma, multiple myeloma, or other cancers).
The results may detect the cause of anemia (too few red blood cells), abnormal white blood cells, or thrombocytopenia (too few platelets).
Additional conditions for which the test may be performed:
• Disseminated coccidioidomycosis (a body-wide fungal infection)
• Hairy cell leukemia
• Hodgkin or non-Hodgkin lymphoma
• Idiopathic aplastic anemia
• Multiple myeloma
• Myelodysplastic syndrome (MDS)
• Neuroblastoma
• Polycythemia vera
• Primary amyloid
• Primary myelofibrosis
• Primary thrombocythemia
• Secondary aplastic anemia
• Secondary systemic amyloid
• Waldenstrom macroglobulinemia

Risks

There may be some bleeding at the puncture site. More serious risks, such as serious bleeding or infection, are very rare.

Alternative Names

Biopsy - bone marrow

References

Choby B. Bone marrow aspiration and biopsy. In: Pfenninger JL, Fowler GC, eds.Pfenninger & Fowler's Procedures for Primary Care
Hutchison RE, McPherson RA, Schexneider KI. Basic examination of blood and bone marrow. In: McPherson RA, Pincus MR, eds.Henry's Clinical Diagnosis and Management by Laboratory Methods

Bone marrow transplant

A bone marrow transplant is a procedure to replace damaged or destroyed bone marrow with healthy bone marrow stem cells.
Bone marrow is the soft, fatty tissue inside your bones. Stem cells are immature cells in the bone marrow that give rise to all of your blood cells.

Description

There are three kinds of bone marrow transplants:
• Autologous bone marrow transplant: The term auto means self. Stem cells are removed from you before you receive high-dose chemotherapy or radiation treatment. The stem cells are stored in a freezer (cryopreservation). After high-dose chemotherapy or radiation treatments, your stems cells are put back in your body to make (regenerate) normal blood cells. This is called a rescue transplant.
• Allogeneic bone marrow transplant: The term allo means other. Stem cells are removed from another person, called a donor. Most times, the donor's genes must at least partly match your genes. Special blood tests are done to see if a donor is a good match for you. A brother or sister is most likely to be a good match. Sometimes parents, children, and other relatives are good matches. Donors who are not related to you may be found through national bone marrow registries.
• Umbilical cord blood transplant: This is a type of allogeneic transplant. Stem cells are removed from a newborn baby's umbilical cord right after birth. The stem cells are frozen and stored until they are needed for a transplant. Umbilical cord blood cells are very immature so there is less of a need for matching. But blood counts take much longer to recover.
Before the transplant, chemotherapy, radiation, or both may be given. This may be done in two ways:
• Ablative (myeloablative) treatment: High-dose chemotherapy, radiation, or both are given to kill any cancer cells. This also kills all healthy bone marrow that remains, and allows new stem cells to grow in the bone marrow.
• Reduced intensity treatment, also called a mini transplant: Patients receive lower doses of chemotherapy and radiation before a transplant. This allows older patients, and those with other health problems to have a transplant.
A stem cell transplant is usually done after chemotherapy and radiation is complete. The stem cells are delivered into your bloodstream usually through a tube called a central venous catheter. The process is similar to getting a blood transfusion. The stem cells travel through the blood into the bone marrow. Most times, no surgery is needed.
Donor stem cells can be collected in two ways:
• Bone marrow harvest. This minor surgery is done under general anesthesia. This means the donor will be asleep and pain-free during the procedure. The bone marrow is removed from the back of both hip bones. The amount of marrow removed depends on the weight of the person who is receiving it.
• Leukapheresis. First, the donor is given 5 days of shots to help stem cells move from the bone marrow into the blood. During leukapheresis, blood is removed from the donor through an IV line in a vein. The part of white blood cells that contains stem cells is then separated in a machine and removed to be later given to the recipient. The red blood cells are returned to the donor.

Why the Procedure is Performed

A bone marrow transplant replaces bone marrow that either is not working properly or has been destroyed (ablated) by chemotherapy or radiation. Doctors believe that for many cancers, the donor's white blood cells can attach to any remaining cancer cells, similar to when white cells attach to bacteria or viruses when fighting an infection.
Your doctor may recommend a bone marrow transplant if you have:
• Certain cancers, such as leukemia, lymphoma, and multiple myeloma
• A disease that affects the production of bone marrow cells, such as aplastic anemia, congenital neutropenia, severe immunodeficiency syndromes, sickle cell anemia, thalassemia
• Had chemotherapy that destroyed your bone marrow

