blood test

Question 1

Leukemia

Answer 1

Hematopoietic malignancy with unregulated proliferation of leukocytes

Question 2

Acute Myeloid Leukemia (AML) Basics

Answer 2

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

Question 3

myeloid cells become

Answer 3

monocytes, granulocytes, erythrocytes, and platelets

Question 4

Acute Myeloid Leukemia treatment

Answer 4

aggressive chemo

Question 5

Chronic Myeloid Leukemia special notes

Answer 5

not curable in older adults

Question 6

acute myeloid leukemia manifestations

Answer 6

fever and infection, weakness and fatigue, bleeding tendencies, pain from enlarged liver or spleen, hyperplasia of gums, bone pain

Question 7

Acute Lymphocytic Leukemia manifestations

Answer 7

Pain from enlarged liver/spleen, bone, CNS; headache and vomiting
Most men present with testicular pain, headache, n/v.

Question 8

Chronic Lymphocytic Leukemia

Answer 8

Common malignancy of older adults, and the most prevalent type of adult leukemia
Increased lymphocyte count is always present with CLL.

Question 9

chronic lymphocytic leukemia manifestations

Answer 9

“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

Question 10

Myelodysplastic Syndromes

Answer 10

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

Question 11

myelodysplastic syndromes cure

Answer 11

Only cure is with HSCT
treatments can include blood transfusion, bone marrow–stimulating agents, immunosuppressive therapy in some, chelation therapy, and myeloid growth factors

Question 12

Myeloproliferative Neoplasms

Answer 12

Polycythemia vera
Essential thrombocythemia
Primary myelofibrosis

Question 13

Polycythemia Vera overview

Answer 13

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

Question 14

polycythemia vera treatment

Answer 14

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

Question 15

Essential Thrombocythemia

Answer 15

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

Question 16

Primary Myelofibrosis

Answer 16

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

Question 17

Primary Myelofibrosis Treatment

Answer 17

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

Question 18

Hodgkin Disease

Answer 18

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

Question 19

hodgkin disease symptoms and treatment

Answer 19

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

Question 20

Non-Hodgkin Lymphoma (NHL)

Answer 20

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

Question 21

non-hodkin lymphoma manifestations and treatment

Answer 21

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

Question 22

Multiple Myeloma manifestations

Answer 22

bone pain reported in 80%, mostly back and ribs; osteoporosis and fractures related to bone destruction; hypercalcemia, renal impairment and failure, anemia

Question 23

multiple myeloma and crabs

Answer 23

C- hypercalcemia
R – renal dysfunction
A – anemia
B – bone destruction – osteoclasts break down the bone

Question 24

hypercalcemia s/s

Answer 24

cardiac arrhythmias, shortened QT interval, weakness, nephrolithiasis, constipation, depression, confusion, fatigue, and anorexia
Risk for pain and pathologic bone fractures. Focus on safety

Question 25

Hypoproliferative anemia

Answer 25

defect in production of erythrocytes (RBCs)
can lead to megaloblastic cells

Question 26

Hemolytic anemia

Answer 26

excess destruction of erythrocytes (RBCs)
Caused by altered erythropoiesis, or direct injury to the erythrocyte.

Question 27

manifestations of anemia

Answer 27

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)

Question 28

Erythropoietin

Answer 28

made by kidneys to stimulate red blood cell production

Question 29

Sickle cell disease big points

Answer 29

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

Question 30

sickle cell trait big points

Answer 30

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.

Question 31

Immune hemolytic anemia

Answer 31

low hbg, low hct, increased reticulocyte count, increased bilirubin

Question 32

Hemolytic anemia big notes

Answer 32

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)

Question 33

Iron deficient anemia

Answer 33

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

Question 34

Hypoproliferative Anemias

Answer 34

Iron deficiency anemia
Anemia in renal disease
Anemia of inflammation
Aplastic anemia
Megaloblastic anemia
>Folic acid deficiency
>Vitamin B12 deficiency

Question 35

Polycythemia

Answer 35

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

Question 36

von Willebrand disease

Answer 36

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

Question 37

bleeding disorders notes

Answer 37

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

Question 38

Acquired Coagulation Disorders

Answer 38

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

Question 39

signs and symptoms and progression of thrombi and bleeding

Answer 39

Decrease in temp, superficial gangrene, frank hemmorage, bleeding from gums, wounds, petichie, so much more

Question 40

Hematopoiesis

Answer 40

formation and maturation of blood cells

Question 41

Stroma

Answer 41

where the stimulating factors are made. Hormones or cyto-something

Question 42

Vitamin B12 and folic acid

Answer 42

required for DNA synthesis and RBCs. Requires intrinsic factor from the stomach. Must be taken from the diet.

Question 43

iron deficiency of anemia s/s

Answer 43

Low serum iron and low serum feratin along with symptoms of PICA

Question 44

Megaloblastic anemia is caused by

Answer 44

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

Question 45

what indicates an ACUTE infection process

Answer 45

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

Question 46

Eosinophils are for

Answer 46

allergic reaction

Question 47

Basophils

Answer 47

histamine and hypersensitivity reaction

Question 48

Neutrophils

Answer 48

(prevents or eliminates infection via phagocytosis) 2x the size of a RBC
>Bands: left shift (immature, increases during infection)

Question 49

old people and blood production

Answer 49

less able to increase blood cell production when blood cell demand is increased. Bone marrow’s ability to respond to demand is decreased

Question 50

Splenectomy

Answer 50

acute risk of infection. (seek medical attention for even MINOR signs of infection, especially immediately after procedure)

Question 51

Apheresis

Answer 51

(blood is taken from the patient and passed through a centrifuge, specific shit is taken out and blood is returned)

Question 52

blood donation and temperature

Answer 52

Oral temp cant be higher than 99.6F

Question 53

Pretransfusion assessment

Answer 53

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.

Question 54

speed of blood transfusion

Answer 54

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.

Question 55

blood transfusion signs to look for

Answer 55

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.

Question 56

Acute hemolytic reaction s/s:

Answer 56

** fever, chills, chest tightness, dyspnea, nausea, anxiety, hemoglobinuria (check catheter bag before and during infusion), bronchospasm, etc**

Question 57

TRALI

Answer 57

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.