Exam 2: Hematological Alterations Flashcards
What organs keep your blood in balance?
Spleen: destroys cells and platelet storage
What stimulates RBC production?
- Stimulated by decreased oxygen
- Kidney then produces erythropoietin
How long do RBC’s live?
90-120 days
RBC Labs: Size (Cytic)
MCV: Normal 80-94 Small: microcytic Normal: normocytic Large: macrocytic
RBC Labs: Hemoglobin (Chromic)
MCH:
Normal 26-24
Normal: normochromic
<26: hypochromic
*Look at these values. Especially for iron deficiency anemia.
WBC: Lymphocytes
- Found in bone marrow, spleen, lymph glands
- Responsible for immunity
WBC: Neutrophils
- Attack bacteria/viruses
- Elevated in acute inflammation
WBC: Monocytes
- Macrophages
- Increased in chronic inflammation
WBC: Eosinophils
- Kills parasites
- Increased in allergies
WBC: Basophils
-Elevated during healing
Platelets
- Promote hemostasis
- Produced in bone marrow
- Stored in the spleen
- Live 8-10 days
Iron Deficiency Anemia
- Most common cause of anemia in infancy, childhood and adolescence.
- Depleted Fe stores -> decreased supply of Fe needed to make hgb for RBC
What are risk factors for iron deficiency anemia?
- Decreased iron intake
- Increased iron or blood loss
- Periods of increased growth
- Fastest growth periods: 6-24 months and Adolescence
What are the causes of iron deficiency anemia?
- Decreased iron intake
- Inadequate iron stores: premature, multiple birth, anemic mother
- Decreased absorption: never give iron w/ milk; vitamin C enhances absorption
- Blood loss: hemorrhage, parasites
- Excessive demands: premature, pregnancy
- Inability to form Hgb: Lack of B12 and folic acid
Iron Deficiency Anemia: Decreased iron intake
Rare before 6 months: maternal iron stores still present
Increasing iron intake
- Cow’s milk: whole milk after 1 year; formula/breast milk until 1 year
- After four months: cereal/veg/fruits/meats
What are clinical manifestations of iron deficiency anemia?
- Pallor with porcelain-like skin
- Pale mucous membranes
- Pale conjunctiva
- Tachycardia
- Tachypnea
- Lethargy
- Fatigue
- Irritability
Children with lead poisoning often have associated
Iron-deficiency anemia
Diagnostics: Iron Deficiency Anemia
- History: emphasis on nutrition
- CBC:
- Low hgb
- Decreased MCV
- Decreased MCH
- Increased TIBC (total iron binding capacity)
Iron Deficiency Anemia: Management
- Increase dietary intake
- Iron supplementation
Iron Deficiency Anemia Management: Increased Dietary Intake
- Iron fortified
- Limit cow’s milk to 24 oz/day or less
- Iron rich foods
Iron Deficiency Anemia Management: Iron Supplementation
- Daily oral preparation
- Give with a multivitamin or fruit juice: Vitamin C increases absorption
- Don’t give with milk or antacids: decreases absorption
- 2 divided doses between meals
- Can stain teeth (take through a straw and brush teeth after)
- Causes black, tarry stools
Iron Rich Foods include
- Carbs: bread, cereal, whole grains
- Proteins: egg yolk, meats/liver, shellfish, tofu
- Veggies/fruits: dark leafy greens, potatoes, dried fruits, raisins and prune juice
- Other: kidney beans, legumes, nuts and seeds
Sickle Cell Disease
- Inherited
- Autosomal recessive condition
- Primarily affects individuals from African decent
Sickle Cell Disease is characterized by
- Production of sickle hemoglobin
- Chronic Hemolytic Anemia
- Ischemic tissue injury
Sickle Cell Disease Manifestations are a result of
- Obstruction caused by the sickled RBC’s and increased destruction of RBC’s.
- Infants do not produce HgS until about 4 months of age (d/t maternal stores)
What are clinical manifestations of sickle cell disease?
