Exam 5- hematology-Cha 1 Flashcards
1
Q
Blood Components
made up of x4
A
RBC
WBC
Platelets
Plasma
2
Q
Rbc carry what x2 in body
A
carry hemoglobin and iron in the body
3
Q
Hemolysis-
breakdown
recycling
converted
excreted
A
Breakdown of old and damaged RBC
Recycling of amino acids and iron
Converted into bilirubin
Excreted in bile
4
Q
Diseases that increase hemolysis/ impair liver function
Leads to
Can lead to
A
Leads to increased bilirubin in the blood
Can lead to jaundice
5
Q
White Blood Cells- Leukocytes
normal is
defesnes
originate where
A
Normal is 4,000-11,000
Defenses against microorganisms
Originate from stem cells in bone marrow
6
Q
Leukocytosis=
Leuokpenia=
A
Leukocytosis= high wbc
Leuokpenia= low wbc
7
Q
Neutrophils
what %
do what
A
- 60-70% of wbc-
first to respond to injury/ inflammation
8
Q
Eosinophil’s
respond to
increased
A
- respond to parasites and allergies
increased numbers when those are involved
9
Q
Basophils
respond to
contain
A
- respond to allergies
contain histamines
10
Q
Monocytes
immature
A
- immature inflammatory immune response
11
Q
Lymphocytes
immature
A
- immature inflammatory immune response
12
Q
Segs
A
- mature neutrophiles
13
Q
Bands
A
- immature neutrophils
14
Q
WBC are increased with
x3
A
infection/ inflammation
auto immune disordes
leukoemia
15
Q
Decreased wbc x2
A
prolonged infection
bone marrow suppression
16
Q
platlets
formed where
production controlled by
made where
A
formed in bone marrow
production is controlled by thrombopoietin
made in spleen and can circulate for 7-10 days in body
17
Q
platlets
produces x2
aggregate why
requires what to clot
A
produce ATP and remediators for clotting
aggregate in resonse to trauma
requires calcium to clot- platelets alone will not clot
18
Q
Thrombocytosis
Thrombocytopenia
A
Thrombocytosis- large amount of platlet cells
Thrombocytopenia- decreased amount of platelet cells
19
Q
Platelets-Normal 150,000-450,000
What affects platelet levels?
x3
A
High altitude
Increased exercise
Chronic Cold weather
20
Q
Hemostasis-
control
interaction
A
control of bleeding-
interaction between platelets and clotting mechanisms
21
Q
goal of hemostasis
A
goal is to maintain a steady blood flow, blood volume , and blood pressure despite injury
22
Q
first stage-Vessel spasm
does what
Five Stages of Hemostasis
A
- contracts for 1 minute
23
Q
second stage-Formation of platelet plug-
does what
Five Stages of Hemostasis
A
platelets attach to damaged vessels
24
Q
third stage-Formation of insoluble fibrin clots
does what
Five Stages of Hemostasis
A
- mesh of clots
25
fourth stage-Clot retraction
happens when
what happens
Five Stages of Hemostasis
- happens in 30 minutes/
platelets pull the edge of damaged vessel together
26
fifth stage-Clot dissolution-
what happens
Five Stages of Hemostasis
after clot is formed, body starts to dissolve it to restore blood flow to area.
