Hematologic and Oncologic Emergencies Flashcards
What is pallor?
What is a possible cause?
decreased or absent skin color, possible caused by a decrease in Hgb
What is flushing?
What is a possible cause?
Transient episodes of red skin around the face and neck, possible cause; increased hemoglobin level (polycythemia) and capillary congestion
What is Jaundice?
What is a possible cause?
Yellowish skin and mucous membranes, possible causes; accumulation of bile pigment caused by rapid hemolysis or liver damage.
What is Cyanosis?
What is a possible cause?
bluish skin and mucous membranes, possible causes; decreased hemoglobin level and an excessive concentration of deoxygenated hemoglobin in the blood.
What is Pruritis?
What is a possible cause?
is an unpleasant cutaneous sensation that provokes the desire to rub and scratch the skin. The possible causes include hodgkin’s disease and increased bilirubin level
What is Petechia?
What is a possible cause?
- tiny purple spots appearing on the skin as a result of tiny hemorrhages (bleeding) within the dermal or submucosal layers.
What is Angioma?
What is a possible cause?
a benign tumor of the blood or blood vessels. It is usually congenital. Some may disappear spontaneously
What is Telangiectasia?
What is a possible cause?
can be a small angioma with a tendency to bleed, focal red lesions, or course or fine red lines that are caused by the dilation of small vessels.
chronic anemia may result from diminished erythrocyte production which occurs in these 7 conditions
Iron deficiency anemia Thalassemia Lead poisoning Vitamin B12 deficiency Chronic liver and renal disease Hypothyroidism Can also stem from decreased bone marrow production, which causes aplastic anemia.
Sickle cell disease
Normal red blood cells have a lifespan of about __ days, Hgb S RBC’s have a lifespan of about __ to __ days, leading to chronic anemia and elevated reticulocyte count
120
10 - 20
Sickle cell disease
Factors that can predispose the cells to sickling include (9)
Exposure to low O2 concentrations, dehydration, infection, acidosis, high altitudes, exposure to cold, alcohol intoxication, emotional stress, pregnancy
Sickle cell disease
Vaso-occlusive crisis occurs when small vessels in the bone, soft tissue, and organs such as (5)
liver, spleen, penis, brain, lungs
Sickle cell disease
Acute aplastic crisis
what is it?
occurs from an abrupt, temporary cessation of RBC production in the bone marrow, and commonly occurs from infection (infectious crisis)
Sickle cell disease Acute sequestration What organ does it originate in? What are the S/S? Is the leading cause of what in this patient population?
the spleen abruptly enlarges, trapping a large portion of RBC’s. Other findings include vomiting, left sided abdominal pain, and shock
Can occur rapidly and is the leading cause of death in pediatric patients with sickle cell disease
Sickle cell disease Acute Chest Syndrome How is it described? What causes it? What does it cause?
The syndrome is a vaso-occlusive crisis involving the pulmonary vessels and is typically precipitated by a lung infection, resulting inflammation and loss of O2 tension leads to the sickling of RBCs and further vaso-occlusion. Pulmonary infarction and death may result.
Sickle cell disease
Acute Chest Syndrome
what are the S/S and treatments?
Chest pain, dyspnea, cough, fever, wheezing, hypoxia, pulmonary infiltrates that appear as a total white-out on chest radiography
Because acute chest syndrome may progress to pulmonary failure, provide immediate aggressive treatment with O2, broad spectrum ABx, analgesics, and close monitoring
Sickle cell disease
What are the treatments?
Rehydration with oral and IV fluids
Pain medications
Hydroxyurea (Droxia) is an effective therapy for adult and pediatric patients with SSD. The medications stimulates the production of hemoglobin F, a form of Hgb that does not sickle when deoxygenated.
Sickle cell disease
What are the treatments?
Rehydration with oral and IV fluids
Pain medications
Hydroxyurea (Droxia) is an effective therapy for adult and pediatric patients with SSD. The medications stimulates the production of hemoglobin F, a form of Hgb that does not sickle when deoxygenated.
Leukemia
What is it and how does it produce its affect?
A malignant disorder of the blood and blood forming organs characterized by the excessive, abnormal growth of leukocyte precursors in the bone marrow.
An uncontrolled increase in immature WBCs decreases the production and function of normal WBCs. The bone marrow becomes crowded with these defective cells, which reduces its ability to produce normal precursors to other blood cells, such as erythrocytes and platelets.
Leukemia
What are the 2 classifications? Describe each of them. Are they acute or chronic?
Classified as either Lymphogenous or myelogenous
Lymphogenous - leukemias result from a cancerous growth of lymphoid cells
Myelogenous leukemias result from a cancerous growth of myelogenous cells in the bone marrow.
