Exam 4: Mon 11/30 Hematologic disorders Flashcards
What are some exaggerated responses to minimal exercise?
- Chest pain
- Palpitations
- Dyspnea
- Severe weakness
- Fatigue
Neurological symptoms include:
- Headache
- Drowsiness
- Dizziness
- Syncope
- Polyneuropathy
What are some common S&S of Hematologic Disorder?
- Skin and fingernail bed changes (cyanosis, clubbing)
- Swelling, pain in joints
- Exaggerated response to minimal exercise (dyspnea, chest pain, palpitations, severe weakness, fatigue)
- Easy bruising
- Neurological symptoms (headache, drowsiness, dizziness, syncope, polyneuropathy)
What the PT may have SSEEN in the patient.
What is Edema?
Excess fluid in interstitial tissues or body cavities
What is Congestion?
excess blood within vessels of an organ or tissue
What is an Infarction?
Area of necrosis
What is a Thrombus?
A solid mass of clotted blood
What is Lymphedema?
A Hematolymphatic disorder, obstruction of lymph vessels or nodes
What is Purpura?
A Hemorrhagic condition in which there is insufficient platelets to plug leaking vessels, blood moves under skin and through mucous membranes, producing spontaneous ecchymoses (bruises) or petechiae
What is Petechiae?
Small red pataches on skin
What is Thrombocytopenic purpura?
A decrease in circulating platelets, acute bleeding from any body orifice
When does Shock occur?
When the cardiovascular system fails to perfuse the tissues adequately
What are some effects of shock? (what it leads to)
- Impaired cellular metabolism
- Impaired oxygen use
- Impaired glucose use
Manifestations of Shock:
Manifestations vary based on stage but often include
- Altered mental status (AMS)
- ↓ pulses and urine output
- Increased respiratory rate
- Tachycardia
- Cool extremities
- Hypotension
Make A last DITCH effort to save the patient in shock.
What are some types of Shock?
- Cardiogenic –↓ cardiac output
- Hypovolemic – loss of whole blood or interstitial fluid
- Neurogenic – usually trauma to spinal cord or CNS, massive parasympathetic overstimulation and sympathetic understimulation
- Anaphylactic – hypersensitivity/allergic reaction
- Septic - infection
What is Cardiogenic Shock?
Decreased cardiac output
What is Hypovolemic Shock?
Loss of whole blood or interstitial fluid
Neurogenic Shock
Usually trauma to spinal cord or CNS, massive parasympathetic overstimulation and sympathetic understimulation
Anaphylactic shock
Hypersensitivity/allergic reaction
Septic shock
Infection
What is Lymphadenopathy?
- Abnormal enlargement of lymph nodes
- Should feel rubbery, mobile, small (≤1 cm)
What is Splenomegaly?
Splenomegaly present in many hematologic conditions, including:
- Infectious mononucleosis
- Hodgkin’s lymphoma, or
- When spleen taking over for bone marrow and producing RBCs (extramedullary hematopoiesis
A palpable spleen indicates spleen pathology- should not be able to palpate the spleen
Palpating the spleen and liver (while we’re in the neighborhood…)
What are some special considerations for Hematologic Disorders regarding changes in coagulation?
Changes in coagulation may ↑risk of thrombus, ↑ work for heart, breathing, tissue perfusion
What are some special considerations for Hematologic Disorders regarding exercise and sports?
Exercise and sports – can ↑blood volume (plasma) immediately, and ↑erythrocytes over time
- Blood doping through exogenous EPO – can ↑ blood viscosity and thrombus formation, risky process
What are the 3 systems of the body that are linked in this section as we study blood
- hematological
- lymphatic
- immune
True or False: We will see polycythemias much more commonly in our patients compared to anemias.
False
Anemias are more common
What may occur during anaphylactic shock? (4)
- loss of consciousness
- hives
- tongues swelling/ unable ot swallow
- rapid swelling of throat tissues
What is normovolemic?
a normal volume of blood in the body.
