Hematologic Disorders Flashcards
Anemia
Not enough cells resulting in inability to carry enough O2 to the tissues
Anemia S&S
Cold extremities, lightheadedness
WBC levels
4,500 - 10,500
Hgb levels
M: 13.5 - 17.5
F: 12 - 16
H&H levels
M: 42 - 52%
F: 37 - 47%
Platelet levels
150,000 - 450,000
Neutrophil infection level
> 67%
Segmented neutrophils (segs) infection level
> 55%
Neutrophil band infection level
> 5/6%
Iron deficiency anemia
Lack of iron so can’t make Hgb for RBC to carry O2
Iron deficiency anemia clinical manifestation
- Fatigue, pallor
- *Tachycardia bc lack of blood
- *Tachypnea
- *SOB
- Fissures (mouth/anus)
- Glossitis (tongue: smooth, swollen, reddened)
- Spoon-shaped fingernails (not common in industrialized countries)
- Brittle hair
Iron deficiency anemia labs
- Hgb/Hct: low
- MCV: low (indicate size of RBC)
- MCH: low (indicate Hgb concentration)
- MCHC: low (indicate Hgb concentration)
- Serum ferritin: low
- Serum iron: low
- TIBC: high bc body trying to compensate
- Transferrin saturation: low
Iron deficiency anemia nursing assess
- VS: tachycardia, tachypnea
- Fatigue, pallor
- SOB
- LOC
- Change in hair, tongue (beefy red), nails (spoon)
- Assess for blood loss: emesis, sputum, urine, stool
- Labs: Hgb, Hct, MCV, MCH, MCHC, serum iron, ferritin, TIBC, transferrin sat
Sickle cell disease patho
- Genetic disorder of Hgb –> RBC shape changed d/t lack of O2
- Sickle shaped RBC causes vasoocclusion, lack of O2, hemolysis (breaks up which causes anemia)
Types of sickle cell crisis
Result of increased sickling and anything causing hypoxemia and vasoconstriction.
- Vaso-occlusive
- Aplastic
- Sequestration
- Hemolytic crisis
Vasoocclusive crisis
- Most common
- Vessel obstruction by clumping, tiss hypoxia, pain
Aplastic
Bone marrow ceases to make RBCs
Sequestration
- Most severe
- Pooling of RBCs in spleen, shock, CV failure
Hemolytic crisis
- RBC hemolysis
- Decreased Hgb
- Jaundice
Sickle cell disease clinical manifestations (no crisis)
Anemia
- Fatigue
- Pallor
- SOB
Sickle cell disease clinical manifestations (crisis)
Vasoocclusive
- Pain
- Swelling
Which areas are most affected by vasoocclusion?
- Distal areas: joints, bones, chest, abdomen
- Wound healing in the extremities
What happens if ischemic organ damage in SS?
- Cerebrovascular, pulmonary, and splenic infarcts
- Priapism: painful erection that doesn’t go away
- Liver and kidney damage
Sickle cell anemia assess
- VS: tachycardia, tachypnea, fever (infection)
- Fatigue, pallor, SOB
- Pain and swelling in joints, jaundice (if hemolytic crisis)
- Psychosocial: depression, anger
- Diagnostic tests
Sickle cell anemia diagnostic tests
- Hgb, serum bilirubin
- Serum iron, vitamin B12, folate level
- Chest x-ray
Sickle cell anemia nursing action
- Administer O2 as ordered
- Provide hydration/fluids esp for kidney bc need to prevent infection
- Pain meds as ordered
- Antipyretics as ordered
- Blood transfusions as ordered
- Emotional support
Sickle cell anemia patient teaching
- Avoid cold temps and restrictive clothing
- Patho of disease
- Infection prevention (vaccines, dental hygiene, hand washing…)
- Avoid high-altitudes
Leukemia
Uncontrolled replication of WBCs - leukemic cells/blasts
Leukocytosis
uncontrolled cloning of immature abnormal cell –> fills BM –> enters circulation
Leukemia clinical manifestations
- Painful lymphadenopathy (neck, groin, armpit) d/t cells go to lymph glands
- Anemia d/t lack of RBC
- Infection d/t lack of neutrophil
- Bleeding d/t thrombocytopenia
- LUQ pain d/t splenic sequestration of blasts
Leukemia diagnostic tests
- CBC shows diff types of WBCs (neutrophils, eosinophils, basophils)
- Biopsy
- Lumbar puncture
Which tests diagnose leukemia?
- Biopsy and bone marrow aspirate: type of leukemia, chromosomal abnormalities
- Lumbar puncture: CSF involvement
Complications of pancytopenia (low levels of all three: RBC, WBC, platelet)
- Infection secondary to neutropenia < 1000
- Hemorrhage and bleeding secondary to thrombocytopenia < 150,000
- Anemia
Leukemia nursing action
- Administer chemo as ordered
- Neutropenic/bleeding precautions
- Antibiotics, antivirals, antifungals (prophylactic) as ordered
- Symptom management of N/V, diarrhea, stomatitis
- Administer blood prods as ordered
What’s medical emergency in neutropenic pt?
Fever
Hodgekins vs Non-hodgekins lymphoma
- H: better survival rate, Reed Steinburg cell present
- N: higher in industrialized countries
Lymphoma
Single stem cell in lymph develops into solid tumor and spreads to other LN or spleen
Lymphoma diagnostic tests
Labs:
- CBC w diff, CMP, coagulation studies, LDH
Radiology:
- Chest x-ray
- CT scan
- PET scan
- MRI
…
What does lymph node biopsy show
Presence of RS cells –> determine HL or NHL
What does bone marrow biopsy/lumbar puncture show in lymphoma
Symptoms indicating involvement
