Les problèmes de saignement
Authors:
Dr. Christine Maheu, RN, PhD ,
Ms. Rosemary Cashman ,
Kyla Johnson, Occupational Therapist, Segal Cancer Centre, Jewish General Hospital ,
Ms. Maureen Parkinson, Vocational Rehabilitation Counsellor, M.Ed. C.C.R.C, BC CancerDr. Christine Maheu, RN, PhD
Dr. Christine Maheu is an Associate Professor in the Ingram School of Nursing, Faculty of Medicine, McGill University. Dr. Maheu is also an Affiliate Scientist at the University Health Network and the University of Toronto. At McGill University, she teaches research methods, supervises graduate students (masters, doctoral, post-doctoral), mentors practicing nurses and students in research, and conducts research in English and French. She has held research awards with the Canadian Institutes of Health Research, the Canadian Cancer Society, and the Canadian Partnership Against Cancer. These awards funded her research in psychosocial oncology, which focuses on developing and testing psychosocial interventions or measurements tools for various cancer populations. Additionally, in partnership with Ipsos Canada and funded by the Canadian Partnership Against Cancer, she is co-leading a nationwide survey of the needs of cancer patients for transition care from the end of their treatment to three years after their diagnosis. Dr. Maheu received awards for excellence in nursing research (2013, 2015, 2016) from Ovarian Cancer Canada, the Canadian Association of Nurses in Oncology, and the Quebec Association of Nurses in Oncology.
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Ms. Rosemary Cashman
Ms. Rosemary Cashman is a nurse practitioner at the BC Cancer Agency and an Adjunct Professor in the Faculty of Nursing at the University of British Columbia. Her professional experience includes the care of lymphoma, lung cancer and brain cancer patients. She co-chairs the Patient and Family Advisory Council, which guides the brain tumour care program at the BC Cancer Agency. She has authored book chapters and articles related to the care of brain tumour patients and their families. Ms. Cashman was involved in developing and implementing a rapid-access radiotherapy clinic for the palliative treatment of lung cancer and she continues to work in this clinic.
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Kyla Johnson, Occupational Therapist, Segal Cancer Centre, Jewish General Hospital
Ms. Kyla Johnson, M.Sc.A., originally from Edmonton, Alberta, Kyla Johnson works as an Occupational Therapist at the Segal Cancer Center of the Jewish General Hospital. She holds a Master of Science in Occupational Therapy from McGill University. Her goal as a rehabilitation professional in Oncology is to enable people with cancer to be able to do what they want and need to do, in all stages of their cancer experience. Kyla helps develop strategies and accommodations to facilitate a return to meaningful life roles, including work. She is specialized in cancer-related cognitive dysfunction and runs a weekly group teaching strategies to improve daily cognitive functioning. Kyla also leads a volunteer yoga class for young adults with cancer. She lives in Montreal, Quebec.
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Ms. Maureen Parkinson, Vocational Rehabilitation Counsellor, M.Ed. C.C.R.C, BC Cancer
Ms. Maureen Parkinson is the province-wide vocational rehabilitation counsellor at the BC Cancer Agency. She has also been vocational rehabilitation counsellor at a public rehabilitation hospital and vocational rehabilitation consultant to insurance companies and the court system. She has instructed and facilitated Service-Canada-funded programs on job searching and career exploration. Ms. Parkinson has a Masters in Counselling Psychology, is a Canadian Certified Rehabilitation Counsellor, and completed the Certified Return to Work Coordinator Program through the National Institute for Disability Management and Research. She has developed return-to-work and job-search seminars for cancer patients and created the guidebook “Cancer and Returning to Work: A Practical Guide for Cancer Patients” as well as on-line articles about returning to work and school. She also co-authored a paper commissioned by the Canadian Association of Psychosocial Oncology, “Cancer and Work: A Canadian Perspective”.
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Certains cancers et traitements associés sont susceptibles de modifier les mécanismes physiologiques qui contrôlent le saignement . Par ailleurs, les traitements contre le cancer peuvent temporairement réduire le nombre de plaquettes, c’est-à-dire les cellules sanguines qui aident le sang à coaguler. Lorsque ces dernières deviennent trop peu nombreuses, le patient risque de saigner beaucoup, même en cas de très petites lésions. À l’opposé, le sang peut aussi devenir trop épais et former de gros caillots risquant de se regrouper dans les jambes ou d’être acheminés vers des organes comme le cerveau, le cœur et les poumons.
Conséquences sur le travail
En cas de problème de saignement, le patient doit absolument éviter les activités risquant de provoquer une hémorragie en cas de blessure ou d’autre traumatisme. Certains types de cancers favorisent davantage la formation de caillots, tout comme ceux qui ont une croissance active ou touchent des personnes dont la mobilité est limitée. Il est possible de réduire les risques en buvant beaucoup. Si le patient est souvent assis, il devra se lever et marcher régulièrement.
Les solutions accessibles au patient
Montrez des moyens de gérer la situation aux patients particulièrement vulnérables aux problèmes de saignement. Il se peut qu’il ne ressentent aucune différence en cas de réduction du nombre de plaquettes (ou thrombocytopénie), mais vous pouvez leur expliquer certains des signes avant-coureurs, soit :
- La tendance aux ecchymoses
- La présence de petites taches rouges (pétéchies) sur les bras et les jambes
- Le saignement des gencives lors du brossage des dents
- Des menstruations particulièrement longues ou abondantes
- L’apparition soudaine de forts maux de tête, avec ou sans faiblesse des membres
Signes indiquant la présence de caillots :
- Le gonflement des jambes, le plus souvent sur un côté seulement, avec ou sans douleur dans le muscle ou sous le genou
- Une respiration difficile ou douloureuse
- Des secrétions roses lors de la toux
Voici les étapes à suivre pour protéger la santé du patient en cas de faible numération plaquettaire, d’après le document Low blood cell counts: Side effect of cancer treatment de Mayo Clinic :
- Adopter un régime alimentaire équilibré.
- Éviter de se blesser.
- Éviter les germes.
- Se reposer.
Mesures d’adaptation du lieu de travail
La modification des tâches :
- Demander que d’autres personnes prennent en charge les tâches pour lesquelles le risque de blessure est plus élevé.
- Demander de l’équipement de protection adapté à l’emploi.
La modification du milieu de travail pour réduire les risques de chute :
- Éliminer tout enchevêtrement et tout câble ou fil lâche sur le lieu de travail.
- Prévoir un éclairage suffisant dans tous les espaces de travail.
- Ne jamais laisser de liquide déversé sur le sol.
- Aplanir les surfaces du sol inégales.
Retour à la liste des effets secondaires courants des traitements contre le cancer
