exam 4- HEMATOLOGY Flashcards
normal counts for
RBC
WBC
Hgb/Hct
platlets
RBC: 3-6
WBC: 4500-11,000
Hgb: 13-17 M or 12-15 F
Hct: 41-50 M or 36-48 F
platlets: 150-450k
Hgb and s/s of mild anemia
10-12 exertional dyspnea, fatigue, palpitations
Hgb and s/s of severe anemia
<6 - Pallor, glossitis, smooth tongue, tachycardia and murmurs, tachypnea, dyspnea at rest, bone pain
Hgb and s/s of mod anemia
6-10 / dyspnea, fatigue and bounding pulse
3 causes of decreased RBC production
deficient nutrients / dec erythropoetin / dec iron available
4 causes of increased RBC destruction
SCD / incompatible blood / trauma / medication
anemia is a def in what 3
number of RBC / quantity of Hgb / volume of RBC (Hct)
interventions for anemia 5
RBC replacement with med erythropoetin
O2
increased iron intake (nutrition)
alternating rest and activity
monitoring cardiorespiratory
hereditary vs acquired hemolytic anemia
hereditary = RBC defect themselves in SCD
acquired: RBC normal but outside factor causes destruction
both are destruction>production
what is acquired hemolysis anemia a result of
hemolysis of RBC from extrinsic factors
4 specific s/s to acquired hemolytic anemia
jaundice
splenomegaly
flank pain -
blood transfusion rxn
major focus of tx for acquired hemolytic anemia
maintence of renal function
focus of care for acquired hemolytic anemia 6
supportive care
emergency prep for crisis
aggressive hydration and electrolyte replacement
corticosteroids
blood products
splenectomy
8 step pathphys of SCD
crescent shape RBC -> clogged vessel -> hemostasis -> self perpetuating hypoxia -> more sickling -> tissue necrosis -> major organ damage
5 triggers to SCD
low O2
infection (most common)
stress
altitude
surgery
how to prevent SCD crisis
O2 to reverse initial sickling
5 s/s of SCD
usually asymptomatic unless in an episode
PAIN
pallor mucuous membranes
jaundice
gallstones
spleen and kindey dysfunction
most common complication of SCD
pnemuococcoal pneumonia
3 lung complications of SCD
pnuemonia, tissue infarction, fat embolism
5 s/s of acute chest syndrome and what is it a complication of
fever, chest pain, cough, lung infiltrates, dyspnea
9 priorities of SCD interventions
O2
assess respiratory
rest with VTE prophylaxis
fluids
transfusion therapy
pain management with opioids
folic acid
hydroxurea (increases Hgb production and alters adhesion of sickle RBC)
stem cell transplant
clotting stages 5
vasoconstriction, vessel clogs
platlets adhere
platlets bind to fibrinogen
ADP released and platlet plug forms
thrombin converts fibrinogen to fibrin network
thrombocytopenia vs hemophillia vs DIC defintions
Thrombocytopenia - reduction of platelets
Hemophilia - genetic disorder caused by a defective or deficient coagulation factor
Disseminated Intravascular Coagulation (DIC) - Abnormal response of the normal clotting cascade stimulated by a disease process or disorder
2 causes of thrombocytopenia
drug and other diseases
platlet count for thrombocytopenia and what does it result in
<150,000 and abnormal hemostasis aka prolonged or spontaneous bleeding
tx for autoimmune thrombo.
corticosteroids and splenectomy
tx for thrombotic thrombo.
plasma
tx for heparin thrombo.
protamine sulfate
major complication of thrombocytopenia and the s/s
hemorrage - weakness, fainting, dizziness, tachycardia, abdominal pain, and
hypotension
main s/s of thrombocytopenia
usually asymptomatic but also Bleeding into the skin is seen as petechiae, purpura, or superficial
ecchymoses.
