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Unit 1 > 9-24a Common Blood Disorders > Flashcards

9-24a Common Blood Disorders Flashcards

1
Q

What are WBCs? Normal range?

A

cells of the immune/inflammatory response

5000 - 10000 cells/mcL

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2
Q

disorders of low amounts of WBCs? What can this be the result of?

A

Leukopenia
bone marrow failure = check medications that could be causing this
overwhelming sepsis/infection could have used up WBCs
genetic
viral infection
most commonly a medication response

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3
Q

functions of the hematologic system?

A

through RBCs: deliver O2 to various tissues
hemoglobin has iron that helps bind to O2 and transport it to tissues for gas exchange

waste removal via delivery of waste products to organs (spleen, liver, kidneys)

WBCs play role in immune function (neutrophils largely that respond to bacterial infection; lymphocytes fighting virsus)

injury repair: hemostasis and appropriate inflammatory response via platelets

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4
Q

What are precautions for leukopenia?

A

strict with infection control
strict hand hygiene
glove and gown and mask

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5
Q

What are precautions for leukopenia?

A 
strict with infection control
strict hand hygiene
glove and gown and mask
Critical value: below 7-8
frequent systems check and slow movements
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6
Q

What is blood primarily made up of? What makes up the main components?

A 
plasma (55%): largely water but also proteins resp. for circulating 
formed elements (45%): leukocytes, platelets and RBCs
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7
Q

What are symptoms to look for with anemia?

A 
CP, SOB
Increased HR
Lightheaded
Increased RR
Low BP
weakness, pail, tired
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8
Q

What is the most common cause of anemia? What causes this? How do you treat it?

A

Iron Deficiency Anemia from:

chronic blood loss (colon cancer)

chronic dietary deficiency

PICA: ice chips

supplement; then find out underlying cause

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9
Q

What can also cause anemia?

A

Vitamin B12 and Folate deficiencies, Blood loss, chronic disease, and bone marrow failure

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10
Q

What is hematopoiesis?

A

creation of blood cells in the bone marrow (healthy adults)
extramedullary hematopoeisis suggests pathology in bone marrow

occurs via pluripotent hematopoietic stem cells

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11
Q

The pluripotent cell turns into which two kinds of cells?

A

Lymphoid (lymph organs) or Myeloid (stays in bone marrow and makes platelets, RBCs, and WBCs

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12
Q

What are the different WBCs?

A 
Neutrophils: bacterial infection
B & T Lymphocytes: viral infections
Monocytes: innate immune system
Eosinophils: parasitic infection/allergic reactions
Basophils: inflammatory mediator
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13
Q

What is the life span for RBCs?

Normal values?

A

90-120 days

  1. 7-6.1 in males
  2. 2-5.4 in females
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14
Q

Where are RBCs disposed of?

A

iron goes to the spleen and is conserved and recycled, while HGB and the RBC travel to the liver and are excreted in the bile

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15
Q

What is HGB? What does it do? Normal values? Critical value?

A 
primary protein within RBCs
binds and transports O2
14-18 g/dL in males
12-16 g/dL in females
less than 8.9 g/dL = impacts health and stability
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16
Q

What are Hematocrit levels? What are normal values?

A

percent of blood volume made up of RBCs

HGB * 3
Male: 42-52%
Female 37-47%

abnormal: RBCs weirdly large, if low: more platelets and wbcs than they should

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17
Q

What are some disorders of RBC, HGB, and HCT

A

Low: Anemia via iron/b12/folate deficiency from blood loss, bone marrow fialure, disease, genetics

high: erythrocytosis via lung disease, smoking, high altitudes

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18
Q

What causes B12 and folate deficiencies? What causes it? Unique symptom? treat?

A

dietary deficiency or malabsorption causes interference w/ DNA synthesis of RBCs
neurologic complaints from B12 (confusion, balance, prioprioception)
supplementation
if GI tract is not absorbing these vitamins, then it needs to be bypassed with injections

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19
Q

What causes blood loss anemia? What are the symptoms and treatment?

A

trauma, surgery, or other blood loss.
Bone marrow tries to keep up appropriately and shows an increased number of immature RBCs
symptoms are sudden
treat with iron supplementation/transfusion

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20
Q

What chronic diseases cause anemia? What is the underlying pathophysiology? Treatment?

A

Chronic, can’t make them much better
kidney disease, liver disease, autoimmune, malignancy, thyroid, inflammation
focus on underlying cause

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21
Q

What causes bone marrow failure? Causes? Symptoms? Treatment?

A

(aplastic anemia) damage to hematopoietic stem cells–affects all cell lines

usually unknown, but also medications, radiation, and viral illness

fatigue/weakness, infection, hemorrhage due to lack of all the blood cells/components

bone marrow transplant

22
Q

What is sickle cell anemia? Why do you have it? symptoms? treatment?

A

abnormal, unstable HGB that sickles due to stressors like hypoxia, dehydration, and over exertion

autosomal recessive inheritance/seen in malaria endemic areas

avascular necrosis (shoulders and hips not getting adequate O2 due to chronic vaso-occlusive crises effecting the bone) requires joint replacement

vaso-occlusive pain crisis (sickle cells clot together and O2 cannot be transported to distal tissues to clot), necrosis
Chest pain must be treated urgently

treat with pain control (narcotic dependence), transfusions, O2, joint replacement surgery

goal is to avoid hypoxia

23
Q

Sickle cell disease precautions?

A

avoid dehydration, over-exertion, hypoxia, and cryotherapy (b/c it could lead to sickling)

CP should be treated urgently

24
Q

What does a low WBC cause?