Risks

A bone marrow transplant may cause the following symptoms:
• Chest pain
• Chills
• Drop in blood pressure
• Fever
• Flushing
• Funny taste in the mouth
• Headache
• Hives
• Nausea
• Pain
• Shortness of breath
Possible complications of a bone marrow transplant depend on many things, including:
• The disease you are being treated for
• Whether you had chemotherapy or radiation before the bone marrow transplant and the dosages of such treatments
• Your age
• Your overall health
• How good of a match your donor was
• The type of bone marrow transplant you received (autologous, allogeneic, or umbilical cord blood)
Complications can include:
• Anemia
• Bleeding in the lungs, intestines, brain, and other areas of the body
• Cataracts
• Clotting in the small veins of the liver
• Damage to the kidneys, liver, lungs, and heart
• Delayed growth in children who receive a bone marrow transplant
• Early menopause
• Graft failure, which means that the new cells do not settle into the body and start producing stem cells
• Graft-versus-host disease, a condition in which the donor cells attack your own body
• Infections, which can be very serious
• Inflammation and soreness in the mouth, throat, esophagus, and stomach, called mucositis
• Pain
• Stomach problems, including diarrhea, nausea, and vomiting

Before the Procedure

Your health care provider will ask about your medical history and do a physical exam. You will have many tests before treatment begins.
Before transplant, you will have one or two tubes, called catheters, inserted into a blood vessel in your neck or arms. This tube allows you to receive treatments, fluids, and sometimes nutrition.
Your doctor or nurse will likely discuss the emotional stress of having a bone marrow transplant. You may want to meet with a mental health counselor. It is important to talk to your family and children to help them understand what to expect.
You will need to make plans to help you prepare for the procedure and handle tasks after your transplant:
• Complete an advance care directive
• Arrange medical leave from work
• Take care of bank or financial statements
• Arrange care of pets
• Arrange for someone to help with household chores
• Confirm health insurance coverage
• Pay bills
• Arrange for care of your children
• Find housing for yourself or your family near the hospital, if needed

After the Procedure

A bone marrow transplant is usually done in a hospital or medical center that specializes in such treatment. Most of the time, you stay in a special bone marrow transplant unit in the center. This is to limit your chance of getting an infection.
Depending on the treatment and where it is done, all or part of an autologous or allogeneic transplant may be done as an outpatient. This means you do not have to stay in the hospital overnight.
How long you stay in the hospital depends on how much chemotherapy or radiation you received, the type of transplant, and your medical center's procedures. While you are in the hospital, you will be isolated because of the increased risk of infection. The health care team will closely monitor your blood count and vital signs.
While you are in the hospital you may:
• Receive medications to prevent or treat infections, including antibiotics, antifungals, and antiviral drugs
• Need many blood transfusions
• Be fed through a vein (IV) until you can eat by mouth and stomach side effects and mouth sores have gone away
• Be given medications to prevent graft-versus-host disease

Outlook (Prognosis)

How well you do after transplant depends on:
• The type of bone marrow transplant
• How well the donor's cells match yours
• What type of cancer or illness you have
• Your age and overall health
• The type and dosage of chemotherapy or radiation therapy you had before your transplant
• Any complications you may have
A bone marrow transplant may completely or partially cure your illness. If the transplant is a success, you can go back to most of your normal activities as soon as you feel well enough. Usually it takes up to 1 year to recover fully.
Complications or failure of the bone marrow transplant can lead to death.

Alternative Names

Transplant - bone marrow; Stem cell transplant; Hematopoietic stem cell transplant; Reduced intensity, nonmyeloablative transplant; Mini transplant; Allogenic bone marrow transplant; Autologous bone marrow transplant; Umbilical cord blood transplant

References

Bashir Q, Champlin R. Hematopoietic stem cell transplantation. In: Niederhuber JE, Armitage JO, Doroshow JH, et al., eds.Abeloff's Clinical Oncology
Heslop HE. Overview of hematopoietic stem cell transplantation. In: Hoffman R, Benz EJ Jr, Silberstein LE, et al., eds.Hematology: Basic Principles and Practice

Bone marrow transplant - discharge

Transplant - bone marrow - discharge; Stem cell transplant - discharge; Hematopoietic stem cell transplant - discharge; Reduced intensity, non-myeloablative transplant - discharge; Mini transplant - discharge; Allogenic bone marrow transplant - discharge; Autologous bone marrow transplant - discharge; Umbilical cord blood transplant - discharge

What to expect at home

You have had a bone marrow transplant. It will take 6 months or more for your blood counts and immune system to fully recover. During this time, your risk of infection, bleeding, and skin problems is higher.
Your body is still weak. It may take up to a year to feel like you did before your transplant. You will likely get tired very easily. You may also have a poor appetite.
If you received bone marrow from someone else, you may develop signs of graft-versus-host disease (GVHD). Ask your doctor or nurse to tell you what signs of GVHD you should watch for.

