Assessment of Hematologic Function Flashcards
1
Q
Hematologic System
- Blood
- Lymph nodes/nodules
- Thymus
- Accessory organs (liver, spleen)
- Bone marrow
A
- Lymph nodes are interconnected in our bodies by lymph vessels. Most are found in the thoracic and abdominal cavities, the neck, axilla, inguinal, and superficial areas
> Look to see if there are changes to the lymph shape or size
2
Q
Lymph nodes produce Ig and IgA (immunoglobulins)
Nodules are smaller than lymph nodes but equally important
A
3
Q
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Is an endocrine organ responsible for producing T cells
The accessory organs are the liver and spleen
A
Thymus
4
Q
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Is the primary producer of most clotting factors; is the storage site for most blood cells
A
Liver
5
Q
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This organ balances blood cell production and destruction; assists with immune function; iron metabolism; and restores platelets and blood cells
A
Spleen
6
Q
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Is the major site of blood cell and stem cell formation
Produces most of the cells of the blood (RBC’s, WBC’s, platelets) and is involved in the immune response
A
Bone marrow
7
Q
Blood Function
- Carry oxygen to cells
- Assist with acid-base balance
- Transport carbon dioxide back to the lungs
- Coagulation
- Defense against infection
A
- Blood volume is higher in males (5-6L) opposed to females (4-5L) [can vary based on factors]
- Blood is more viscous than water; made in the bone marrow, spleen, and liver
- Affected by age, body composition, nutrition, hydration, medications
> NSAIDs impair the hematologic system
8
Q
Blood Composition
- Plasma (55%)
> Proteins (8%) [albumin, globulin, fibrinogen]
> Water (90%)
> Other solutes (2%) [nutrients, electrolytes, waste products, hormones, gases]
A
- Buffy coat: WBC’s and platelets (<1%)
- RBC’s (45%)
9
Q
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Is the component of plasma involved in blood clotting
A
Fibrinogen
10
Q
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Is the component of plasma that maintains osmotic pressure of the blood which prevents plasma from leaking into tissues
A
Albumin
11
Q
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Is the component of plasma that is involved in the transportation of substances and antibiotic function
A
Globulin
12
Q
Erythrocytes (RBC’s)
- Erythrocyte - mature RBC
- Reticulocyte - immature RBC
- Needs Vitamin B12 and folic acid for RBC maturation
A
- Lifespan is 120 days
- Normal: 4-6 million
- Responsible for producing hemoglobin
13
Q
Hemoglobin’s main function is to carry oxygen; carry iron to tissues, lungs, and other organs
> Needs iron in order to produce hemoglobin (Hgb)
A
14
Q
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Normal Hgb in females ?
A
12-16
15
Q
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Normal Hgb in males ?
A
13-18
16
Q
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Is a growth factor that stimulates RBC production in the bone marrow
> Is released by the kidneys and the bone marrow produces it
A
Erythropoietin
17
Q
Leukocytes (WBC’s)
- Function = inflammation/immunity
- Most are formed in the bone marrow
- What is a normal count?
- What are the 2 categories?
A
5000 - 10,000 μL
Granulocytes, agranulocytes
18
Q
What are the 3 types of granulocytes?
A
- Neutrophils
- Eosinophils
- Basophils
19
Q
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Are responsible for allergic reactions/responses
A
Eosinophils
20
Q
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Are involved in the allergic response; release histamine and also heparin to correct tissue damage
A
Basophils
21
Q
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Are the primary responders to inflammation; comprise 55-70% of WBC’s
A
Neutrophils
22
Q
- Chemotherapy patients may need an ANC level done daily
> What is their neutrophil count? - ANC determines the risk for bacterial infection; looks at immune status helps determine the need for reverse precautions
> The higher the ANC, the higher the chance to being resistant to infection; a lower # indicates being more susceptible to infection
A
<1000 = risk for bacterial infection
<500 - high risk
23
Q
What are the 2 types of agranulocytes?
A
- Monocytes
- Lymphocytes
24
Q
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These cells destroy bacteria
A
Monocytes
25
?
These cells enhance the immune response
Lymphocytes
26
Leukopenia - a reduction in WBC's
Someone with a very low ANC ⥰ Neupogen
27
Rx's that affect WBC's
Might these lower or increase the WBC count?