Both types may be acute or chronic
What is the most common cause of cancer in pediatrics?
Acute Lymphoblastic Leukemia (ALL) - although it also occurs in adults, it is the most common type of cancer in children on the US and accounts for 75% of pediatric leukemia cases.
What happens when a patient with Acute Lymphoblastic Leukemia (ALL) has a rise in WBC count over 50K?
When the WBC count rises to more than 50,000, the patient is at risk for leukostasis (WBC clumping or aggregation). Leukostasis primarily affects the brain and lungs, which can participate stroke and pulmonary infarcts, respectively.
This type of leukemia Prevalence increases with age, with the median onset at 70 years, but affects all age groups.
What is it associated with?
Acute Myeloid Leukemia (AML)
Associated with some genetic disorders such as Downs Syndrome, congenital neutropenia, and Fanconi’s anemia.
It has been associated with radiation exposure and the use of specific medications, such as immunosuppressants and chemotherapeutic agents.
This type of leukemia Prevalence increases with age, with the median onset at 70 years, but affects all age groups.
What is it associated with?
Acute Myeloid Leukemia (AML)
Associated with some genetic disorders such as Downs Syndrome, congenital neutropenia, and Fanconi’s anemia.
It has been associated with radiation exposure and the use of specific medications, such as immunosuppressants and chemotherapeutic agents.
Thrombocytopenia
what is it?
what are some possible causes?
Platelet count of less than 150,000
May result from a congenital or acquired disorder, such as decreased bone marrow production, increased splenic sequestration, peripheral consumption, or the accelerated destruction of platelets.
Additional causes may be from
Menses, nutrition, sepsis, tumors, medications, bleeding
Severe deficiencies in iron, folic acid, or vitamin B12
Immune Thrombocytopenic Purpura (ITP, also referred as idiopathic thrombocytopenic purpura)
What is it? How does it manifest?
is a condition in which a decreased number of circulating platelets manifests as a bleeding tendency, easy bruising (purpura), or extravasation of blood from capillaries into the skin and mucous membranes (petechia)
Hemophilia
Occurs almost exclusively in ____ but can be carried in ____, ranging from mild to severe.
What are the three types?
males females Hemophilia A Hemophilia B Willebrand's disease
Hemophilia A, what factor is the cause?
Hemophilia A (classic hemophilia) results from a problem with factor VIII production. In most patients with Hemophilia A, factor VIII is produced in insufficient quantities. In a small number of patients with hemophilia A, a defective form of factor VIII is produced.
Hemophilia B, what factor is the cause?
Hemophilia B (christmas disease) is less common than B, and is caused by the absence or functional deficiency of factor IX.
Von Willebrands Disease is usually ____ acute than A or B and (does/does not) occurs in both sexes. In this type of hemophilia, the specific coagulation disorder is defective platelet adherence and a decreased level of factor ___.
less
does
VIII
What is The most common hereditary blood disorder?
Who has it (what ethnic group?)
Factor V Leiden Thrombophilia
Between 3 and 8% of people with European ancestry carry at least one copy of factor V Leiden mutation in each cell.
What is The most common hereditary blood disorder?
Factor V Leiden Thrombophilia
Factor V Leiden Thrombophilia Increases the risk of
4
Superficial venous thrombosis
DVT
PE
Adverse pregnancy outcomes such as fetal loss, pregnancy induced HTN, intrauterine growth retardation, and stillbirth
The activation of coagulation cascade leads to accelerated clotting. The excessive release of fibrin into the circulation triggers thrombosis, especially in the small vessels. As accelerated coagulation the fibrinolysis system begins to function at an accelerated rate. Then platelets, clotting factors, and fibrinogen are consumed faster than the body can replace them. As the system becomes overwhelmed, simultaneous hemorrhage and clotting occur.
What is this condition?
Disseminated Intravascular Coagulation (DIC)
Disseminated Intravascular Coagulation (DIC)
Describe this condition
The activation of coagulation cascade leads to accelerated clotting. The excessive release of fibrin into the circulation triggers thrombosis, especially in the small vessels. As accelerated coagulation the fibrinolysis system begins to function at an accelerated rate. Then platelets, clotting factors, and fibrinogen are consumed faster than the body can replace them. As the system becomes overwhelmed, simultaneous hemorrhage and clotting occur.
What is this condition?
Disseminated Intravascular Coagulation (DIC) Can be triggered by these 5 things
Infection, especially gram negative sepsis
Shock
Severe trauma
Neoplasms
Obsteric complications, such as pregnancy-induced HTN, retained placenta, incomplete abortion, and amniotic fluid embolism
In Disseminated Intravascular Coagulation (DIC), Thromboses in major organs can cause symptoms of organ failure, such as (6)
Renal function impairment, adult respiratory distress syndrome, CNS manifestations, necrosis of the skin, bone, and bone marrow
What are the S/S and lab values (5) that you would see in a patient with Disseminated Intravascular Coagulation (DIC)
S/S; look for bleeding caused by the consumption of platelets, fibrin, and clotting factors.
