HEMATOLOGIC DISEASES Flashcards
Blood Components
- RBC/ Erythrocytes: ↓ RBC= ANEMIA
- WBC/ Leukocytes: ↓EBC= LEUKOPENIA
- Platelet/ Thrombocytes: ↓platelets:
Thrombocytopenia
4.Plasma: Liquid Portion of Blood
↓RBC, ↓WBC, ↓PLATELET
APLASTIC ANEMIA
2 types of Plasma
-Serum Plasma
-Protein Plasma
type of plasma which is the Liquid portion of blood
SERUM PLASMA
↑PLASMA
-Hemodillution
-↓ blood viscosity
↓PLASMA
-Hemoconcentration
-↑blood viscosity
-Risk for thrombus (clot formation)
type of plasma that is Produced by the liver
PLASMA PROTEIN
Types of plasma protein
-ALBUMIN
-FIBRIN
-GLOBULINS
Type of protein plasma that is abundant and (+) oncotic pressure, stays in the intravascular
ALBUMIN
↓Albumin
-Hypoalbuminemia
- (-) oncotic pressure
-Edema & Ascites
Type of protein plasma that is the clotting factor
Risk for: Bleeding & ecchymosis
FIBRIN
3 Types of Globulin
AH- BI- GA
-Alphaglobulin: transport Hormones
-Betaglobulin: transport Iron
-Gammaglobulin: transport Antibodies
:Produces in WBC (B-cells)
but scattered in plasma
Antibodies attack its own cells/body
Autoimmune disease
Treatment & Drug of choice for autoimmune diseases
Tx: Plasmapheresis: removal of antibodies on plasma
DOC: Steroids (Prednisone)
Complications of Plasmapheresis
- Immunosuppression
- Hypovolemia (Hypotension)
- Allergic Reaction
BLOOD PREPARATION
-Whole blood
-Packed RBC
-Platelet Concentrate
-FFP (Fresh Frozen Plasma)
Whole Blood
-Massive blood loss
-Hypovolemic shock
-Surgery: amputation
Packed RBC
-Anemia
-Fluid overload
-CHF
-Pulmonary Edema
-Renal Failure
Platelet concentrate
-Bleeding disorders
-Dengue
-Thrombocytopenia
-Hemophilia
-ITP (Idiopathic Thrombocytopenia Purpura)
FFP (FRESH FROZEN PLASMA)
-↑Blood Viscosity
-Burns: ↑hematocrit
-Polycythemia Vera
Whole Blood & Packed RBC must be transfused within:
2-4 hours; Maximum of 6 hours
Platelet concentrate & FFP must be transfused within:
10-20 minutes
Nursing Safety during Blood Tranfusion:
Blood typing, cross, matching, and transfusion orders must be checked by
“2 NURSES”
If there is only 1 available nurse
“GO TO THE NEAREST NURSING STATION”
If 2 units is received:
“TRANSFUSE ONLY 1 UNIT AND SEND THE 1 UNIT IN THE LABORATORY”
If there is an error notice in the blood details:
“RETURN TO THE BLOOD BANK”
What must be done prior to transfusion:
“CARDIOPULMONARY (CP) CLEARANCE”
-To adjust rate
Monitor for complication of blood transfusion
What to prepare for Blood Transfusion
-Blood set
-Large-Bore needle (Gauge 18)
-PNSS (Saline solution): NO D5
CONTAINING, CAUSES HEMOLYSIS
-Alternative line: For emergency meds.