A

high susceptibility to infection

notable when the count is less than 1000

25
Q

Precautions for someone with a low WBC count?

A

More strict with infection control
strict hand hygiene, gloves, mask, gown
disinfected equipment

26
Q

Four types of leukemia? Difference b/w acute and chronic?

A

Acute Lymphocytic Leukemia: Most common leukemia in children; good prognosis; IDed by many immature blood cells

Acute Myeloid Leukemia: young-middle aged adults; auer rods

Chronic Lymphocytic Leukemia: Most common leukemia in adults

Chronic Myeloid Leukemia

chronic: overproduction of mature WBCs; abnormality more circulated “philadelphia chromosomes” – first time genetic mutation was found as cause for malignancy
acute: overproduction of immature WBCs

undergo PT so they could tolerate chemo

27
Q

What are lymphomas?

A

Leukemia Involved with lymphatic organs: thymus, spleen, and lymphnode

focal point of malignancy

28
Q

What are the two types of lymphoma?

A

Hodgkin’s: late teens-early 20s with chemo and radiation

29
Q

What are platelets?

A

responsible for hemostasis (appropriate clotting and prevention of bleeding)

megakaryocyte shoots out pieces of cytoplasm into circulation (platelets)

30
Q

What do platelets do?

A

Form a scab or clot to prevent bleeding

release signals to WBCs and inflammatory mediators

31
Q

How long do platelets circulate for?

A

7-10 days

32
Q

What anti-platelet medications do? What is an example of one?

A

aspirin binds to a platelet irreversibly and affects its ability to bind to other platelets and affect hemostatic repsonse

33
Q

At what level are patients susceptible to spontaneous bleeding? Normal values? For surgery?

A 
140,000-400,000
less than 10-20k 
concerning in brain and trauma
50k
PT: if a patient has less than 20k platelets, nothing fall-risk or exertional
34
Q

What causes a low platelet count?

A

all used up in bleeding

destroyed in immune processes (autoimmune disease/hyperactive spleen)

35
Q

What causes a high platelet count?

A

thrombocytosis
don’t know what the cause is
bodies produce more platelets as a reaction to bleeding, inflammatory response, infection
polycythemia vera: overproduction of multiple cell lines

36
Q

Concerning symptoms for ind. with low/high platelet count?

A

low: bleeding disorders involving spontaneous, nose bleeds/easy bruising, gum bleeding, ptekei
high: stroke, heart attack, arterial clotting from lack of adequate blood flow

37
Q

Precautions for patients with low platelet counts?

A

less than 20k: only ADL
20-50k: light exercises only; limit exertion
50-150k: limit heavy exertion

38
Q

What is the order of response to a wound?

A
  1. platelet 2. fibrin (reinforce platelet)
39
Q

What lab results do we use to monitor homeostatic ability/bleeding-disorder causing medications?

A

aPTT (activated partial thromboplastin time): used for heparin monitoring

PT/INR: (prothrombin time and international normalized ratio) used for warfarin monitoring: should be between 2 and 3; critical value: 4.9, take precautions/hold therapy

40
Q

What is the most common inherited bleeding disorder?

A

Von Willebrand disease: lack von willebrand factor that goes into creation of fibrin clot
asymptomatic except for “bleeding challenge”
treat with DDAVP – used as prophylaxis during surgeries
Aminocaproic acid
PT: be cautious for activities that could cause falls

41
Q

`What is Hemophilia?

A

deficiency of clotting factors; genetic x-linked condition; effects mostly male patient at an early age (3-4)

deficiency of Factor VIII: hemophilia A
deficiency of Factor IX: hemophilia B

significant joint damage b/c blood seeps into the joint; spontaneous or from minor trauma; blood is toxic to the joint and can result in deterioration over time

42
Q

Treatment of Hemophilia?

A

transfuse blood clotting factors they’re deficient in

if already bleeding: can cause anemia

43
Q

PT with hemophilia patients?

A

positive for QOL, pain control, mobility, ROM

can be safe, just need precautions

44
Q

Precautions for patient with bleeding disorder?

A

cannot be actively bleeding, need to make sure treated (clotting factor levels treated prior)

parasthesia, numbness, swelling: discontinue therapy and get doctor to do an assessment

45
Q

What is virchow’s triad? Components?

A

goes through risk factors for clotting:
Stasis: prolonged immobility
Vessel wall injury: surgically or traumatic
hypercoagulability: genetic, estrogen therapy, smokers

46
Q

How does a clotting disorder first present? Where is the pain?

A

DVT in deep veins of the LE
Calf pain, swelling, redness and tenderness– medially and posterior knee/popliteal area
usually unilateral

47
Q

What is concerning about a DVT?

A

can result in spread of clot to lungs (PE)
leads to Chest pain, Shortness of breath, Tachycardia,, tachypnea, and Hypoxia
severe and can be fatal

48
Q

What patients are at risk for clotting disorders?

A

prone to clotting genetically: Factor V Leiden or estrogen therapy pts, genetic deficiency in protein c or s can lead to clot formation without termination of hemostasis

49
Q

Is mobility safe for pts with a DVT?

A

early ambulation is beneficial and decreases long-term pain, etc.

50
Q

What do you need to look for with a patient with a clotting disorder?

A

evidence of a clot in the leg: calf pain, tenderness, redness, swelling, warmth

ask patient if they have CP, trouble breathing

pay attention to HR, RR, and O2 levels

Unit 1 (25 decks)

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