What are some special considerations for Hematologic Disorders regarding platelet levels and exercise?
- Platelet disorders – low platelets (40-60,000), keep exercise in low-load (1-2 lb.) resistance; OK for walk, bike, ADL
- 20-40,000 range, low intensity and no resistance
- Below 10,000, at risk for spontaneous bleed
What are some special considerations for Hematologic Disorders regarding the spleen?
- Splenomegaly usually associated with rapid destruction of blood cells
- Follow clotting precautions (as in difficulty with clotting
- Integrate breathing techniques and educate about avoiding injury (especially abdomen)
What are some special considerations for Hematologic Disorders regarding blood pressure?
In general – any time systolic BP drops 20 points or more, accompanied by HR↑ 15 BPM or more, may indicate hypovolemia
- Dehydration is most likely cause, or diarrhea, slow GI bleed
- May be normovolemic but on antihypertensives
What are recombinant human erythropoietin products and what are they good for?
- pharmaceutical agents such as rHuEpo, EPO, Epogen developed through DNA technology
- stimulate erythropoietin and elevate RBCs
- Reduce need for human blood transfusions in clinical situations such as chronic renal disease, cancer-related anemia, or surgical procedures like joint arthroplasty
- very important to certain religions such as Jehovah Witness
7 possible reactions to a blood transfusion or blood products
- Febrile Nonhemolytic Reaction
- Transfusion-Related Acute Lung Injury
- Acute Hemolytic Transfusion Reaction
- Delayed Hemolytic Transfusion Reaction
- Allergic Reaction
- Anaphylaxis
- Septic Reaction
What is a Febrile Nonhemolytic Reaction? (5)
- occurs in <1% RB and 30% platelet transfusions
- Reaction of either donor leukocyte cytokines, or alloantibodies of recipient
- Stop the transfusion, administer antipyretics or corticosteroids
- Usually transient
- S/S: fever, chills, HA, GI upset, hypertension, tachycardia
What is Transfusion-Related Acute Lung Injury? (3)
- occurs in 1 in 2000 transfusions
- Ranges from mild SOB to Adult Respiratory Distress Syndrome (ARDS)
- S/S: pulmonary edema, acute respiratory distress, severe hypoxia
What is Acute Hemolytic Transfusion Reaction? (4)
- 1 in 25,000
- ABO incompatibility (blood type, ex: I’m O+)
- Can be fatal or result in DIC, renal failure, severe hypotension
- S/S: fever, chills, GI upset, flank/ abdominal pain, HA, dyspnea, hypotension, tachycardia, red urine
4 points about Delayed Hemolytic Transfusion Reaction
- Donated erythrocytes quickly removed by recipient’s alloantibody
- May occur 1-4 weeks post transfusion
- Often asymptomatic, just no boost from transfusion
- S/S: unexplained anemia, jaundice, increased LDH level
3 points regarding allergic reactions to donated blood products
- typically it is a reaction to Donated Plasma
- Treated by antihistamines, corticosteroids
- S/S: hives, rash, wheezing, mucosal edema
3 points regarding anaphylaxis with donated blood products
- occurs in 1 in 20,000-50,000
- Treated as shock protocol
- S/S abrupt hypotension, edema of larynx, difficlty breathing, GI upset, shock, respiratory arrest
Ana makes the GRADES
4 points about septic reactions with donated blood products
- Result of bacterial contamination but rare due to improved lab screening
- Hepatitis B or C infection resulting from septic transfusions has significantly decreased over the years
- Treat per source of sepsis
- S/S: fever, chills, hypotension, HA, back pain, chest pain, abdominal pain, SOB
What is bloodless medicine and surgery? (4)
- Techniques reduce need for blood products and are acceptable for religious groups, such as Jehovah’s Witnesses
- Minimally invasive surgery (scopes, gamma knife, harmonic scalpel, argon beams)
- Normovolemic hemodilution
- Cell salvage techniques, retransfusing own blood – but can increase infection/hemolysis rates
What is Normovolemic hemodilution?