27
Amount of oxygen that gets to tissues depends on
availability
diffusing
number
amount
ability
Availability of oxygen in alveoli
Diffusing surface and capacity of lungs
Number of RBCs
Amount and type of (hemoglobin)Hbg
Ability of cardiovascular system to transport
28
Anemia
is what
every type of anemia decreases
leading to
abnormally low rbc count or reduced hemoglobin count
every type of anemia decreased-> oxygen carrying capacity,
leading to tissue hypoxia
29
S/S of anemia- If slowly- then body may be able to develop compensation mechanisms
what skin
what hr
a
f
h
d
what chages
what rr
what repository
what pain
Pale and cool skin
Tachycardia
Angina
Fatigue- due to ischemia/hypoxia
Headache
Dizziness
Vision changes
Tachypnea
Dyspnea
Bone pain- dt inc rbc production
30
S/S of long term anemia-
c
m
c f
Chf,
murmurs,
clubbed fingers
31
Chronic blood loss
happens from what
Anemia causes-
slow bleed from ulcers and cancer
32
Anemia- chronic blood loss
s/s are
minimal and during exercise or increased 02 consumption situations
33
Acute
caused by
Anemia causes-blood loss
caused by trauma-
34
Acute anemia s/s
what hr
what constricts
what contracts/releases
tachycardiac,
peripheral vessels will constrict,
liver will constrict and release a bolus of blood
35
Anemia can also be caused by
decreased
insufficient
decreased RBC production
insufficient or abnormal hemoglobin
36
Most common anemia is Iron deficiency anemia-
iron needed for what
body cant do what
iron is optimal for rbc formation
, body cannot synthesis hemolobin without iron
37
Hemolytic Anemia
characterized by
premature destruction/ hemolysis of blood cells
38
Hemolytic Anemia
s/s
f
j
i
- fatigue,
jaundice,
irritability
39
Hemolytic Anemia
Intrinsic-
Two types of causes
disorder of blood cells- sickle cell
40
Hemolytic Anemia
Extrinsic
Two types of causes
- outside of blood cells-
drugs, toxins, chemicals, trauma, and mechanical damage
41
heridtary->
usually//except
episodes happen where
Hemolytic Anemia- Sickle Cell
Hereditary- most common In black americans
Usually is asymptomatic unless stressed by hypoxia
Episodes happen where cells are crescent shaped- abnormal hemoglobin form in RBCs
42
Hemolytic Anemia- Sickle Cell
These patients are not always in a sickle cell crisis, but can be in one--s/s of sickling
p
f
j
i
- pallor,
fatigue,
jaundice,
irritability
43
If person with trait for sickle cell had kid with Someone who doesn’t have trait,
then child may have trait but not the disease
44
If 2 people with the sickle cell trait have kids-
25% of disease in their children
45
Sickle Cell Anemia Signs and symptoms-
p
f
j
i
pallor,
fatigue,
jaundice
, irritbility
46
Sickle Cell Crisis
will experience x2 what hallmark signs
sickle cells do what
causing
Will experience Severe pain/ fever-
sickle cells clump together and obstruct capillary blood flow causing ischemia and possible infarction
47
sickle cell crisis
what gets back to normal shape
repeated acts
pts need to gain oxygen levels and rbc need to get back to normal shape/
repeated acts will weaken RBCs
48
Sickle Cell Crisis triggers
s
I
excessive
h
low
low
d
stress,
infection,
excessive exercise,
hypoxia,
low environmental 02,
low body temperature
dehydration
49
sickle cell crisis s/s-
f
h
what pain//how long
what resp
fever
headache,
abdominal /extremity pain for 4-6 days.
SOB
50
What is damaged by sickle cell crisis
what does that do
Spleen and kidney damage
kidney damage will decrease Erythpoetnan release- will decrease rbc production
51
Treatment for Sickle Cell Crisis
what control
large
prevention
education
pain control-pca pump- morphine
Large amounts of fluids
Prevention of stress and infection
Education on vaccines
52
Meds
h
f a
what transplant
Treatment for Sickle Cell Crisis
- hydroxyurea decreased production of abnormal RBC
folic acid – assists with production of mature rbc
stem cell transplant- very expensive and could lead to death- only known cure for sickle cell crisis
53
Treatment for Sickle Cell Crisis
most infants
Most infants are tested for this so the parents know
54
Be aware of blood transfusions-
may have/causes
damages
what hmg for blood transfusion
Treatment for Sickle Cell Crisis
may have immune response that causes excess iron
which damages heart, liver and other organs
hmg under 7
55
what 2 labs in sickle cell
decreased HGB and rbc
56