Oral care

• Brush your teeth and gums 2 to 3 times a day for 2 to 3 minutes each time. Use a toothbrush with soft bristles.
• Let your toothbrush air dry between brushings.
• Use a toothpaste with fluoride.
• Floss gently once a day.
Rinse your mouth 4 times a day with a salt and baking soda solution. (Mix one half teaspoon of salt and one half teaspoon of baking soda in 8 ounces of water.)
Your doctor may prescribe a mouth rinse. Do not use mouth rinses with alcohol in them.
Use your regular lip care products to keep your lips from drying and cracking. Tell your doctor if you develop new mouth sores or pain.
Do not eat foods and drinks that have a lot of sugar in them. Chew sugarless gums or suck on sugar-free popsicles or sugar-free hard candies.
Take care of your dentures, braces, or other dental products.
• If you wear dentures, put them in only when you are eating. Do this for the first 3 to 4 weeks after your transplant. Do not wear them at other times during the first 3 to 4 weeks.
• Brush your dentures 2 times a day. Rinse them well.
• To kill germs, soak your dentures in an antibacterial solution when you are not wearing them.

Preventing infections

Take care not to get infections for up to 1 year or more after your transplant.
Practice safe eating and drinking during cancer treatment.
• Do not eat or drink anything that may be undercooked or spoiled.
• Make sure your water is safe.
• Know how to cook and store foods safely.
• Be careful when you eat out. Do not eat raw vegetables, meat, fish, or anything else you are not sure is safe.
Wash your hands with soap and water often:, including:
• After being outdoors
• After touching body fluids, such as mucus or blood
• After changing a diaper
• Before handling food
• After using the telephone
• After doing housework
• After going to the bathroom
Keep your house clean. Stay away from crowds. Ask visitors who have a cold to wear a mask, or not to visit. Do not do yard work or handle flowers and plants.
Be careful with pets and animals.
• If you have a cat, keep it inside.
• Have someone else change your cat's litter box every day.
• Do not play rough with cats. Scratches and bites can get infected.
• Stay away from puppies, kittens, and other very young animals.
Ask your doctor what vaccines you may need and when to get them.

Other self-care

• If you have a central venous line or PICC line, know how to take care of it.
• If your doctor or nurse tells you your platelet count is low, learn how to prevent bleeding during cancer treatment.
• Stay active by walking. Slowly increase how far you go based on how much energy you have.
• Eat enough protein and calories to keep your weight up.
• Ask your doctor about liquid food supplements that can help you get enough calories and nutrients.
• Be careful when you are in the sun. Wear a hat with a wide brim. Use sunscreen with SPF 30 or higher on any exposed skin.
• Do not smoke.

Follow-up

You will need close follow-up care from your transplant doctor and nurse for at least 3 months. Be sure to keep all your appointments.

When to call the doctor

Call your doctor if you have any of these symptoms:
• Diarrhea that does not go away or is bloody.
• Severe nausea, vomiting, or loss of appetite.
• Inability to eat or drink.
• Extreme weakness.
• Redness, swelling, or draining from any place where you have an IV line inserted.
• Pain in your abdomen.
• Fever, chills, or sweats. These may be signs of infection.
• A new skin rash or blisters.
• Jaundice (your skin or the white part of your eyes looks yellow).
• A very bad headache or a headache that does not go away.
• A cough that is getting worse.
• Trouble breathing when you are at rest or when you are doing simple tasks.
• Burning when you urinate.

References

Be The Match. Post-transplant care guidelines. http://bethematch.org/For-Patients-and-Families/Support-and-resources/Educational-resources/Survive-resources.Accessed May 7, 2014.
Bishop MR, Pavletic SZ. Hematopoietic stem cell transplantation. In: Abeloff MD, Armitage JO, Niederhuber JE, et al., eds.Abeloff's Clinical Oncology
Vose JM. Hematopoietic stem cell transplantation. In: Goldman L, Schafer AI.Goldman's Cecil Medicine

Bone-marrow transplant - series

Normal anatomy

Overview

Bone-marrow is a soft, fatty tissue found inside of bones that produces blood cells (red blood cells, white blood cells, and platelets). Red blood cells carry oxygen throughout the body. White blood cells act to ward off infection. Platelets aid in blood-clotting.