* Beta adrenergic agonists (i.e., albuterol)
* Corticosteroids
* Epinephrine
* Granulocyte colony stimulating factor
* Heparin
* Lithium
may INCREASE
28
Might these lower or increase the WBC count?
* Antibiotics, anticonvulsants
* Anti-thyroid, arsenicals
* Captopril
* Chemotherapy drugs, Chlorpromazine
* Clozapine, diuretics
* Histamine-2 blockers
* Sulfonamides
* Quinidine, terbinafine, ticlopidine
may LOWER
29
Thrombocytes (Platelets)
* Smallest cell
! Controls bleeding
Normal count is ?
Lifespan of 1-2 weeks
! Thrombocytopenia is a deficiency in platelets
150,000 - 400,000 μL
30
Thrombocytes (Platelets)
* Formed in the bone marrow; stored in the spleen; and released as needed. Used to control bleeding
* Stick to an injured vessel wall and form platelet plugs; helps to repair damage to small cells to control bleed
<50,000 μL = huge risk for bleeding
Bleeding & Coagulation Measurements
* PT
* INR
* PTT or aPTT
* Platelet agglutination/aggregation
31
What is a normal PT?
10-13
32
What is a normal INR?
0.8-1.2
33
What is a normal PTT/aPTT?
20-36
34
* INR can be used with PT for those on warfarin
* Therapeutic INR for coumadin is 2.0-3.0
* PTT - looks at how long it takes the blood to clot and evaluates clotting factors II, V, VII, and IX
* PTT usually drawn on patients receiving heparin therapy; ranges can differ based on patient complication (cardiac issue vs DVT)
35
Which hematological measurement is looked at for warfarin?
PT/INR
36
Which hematological measurement is looked at for heparin?
PTT
37
Age-Related Changes to the Hematological System
> As the body ages, the # of cells are gradually reduced
> Lean body mass decreases
> Fat tissue increases until around 60
> Bone mass and intracellular fluids also tend to decrease
> Normal aging causes a decrease in total body water
* Blood volume decreases with age; bone marrow activity production to make RBCs and WBCs may be decreased
* Circulating Hgb and Hct levels may be lower, leading to fatigue in the older individual
* Reduction in lymphocyte count leads to decreased ability to fight infection
38
?
* An insufficient supply of healthy RBCs
* Common causes = nutritional, hereditary, bone marrow disease, or bleeding
Anemia
! Is a clinical sign; NOT a specific disease; can be referred to as a disease
These patients have an insufficient amount of RBCs; decreased Hgb, Hct
! Hgb (g/dL) will determine how severe the anemia is
39
Mild anemia: 10-14 g/dL
Moderate: 6-10 g/dL
Severe: <6 g/dL
40
Hematocrit - the % of RBCs
Normal % in males is __-__%; is slightly higher than females __-__%
! Hct is 3x the Hgb
Males: 42-52%
Females: 37-47%
41
Clinical Manifestations of Anemia
* Pallor, fatigue
* Intolerance to cold, cold to touch
* Nails brittle/ridged "spoon shaped"
* Tachycardia
* Weakness, palpitations
* Orthostatic hypotension, headache
Types of Anemia
> Iron deficiency
> Vitamin B12 deficiency
> Folic acid deficiency
> Aplastic
* Iron deficiency anemia **lacking iron** as opposed to aplastic anemia **where the bone marrow doesn't make enough new blood cells**
42
Iron Deficiency Anemia
* Most common
* Causes - insufficient dietary intake, blood loss, impaired absorption
- Common in women, menstruating women, childbearing or pregnant women, older adults, and people with poor dietary habits
- Type tends to be chronic and dietary intake is a big factor
* Another source is from blood loss (i.e., from the GI tract [coffee-ground emesis, black tarry stools] or menstruation)
> Also, the patient with impaired intestinal absorption or someone who's had gastric bypass surgery
* Increase dietary intake - red meat, organ meat, egg yolks, leafy green vegetables
> May need iron supplements [! Constipation = offset with fiber or increased water intake] or IM injections
43
Vitamin B12 Deficiency
* Lack of B12 in the diet
* Poor absorption
* Diagnosed: CBC, MMA (methylmalonic acid), or Schilling Test
* Treatment = dietary, B12 injections, nasal inhalation
* Increase intake through animal protein, meat, seafood, eggs, and dairy
* Psychiatric and neurological dysfunction; *glossitis* and paresthesia
* Someone who is unable to absorb vitamin B12 may be lacking the intrinsic factor needed to absorb B12; known as **pernicious anemia** (**glossitis**)
* Identifying the cause and whether the patient is able to absorb it or not will help determine treatment
44
Folic Acid Deficiency Causes (Water-Soluble B9)
* Dietary
* Malabsorption
* Medications
* Affects the elderly, chronic illness, chronic ETOH abuse
* Occurs in those who don't eat vegetables or go on extreme diets
* Also, malabsorption due to Crohn's or gastric bypass; chronic illness; chronic alcohol abuse
* Rx's - oral contraceptives, metformin, anticonvulsants, chemotherapeutic agents (methotrexate)
! Increase intake of fortified cereals, grains, green vegetables, yeast extracts, nuts, and folic acid supplements
45
?