Blood Tranfusion Complications:
-Pulmonary Edema
-Tranfusion Reaction
Blood Tranfusion Complications: Cause of Pulmonary edema
Rapid Infusion
Manifestation:
-Dyspnea
-(+)Rales or Crackles
Management for Pulmonary edema
-↓ Infusion Rate: don’t stop since its compatible
-POC: High backrest
-DOC: Diuretics : Eliminate excess fluid
Blood Tranfusion Complications: Cause transfusion reaction
Incompatible blood
Manifestations:
-SOB
-Tightness of throat
-Wheezing
Plan of care for Transfusion Reaction:
-Stop the infusion
-Infuse Saline solution (NSS)
-POC: High backrest
-DOC: Epinephrine (Rapid acting Bronchodilator)
Blood type , Destroys, Tranfuse
BLOOD TYPE DESTROYS TRANSFUSE
A B, AB A,O
B A, AB B,O
AB X A, B, AB, O
O AB O
Universal Recipient
AB
Universal Donor
O
Cross matching
”+” : Impure; Presence of Antigen
“-“: Pure
A+ = A+
A-= A-
-Microcytic Anemia
-Hypochromic Anemia
Iron Defeciency Anemia (IDA)
Manifestations of IDA
4F’s
-Fatigue (Tiredness)
-Fainting
-Forgetfulness
-Fallor (Pallor)
+
-Dyspnea & Tachycardia
-Pale White Tongue
Early sign of IDA
Dyspnea & Tachycardia
-Compensatory Mechanism ↓ O2
Late S/sx of Anemia
Concave Fingernails or Spoon Nails
PLAN OF CARE FOR IDA:
Diet: ↑Iron Diet
-Organ Meat: Liver =↑abundant in Iron
-Lean Meat: No fat, Full meat
-Green Leafy Vegetables: Easy Access
Iron supplement
-When: Before meal
-How: w/Orange juice or w/Vitamin C
-Black Stool: Normal, Document
-Constipation: ↑fiber diet & fluid intake
-Staining of teeth (yellow): Should be taken w/ straw
When is the best time to give Iron Supplement?
Before Meals
-↑hcl
How will you give Iron Supplement?
With Orange Juice
With Vitamin C
Iron IM is given via?
-Given via Z-track Technique or zigzag technique
R: Prevent Leakage in subq tissue, prevent staining
Contraindication of Iron
Dont’s of Iron:
CA-TS-MI-EG- A
CApe( Coffee)
TSaa (Tea)
MIlk: Breastfeeding
EGg
Antacids: ↓Iron absorption; ↓Hcl
-Coffee & Tea= Stimulants
-Milk & Egg= Calcium
↓Iron absorption
Why Iron must not be given along with Antacids?
Antacids: ↓Iron absorption; ↓Hcl
↓Folic Acid or B9
↓B12
Megaloblastic Anemia
Common Cause of Megaloblastic Anemia
-Overcooking of Green Leafy Vegetables:
↓B9
-Alcoholism
Complications of Megaloblastic Anemia:
-Neural Tube defects
-Macrocystic anemia
-Hyperchromic anemia
-Large RBC: Malabsoprtion Syndrome
Manifestation of Megaloblastic Anemia
-IDA + “Sore Tongue”
-4F+ dyspnea & tachycardia
PLAN OF CARE FOR MEGALOBLASTIC ANEMIA:
-Encourage Green Leafy Vegetables
Broccoli
Spinach
Asparagus
Broad Beans
-Folic Acid Supplement: 1mg/Day PO
Lack of intrinsic Factor that absorbs Vitamin B12 (Cyanocobalamine)
PERNICIOUS ANEMIA
Common Cause of Pernicious Anemia
Gastric Surgery
-Gastrectomy
-Antrectomy
Billroth 1: Gastroduodenostomy;
Gastric Ulcer
Billroth 2: Gastrojuojenostomy;
Duodenal Ulcer
Antrum: base of stomach —>
Parietal Cell: Produces HCL & Intrinsic Factor which absorbs Vit. b12
Manifestation of Pernicious aNEMIA
IDA +”Beefy Red tongue”
+
“Peripheral Neuritis”
Function of Vitamin B12
RBC production= IDA
Myelin Sheath Formation = Peripheral
Neuritis
Diagnostic Test for Pernicious Anemia
Schilling’s Test
-Radioactive Vit. B12 (Oral
-24 hour urine collection
↑ 40% Vit B12 (urine)
= (+) Pernicious Anemia
Management for Pernicious Anemia
- Given Vit. B12 (IM): IM Injection every month for life
**Uncompliance: Death within 2-3 years - Give Hcl solution 10ml mix with water for 1 week after vitamin B12 Administration.