Indications

Overview

Bone-marrow transplants are performed for:
• deficiencies in red blood cells (aplastic anemia) and white blood cells (leukemia or lymphoma)
• aggressive cancer treatments (chemotherapy or radiation therapy)
• inherited (genetic) diseases (such as thalassemia)
• immune-system disorders (such as congenital neutropenia and severe-combined immunodeficiency syndrome)

Procedure

Overview

While you are awake and pain-free (using local anesthesia), bone marrow is removed from the top of the hip bone (iliac crest). The bone marrow is filtered, treated, and transplanted immediately. Other times it's frozen and stored for later use. The bone marrow is then transfused through a vein (IV line). It naturally transports itself back into the intended bone cavities, where it grows quickly to replace the old bone marrow.

Aftercare

Overview

Bone-marrow transplants prolong the life of patients who might otherwise die. As with all major organ transplants, however, it is difficult to find bone-marrow donors, and the cost of surgery is very high. The donor is usually a sibling with compatible tissue. The more siblings you have, the better the chance of finding the right match. Occasionally, unrelated donors act as a source for bone-marrow transplants. The hospitalization period is three to six weeks. During this time, you are isolated and under strict monitoring because of the increased risk of infection. Attentive follow-up care is required for two to three months after discharge from the hospital. It takes about six months to a year for the immune system to fully recover from this procedure. Relatively normal activities are resumed after consulting with your doctor.

Cryoglobulins

Cryoglobulins are abnormal antibody proteins. This article describes the blood test used to check for them.
In the laboratory, cryoglobulins come out of solution in blood when the blood sample is cooled below 98.6 degrees Fahrenheit (37 degrees Celsius). They dissolve again when the sample is warmed up.
Cryoglobulins come in three main types, but in 90% of cases, the cause is hepatitis C. The disease in which cryoglobulins are found is called cryoglobulinemia.

How the Test is Performed

Because they are temperature sensitive, cryoglobulins are hard to accurately detect. The blood specimen must be collected in a special way, and the test should only be done in laboratories that are equipped for it. It is important that the laboratory allows the blood sample to clot and to spin it down at 37 degrees Celsius. It is a good idea to learn the correct method for testing so you can check with the lab to make sure they are following the proper procedure.
Blood is drawn from a vein. A vein on the inside of the elbow or the back of the hand is used in most cases. Blood should NOT be drawn from a catheter that has heparin in it. The site is cleaned with germ-killing medicine (antiseptic). The health care provider wraps an elastic band around the upper arm to apply pressure to the area and make the vein swell with blood.
Next, the health care provider gently inserts a needle into the vein. The blood collects into an airtight vial or tube attached to the needle. The elastic band is removed from your arm. The vial should be at room or body temperature before it is used. Vials that are colder than room temperature may not give accurate results.
Once the blood has been collected, the needle is removed, and the puncture site is covered to stop any bleeding. The filled vial should immediately be placed in a temperature-controlled vessel to keep it at body temperature.

How to Prepare for the Test

You may want to call ahead to ask to have your blood drawn by a lab technician who has experience collecting blood for this test.

How the Test will Feel

Some people feel discomfort when the needle is inserted. Afterward, there may be some throbbing.

Why the Test is Performed

This test is most often done when a person has symptoms of a condition associated with cryoglobulins. Cryoglobulins are associated with cryoglobulinemia. They also occur in other conditions that affect the skin, joints, kidneys, and nervous system.

Normal Results

Normally, there are no cryoglobulins.
Note: Normal value ranges may vary slightly among different laboratories. Talk to your doctor about the meaning of your specific test results.
The example above shows the common measurement for results for these tests. Some laboratories use different measurements or may test different specimens.

What Abnormal Results Mean

A positive test may indicate:
• Hepatitis (especially hepatitis C)
• Infectious mononucleosis
• Leukemia
• Lymphoma
• Macroglobulinemia - primary
• Multiple myeloma
• Rheumatoid arthritis
• Systemic lupus erythematosus
Additional conditions under which the test may be performed:
• Nephrotic syndrome

Risks

Risks associated with having blood drawn are slight, but may include:
• Excessive bleeding
• Fainting or feeling light-headed
• Hematoma (blood accumulating under the skin)
• Infection (a slight risk any time the skin is broken)

References

Ferri FF. Cryoglobulimenia. In: Ferri FF, ed.Ferri's Clinical Advisor 2015.

Fibrinopeptide A

Fibrinopeptide A is a substance released as blood clots in your body. A test can be done to measure the level of this substance in your blood.

