blood test Flashcards
Leukemia
Hematopoietic malignancy with unregulated proliferation of leukocytes
Acute Myeloid Leukemia (AML) Basics
Defect in stem cell that differentiate into all myeloid cells: monocytes, granulocytes, erythrocytes, and platelets
Most common nonlymphocytic leukemia
Affects all ages with peak incidence at age 67 years
Prognosis is highly variable
myeloid cells become
monocytes, granulocytes, erythrocytes, and platelets
Acute Myeloid Leukemia treatment
aggressive chemo
Chronic Myeloid Leukemia special notes
not curable in older adults
acute myeloid leukemia manifestations
fever and infection, weakness and fatigue, bleeding tendencies, pain from enlarged liver or spleen, hyperplasia of gums, bone pain
Acute Lymphocytic Leukemia manifestations
Pain from enlarged liver/spleen, bone, CNS; headache and vomiting
Most men present with testicular pain, headache, n/v.
Chronic Lymphocytic Leukemia
Common malignancy of older adults, and the most prevalent type of adult leukemia
Increased lymphocyte count is always present with CLL.
chronic lymphocytic leukemia manifestations
“B symptoms,” a constellation of symptoms including fevers, drenching sweats (especially at night), and unintentional weight loss
increased lymphocyte count is always present with CLL
Myelodysplastic Syndromes
Disorder of the myeloid stem cell
May be asymptomatic or present with fatigue or illness
Diagnosed with CBC or bone marrow biopsy
can develop into anemia
myelodysplastic syndromes cure
Only cure is with HSCT
treatments can include blood transfusion, bone marrow–stimulating agents, immunosuppressive therapy in some, chelation therapy, and myeloid growth factors
Myeloproliferative Neoplasms
Polycythemia vera
Essential thrombocythemia
Primary myelofibrosis
Polycythemia Vera overview
may be given therapeutic phlebotomy
Proliferative disorder of the myeloid stem cells
Symptoms include ruddy complexion, splenomegaly, high blood pressure, generalized pruritis, and erythromelalgia
Diagnosis: elevated hgb or hct and the presence of an acquired mutation in the JAK2 gene
Risks include thrombosis complications (CVA, MI) and bleeding from dysfunctional platelets
polycythemia vera treatment
Phlebotomy (initially 500 mL or once or twice a week)
Chemotherapeutic agents to suppress marrow function
Aggressive management of atherosclerosis
Allopurinol of rasburicase to prevent gout
Aspirin for pain
Platelet aggregation inhibitors
Interferon-alfa
Essential Thrombocythemia
Also called primary thrombocythemia
Stem cell disorder within the bone marrow
Symptoms usually occur from vascular occlusion, headaches, enlarged spleen, and hemorrhage
Treatment based on risk for developing thrombosis or hemorrhage, and the presence of symptoms
Primary Myelofibrosis
Chronic myeloproliferative disorder within the stem cell
Pancytopenia is common – all cells are low
Symptoms include enlarged spleen, fatigue, pruritus, bone pain, weight loss, infection, bleeding, and cachexia
night sweats, fever, weight loss
Primary Myelofibrosis Treatment
not curable, symptoms are treated
Blood transfusions and erythroid‐stimulating agents for anemia
HSCT useful in younger people, only current therapy to reduce fibrosis of marrow
Splenectomy may be used to control significant problems
Hodgkin Disease
Relatively rare malignancy that has a high cure rate
Suspected viral etiology, familial pattern, incidence in early 20s and again after the age of 50 years; more common in men
has reed sternburg cells
hodgkin disease symptoms and treatment
Manifestations: painless lymph node enlargement; pruritus; B symptoms: fever, sweats, weight loss
Treatment is determined by stage of the disease and may include chemotherapy, radiation therapy, or both, and HSCT for advanced disease
Non-Hodgkin Lymphoma (NHL)
Lymphoid tissues become infiltrated with malignant cells; spread is unpredictable and localized disease is rare
Increased in autoimmune, prior treatment for cancer, organ transplant, viral infections, exposure to pesticides
non-hodkin lymphoma manifestations and treatment
Manifestation: lymphadenopathy, B symptoms, and symptoms associated with lymphomatous masses
Treatment is determined by type and stage of disease and may include interferon, chemotherapy, radiation therapy, and HSCT
Multiple Myeloma manifestations
bone pain reported in 80%, mostly back and ribs; osteoporosis and fractures related to bone destruction; hypercalcemia, renal impairment and failure, anemia
multiple myeloma and crabs
C- hypercalcemia
R – renal dysfunction
A – anemia
B – bone destruction – osteoclasts break down the bone
hypercalcemia s/s
cardiac arrhythmias, shortened QT interval, weakness, nephrolithiasis, constipation, depression, confusion, fatigue, and anorexia
Risk for pain and pathologic bone fractures. Focus on safety
Hypoproliferative anemia
defect in production of erythrocytes (RBCs)
can lead to megaloblastic cells
Hemolytic anemia
excess destruction of erythrocytes (RBCs)
Caused by altered erythropoiesis, or direct injury to the erythrocyte.
manifestations of anemia
A healthy person can use 50% of their hemoglobin in a few months and have no symptoms, if it is happening rapidly it can lead to vascular collapse
Depends on how fast, duration, metabolic requirements, concurrent problems, and concomitant features
Fatigue, weakness, malaise, pallor or jaundice, gardiac, GI, neurologic and respiratory symptoms, tongue changes (beefy red tongue – pernicious anemia), nail changes, angular cheilitis (cracks in the corner of the mouth), pica (cravings for non food items)
Erythropoietin
made by kidneys to stimulate red blood cell production
Sickle cell disease big points
VERY PAINFUL, Low Hct, abnormalities in blood smear. Often diagnosed in childhood and deal with life long problems. Notify provider immediately with signs of infections fatigue is common – get activities done in morning and avoid cold weather
sickle cell trait big points
Educate these patients that if they have a children with someone else with sickle cell trait they have a 1 in 4 chance to have a child with sickle cell disease. 1 in 365 African Americans have sickle cell trait
Sickle cells only last 10-20 days rather than 120 days for a normal cell. 10% of sickle cell patients under 20 have strokes. Diagnostic is normal Hct, Hg and normal blood smear.