Labs - PT, PTT, fibrinogen levels, fibrin split products, and fibrin degradation products (D-dimer)
Oncologic Emergencies Are structural or metabolic problems that fall into three categories
What are they?
1 Cytopenias
2 Electrolyte and fluid imbalances
3 Tumor-mediated compression of surrounding structures
Oncologic Emergencies
Cytopenias
Give three examples
Anemia
Neutropenia
Thrombocytopenia
This cytopenia is an absolute ____ count of less than 1,500 increasing the risk of bacterial, viral, and fungal infections
neutrophil (blank)
Neutropenia
Neutropenia can result from these three conditions
Neoplasm, medications, infection, chemotherapy, radiation, bone marrow transplantation
Sepsis
Thrombocytopenia
____ is the leading cause of death in cancer patients, but will show few signs of infection
Sepsis
Oncologic Emergencies
Electrolyte and fluid imbalances
this condition results from massive breakdown of tumor cells, spontaneously or as a direct result of chemotherapy or radiation therapy. The destroyed cells release their contents which have high ___ and ___
Tumor lysis syndrome
K and PO4
Tumor lysis syndrome can cause these four Electrolyte and fluid imbalances. How do they relate with each other?
Hyperkalemia Hyperphosphatemia Hypocalcemia Hyperuricemia The excess phosphorus in the blood binds with calcium, causing reciprocal hypocalcemia. The lysed cells also release nucleic acids, which break down to uric acid, causing hyperuricemia
Tumor-mediated compression of surrounding structures can cause these two conditions
Superior vena cava syndrome
Spinal cord compression
Tumor lysis syndrome S/S depend on the extent of the electrolyte imbalance but may include these (11)
Fatigue, nausea, anorexia, muscle cramps, paresthesia, widened QRS complex, dysrhythmias, abdominal cramps, diarrhea, flank pain, renal failure
Treatment of Tumor lysis syndrome can include these (3)
- Hydration
- NaHCO3 to alkalinize the urine and prevent renal failure from uric acid deposits in the kidneys
- Administer calcium chloride or gluconate, sodium bicarbonate, hypertonic glucose, and insulin to move potassium from the serum into the intracellular spaces. This decreases the serum k concentration.
Other than hydration, alkalization of the urine, and the use of calcium chloride or gluconate, sodium bicarbonate, hypertonic glucose, and insulin to move potassium from the serum into the intracellular spaces, what are 4 medications used in the treatment of Tumor lysis syndrome
Also administer Kayexalate to pull K into the gastrointestinal tract for excretion
Give diuretics to increase the excretion of uric acid and electrolytes
Administer allopurinol (Aloprim) to prevent uric acid formation
Give a phosphate-binding agent, such as aluminum hydroxide (AlternaGel) to help with the hyperphosphatemia
What is SIAH?
Syndrome of inappropriate antidiuretic Hormone
Syndrome of inappropriate antidiuretic Hormone leads to what?
fluid retention by the kidneys, causing water intoxication (serum Na less than 129). The excess fluid moves to the cells by osmosis causing cellular swelling.
water intoxication will have a serum Na less than __
129
____ ____ can be the most life-threatening sequela of SIAH
Cerebral edema
S/S of Cerebral edema include (8) and can progress to (4)
HA, personality changes, MS changes, irritability, lethargy, confusion, NVDA, muscle cramps
Can progress to seizures, papilledema, coma, and death
Treatment of SIAH includes (4)
includes fluid restriction, the cautious administration of hypertonic NaCl infusions, and diuretics
Care for seizures
Superior Vena Cava Syndrome is Obstruction of the SVC that can be caused by either (2), or, this can occur within the vessel
May be from outside the SVC by a lymph node or tumor that compresses the vessel
Inside the vessel; thrombus due to vascular access device
This accounts for about __% of patients with Superior Vena Cava Syndrome
Advanced lung CA
S/S of Superior Vena Cava Syndrome are usually subtle but include
Gradual swelling of the neck, face, or arm, which is worse after sleeping supine, dyspnea, chest pain, hoarseness
Rapid onset SVC syndrome may produce life threatening manifestations of these two things.
well… it’s sort of two things
cerebral edema (MS changes, dizziness, and vision changes), and airway obstruction due to laryngeal swelling
Superior Vena Cava Syndrome treatment includes (3)
Place in semi fowlers position
Refer to oncologist; chemotherapy
Remove offending vascular access device and administer a fibrinolytic or anticoagulant as ordered