thrombocytopenia education
- Notify your HCP of any symptoms of bleeding. These include:
* Black, tarry, or bloody bowel movements
* Black or bloody vomit, sputum, or urine
* Bleeding from the mouth or anywhere in the body
* Bruising or small red or purple spots on the skin
* Difficulty talking, sudden weakness of an arm or leg,
confusion
* Headache or changes in how well you can see - Ask your HCP about restrictions in your normal activities, such
as vigorous exercise or lifting weights. Generally, walking is
safe. Wear sturdy shoes or slippers. If you are weak and at risk
for falling, get help or supervision when getting out of bed or
chair. - Do not blow your nose forcefully; gently pat it with a tissue if
needed. For a nosebleed, keep your head up and apply firm
pressure to the nostrils and bridge of your nose. If bleeding
continues, place an ice bag over the bridge of your nose and the
nape of your neck. If you are unable to stop a nosebleed after 10
minutes, call your HCP. - Do not bend down with your head lower than your waist.
- Prevent constipation by drinking plenty of fluids. Do not strain
when having a bowel movement. Your HCP may prescribe a
stool softener. Do not use a suppository, an enema, or a rectal
thermometer without the permission of your HCP. - Shave only with an electric razor. Do not use blades.
- Do not tweeze your eyebrows or other body hair.
- Do not puncture your skin, such as getting tattoos or body
piercing. - Do not use any medication that can prolong bleeding, such as
aspirin. Other medications and herbs can have similar effects. If
you are unsure about any medication, ask your HCP or
pharmacist about it in relation to your thrombocytopenia. - Use a soft-bristle toothbrush to prevent injuring the gums.
Flossing is usually safe if done gently using the thin tape floss.
Do not use alcohol-based mouthwashes since they can dry your
gums and increase bleeding. - Women who are menstruating should keep track of the number
of pads that are used per day. When you start using more pads
per day than usual or bleed more days, notify your HCP. Do not
use tampons; only use sanitary pads. - Ask your HCP before you have any invasive procedures done,
such as a dental cleaning, manicure, or pedicure.
The proper
cause and incidence of hemophillia
autosomal recessive genetic
if mom has it then sons have 50% chance
if dad has it and he has daughters then the daughters are carriers and their sons have 50%
thrombocytopenia vs hemophillia
thrombo: low platlets , normal labs
hemophillia : no clotting factors, normal PT and platlets but prolonged PTT
4 interventions general for thrombocytopenia
corticosteroids to supress spleen
splenectomy
treat underlying cause
stop heparin
9 ss of hemophillia
Slow, persistent, prolonged bleeding from minor trauma;
Delayed bleeding after minor injury;
Uncontrolled hemorrhage after dental procedure;
Frequent epistaxis
GI bleeding
Hematuria from GU trauma
Ecchymosis & subQ hematoma
Hemarthrosis
Pain, anesthesia from nerve compression
6 intervention/education for hemophillia
Factor replacement (fresh frozen plasma)
Managing bleeding emergencies
Rest affected joints, ice, analgesia
easy exercise
Daily oral care
avoid injury
3 dx for hemophillia
factor deficiency
prolonged PTT
normal PT and platlets
name wbc
lymphocytes, monocytes, granulocytes
when is neutropenia dx
ANC <1000
2 phagocytic mechanisms impaired in neutropenia
LACK OF inflammation, lack of puss
what to do if someone with neutropenia has sore throat, fever >100.4
go to ED or contact HCP
6 interventions for neutropenia
close monitoring
determine cause
identify organism
hematopoeitc growth factor
protective enviornmental practices
7 education for neutropenic
hand hygiene
avoid crowds
daily skin and mouth care
no uncooked meats and flowers and fruits
protective equipment
monitor temp
filgrastim moa, common SE, storage, admin, monitor
stimulates BM to produce neutrophils
bone pain common SE
store in fridge
dont shake
monitor CBC and WBC should increase
Acute hemolytic reaction and ss
most common cause is transfusion of ABO-incompatible blood
Low back pain
Dark urine
Renal failure
Tachypnea/Dyspnea
Tachycardia
Shock
CL management
