9-24a Common Blood Disorders Flashcards
What are WBCs? Normal range?
cells of the immune/inflammatory response
5000 - 10000 cells/mcL
disorders of low amounts of WBCs? What can this be the result of?
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
functions of the hematologic system?
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
What are precautions for leukopenia?
strict with infection control
strict hand hygiene
glove and gown and mask
What are precautions for leukopenia?
strict with infection control strict hand hygiene glove and gown and mask Critical value: below 7-8 frequent systems check and slow movements
What is blood primarily made up of? What makes up the main components?
plasma (55%): largely water but also proteins resp. for circulating formed elements (45%): leukocytes, platelets and RBCs
What are symptoms to look for with anemia?
CP, SOB Increased HR Lightheaded Increased RR Low BP weakness, pail, tired
What is the most common cause of anemia? What causes this? How do you treat it?
Iron Deficiency Anemia from:
chronic blood loss (colon cancer)
chronic dietary deficiency
PICA: ice chips
supplement; then find out underlying cause
What can also cause anemia?
Vitamin B12 and Folate deficiencies, Blood loss, chronic disease, and bone marrow failure
What is hematopoiesis?
creation of blood cells in the bone marrow (healthy adults)
extramedullary hematopoeisis suggests pathology in bone marrow
occurs via pluripotent hematopoietic stem cells
The pluripotent cell turns into which two kinds of cells?
Lymphoid (lymph organs) or Myeloid (stays in bone marrow and makes platelets, RBCs, and WBCs
What are the different WBCs?
Neutrophils: bacterial infection B & T Lymphocytes: viral infections Monocytes: innate immune system Eosinophils: parasitic infection/allergic reactions Basophils: inflammatory mediator
What is the life span for RBCs?
Normal values?
90-120 days
- 7-6.1 in males
- 2-5.4 in females
Where are RBCs disposed of?
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
What is HGB? What does it do? Normal values? Critical value?
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
What are Hematocrit levels? What are normal values?
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
What are some disorders of RBC, HGB, and HCT
Low: Anemia via iron/b12/folate deficiency from blood loss, bone marrow fialure, disease, genetics
high: erythrocytosis via lung disease, smoking, high altitudes
What causes B12 and folate deficiencies? What causes it? Unique symptom? treat?
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
What causes blood loss anemia? What are the symptoms and treatment?
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
What chronic diseases cause anemia? What is the underlying pathophysiology? Treatment?
Chronic, can’t make them much better
kidney disease, liver disease, autoimmune, malignancy, thyroid, inflammation
focus on underlying cause
What causes bone marrow failure? Causes? Symptoms? Treatment?
(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
What is sickle cell anemia? Why do you have it? symptoms? treatment?
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
Sickle cell disease precautions?
avoid dehydration, over-exertion, hypoxia, and cryotherapy (b/c it could lead to sickling)
CP should be treated urgently
What does a low WBC cause?
high susceptibility to infection
notable when the count is less than 1000
Precautions for someone with a low WBC count?
More strict with infection control
strict hand hygiene, gloves, mask, gown
disinfected equipment
Four types of leukemia? Difference b/w acute and chronic?
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
What are lymphomas?
Leukemia Involved with lymphatic organs: thymus, spleen, and lymphnode
focal point of malignancy
What are the two types of lymphoma?
Hodgkin’s: late teens-early 20s with chemo and radiation
What are platelets?
responsible for hemostasis (appropriate clotting and prevention of bleeding)
megakaryocyte shoots out pieces of cytoplasm into circulation (platelets)
What do platelets do?
Form a scab or clot to prevent bleeding
release signals to WBCs and inflammatory mediators
How long do platelets circulate for?
7-10 days
What anti-platelet medications do? What is an example of one?
aspirin binds to a platelet irreversibly and affects its ability to bind to other platelets and affect hemostatic repsonse
At what level are patients susceptible to spontaneous bleeding? Normal values? For surgery?
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
What causes a low platelet count?
all used up in bleeding
destroyed in immune processes (autoimmune disease/hyperactive spleen)
What causes a high platelet count?
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
Concerning symptoms for ind. with low/high platelet count?
low: bleeding disorders involving spontaneous, nose bleeds/easy bruising, gum bleeding, ptekei
high: stroke, heart attack, arterial clotting from lack of adequate blood flow
Precautions for patients with low platelet counts?
less than 20k: only ADL
20-50k: light exercises only; limit exertion
50-150k: limit heavy exertion
What is the order of response to a wound?
- platelet 2. fibrin (reinforce platelet)
What lab results do we use to monitor homeostatic ability/bleeding-disorder causing medications?
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
What is the most common inherited bleeding disorder?
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
`What is Hemophilia?
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
Treatment of Hemophilia?
transfuse blood clotting factors they’re deficient in
if already bleeding: can cause anemia
PT with hemophilia patients?
positive for QOL, pain control, mobility, ROM
can be safe, just need precautions
Precautions for patient with bleeding disorder?
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
What is virchow’s triad? Components?
goes through risk factors for clotting:
Stasis: prolonged immobility
Vessel wall injury: surgically or traumatic
hypercoagulability: genetic, estrogen therapy, smokers
How does a clotting disorder first present? Where is the pain?
DVT in deep veins of the LE
Calf pain, swelling, redness and tenderness– medially and posterior knee/popliteal area
usually unilateral
What is concerning about a DVT?
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
What patients are at risk for clotting disorders?
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
Is mobility safe for pts with a DVT?
early ambulation is beneficial and decreases long-term pain, etc.
What do you need to look for with a patient with a clotting disorder?
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
