Case study 32.3

Mary requires additional tests including peripheral blood immunophenotying, a test of the blood which examines the antigens (proteins) on the cell surface and which is diagnostic in patients with CLL. A bone marrow examination is no longer required to diagnose CLL and is only performed where a diagnosis is unclear or as part of the staging process in a patient requiring treatment for their CLL and to identify cytogenetic abnormalities which may influence the patients treatment plan, e.g. patients with 17p deletion will not respond to standard FCR chemotherapy.

She should be advised of the importance of reporting any signs or symptoms of anaemia, thrombocytopenia, recurrent infections and any B symptoms. In addition, she should be advised to have the HIb, influenza and pneumonia vaccinations prophylactically due to her increased risk of infections. In addition, Mary should be educated on the higher risk of other malignancies associated with CLL (the most common being skin cancer) and the importance of early detection and prevention including advice on skin protection and maintaining a healthy lifestyle. Mary should also be provided with written information on CLL, ‘watch and wait policy’, support services available and the contact details of the haematology staff.

The nurse should also educate Mary’s daughter on the treatment plan and to report any symptoms that Mary may experience to the hospital. Mary’s daughter should also be provided with the contact details for the haematology staff should she need to make contact with any questions about her Mother between review visits at the clinic.

Health promotion advice to Mary includes the need to stop smoking. She should be given smoking cessation support within the hospital and community.