Hematologic Disorders Flashcards
Causes of Anemia?
decreased RBC production, blood loss and increased RBC destruction
Levels of tissue hypoxia and Hgb levels:
1) mild
2) moderate
3) severe
1) 10-12 g/dl
2) 6-10 g/dl
3) < 6 g/dl
Anemia Manifestations: Integumentary Changes
pallor, jaundice and pruritis (increase in bile salts)
Anemia Manifestataions in older adults?
confusion, fatigue, pallor, ataxia and HF
Anemia: Diagnostic Studies
- CBC – Hgb, Hct, MCV, MCH, MCHC, reticulocytes, platelets
- Iron studies – serum iron, TIBC, serum ferritin
- Serum B12 level
- Serum folate
- Stool guaiac test
Causes of Megaloblastic Anemia?
- Cobalamin (B12) deficiency
- Folic Acid deficiency
At-risk groups for Iron deficiency Anemia?
elderly, pregos, premenopausal, low socioeconomic status, and blood loss
Causes of Iron-Deficiency Anemia
- Inadequate dietary intake
- Iron absorption altered
- Duodenum
- Blood loss from GI/GU tract or Hemodialysis
Iron-Deficiency Anemia: Labs
- decreased: H/H, MCV, serum iron
- normal: B12, folate
Oral iron supplement A/E?
heartburn, constipation, diarrhea
Indications for parental Iron supplementation?
malabsorption of oral iron, oral iron intolerance, need for higher doses, poor compliance with oral iron
What are good dietary sources of iron?
Liver and muscle meats, eggs, dried fruit, legumes, dark green leafy vegetables, whole grains, enriched bread, potatoes
Cobalamin (B12) Deficiency: Etiology
missing protein needed for absorption
Cobalamin (B12) Deficiency causes?
- Gastric mucosa not secreting
- GI alterations: surgery, chronic diseases
- Chronic alcoholics
- Long-term users of
- H2-histamine receptor blockers
- Proton pump inhibitors
- Strict vegetarians
Gastrointestinal manifestations of Cobalamin (B12) Deficiency?
Sore tongue, anorexia, n & v, abdominal pain
Neuromuscular manifestations of Cobalamin (B12) Deficiency?
Weakness, paresthesias (feet & hands), ↓ vibratory and position senses, ataxia, muscle weakness, impaired thinking
Treatment of Cobalamin (B12) Deficiency?
- Cobalamin (Parenteral or intranasal)
- Lifelong if no GI absorption (diet not effective)
- If long-standing neuromuscular complications, may not reverse
S/S of anemia develop as a result of what issue?
slow development, related to tissue hypoxia
Folic Acid Deficiency S/S?
similar to cobalamin deficiency, except for neurologic symptoms
Common causes of folic acid deficiency?
- Dietary deficiency/malabsorption syndromes
- Drugs
- Increased requirement
- Alcohol abuse/anorexia
- Hemodialysis (FA is filtered out)
What is the cause of pernicious anemia?
B12 deficiency due to the gastric mucosa not secreting
Megaloblastic Anemia: Nursing & Interprofessional Management?
- Early detection and treatment
- Family hx of pernicious anemia?
- Ensure safety
- Pt haas diminished sensations to heat/pain from neurologic impairment
- Protect from falls, burns or trauma
- Frequent medical screening for the potential risk of developing gastric cancers
What differentiates cobalamine (B12) deficiency from folic acid deficiency?
both have similar s/s manifestations, the pt with B12 deficiency will have neurologic symptoms which are absent in folic acid deficiency
What are the clinical manifestations or s/s of Sickle Cell Disease?
- Usually asymptomatic except during sickling episodes
- Pain from tissue hypoxia and damage
- Pallor of mucous membranes
- Jaundice from hemolysis
Complications of Sickle Cell Disease?
- Organs affected by hypoxia
- Infection-major cause of morbidity and mortality
SCD Sickling Episodes are triggered by _____ with _____ being the most common precipitator?
- low O2 tension in the blood
- infection
Initial sickling in SCD can be reversed with?
re-oxygenation
S/S of Sickle Cell Crisis?
- Severe, painful, acute exacerbation of sickling → vaso-occlusive crisis
- Severe capillary hypoxia → tissue necrosis
- Life-threatening shock: from severe ↓ tissue O2, ↓circulating fluid volume
Sickle Cell Disease: Nursing & Interprofessional Management (prevention)?
prevent infection (i.e. vaccination) and organ damage with prompt tx
Sickle Cell Disease: Nursing & Interprofessional Management (education)
- Avoid high altitudes
- Keep hydrated
- Treat infections promptly
- Importance of prompt medical attention
- Pain control
Tx for hospitalized patients in sickle cell crisis ?
