Hematologic

Question 1

Anemia is caused by what three things

Answer 1

1. decrease production of RBC
2. increase destruction of RBC
3. increase loss of blood = bleeding

Question 2

Iron deficiency anemia (patho, s/sx, dx, tx, nursing )

Answer 2

Patho: nutritional deficiency

S/sx: pallor, fatigue, tachypnea, tachycardia, pica(eating strange things)

Dx: Hgb <11

Tx: PO replacement, fortified formula/cereal

Nursing: when giving iron give with vit. C (orange juice) helps increase absorption on empty stomach. Give with straw

Question 3

Aplastic anemia

Answer 3

Patho: decreased RBC, WBC, and platelets or pancytopenia= decrease # of all blood cells caused by bone marrow failure
- can be congenital or acquired (chemo/ radiation)

S/Sx: Tachycardia, tachypnea
- petechiae, purpura, bleeding brusing (r/t decrased PLT)
- infection, fever (r/t decreased WBC)
- pallor fatigue (r/t RBC)

Dx: labs, bone marrow aspiration

Tx: remove causative agent, transfusions, immunosuppression, bone marrow transplant

Question 4

what is the factor missing in Hemophilia A

Answer 4

Factor VIII

Question 5

what is the factor missing in hemophilia B

Answer 5

Factor IX

Question 6

Hemophilia

Answer 6

Patho: deficiency of clotting factor that leads to increased bleeding (hemorrhage)

S/sx: bleeding episodes

Dx: genetic testing , low factors

Tx: replace missing factor by IV
- Med: Desmopressin (release factor VIII in the body) - USED FOR HEMOPHILIA A

Nursing: Be aware of injuries and surgeries, educate on sprt and activity safety

Question 7

Hemiarthrosis

Answer 7

Patho: bleeding into the joint, happens with hemophilia

S/sx: warmth, pain, decreased mvt., bruising

Tx: RICE ( rest, ice, compression, elevation)

Nursing: ROM and physical therapy after bleeding stopped

Question 8

Von Willebrand Disease

Answer 8

patho: deficiency of VW factor (affects males and females)

S/Sx: increased bleeding w/procedure and menses

Tx: desmopressin or VW factor infusion

Question 9

Sickle Cell disease

Answer 9

Patho; Hgb A is replaced w/ Hgb S ( makes RBC sickle shaped)
- hereditary: autosomal recessive

Seen in: AA, Hispanic, Middle eastern

Dx: newborn screening, sickle turbidity test, genetic testing

Triggers : infection, dehydration, hypoxia, high altitude, trauma, emotional/physical stress, temperature extrems

Tx: oxygen, hydration, pain medication (narcotics)

Question 10

Other things to know about sickle cell disease

Answer 10

• Can be anemic (Hgb <7)
• Will have high bilirubin in urine (dark urine)
• will need frequent blood transfusions
• Acute Chest Syndrome (can kill them)
  S/sx: chest pain, back pain, wheezing
  Tx: use bronchodilators and incentive spirometer
• Pt with this diagnosis will take prophylactic antibiotics ( bacterial infections can be deadly )
• HYDROXYUREA: improves fetal and total Hgb levels and reduces sickling episodes

Question 11

What are the three different sickle cell crisis

Answer 11

1. Vaso-occlusive
2. Splenic Sequestrian crisis
3. Aplastic crisis

Question 12

Vaso- occlusive crisis

Answer 12

Patho: RBC’s become rigis and clump together
(MOST COMMON)
- Can lead to tissue engorgement, ischemia, organ damage, joint pain and strokes
- Spleen affected: may need removal (infection risk)
(spleen filters the blood)

Question 13

Splenic Sequestrian crisis

Answer 13

Patho: blood pools in spleen

S/Sx: profound enemia, hypovolemia, shock ( tachycardia, hypotension, pale, no capp refill, dizzy, pass out )

• A EMERGENCY

Question 14

Aplastic Crisis

Answer 14

Patho: diminished production and increased destruction of RBC

S/Sx: anemia, pallor, jaundice

• A EMERGENCY