final: blood Flashcards
normal platelet count
150,000-400,000
normal RBC
4-6
normal Hct
35-50%
normal Hgb
12-17
normal WBC count
4,000-11,000
neutrophils
bacterial infections
new
50-70%
monocytes
chronic bacterial infections
4-6%
lymphocytes
viruses
25-35%
eosinophils
inflammatory, allergies, parasites
1-3%
basophils
inflammatory, release histamine
0.5-1%
neutropenia
reduction of neutrophils < 1500
know rate of decline
normal signs of inflammation may be absent due to lack of phagocyte activity
normal signs of inflammation may be absent due to lack of phagocyte activity
neutropenia
neutropenic fever
> 100.4 + neutrophil count < 500
medical emergency
important care for pts with neutropenia
hand washing daily temperatures at home shower/bathe daily electric razor infection control
hemochromatosis
excess iron disorder
iron accumulates in liver (hepatomegaly)
hemochromatosis treatment
remove 500 mL blood weekly for 2-3 years
what should pts with hemochromatosis avoid
vitamin C
iron supplements
uncooked seafood
iron rich foods
polycythemia
high number of RBC
may impair circulation (hyperviscosity/hypervolemia)
symptoms of polycythemia
caused by hypervolemia, hyperviscority, HTN
HA, vertigo, dizziness, tinnitus, angina, CHF, claudication, thrombophlebitis, hemorrhage, epistaxis, GI bleed, hepatomegaly, splenomegaly, increased uric acid etc
what secondary disease are polycythemia pts at risk for
gout
because of increased uric acid
splenomegaly is a symptom of ___ polycythemia only
primary
polycythemia treatment
phlebotomy (300-500 mL) q 2-3 months
hydration
thrombocytopenia
decreased platelets (< 150,000) increased risk of bleeding
level of platelets for prolonged bleeding from trauma
< 50,000
level of platelets for spontaneous/life-threatening bleeding
< 20,000
immune thrombocytopenia purapura (ITP)
large bruising
autoimmune
1-3 day platelet life
acute immune thrombocytopenia purapura (ITP) mostly seen in
kids after a viral illness
chronic immune thrombocytopenia purapura (ITP) mostly seen in
women 20-40
treatment of immune thrombocytopenia purapura (ITP)
steroids IV immunoglobulin immunosuppression splenectomy platelet transfusions
thrombotic thrombocytopenia purpura (TTP)
nonimmune
blood clots in small vessels of body (blocks blood flow)
hemolytic anemia thrombocytopenia neurologic abnormalities fever w no infection renal abnormalities
TTP-HUS
hemolytic anemia
acute kidney failure
thrombocytopenia
cause of thrombotic thrombocytopenia purpura (TTP)
deficiency of ADAM TS 13
bleeding and clotting occur simultaneously
medical emergency!
thrombotic thrombocytopenia purpura (TTP)
which disease should you not give platelets
thrombotic thrombocytopenia purpura (TTP)
heparin-induced thrombocytopenia (HIT)
heparin-induced thrombocytopenia (HIT)
bleeding is not an issue
discontinue heparin
heparin-induced thrombocytopenia (HIT) common adverse outcomes
DVT
PE
thrombocytopenia manifestations
bleeding!
epistaxis, gingival bleeding, large bulls hemorrhages on buccal mucosa, petechiae, purpura, ecchymosis
prolonged bleeding after procedures
complication: hemorrhage
hemophilia
hereditary bleeding disorder caused by defective or deficient coagulation factors
autosomal recessive…displayed in males
hemophilia A
factor VIII deficiency
hemophilia B
factor IX deficiency
von williebrand disease
hereditary bleeding disorder caused by deficiency in von williebrand protein needed for platelets to stick to each other
autosomal dominant…seen in both genders
manifestations of hemophilia and von williebrand
slow, persistent bleeding from minor trauma
uncontrollable bleeding after major procedures (dental)
epistaxis
GI/GU bleeding
splenic rupture from falls
ecchymosis
hemarthrosis
90% of older people with this disease are HIV seropositive
hemophilia
from blood transfusions
teaching for hemophilia and von williebrand
non contact sports wear gloves for chores medical alert bracelet administration of factor replacement at home kids: helmet to school
leukemia
malignancy affecting blood/blood forming tissues of bone marrow, lymph system and spleen
WBC > 100,000
loss of regulation of cell division occurs in
leukemia
how is leukemia treated
chemotherapy
stem cell transplant
combination chemo is mainstay for 3 reasons
- decrease drug resistance
- minimize drug toxicity
- interrupt cell growth at different stages
stem cell transplant
allows for large doses of chemo/radiation
hodgkin’s lymphoma
reed-sternberg cells in lymph node biopsy
hodgkin’s lymphoma manifestations
insidious
begins w one sided enlargement of nodes on neck
nontender, painless
“B” symptoms
fever
night sweats
weight loss
treatment of hodgkin’s lymphoma
chemo/radiation
aggressive..potentially life-threatening
non-hodgkin’s lymphoma
unpredictable spread
not diagnosed until later stages
non-hodgkin’s lymphoma treatment
radiation alone for localized
chemo for aggressive disease
chemo+radiation for intermediate forms
cranial radiation or intrathecal chemo may be used if CNS involvement probable
multiple myeloma
malignancy of plasma cells
infiltrate and destroy bone marrow
multiple myeloma prognosis
mean survival 3-5 years
multiple myeloma symptoms
classic: skeletal pain
slow and insidious
pain triggered by movement
can impinge on spinal cord
multiple myeloma diagnostics
pancytopenia and hypercalcemia
bone marrow biopsy
lab/radiological exams
multiple myeloma cure
there is none
control may be possible with chemo, steroids, radiation, biologic agents
multiple myeloma management
hydration (to minimize hypercalcemia) electrolytes and I&O careful with ambulation (high fracture risk, peripheral neuropathy) pain management DVT infection