PERNICIOUS ANEMIA (↓ B9) IS PART OF MEGALOBLASTIC ANEMIA (↓B12)
SKL
Sickling or Clamping of RBC
Crescent Shaped RBC
Sickle-cell anemia
Normal shape of RBC
Spherical
Shape of RBC with Sickle cell anemia
Crescent Shape
Predisposing Factors of Sickle Cell Anemia
-Dehydration
-Stress
-Surgery
-↑ Altitude
-Infection
***Causes clamping of RBC
Not Rigid: Reversible
Rigid: Irreversible
Sickle cell can’t enter the Vessel because of obstruction
-Microcirculation is obstructed by sickled RBC, causing ischemic injury to organ and resultant pain.
Vaso-Occlusive Crisis
Manifestation of sickle-cell anemia
Splenomegaly
Anemia
Hypovolemic Shock
Joint pain
Erectile Dysfunction
Pooling of blood in the spleen
Hypovolemic Shock
Sequestration of blood in spleen
Splenomegaly
Destruction of RBC, by the spleen that results to ↓ RBC
ANEMIA
Plan of Care for Sickle-Cell:
1) PRIORITY: H-O-P
-Hydration: Oral; IV =To inflate cells
-Oxygen Administration
-Pain Management:
DOC: Morphine Sulfate (Opiod/Narcotics)
2) Blood Transfusion: Due to Anemia
3) Diet:
↑ Calories: Provide Energy
↓ Iron: Destroyed RBC leaves Iron =
Iron Toxicity
↑Folic Acid: Replacement for IRON
- IRON TOXICITY:
DOC: Deferoxamine
What is replacement of Iron for Sickle Cell Anemia?
Folic Acid
Diagnostic Test for Sickle Cell Anemia:
1) Sickle-Turbidity Test/ Sickledex
-Blood is mix in sickledex solution
Result: Cloudy = (+) Sickle Cell Anemia
2) Hgb Electrophoresis
-Introduction of electricity in the blood that causes clamping
Vit B1
Thiamine
Vit B2
Riboflavin
Vit B3
Niacin
Vit B5
Pantothenic Acid
Vit B6
Pyridoxine
Vit B7
Biotin
Vit B9
Folic Acid
Vit B12
Cobalomin/ Cyanocobalamin
-Hypoplasia of bone marrow
-↓Bone marrow activity
-↓RBC: Anemia; fatigue & Dyspnea
-↓WBC: Leukopenia; Prone to infection
-↓Platelet: Thrombocytopenia; Bleeding
Aplastic Anemia/ Pancytopenia
Immature WBC (↑Bands)
Leukemia
↓RBC: Anemia
↑WBC (immature): Prone to infection
↓Platelet: Bleeding
Two types of WBC
-Bands: Immature WBC
-Segs: (Segmentor) Mature WBC
Diagnostic Test for Leukemia
Bone Marrow Aspiration
Site of Bone Marrow Aspiration for Pediatric:
Posterior TIBIA
Site of Bone Marrow Aspiration for ADULT:
Iliac Crest
Types of Leukemia
AML (Acute Myelogenous Leukemia)
-AMatandaL (Matanda)
-Common in adult
-Life threatening: Poor prognosis
-Myelogenous: all WBC comes from
ALL (Acute Lymphocytic Leukemia)
-Common in Pedia
PLAN OF CARE LEUKEMIA
-Bone Marrow Transplant: Precaution similar with B.T.
