Comprehensive Nursing Pharmacology Q 39
Chemotherapeutic agents often produce a certain degree of myelosuppression including leukopenia. Leukopenia does not present immediately but is delayed several days to weeks because:
A. The patient’s hemoglobin and hematocrit are normal.
B. Red blood cells are affected first.
C. Folic acid levels are normal.
D. The current white cell count is not affected by chemotherapy.
Correct Answer: D. The current white cell count is not affected by chemotherapy.
The time required to clear circulating cells before the effect that chemotherapeutic drugs have on precursor cell maturation in the bone marrow becomes evident. Leukopenia is an abnormally low white blood cell count. Answers A-C pertain to red blood cells. Neutropenia, with decreased production with marrow hypoplasia, can be primary and due to chronic benign neutropenia, cyclical neutropenia, and other congenital and familial neutropenias. It can be secondary to cytotoxic drugs, aplastic anemia, leukemia, drug reactions, and infections. Neutropenia, with increased destruction with marrow hyperplasia, is due to hypersplenism and immune neutropenia.
Option A: Low levels of neutrophils may be due to hypoplastic bone marrow, an infection, radiation exposure, tumor infiltration of the bone marrow, myelofibrosis, prolonged exposure to a drug, or a hereditary disorder. Congenital neutropenia or Kostmann syndrome is acquired in an autosomal recessive fashion.
Option B: In primary neutropenia disorders such as chronic granulomatous disease presents with recurrent infections affecting many organs since childhood. It is caused by a failure to produce toxic reactive oxygen species so that the neutrophils can ingest the microorganisms, but they are unable to kill them, as a significant consequence granuloma can obstruct organs such as the stomach, esophagus, or bladder.
Option C: Neutropenia can differentiate from antibody deficiency disorders, where a class or different classes of immunoglobulins are below the normal range or absence. These disorders may present clinically by recurrent infections with bacteria and fungi; some of them are opportunistic pathogens, so the use of antimicrobials to treat infectious diseases is a norm.