Haematological issues Flashcards
Sickle cell Anameia:
- An inherited disorder that affects red blood cells
- Most commonly seen within African American peoples
and those originating from the Mediterranean region
- The disease is characterised by red blood cells that are
sickle or oblong shaped, contain hemoglobin S, are poor oxygen carriers, and live for only 16 days
Presentation and acute crises:
Patients may present with hypoxia; swelling or rupture
of blood vessels or spleen; and possibly even sudden
death
There are four main types of sickle cell crises:
- Vaso-occlusive crisis
- Aplastic crisis
- Hemolytic crisis, and
- Splenic sequestration crisis
Vaso-occlusive crisis:
Blood flow to organs is restricted
Aplastic Crisis:
Worsening of baseline anaemia
Hemolytic crisis:
Acute, Accelerated drop in hemoglobin level
Splenic sequestration crisis:
Acute enlargement of spleen.
Complications of crisis’s:
- Cerebral vascular attack(CVA)
- Gallstones (cholecystitis)
- Acute jaundice
- Avascular necrosis
- Splenic infection
- Osteomyelitis
- Opiate tolerance
- Leg ulcers
- Retinopathy
- Chronic pain
- Pulmonary hypertension
- Chronic renal failure
Physical signs indicating sickle cell crisis include:
- Swelling of fingers and toes
- Priapism
- Jaundice
Hospital care for sickle cell crisis + Hospital care for hemophilia:
Hospital care for sickle cell crisis: - Analgesics - Penicillin - IV fluid - Blood transfusion Hospital care for hemophilia: - IV therapy (for hypotension) - Transfusion of plasma
Risk factors for thrombophilia:
- Recent surgery,
- impaired mobility,
- congestive heart failure,
- cancer,
- respiratory failure,
- infectious diseases,
- over 40 years of age,
- being overweight/ obesity,
- smoking,
- oral contraceptive use
Hemophilia patients:
- Be alert for signs of acute blood loss.
- Note bleeding of unknown origin.
- Be alert for signs of hypoxia.
DIC:
- Primarily from bleeding and ischemia to affected
organs.
- Bleeding causes oozing of blood from various orifices,
ecchymosis, and petechiae.
- Hypoperfusion and shock result from haemorrhage
and changes in vascular tone.
- Acute renal failure occurs as a result of shock and
hypoperfusion as well as ischemia. - Skin may be jaundiced as a result of hepatic dysfunction
and haemolysis.
- Pulmonary symptoms such as dyspnoea and
haemoptysis can occur from sepsis and pulmonary
haemorrhage.
- Pulmonary emboli are possible as a result of
hypercoagulation.
- Central nervous system dysfunction occurs as a result of
coagulation, haemorrhage, and shock, and is manifested
by stroke, coma, and focal neurologic deficits.
DIC Correction of underlying process:
DIC Management strategies - Airway and hemodynamic management - Blood product administration with the goals of: o Correcting severe thrombocytopenia (<20,000) o Haemorrhage management o Coagulation factor replacement - Mitigation of hypercoagulation
Complications of haemophilia:
- IV access should only be performed where a
therapeutic intervention is required in the prehospital
setting.
- Consider that an uncontrolled haemorrhage may be
the reason for attendance, and that fluid
administration may be required. This should not delay
transport to definitive care.
Complications of Lymphoma:
Anaemia in cancer patients results from many factors,
including chemotherapy, radiation treatment,
gastrointestinal blood loss and iron deficiency.
Chemotherapy and radiation treatment are both
designed to kill cancer cells, but in the process kill or
damage healthy cells as well, including RBCs.
Because of its toxicity, chemotherapy can suppress
RBC production in the bone marrow and can also
affect kidney function, including the production of
erythropoietin.