pt may need what if they are getting blood transfusion
pt may need treatment for excess iron if they have transufion blood
57
Acquired Hemolytic Anemia
Caused by something outside of RBc-
mechanical
d
b
r
what disorders
I
what responses
what chemicals
mechanical trauma like heart valves,
dialysis,
burns,
radiation,
autoimmune disorders,
infections,
immune responses to blood transfusions
chemicals like drugs/ snake venom
58
Acquired Hemolytic Anemia-Signs and symptoms
enlarged
j
p
what hr
what else
- enlarged spleen,
jaundice,
pallor,
tachycardia,
bone fractures leading to long term bone deformities
59
Aplastic Anemia-Rare-
bone marrow does what
leading to
normal/replaceed
bone marrow fails to produce all 3 types of blood cells,
leading to pancytopenia// normal marrow is replaced with fat
60
aplastic anemia
50% caused by
other causes are:
what damage
what infecetion
what chemicals
50% of cause is unknown
Other cause is
stem cell damage from chemo,
viral infections like hep c
, chemicals like arsenic/ benzine
61
Aplastic Anemia
S+Sx-
f
p
w
h
d
I
bleeding where
e
what labs
Fatigue
Pallor
Weakness
Headahce
Dyspnea
infections
bleeding gums
eccymoisis( bruising)
low rbc, wbc and platelets
62
decreased wbc do what
decreased platelets leads to
aplastic anemia
Decreased wbc are lead to infections
Decreased platelets can lead to bleeding gums and ecchymosis
63
tissue taken from where
may be
need to
painful->
Diagnostic Tests-Bone Marrow Biopsy
Tissue is taken out of posterior iliac crest or sternum,
May be sedated
Need to remain still
Painful but brief-like 20 mins
64
Post procedue care-
pressure for how long
apply
may waht
Diagnostic Tests-Bone Marrow Biopsy
apply pressure for 5-10 minutes,
apply ice if bruising
may ache for 1-2 days
65
Iron deficiency-
what supplements
Medications to Treat Anemias
iron supplements like oral supplements, parenteral, or im-very painful
Ferrous sulfate
66
Sickle cell anemia
treat w->
what other
what subq
Medications to Treat Anemias
- treat with hydroxyurea,
folic acid,
erythropoietin subq- can increase rbc production
67
Aplastic anemia-
what med
what else
Medications to Treat Anemias
prednisone,
blood transfusions- packed rbc, whole blood, or platlets
68
Iron foods
- eggs , meat, green beans and dried fruit
69
Folic acid foods
-green leafy vegetables, organ meats, eggs
70
Vit b12- foods
eggs, milk, meat , cheese
71
Leukemia
chronic
pt will
common in
Chronic malignant disorder of wbc
Pt will have reversed ratio of rbc to wbc
Common in children and men// causes unknown
72
Leukemia-Risk factors-
c
what exposure
treatment from
cig smoke,
chemical exposure,
treatment from other cancers
73
Leukemia s/s broad
a
I
b
anemia
infection
bleeding
74
Leukemia- Signs and Symptoms
Anemia:
p
f
what hr
what resp
-pale,
fatigue
, tachycardia,
dyspnea,
75
Leukemia- Signs and Symptoms
Infection
f
night
frequent
- fever,
night sweats,
frequent infection
76
Leukemia- Signs and Symptoms
Bleeding
- bruising
77
Leukemia
without treatment
with treatment
Without treatment- is fatal
With treatment- 5 year survival rate is just over 50%
78
Acute
what
Leukemia classification
-rapid onset and progression
79
Chronic
what
Leukemia classification
- gradual onset
80
Lymphocytic or lymphoblastic-
Leukemia classification
immature lymphocytes
81
Myeloid
involves
interferes w
Leukemia classification
- involves stem cells-
interferes with types of blood cell formation
82
AML
Leukemia classification
- worst of leukemias
83
Acute Lymphocytic Leukemia- ALL
most common in
what onset
Most common type in children/ young adults
Rapid onset
84
Acute Lymphocytic Leukemia- ALL S/S-
I
b
wt
what pain
h
infection,
bleeding,
wt loss,
bone pain,
headache
85
Acute Lymphocytic Leukemia- ALL
Treatment-
c
what transplant
what transplant
chemo,
bone marrow transplant,
stem cell transplant,
remission rate is 90%
86
Chronic Lymphocytic Leukemia- CLL
what progression
might require
Slower progression- older adults
might require no treatment at all or just monitoring
87
Chronic Lymphocytic Leukemia- CLL
s/s
f
I
p
fatigue,
infection
pallor
88
Acute Myeliod Leukemia- AML
strong association w
pts will have x2
strong association with exposure to toxins-like chemo and smoke and stuff
pts will have neutropenia and thrombocytopenia
89
Acute Myeliod Leukemia- AML
S/S –
f
w
f
what pain
b
p
b
fatigue,
weakness,
fever,
bone pain,
bleeding,
petechia,
bruising
90
