INITIAL DIAGNOSIS

Upon learning that they have been diagnosed with a blood disorder, most people understandably feel a mix of emotions ranging from fear to a general sense of uncertainty about the challenges they may face ahead. One powerful strategy for managing this initial wave of anxiety is to become better informed about this group of disorders. Arming yourself with knowledge about blood disorders, their effects, and treatment options is an advisable way to prepare for the challenges and choices these illnesses often bring. This quick reference guide is designed to be a first stop on the road to self-education about blood disorders.

The Facts
In 2007 in the United States, there will be an estimated 44,240 new cases of leukemia, 60,900 cases of lymphoma, and 14,600 cases of multiple myeloma. During the same period, there will be an estimated 60,400 deaths combined from leukemia, lymphoma, and myeloma.

Causes
The specific cause of blood disorders is not known and most people with blood disorders have no known risk factor. Cancerous blood disorders are caused by mutations within the genes of cells. While the specific cause of these mutations is not clear, some studies have shown possible links between excessive exposure to benzene, cigarette smoke, and radiation with the incidence of cancerous blood disorders.

Given that the causes of blood disorders are largely unknown, they are hard to prevent. However, avoidance of smoking and exposure to benzene and high levels of radiation are advisable in terms of reducing the risk of contracting blood disorders.

Types of Blood Disorders
Many types of blood disorders exist, involving the production of key blood components that are either deformed or immature. Depending upon the disease, blood disorders can affect white blood cells, red blood cells, plasma cells, or platelets. Blood disorders are accompanied by a number of possible medical conditions, including a reduction in the blood’s ability to clot normally, a tendency toward the blood clotting too easily, and problems with the production of hemoglobin. Some blood disorders are cancer-related, including:

Leukemia occurs when the body produces large numbers of abnormal or immature blood cells, with most leukemias occurring in white blood cells. The various types of leukemia include acute lymphoblastic leukemia, acute myelogenous leukemia, acute non-lymphocytic leukemia, hairy cell leukemia. The primary distinction among the various types of leukemia lies primarily in two factors: the types of white blood cells affected and how fast the disease develops.

Lymphoma develops when the body produces too many lymphocytes, a type of white blood cell that is produced in the lymph nodes and serves important immune functions. The two primary types of lymphomas are Hodgkin lymphoma and non-Hodgkin lymphoma, which differ in terms of how they spread in the body, their causes, and treatments.

Multiple myeloma involves a malignancy of the plasma cells, which are immune system cells in bone marrow that produce antibodies. Multiple myeloma is the second most prevalent blood cancer after non-Hodgkin lymphoma.

Meanwhile, non-cancer-related blood disorders include myeloproliferative disorders (the production of deformed cells in the bone marrow that always begins as a non-cancerous disease but may later become cancerous), histiocytosis (an immune system disorder), thrombocytopenia (involving a low blood platelet count), thrombosis (a group of disorders causing the blood to clot too easily), hemophilia (a reduction in the blood’s ability to clot normally), and hemoglobinopathies such as thalassemia and sickle-cell disease (involving the underproduction of hemoglobin and often resulting in anemia).

Key Terminology (Initial Diagnosis)

Acute Lymphoblastic Leukemia (ALL): ALL is a usually rapidly progressive malignant disorder involving the production of immature white blood cells (Blasts) which results in the replacement of normal bone marrow with blast cells. Also called Acute Lymphocytic Leukemia. Appears most frequently in children.

Acute Myelogenous Leukemia (AML): AML is a malignant disorder involving the white cells which results in the excessive accumulation of myeloid blast cells in both the bone marrow and the bloodstream. AML occurs in all ages and is the more common acute leukemia in adults. AML affects a different type of white cells than does ALL.

Acute Non-Lymphocytic Leukemia (ANLL): Terminology for acute leukemia's which are not lymphocytic.

Biopsy: Removing tissue that has been invaded by cancer cells.

Bone marrow: A substance with the consistency of thick blood found in the body's hollow bones, such as legs, arms and hips. Marrow produces platelets, red blood cells and white blood cells, the primary agents of the body's immune system.

Hairy Cell Leukemia (HLC): A rare type or variant of chronic leukemia. Primarily a disease of middle-aged men.

Hematopoietic: Of, or pertaining to, the formation and maturation of blood cells and their derivatives.

Hemoglobin: The material in blood which enables it to carry oxygen.

Hemophilia: A bleeding disorder caused by a deficiency in one of the blood clotting factors.

Hodgkin lymphoma: A lymphoma most frequently occurring in young adults, Hodgkin disease not responding to chemotherapy may be treated by autologous BMT and less frequently by allogeneic BMT.

Leukemia: Any of a group of potentially fatal diseases involving uncontrolled growth of white blood cells. Leukemias are classified based upon rapidity of course of disease and the type of cell affected.

Lymphocyte (or “T-cell”): A type of white blood cell subdivided into T-cells and B-cells. T-cells provide cellular immunity and B-cells form antibodies.

Lymphoma: Malignant proliferation of lymphocytes, generally within lymph nodes, but sometimes involving other tissues such as the liver and spleen. Lymphoma includes both Hodgkin and Non-Hodgkin diseases.