- Chronic hemolytic anemia
- Pallor
- Jaundice
- Fatigue
- Cholelithiasis
- Delayed growth and puberty
- Avascular necrosis of the hips and shoulders
- Renal dysfunction
- Retinopathy
Sickle Cell Crisis includes
- Vaso-Occlusive Crisis
- Acute Sequestration Crisis
- Apastic Crisis
Vaso-Occlusive Crisis: Painful Episode
- Most common
- Painful episode
- Precipitated by infection, cold, stress, acidosis and hypoxia
Vaso-Occlusive Crisis includes
- Painful episode
- Acute Chest Syndrome: can be confused with pneumonia
- Hand-and-foot syndrome
- Priapism
- CVS
Treatment for Vaso-Occlusive Crisis: Pain Episode
- IVF
- Opioids
- NSAIDs
- O2
Acute Chest Syndrome
…
Treatment for Acute Chest Syndrome
- IVF
- O2
- Transfusion
Acute Sequestration Crisis
- Blood volume pooling in the spleen
- Life-threatening condition
Acute Sequestration Crisis Treatment
- IVF
- Blood Transfusion
- Possible splenectomy
Apastic Crisis
- Profound anemia caused by diminished erythropoiesis
- Treat with transfusion
Evaluation of Sickle Cell Disease
- CBC: Elevated reticulocyte count
- Hemoglobin electrophoresis
- Universal screening for newborns
- Prenatal diagnosis: chronic villi sampling at 8-10 weeks gestation; amniocentesis at 15 weeks gestation
Treatment of Sickle Cell Disease
- Vaccinations: pneumococcal and meningococcal; influenza
- Spleenectomy
- Prophylactic ABT: PCN V
- O2 and blood transfusion: To reduce the number of circulating sickle cells
- Analgesia
Management of Sickle Cell Disease: Monitoring
- Monitor for stroke
- Monitor for infection
Management of Sickle Cell Disease: Interventions
- Maintain adequate hydration and blood flow
- Extend extremities to promote venous return
- HOB no more than 30 degrees
- Diet: high calorie, protein w/ folic acid.
Hemophilia
- Hereditary bleeding disorder: dysfunction or absence of specific coagulation proteins
- X-linked autosomal recessive disorder
- No cure
Hemophilia A (Classic)
Deficiency of coagulation factor VIII.
Most common.
Hemophilia B (Christmas)
Deficiency of factor IX
Hemophilia Manifestations
- Bruise easily
- Epistaxis
- Hematuria
Hemophilia: Bleeding with
- Loss of deciduous teeth
- Injections
- Minor lacerations
Hemophilia: It is common to develop
Bleeding in muscles and joints
Hemophilia: Labs
- PT
- PTT
- Fibrinogen level
- Platelet count
- Factor assays
Hemophilia Management
- Individual and depends on severity
- Prevent excessive bleeding and tissue damage.
- Supply the body with missing or ineffective factor: regularly scheduled, beginning in early childhood
- Avoid aspirin and NSAIDs: will increase bleeding
How is bleeding treated in hemophilia?
RICE: Rest, Ice, Compression, Elevation
Treatment for Hemophilia
- Replacement of missing clotting factors
- Additional meds: pain relievers and corticosteroids
- Desmopressin acetate (DDAVP): vasoconstrictor action to stop bleeding
What are major risks associated with factor replacement therapy?
- Hepatitis
- HIV
- Joint Problems (prophylactic therapy to prevent)
Immune Thromboycytopenia
- Acquired hemorrhagic disorder
- Evolution of antibodies against multiple platelet antigens: usually follows a viral illness; an autoimmune process
Immune Thrombocytopenia: Characterized by
- Thrombocytopenia: platelet count <20,000**
- Purpuric rash
- Normal bone marrow
What are clinical manifestations of immune thrombocytopenic purpura?
- Sudden onset of bruising and petechiae
- Bleeding that involves the mucous membranes and gums
Immune Thrombocytopenic Purpura Evaluation
- History
- Physical Exam
- CBC
- Peripheral Blood Smear
Immune Thrombocytopenic Purpura Management
- Frequent neurological assessment
- Restore platelet count to >20,000
- Anti-D antibody administration
- IV or oral steroids: blocks the autoimmune destruction of platelets
- IVIG
- Splenectomy
- Platelet transfusion: only if active, uncontrolled bleeding.
Immune Thrombocytopenic Purpura Interventions
- Extra-soft bristle tooth brushes
- If splenectomy performed, administer prophylactic penicillin daily
What should be avoided in patients with immune thrombocytopenic purpura?
- Avoid aspirin and NSAID’s
- No contact sports
- Delay administration of live virus vaccines
- Avoid IM injections