- O2 for hypoxia and to control sickling
- Vigilance for respiratory failure
- Rest
- DVT prophylaxis
- Administration of fluids and electrolytes
- Transfusion therapy
- Chelation therapy with repeat exacerbations
Sickle Cell Disease: Nursing & Interprofessional Management (pain management)?
- Often pain medication tolerant
- Require continuous & breakthrough analgesia with morphine & hydromorphone
- Multimodal & interdisciplinary approach involving emotional & adjunctive measures
Sickle Cell Disease: Nursing & Interprofessional Management (other)
- Administer folic acid
- Hydrea - only antisickling agent shown to be clinically beneficial
- Hematopoietic stem cell transplantation (HSCT)-only available cure
Thrombocytopenia
Condition where platelets levels are < 150K
Thrombocytopenia: Clinical Manifestations?
- Patients are often asymptomatic
- Most common symptom is mucosal or cutaneous bleeding
- ↓ Platelet count
Prolonged bleeding with routine procedures occur with a platelet count of?
< 50k
Patients are at increased risk of hemorrhage with a platelet level of?
< 20k
What is the most common symptom of thrombocytopenia?
mucosal or cutaneous bleeding
What is the most common type of acquired thrombocytopenia?
Immune Thrombocytopenic Purpura (ITP)
What is Immune Thrombocytopenic Purpura (ITP)?
- Syndrome of abnormal destruction of circulating platelets
- Primarily an autoimmune disease
ITP Interprofessional Care?
- Corticosteroids
- Splenectomy if patients do not respond to other treatments
When are platelet transfusions done?
- <10k or if actively bleeding or prophylactically for planned procedure
Acute Intervention for Thrombocytopenia: Nursing Management?
- Evaluate and treat bleeding
- Avoid SQ/IM injections-apply pressure or ice packs
- Monitor labs: platelet count, coagulation studies, Hgb, Hct
Health Promotion/Teaching
for Thrombocytopenia: Nursing Management
- Teach self-care measures to reduce risks for bleeding
- Prompt treatment for symptoms of bleeding
- Awareness of medication risks: cancer chemotherapy drugs, heparin, OTC meds that can cause acquired thrombocytopenia
A group of malignant disorders affecting the blood and blood-forming tissues
Leukemia
Leukemia can affect what tissues?
- Bone marrow
- Lymph system
- Spleen
Acute versus Chronic Leukemia?
- Acute: Immature hematopoietic cells proliferate, abrupt onset
- Chronic: Mature forms of WBC, onset is more gradual
Leukemia: Classification?
- Acute myelogenous leukemia (AML)
- Acute lymphocytic leukemia (ALL)
- Chronic myelogenous leukemia (CML)
- Chronic lymphocytic leukemia (CLL)
Acute Myelogenous Leukemia (AML)
– myeloblast proliferation
- S/S-infection/abnormal bleeding, hyperplasia of bone marrow and spleen
Acute Lymphocytic Leukemia (ALL)
- small, immature lymphocytes
- S/S:
- abrupt onset fever,
- bleeding
- Insidious onset of progressive weakness, fatigue, pain, bleeding tendencies
- CNS manifestations are common (e.g. meningitis)
What is the most common type of leukemia in children?
ALL
What is the most common type of leukemia in adults?
CLL
Excessive mature neoplastic granulocytes in bone marrow?
Chronic Myelogenous Leukemia (CML)
Why is folic acid given to treat Sickle Cell Disease?
to increase RBC’s
Which genetic marker is present in > 90% of AML patients?
Philadelphia chromosome
Course of CML?
can be stable for years then have an aggressive (blastic) phase the may not respond well to treatment
Chronic Lymphocytic Leukemia (CLL)
Proliferation of functionally inactive but long-lived, mature-appearing lymphocytes
Complications from early-stage CLL?
- are rare
- May develop as the disease advances
- Lymph nodes enlarge-pain, paralysis from pressure
Tx for CLL?
may not be needed
Leukemia: Clinical Manifestations r/t bone marrow failure?
- Anemia
- Thrombocytopenia
- ↓ number and function of WBCs
Leukemia: Clinical Manifestations r/t infiltration?
- Splenomegaly
- Hepatomegaly
- Lymphadenopathy
- Bone pain
- Meningeal irritation
- Oral lesions
Leukemia: Diagnostic Studies
- Blood counts, Bone marrow biopsy
- Look for leukemic cells outside of the blood/bone marrow with a Lumbar puncture or CT scan
Phases of chemotherapy?
- Induction
- Postinduction/postremission
- Maintenance
Tx for Leukemia?
- Chemotherapy
- Corticosteroids
- Radiation therapy-targeted or total body
- Hematopoietic stem cell transplant
- Biologic and targeted therapy