Multiple Myeloma: A malignant disorder of the plasma cells and frequently associated with bone pain and susceptibility to infection.

Myelofibrosis: A chronic disease characterized by fibrous material in the bone marrow, an enlarged spleen and anemia. Also called agnogenic myeloid metaplasia.

Myelodysplastic: Also called pre-leukemia or "smoldering" leukemia, is a syndrome or disease of the marrow in which inadequate platelets, red blood cells and white blood cells are made. Sometimes a precursor to AML.

Myeloproliferative: A group of disorders characterized by abnormal proliferation by one or more types of marrow cells. Four disorders are generally included as myeloproliferative disorders, including polycythemia vera (PV), myelofibrosis, chronic myelomonocytic leukemia (CMML) and primary thrombocythemia.

Neuroblastoma: A solid tumor found in some children, which in an advanced wide spread stage may be treated by bone marrow transplant.

Neutrophils: Neutrophils fight infections and are the most numerous white blood cells, making up about 56% of white blood cells.

Non-Hodgkin lymphoma: A category of malignancies arising from lymphocytes with many subtypes which have a wide variety of growth patterns and diverse signs and symptoms.

Platelet: A component of the blood important in clotting. Insufficient amounts can lead to excessive bruising and bleeding.

Red Blood Cells (RBC): Red blood cells carry oxygen to and remove carbon dioxide from the body's tissues. These cells contain hemoglobin.

Sarcoma: A malignant solid tumor most frequently found in muscles or bones.

Thalassemia: A group of chronic, inherited anemias that are particularly common in persons of Mediterranean, African and Southeast Asian descent.

Thrombocytopenia: A condition in which there are not enough platelets, leading to easy bruising and excessive bleeding.

Thrombophilia: Thrombophilias are a group of disorders that cause blood to clot too easily.

While Blood Cells (WBC): White blood cells fight infections.

TREATMENT AND POST-TREATMENT SUPPORT

Typical Treatments and their Side Effects
Treatments for cancer-related blood disorders include chemotherapy, radiotherapy, transfusions, antibiotics (for infections), bone marrow transplant, and stem cell transplant. Treatments for other blood disorders might include transfusions and various drug therapies.

Links to Support Resources

American Association of Blood Banks:
http://www.aabb.org/content

American Cancer Society:
http://www.cancer.org/docroot/home/index.asp

American Society of Clinical Oncology:
http://www.asco.org/

Cancer Consultants - Cancer Topics
http://www.texasoncology.com/cancer-blood-disorders.aspx

National Cancer Institute - Cancer Topics:
http://www.cancer.gov/cancertopics

National Cancer Institute:
http://www.cancer.gov/

National Heart, Lung and Blood Institute (NHLBI):
http://www.nhlbi.nih.gov/

National Institutes of Health (NIH):
http://www.nih.gov/

Managing Chemotherapy
Chemotherapy is a commonly-prescribed systemic therapy for treating cancer. While chemotherapy is a powerful technique, it is usually accompanied by a number of side effects. Here is a list of common chemotherapy side effects and some strategies for managing them:

Weakened Immune System:

Avoid crowds, especially those with children.
Wash your hands as frequently as possible.
Prevent breaks in the skin.

Nausea and Vomiting:

Eat smaller meals more frequently.
Avoid sweets and fatty, fried foods.
Eat foods only when they are at room temperature.
Avoid strong odors.
Take anti-emetic drugs.

Diarrhea:

Drink plenty of fluids.
Avoid dairy products.
Try foods that are low in fiber such as bananas, rice, and mashed potatoes.

Constipation:

Drink plenty of fluids.
Eat high fiber foods.

Sore Mouth:

Drink plenty of fluids.
Suck on ice chips.
Chew sugarless gum or eat hard candy.
Moisten dry foods before chewing.

Fatigue:

Plan fewer activities.
Try to rest whenever you can.

Hair Loss:

Try cooling your scalp during chemotherapy, as this may reduce hair loss.
Ask your cancer nurse about wigs and hairpieces, if you are interested in wearing one.

Key Terminology (Treatment and Post-Treatment)

Allogeneic Bone Marrow Transplant: Any bone marrow transplant (BMT) between two individuals, whether they are related or unrelated.

Autologous Bone Marrow Transplant: A portion of the patient's own marrow is removed, stored and then returned to the body after the patient receives high doses of chemotherapy and/or radiation therapy.

Bone Marrow Transplant (BMT): The process of infusing healthy marrow into persons who have undergone high-dose chemotherapy for one of many forms of leukemias, immunodeficiencies, lymphomas, anemias, metabolic disorders, and in some cases, solid tumors.

Complete Blood Count (CBC): A CBC is a common blood test that provides detailed information about three types of cells in your blood: red blood cells, white blood cells, and platelets.

Chemotherapy: The treatment of a disease using chemicals designed to kill cancer cells.

Conditioning: The process of preparing the patient to receive donated marrow, often through the use of chemotherapy and radiation therapy.

Confirmatory Typing (CT): A repeat tissue typing test done to confirm the compatibility of the donor and patient. This is one of the final tests done before transplant.

Mixed Lymphocyte Culture (MLC): A test which measures the level of reactivity between donor and recipient lymphocytes.