remove person’s own blood and replace with intravenous crystalline/colloid solution to maintain volume; post-op, person’s own blood is returned
What can PTs do when working with patients who underwent bloodless procedures? (2)
- monitor lab values when treating patients
- adjust treatment and intensity accordingly
What is Hemochromatosis? Etiology? (6 total)
- Autosomal recessive hereditary disorder
- 1 out of 8-12 people is a carrier of one abnormal gene
- Prevalence is likely higher, as disease is underdiagnosed
- Excessive absorption of iron from small intestine
- Onset of symptoms usually in 40-60 years of age
- Primarily affects Caucasians of Northern European descent
Signs and symptoms of Hemochromatosis (5)
- Weakness
- chronic fatigue
- myalgia
- joint pain
- Abnormal bronzing of the skin
Diagnosis and treatment of hemochromatosis (5)
- Diagnosis – blood tests & liver biopsy
- Treated by bleeding patient (phlebotomy, can be a blood donation)
- Initial treatment may be 1 pint/week
- Maintenance therapy - 1 pint/2-4 months for life
- May need Interventions for flexibility, strength, assistive devices, splints, AD as a result of some of the secondary conditions that may develop
Hemochromatosis may lead to (8)
- Pancreatic damage and diabetes mellitus
- Arthritis
- Liver failure
- Cardiac myopathy, CHF, arrhythmias
- Thyroid deficiency – fatigue & weight gain
- Damage to the adrenal glands – immune and electrolyte regulation problems
- Arthropathy in 40-60% of cases
- Calcium deposits, acute inflammatory arthritis
A place I visited frequently when I lived in Chaio Hsi, Taiwan in 2001
It was just up the street from where I lived! And it for realsies looked just like the picture
Things to consider regarding anemia and exercise (4)
- Anemia will ↓exercise tolerance and may impair oxygenation
- As anemia becomes more severe, may see ↑ cardiac output and ↓exercise tolerance, resulting in dyspnea, tachycardia, palpitations
- Anemia impairs wound healing
- B12 (pernicious) anemia may affect the nervous system
Things to consider regarding anemia and exercise in specific patient populations
- Monitor older adults for circulation issues, changes in cognitive functioning with exercise; sedentary lifestyle may be the result of self-imposed changes to accommodate diminished oxygenation or anemia
- Young female athletes at risk for anemia, iron deficiency; may also have inadequate dietary intake
- Chronic renal failure (CRF) – patients should exercise at lower intensities, VO2 max is about 20% lower than normal
- Patients with both anemia and cardiovascular disease at higher risk for angina
Detailed explanation regarding “decreased” platelet levels and NSAID use
(WARNING: you may fall asleep reading this)
- Aspirin (ASA) and NSAIDs inactivate platelet cyclooxygenase, which is an enzyme needed for thromboxane A2 (platelet aggregation and arterial smooth muscle constrictor)
- Single dose of ASA can suppress normal platelet aggregation for 48 hours – up to a week. It irreversibly inhibits COX, so platelets are inactivated for the rest of their lifespan (they live about 8 days)
- This is why the platelet count is decreased – they’re technically there, but useless.
- NSAIDs effects on COX are reversible, so effects on platelets are milder, such as bruising and skin bleeding – but still safer to D/C NSAIDs pre-op.
What is Disseminated Intravascular Coagulation? AKA: DIC (5)
- Overactivation of the clotting cascade, with paradoxical clotting and hemorrhage at the same time
- Widespread deposition of fibrin in circulation, major organs
- Common after shock, sepsis, OB/GYN complications, cancer, trauma
- Early recognition and treatment has ↓ mortality rate
- Patients will be in ICU; no PT during bleeding episodes, monitor lab values carefully to see when safe to mobilize patient
Picture of DIC (oh jeesh, not that kind, get your mind out of the gutter)
Supposedly, the only things we need to know about finger nails for this test (2)
- pale nails can be a sign of anemia/malnutrition
- bluish nails are indicative of insufficient oxygen.