! Rare
- Deficiency in circulating RBCs
- Chronic exposure to toxic agents, congenital
- Accompanied by decreased leukocytes, platelets
Aplastic anemia
46
- Can cause heart arrythmias
- Can be caused by chronic exposure to toxic agents like pesticides or insecticides, radiation, autoimmune disease, chemotherapy, and other medications. Can also be idiopathic
* Treatment with blood transfusions or immunosuppressive therapy
47
Anemia Management
* Early identification of those at risk
* Dietary modification
* Supplements/rx's
* Blood transfusion
Transfusion Therapy
* Verify prescription
* Test donor's and recipient's blood for compatibility (type and screen/cross-match)
* Examine blood bag for identification
* Check expiration date
* Inspect blood for discoloration, gas bubbles, or cloudiness
48
Transfusion Responsibilities
* Provide patient education
> Obtain informed consent
* Assess VS
> May need to pre-medicate with Tylenol or Benadryl
* Begin transfusion slowly and stay with the patient for the first 15-30 minutes
* Ask patient to report unusual sensations such as chills, SOB, hives, or itching
* Administer blood products per protocol
* Assess for hyperkalemia
! Occurs due to cellular damage and release of potassium into the blood; can occur from units of blood that are too old or too cold [a blood warmer may be used]
49
Transfusion Reactions
* Febrile transfusion reaction
> Chills, fever, tachycardia, HTN, tachypnea
* Hemolytic transfusion reactions
> When the blood type or blood antigens are incompatible
> Fever, chills, headache, tachycardia, tachypnea, chest pain, HTN
* Allergic transfusion reaction
> Itching, bronchospasm, anaphylaxis
50
* Bacterial transfusion reaction
> Can be caused by contaminated blood
> Tachycardia, HTN, fever, chills, and in severe cases, shock
* Circulatory overload
> Happens when blood is infused too quickly
> HTN, bounding pulse, distended neck veins, dyspnea, restlessness, confusion
51
Autologous Blood Transfusion
* Collection and infusion of patient's own blood
* Eliminates compatibility problems; reduces risk for transmission of bloodborne disease
- Also a way to minimize transfusion reactions
- Useful for a surgery; need to be infection-free; Hgb >11 g/dL; and by a provider's prescription
52
Sickle Cell Disease (Anemia)
* Increased RBC destruction
* Genetic disorder
* Sickle-shaped RBCs
* Painful
- RBCs cannot effectively transport oxygen and deliver oxygen to tissues, organs, etc.
- Those with the disease go into times of crisis
> Crisis can be caused by hypoxia, dehydration, infection, pregnancy, high altitudes, stress, alcohol, and strenuous activities
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* Pain is the first and most severe symptom
- Blood is not getting to the tissue and there is poor oxygenation from the obstructed blood flow
* We give these patients more oxygen, analgesics to help with the pain, rehydration, and blood transfusions
> Typically need opiate rx's to ease their pain
54
?
* A greater than normal RBC count
* Temporary or permanent
* Treatment = phlebotomy, hydration, anticoagulants
Polycythemia vera
55
Hgb >18 g/dL
Hct >48-52 in men
Massive production of RBCs, WBCs, and platelets
! A dark, flushed appearance, intense itching, HTN, poor tissue oxygenation (the greater viscosity of blood slows down oxygen exchange to the tissues)
> Are at a high risk for clotting
* 2-3x/week for phlebotomy isn't unusual
* Give radiation or Interferon
! Complications of this disorder are thrombosis, or blood clotting, and hemorrhage; bone marrow scarring; development of AML; HF from the heart being overtaxed; PE concern
- May get hypoxic
