ch 30 hematologic problems - book/1

Question 1

anemia is defined as

3

Answer 1

1. def in the number of RBCs
2. def in quantity or quality of hgb
3. low volume of PRBCs (hematocrit)

Question 2

anemia is dx based on

3

Answer 2

1. CBC
2. reticulocyte count
3. peripheral blood smear

Question 3

most accurate means of classifying anemias

Answer 3

morphology

Question 4

thalassemias is caused by

Answer 4

decreased globin synthesis

Question 5

CM of anemia are caused by the body’s response to

Answer 5

tissue hypoxia

Question 6

anemia s/s mild state

Answer 6

may be w/o s/s

Question 7

mild state anemia s/s if present

Answer 7

1. palpitations
2. dyspnea
3. mild fatigue

Question 8

mild anemia hgb level

Answer 8

10-12

Question 9

moderate anemia hgb level

Answer 9

6-10

Question 10

severe anemia hgb level

Answer 10

<6

Question 11

anemia acute interventions include

4

Answer 11

1. blood transfusions
2. drug therapy (EPO, vitamins)
3. RBC replacement
4. oxygen therapy

Question 12

nutrition - encourage

Answer 12

high iron foods

Question 13

is anemia a normal finding in older adults

Answer 13

no

Question 14

clinical manifestations of anemia in older adults may include
5

Answer 14

1. pallor
2. confusion
3. ataxia
4. fatigue
5. worsening CV and respiratory problems

Question 15

iron def anemia can be caused by

Answer 15

malabsorption of irone from GI surgery and malabsorption syndromes; removal or bypass of the duodenum

Question 16

how much blood must be lost to show melena (blood in stool)

Answer 16

50-75 mL

Question 17

common causes of GI blood loss are

6

Answer 17

1. peptic ulcer
2. gastritis
3. esophagitis
4. diverticula
5. hemorrhoids
6. neoplasia

Question 18

iron def anemia clinical manifestations

6

Answer 18

1. pallor #1
2. glossitis #2
3. cheilitis (inflammation of lips)
4. headache
5. paresthesias
6. burning of tongue

Question 19

iron is absorbed best from

2

Answer 19

duodenum

proximal jejunum

Question 20

when and how to take iron

Answer 20

about an hour before meals, when the duodenal mucosa is most acidic; take with vit c

Question 21

GI s/e of iron

3

Answer 21

1. heartburn
2. constipation
3. diarrhea

Question 22

iron injection

3

Answer 22

1. can stain skin
2. IM or IV
3. use z track

Question 23

groups at increased risk for iron-def anemia

5

Answer 23

1. premenopausal women
2. pregnant women
3. low socioeconomic backgrounds
4. older adults
5. individuals experiencing blood loss

Question 24

iron def anemia - reassess what counts to evaluate the response to therapy
2

Answer 24

hgb and RBC counts

Question 25

monitor what if needing lifelong iron

Answer 25

liver function

Question 26

thalassemia

Answer 26

group of diseases involving inadequate production of normal hgb, and therefor decreasing erythrocyte production

Question 27

group of diseases involving inadequate production of normal hgb, and therefor decreasing erythrocyte production

Answer 27

thalassemia

Question 28

thalassemia is due to

Answer 28

an absent or reduced globulin protein

Question 29

thalassemia minor vs major

Answer 29

minor: usually w/o s/s; mild to mod anemia with microcytosis and hypochromia (pale cells)
major: life threatening; growth physically and mentally is retarded; pale, general s/s of anemia

Question 30

thal major s/s

3

Answer 30

1. pale
2. jaundice from hemolysis of RBCs
3. pronounced splenomegaly

Question 31

chronic BM hyperplasia and expansion of the marrow space

Answer 31

thal major

Question 32

thal major is managed with

3

Answer 32

1. blood transfusions
2. exchange transfusions
3. chelating agents that bind to iron (reducing the iron overloading that occurs with chronic transfusion therapy)

Question 33

what is required for cobalamin absorption

Answer 33

IF

Question 34

most common cause of cobalamin def is

Answer 34

prenicious anemia, which is caused by an absence of IF

Question 35

gastric mucosa is not secreting IF because of either gastric mucosal atrophy or autoimmune destruction of parietal cells

Answer 35

pernicious anemia

Question 36

what is required for secretion of IF

Answer 36

acidic environment

Question 37

causes of cobalamin def include

5

Answer 37

1. GI surgery (gastrectomy, gastric bypass)
2. small bowel resection involving ileum
3. Crohn’s disease
4. ileitis
5. celiac disease

Question 38

general manifestations of anemia r/t cobalamin def develop because of

Answer 38

tissue hypoxia

Question 39

cobalamin anemia s/s

6

Answer 39

1. sore, red, beefy tongue
2. anorexia
3. NV
4. abd pain
5. weakness
6. paresthesias of hands and feet

Question 40

pernicious anemia dx studes

3

Answer 40

1. macrocytic with abnormal shape
2. low cobalamin levels
3. normal folate levels