Acute Myeliod Leukemia- AML
Treatment x2
- chemo and stem cell transplants
91
Chronic Myeliod Leukemia- CML
usually associated w
what onset
then becomes
Usually associated with chromosomal abnormality
Slow onset, and then becomes very aggressive
92
Chronic Myeliod Leukemia- CML
S/S-
w
f
wt
weakness,
fatigue,
wt loss
93
Chronic Myeliod Leukemia- CML
Treatment-
what med
what 2 others
interferon- modifies cells response to cancer
chemo and stem cell transplant
94
Chemotherapy-
affects
kills
puts
Treatments For Leukemia
affects immature cells-
kills leukemic cells in bone marrow
puts cancer into remission
95
Chemo- what to expect
n
I
loss of what
f
what else is affected
Nausea
immunosuppressed
hair loss
fatigue
all other organs are affected
96
What meds help In chemo
anti-
f
antinausua- ondasatron
fluid
97
Combination chemotherapy-
decrease
interrupts
Treatments For Leukemia
decrease drug resistance,
interrupts growth of cancer cells
98
Colony stimulating factors-
helps
Treatments For Leukemia
helps bone marrow regain normal function after chemo
99
Radiation therapy
damages
Treatments For Leukemia
- damages cell of dna
100
Bone marrow transplant
allogenic
Treatments For Leukemia
requires a donor- pt receives bone marrow cells from a donor
101
Bone marrow transplant
uses what
harvested when
treatments for leukemia
uses the pts own bone marrow after chemo/radiation
pts bone marrow is harvested during remission
102
Bone marrow transplant
Procedure for transplant-
what first – does what
risk for
then what
treatments for leukemia
need induction therapy (chemo/radiation) to kill cells in marrow-
huge risk for infection and bleeding
then marrow is infused
103
Bone marrow transplant
Post transplant-
what means graft has taken hold
how long after
treatments for leukemia
if blood cell counts ( WBc, RBC, platelet ) increase then you will know the graft has taken hold-
usually 12-28 days later
104
stem cell transplant
how does it work
risk for what
Treatments for Leukemia
same as bone marrow transplant
risk for graft vs host disease
105
graft vs host disease
happens in what type
can be
- happens in allognous stem cell
can be deadly
106
Graft vs host disease s/s
rash where
what loss
d
what bleeding
what damage
rash in palms/ feet
skin loss
diarrhea
gi bleeding
liver damage
107
treatment for graft vs host disease
a
s
i
antibiotics
steroids
immunosuppressants-
108
biologic therapy like x2
does what
graft vs host disease
cytokines like interferon-
this will modify cells that attack cancer
109
pts can also use complementary therapy
graft vs host disease
like relaxation, hypnosis, and nutrition
110
risk for infection-> leukemia
what type of room
restrict whom
oral
avoid
neutrophils what level
no what food
no what
Protective isolation
Restrict sick visitors
Oral Hygiene
Avoid invasive procedures
Neutrophils <2,000
No raw fruits or veggies
No fresh flowers.
111
Imbalanced Nutrition- leukemia
increased what
f
loss of
daily
/
give them what type of meals
and what illegal drug
increased metabolic needs
fatigue
loss of appetite
daily wts
I/o
give small frequent meals
marijuana- appetite stimulant
112
leukemia
might see what in mouth
mouth sores
113
Malignant Lymphoma
is what
what 2 types
Malignancies of lymphoid tissue
2 types- Hopkins or non Hodgkins
114
Malignant Lymphoma
risks
g
h
c
u
genetic,
hiv,
chemicals,
unknown
115
Hodgkin’s Disease
waht ages
what plays a role
what is prognosis
Ages 15-35 or over 50
epsteins barr virus and genetics play a role
very curable
116
Hodgkin’s Disease S/S-
enlarger//where
f
s
f
wt
enlarged lymph nodes in subclavicular and cervical area,
fever,
sweats,
fatigue
weight loss
117
Hodgkin’s Disease
Treatment
c
r
x2 transplants
-chemo,
radiation
, bone marrow transplants or stem cell transplants
118
Hodgkin’s Disease
be cautious for radiation where
can cause
Radiation on lymph nodes on genitals
can cause sterility in patients
119
Non-Hodgkin’s Lymphoma
More common- in who
what has affect
older adults
causes are unknown but environment/ genetics have an affect
120
Non-Hodgkin’s Lymphoma
Starts where
peripheral lymph nodes and spread
121
Non-Hodgkin’s Lymphoma S/S-
what lymph nodes
f
night
h
changes in
swollen lymph nodes,
fever,
night sweats,
headaches,
mental status changes
122
Non-Hodgkin’s Lymphoma
Treatment-
c
r
x2 transplant
chemo,
radiation,
stem cell transplant, bone marrow transplant