Acute chest syndrome: often cause is infection.
Immune hemolytic anemia
low hbg, low hct, increased reticulocyte count, increased bilirubin
Hemolytic anemia big notes
you will see an increase in bilirubin and increased reticulocyte count. Leads to tissue hypoxia. Bone marrow will respond to this by increasing red blood count by producing reticulocytes (immature red blood cells)
Iron deficient anemia
eat more iron. Intake more iron. Most common in pre-menopausal women and men with GI bleeds. Medical management is iron supplements. Nursing management is increase iron in diet. Organ meat and OJ. Darkened stool is normal when taking iron supplements
Hypoproliferative Anemias
Iron deficiency anemia
Anemia in renal disease
Anemia of inflammation
Aplastic anemia
Megaloblastic anemia
>Folic acid deficiency
>Vitamin B12 deficiency
Polycythemia
Increased volume of RBCs
Too much hct will make the blood flow like honey when we want it to flow like water.
treat underlying cause
von Willebrand disease
factor 8 in clotting cascade. Nose bleeds, bleeding gums, heavy menses. goal with treatment is to replace the deficient protein prior to any invasive procedure to prevent excessive bleeding
bleeding disorders notes
Notify dentist if pt has any invasive dental work with they have thrombocytopenia.
Transfusions tend to be ineffective because antiplatelet transfusions will be broken down by the patient’s own antiplatelet antibodies. Pt’s ITP game is too strong
pt will present with bruising
Acquired Coagulation Disorders
liver disease
Vitamin K deficiency (Once bleeding has stopped. Not used to prevent bleeding.)
Complications of anticoagulant therapy
Disseminated intravascular coagulation (DIC) Antithrombin deficiency
Protein C & S deficiency
Activated protein C resistance and factor V Leiden mutation
Acquired thrombophilia
Malignancy
Thrombotic disorders
Hyperhomocysteinemia
signs and symptoms and progression of thrombi and bleeding
Decrease in temp, superficial gangrene, frank hemmorage, bleeding from gums, wounds, petichie, so much more
Hematopoiesis
formation and maturation of blood cells
Stroma
where the stimulating factors are made. Hormones or cyto-something
Vitamin B12 and folic acid
required for DNA synthesis and RBCs. Requires intrinsic factor from the stomach. Must be taken from the diet.
iron deficiency of anemia s/s
Low serum iron and low serum feratin along with symptoms of PICA
Megaloblastic anemia is caused by
Vitamin b12 and folic acid deficiency. If RBCs are too big, it will not get down to the capillary or even get trapped within the bone marrow
what indicates an ACUTE infection process
ELEVATED WBC WITH ELEVATED BANDS AND NORMAL MONOCYTES
Monocytes last in the blood just a few days, macrophage lasts much longer. Chronic infection would lead to a raised monocyte level
Eosinophils are for
allergic reaction
Basophils
histamine and hypersensitivity reaction
Neutrophils
(prevents or eliminates infection via phagocytosis) 2x the size of a RBC
>Bands: left shift (immature, increases during infection)
old people and blood production
less able to increase blood cell production when blood cell demand is increased. Bone marrow’s ability to respond to demand is decreased
Splenectomy
acute risk of infection. (seek medical attention for even MINOR signs of infection, especially immediately after procedure)
Apheresis
(blood is taken from the patient and passed through a centrifuge, specific shit is taken out and blood is returned)
blood donation and temperature
Oral temp cant be higher than 99.6F
Pretransfusion assessment
must get a good history (prev. transfusions, prev. transfusions reactions – if so what symptoms, how many pregnancies (increased pregnancies can create an increased reaction)- check them more frequently. Full set of vitals before and during, temperature) Patients with heart failure may need a diuretic to help with fluid overload.
speed of blood transfusion
No faster than 75mL per hour (can do slower) to start, can titrate up after the first 15 once you can see how they’re doing. Must be fully transfused within 4 hours to prevent bacterial growth.
blood transfusion signs to look for
fever, chills, rash, lower back pain, anxiety. Tell the patient to call you at the first sign of anything feeling off. Its better to stop and check than to power through.
Acute hemolytic reaction s/s:
** fever, chills, chest tightness, dyspnea, nausea, anxiety, hemoglobinuria (check catheter bag before and during infusion), bronchospasm, etc**
TRALI
most common problem related to blood transfusion. Dyspnea, SOB, hypoxia, hypotension, fever, pulmonary edema. Dx needs a chest x-ray and O2 sat <90 post transfusion. Rule out cardiac problems. Aggressive supportive therapy. Corticosteroids not effective. Most common in FFP and platelets. Limit frequency and amount of blood products being transfused, only get donations from men because women may have extra antibodies from childbirth.