How the Test is Performed

Blood is drawn from a vein, usually from the inside of the elbow or the back of the hand. The site is cleaned with germ-killing medicine (antiseptic). The health care provider wraps an elastic band around the upper arm to apply pressure to the area and make the vein swell with blood.
Next, the health care provider gently inserts a needle into the vein. The blood collects into an airtight vial or tube attached to the needle. The elastic band is removed from your arm.
Once the blood has been collected, the needle is removed, and the puncture site is covered to stop any bleeding.
In infants or young children, a sharp tool called a lancet may be used to puncture the skin and make it bleed. The blood collects into a small glass tube called a pipette, or onto a slide or test strip. A bandage may be placed over the area if there is any bleeding.

How to Prepare for the Test

No special preparation is necessary.

How the Test Will Feel

When the needle is inserted to draw blood, you may feel moderate pain, or only a prick or stinging sensation. Afterward, there may be some throbbing.

Why the Test is Performed

This test is used to help diagnose severe problems with blood clotting such as disseminated intravascular coagulation (DIC). Certain types of leukemia are associated with DIC.

Normal Results

In general, the level of fibrinopeptide A should range from 0.6 to 1.9 nanograms per milliliter (ng/mL).
Note: Normal value ranges may vary slightly among different laboratories. Talk to your doctor about the meaning of your specific test results.

What Abnormal Results Mean

Increased fibrinopeptide A levels may be a sign of:
• Cellulitis
• DIC
• Leukemia at the time of diagnosis, during early treatment, and during a relapse
• Some infections
• Systemic lupus erythematosus SLE

Risks

Veins and arteries vary in size from one patient to another and from one side of the body to the other. Obtaining a blood sample from some people may be more difficult than from others.
Other risks associated with having blood drawn are slight but may include:
• Excessive bleeding
• Fainting or feeling light-headed
• Hematoma (blood accumulating under the skin)
• Infection (a slight risk any time the skin is broken)

Alternative Names

FPA

References

Furie B, Furie BC. Molecular basis of blood coagulation. In: Hoffman R, Benz EJ, Shattil SS, et al, eds.Hematology: Basic Principles and Practice

T-cell count

A T-cell count measures the number of T cells in the blood. Your doctor may order this test if you have signs of a weak immune system such as due to having HIV/AIDs.

How the Test is Performed

A blood sample is needed.

How to Prepare for the Test

No special preparation is necessary.

How the Test will Feel

When the needle is inserted to draw blood, some people feel moderate pain. Others feel only a prick or stinging sensation. Afterward, there may be some throbbing or a slight bruise. These soon go away.

Why the Test is Performed

T cells are a type of lymphocyte. Lymphocytes are white blood cells. They make up part of the immune system. T cells help the body fight diseases or harmful substances.
Your doctor may order this test if you have signs of a weak immune system (immunodeficiency disorder). It may also be ordered if you have a disease of the lymph nodes. Lymph nodes are small glands that make white blood cells.The test is also used to monitor how well treatment for these types of diseases is working.
One type of T cell is the CD4 cell, or “helper cell.” Persons with HIV/AIDS have regular T-cell tests to check their CD4 cell counts. The results help the doctor monitor the disease and its treatment.

Normal Results

Normal value ranges may vary slightly among different laboratories. Some labs use different measurements or test different samples. Talk to your doctor about the meaning of your specific test results.

What Abnormal Results Mean

Higher than normal T-cell levels may be due to:
• Cancer, such as acute lymphocytic leukemia or multiple myeloma
• Infections, such as hepatitis or mononucleosis
Lower than normal T-cell levels may be due to:
• Acute viral infections
• Aging
• Cancer, such as Hodgkin disease, or leukemia
• Immune system diseases, such as HIV/AIDS
• Radiation therapy
• Steroid treatment
The following can affect test results:
• Chemotherapy medications
• Corticosteroids
• Immunosuppressive medications
• Radiation therapy
• Stress
• Surgery

Risks

Risks associated with having blood drawn are slight:
• Excessive bleeding
• Fainting or feeling light-headed
• Hematoma (blood accumulating under the skin)
• Infection (a slight risk any time the skin is broken)
• Multiple punctures to locate veins
This test is often performed on people with weakened immune systems. Therefore, the risk for infection may be higher than when blood is drawn from a person with a healthy immune system.

Alternative Names

Thymus derived lymphocyte count; T-lymphocyte count

References

Berliner N. Leukocytosis and leukopenia. In: Goldman L, Schafer AI, eds.Goldman’s Cecil Medicine
McPherson RA, Massey HD. Overview of the immune system and immunologic disorders. In: McPherson RA, Pincus MR, eds.Henry’s Clinical Diagnosis and Management by Laboratory Methods

Published for educational purposes from the website: MedlinePlus
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.