-Chemotherapy
-Stem cell therapy
Hyperplasia of Bone Marrow
↑ Bone Marrow Activity
Polycythemia Vera
↑RBC; ↑WBC;↑PLATELET
↑RBC 1.↑ Blood viscosity: Prone to Thrombus Thrombus: MI- Chestpain & Dyspnea
CVA- Ischemic, ↓LOC, Confusion,
Disorientation
2.Organ Infiltration
-Hepatomegaly
-Splenomegaly
-Joint Pain
- Rudy Complexion
-Reddish Skin - ↑ RBC
-Activates immune response; (+) Pruritis↑WBC -No signs of Infection ↑Platelet -Overdistention of platelet -Ruptured platelet ---> Bleeding
Diagnostic test Polycythemia Vera
CBC
-reveals that all is ↑
PLAN OF CARE
- ↑Viscosity
-Hydrate (↑ fluids)
-Avoid ↑ altitude
-Monitor s/sx of thromboembolism - (+) Joint Pain
-DOC: Low dose Aspirin - (+) Pruritis
-Well-ventilated room: Sweating ↑ Itchiness
-Starch Bath
-Calamine Lotion (for itching) - (+) Bleeding
-monitor s/sx bleeding
-avoid anti-coagulants
Compensatory due to chronic hypoxia
Polycythemia
Polycythemia Complications:
- Shock
- Blood Loss
- Tetralogy of Fallot: Tet Spell
↓
O2 deprivation
↓
↑ Bone Marrow Activity
↓
↑RBC
↓
Prone to thrombus formation
Goal of polycythemia
Reverse the Hypoxia
Plan of Care for Polycythemia:
-O2 Administration
-Blood transfusion
Whose nurse is ↑ risk for HIV
Hemodialysis Nurse: Handling Needle
Common Causes of HIV/AIDS
Cause: HIV (Retrovirus)
Common:
-Heterosexual/Homosexual: Anal Sex
-Unprotected Sex
-Blood Transfusion: Needle
-Transmitted in pregnancy
Precaution: Universal Precaution
AIDS
HIV + Immunocompromise = AIDS
-TB
-Pneumonia
Manifestation of AIDS:
EARLY SIGNS
-Fever -Sore Throat
-Malaise -Fatigue
-weight loss -Night sweats
-Diarrhea
-Persistent Generalized Lymph Nodes
RASHES: Kaposis Sarcoma
PNEUMONIA IN AIDS: Pneumonystis Carini
(Immunosuppression)
Diagnostic Test for HIV/AIDS
CDT4 Cells
- <200 counts: Indicates AIDS
-<100 counts: Immunosuppression
ELISA TEST
-(+) HIV infection
-False (+) : Frequent or Multiple Blood Transfusion
: Pregnancy
-False (-) : Within few weeks to <3 months
***Best time for ELISA: After 3 months
WESTERN BLOT
-confirmatory test
DRUG OF CHOICE FOR HIV/AIDS: DOC
AZT (Azidothymidine/ Zidovodine)
-Prevent HIV cells replication, Not cure
Platelet is destroyed by own Platelet/ Antibody
ITP (Idiopathic Thrombocytopenic Purpura)
Cause of ITP:
-Unknown
-R/t viral infection in children
Lifespan of platelet with ITP:
1-3 Days
normal lifespan: 7-10 days
Bleeding Manifestation
-Menorrhagia (Heavy Menstruation)
-Bruising
-Bleeding Nares & Gums
-Ecchymosis
-Purpura (purple skin)
Plan of Care
Platelet Transfusion
DOC: ↑ Dose Steroids (Prednisone)
: Immunosuppressant (Immuvan)
Test Viral Infection
-IVIG (IV Immunoglobulin)
Chemotherapy
DOC: Plant alkaloids
(Oncovin) Plant Poison
Splenectomy
-Removal of spleen which is potential site of platelet DESTRUCTION
Plasmapheresis
Lifespan of normal Platelet
7-10 days