123
Staging of Cancer
stage 1-
stage iv-
Stage 1-single node, region or structure
Stage IV- involvement of a site not close to a node
124
Staging of Cancer
A- what
B-x3
A-no systemic symptoms
B-systemic symptoms- night sweats, fever and wt loss
125
Neutropenia
Count of WBC-
happens in:
prolonged
s
what disease
Count of less then 1500 WBC-
happens in
prolonged infection,
starvation
autoimmune disease
126
NeutropeniaCauses
most common cause is
-most common cause is cancer w chemotherapy
127
Neutropenia S/S-
I
c
f
f
infections,
chills,
fever,
fatigue
128
Neutropenia Treatment-
I
what factor
what infusions
what colony
isolation,
growth factor to increase wbc production,
granulocyte infusions,
macrophage colony stimulating factor- stimulates production and function of monocytes
129
Thrombocytopenia-
what platelet count
risk for
platelet count less then 100000-
risk for bleeding
130
Thrombocytopenia
use what with blood draw
how long hold pressure or
use BP cuff to get iv
hold pressure for 5 minutes
131
Idiopathic thrombocytopenia (purpura)
what disease
where what happens
-autoimmune disease
where platelets are destroyed too fast
132
Idiopathic thrombocytopenia (purpura) s/s
p
e
b
what urine
id sytmoms persist- need what
petechia,
epistasis,
bruising-
blood urine
if symptoms persist they may need splenectomy
133
Thrombotic Thrombocytopenia-
clots do what
can affect what
clots that occlude arterials and capillaries
can affect heart, kidneys and brain
134
Thrombotic Thrombocytopenia- s/s
p
h
changes
petechia,
headache
loc changes
135
Heparin induced Thrombocytopenia-
abnormal
what in blood
causes what
abnormal reaction to heparin,
partial platelets may be in blood and cause clotting cascade to develop a thrombus
136
Heparin induced Thrombocytopenia- s/s
p
what extremities
e
e
pain,
pulseless extremities,
erythema
edema
137
What med
does what
stop what
Care for Client With ALL 3 types of Thrombocytopenia
prednisone-
suppress immune system-
stop all heparin before giving
138
Treatments
Care for Client With Thrombocytopenia
- platelet transfusions
139
Surgery-may need
Care for Client With Thrombocytopenia
- may need splenectomy-
140
spleen is where what occurs
where what's produced
where platelet destruction is occurring
where antibodies are produced
141
hemophilia a->
hemophilia b->
only seen in who
who is carrier
Hemophilia-Group of hereditary clotting factor disorders
Hemophilia A- destruction of clotting factor 8
Hemophilia B- christmas disease- clotting factor 9
A and b are only seen in men
females may be carriers
142
Von Willebrands disease-
deficency of what
Hemophilia-Group of hereditary clotting factor disorders
deficiency of protein that mediates protein adhesions
143
Factor XI deficiency-
when what is prolonged
form what
impairs formation of
Hemophilia-Group of hereditary clotting factor disorders
when postop bleeding is prolonged-
form platelet plugs but clotting factor is deficit
impairs formation of a stable fibrin clot
144
Hemophilia s/s
h
b
bleeding of
what bleeding
spontaneous
h
p
what hemorrhage
hemarthrosis
, bruising
, bleeding of the gums,
gi bleeding,
spontaneous epistasis,
hematuria
, pain
intracranial hemorrhage
145
Hemophilia Diagnosis
- receive coagulation study
146
Hemophilia meds
f
c
c
fresh frozen plasma,
Cryoprecipitate
concentrates
147
Special Considerations For Children- iron deficiency anemia
why are kids more at risk
kids who ingest what
why are adolescents
because they need more for their body
kids that drink more milk then eat food are at risk for iron deficiency
adolescents with their menstrual cycle
148
s/s of iron deficiency in kids
pale
poor
enlarged
enlarged
pale mucous membranes,
poor muscle tone,
enlarged spleen,
enlarged heart
149
iron deficiency in kids
treatment
increasing iron rich food
150
Pediatric Anemia Breastfed versus formula-
what happens
iron deficient moms will have iron deficient kids
151
Pediatric Anemia
Screening at x3
9-12 months,
15-18 months
in adolescence
152
Pediatric Anemia
Cows milk may cause what
may also cause
slight bleeding,
which may also cause iron deficney anemia
153
bleeding precautions
what tooth
what sports
what razor
used when
soft bristled toothbrush
non contact sports
electric razor
used in thrombocytopenia or hep/anticoag use
154
what blood product before surgery
FFP
155
S/s of bleeding and coagulation
DIC
life threatening
