Hematologic Disorders Flashcards
What is anemia?
a condition that develops when the blood lacks enough healthy blood cells resulting in a lack of hemoglobin
What does hemoglobin do?
binds oxygen to blood cells
Normal Female Hemoglobin level
12-16 g/dL
Normal Male Hemoglobin level
14-18 g/dL
Hypoproliferative Anemia is caused by what?
- pernicious/vitamin B12 deficiency
- folate deficiency
- iron deficiency
- aplastic
Which two types of anemia are chronic?
Hypoproliferative or Blood loss
Blood loss anemia can also be what?
acute
Blood Loss Anemia
losing RBC’s faster than the body can produce them
Hypoproliferative Anemia
bone marrow does not produce enough RBC’s
Hemolysis Anemia is caused by what?
- autoimmune disease
- thalassemia
- sickle cell
S/S of Anemia
- weak/tired
- SOB
- increased risk for infection
- cold hands/feet
- pallor
- pica
Vitamin B12 deficiency results from what?
- inadequate dietary intake
- malabsorption in GI tract secondary to disease state/surgery
- lack of protein that binds B12
S/S of Vitamin B12 Deficiency
- fatigue/weakness
- jaundice
- sore red tongue
- neurological symptoms: secondary neuropathy, delusions
Treatment for B12 Deficiency
- increase dietary intake
- B12 injection/nasal spray
- B12 supplements
- folic acid supplements
Folate Deficiency results from what?
- deficient dietary intake; especially raw vegetables
- alcoholism
- pregnancy
- small bowel disease (Celiac’s)
S/S of Folate Deficiency
- fatigue/weakness
- mood changes
- lacks neuro symptoms
Treatment of Folate Deficiency
- increase dietary intake
- folic acid supplements
What is the most common type of anemia?
Iron Deficiency Anemia
Iron Deficiency Anemia results from what?
- insufficient dietary intake
- blood loss
- pregnancy/child birth
- alcoholism
What is the most common cause of iron deficiency anemia?
blood loss
S/S of Iron Deficiency Anemia
- extreme fatigue/weakness
- pallor
- tachycardia
- dyspnea
- pica
Treatment for IDA
- take oral iron
- increase dietary intake
- vitamin C increases iron absorption
How should oral iron be taken?
on an empty stomach or with orange juice
Side effects of taking iron are?
- black stools
- abdominal pain
- diarrhea
How should you give an Iron/B12 injections?
Z track method
Most common Hematologic Diseases
- autoimmune diseases: Rheumatoid Arth. & Lupus
- inflammatory bowel disease (Crohn’s, ulcerative colitis)
- chronic infections (HIV, AIDS)
- chronic kidney disease
Manifestations of Hematologic Dx
- mild-moderate
- progress slowly
- stabilize quickly
Acute Blood Loss
associated w/ acute GI bleed, trauma, or surgery
menstrual cycles
Chronic Blood Loss
Chronic GI bleed
S/S of Blood Loss
-hemoglobin may be normal at first but levels will decrease as blood loss continues
Acute Blood Loss S/S
- hypotension
- dizziness
- tachycardia
- tachypnea
Chronic Blood Loss S/S
- fatigue
- pallor
- dyspnea
Treatment for Blood Loss
- blood transfusion
- alternative treatments for religious purposes
Sickle Cell Anemia
inherited disorder that causes RBC’s to become misshapen and breakdown
- become rigid and sticky
- obstruct vessels, limiting O2 to parts of body
Sickle Cell Anemia is most commonly seen in who?
African Americans
Hispanics
S/S of Sickle Cell
- sudden severe episodes of pain
- swelling of hands and feet
- frequent infections
- vision problems
Complications of Sickle Cell
- stroke
- blindness
- priapism
Goals of Treatment for Sickle Cell
- avoid crisis
- relieve symptoms
- prevent complications
Treatment for Sickle Cell
- hydroxyurea
- vaccinations
- antibiotics
- pain meds
- blood transfusions
- daily folic acid
Hydroxyurea
anticancer drug that will stimulate the production of fetal hemoglobin
-helps reduce # of crisis’s
What to do to help w/ fatigue?
- frequent short periods of exercise
- frequent rest periods
- prioritize activities by importance and necessity
What to do for imbalanced nutrition?
- balanced healthy diet
- alcohol limitation/cessation
- individualized dietary plan
- dietary supplements
How to manage perfusion of sickle cell?
- supplemental O2
- IV fluids
- blood transfusion
- monitor BP and hold antihypertensive when needed
Normal Platelet Level
150,000-400,000
Thrombocytopenia means what?
low platelet level
Thrombocytopenia is a result of what?
- decreased production of platelets
- increased destruction of platelets
- increased consumption
What are some causes of Thrombocytopenia?
- malignancy
- infection
- medication
- autoimmune
- disseminated intravascular coagulation
For thrombocytopenia caused by infection you need to what?
treat underlying cause
Immune thrombocytopenia Purpura is most commonly found in who?
Children and young women
Immune Thrombocytopenia Purpura (ITP)
- body produces antibodies against own platelets
- antibodies attach to platelets
- body destroys the platelets that carry its own platelets
S/S of ITP
- platelet count as low as 5000
- easy or excessive bruising
- petechia
- bleeding from gum or nose
- hematuria/Melena
- unusually heavy menstrual flow
1st Line Treatment for ITP w/ < 30,000 platelets or severe bleeding
-begin oral prednisone
ITP is the result of an abnormally acting immune system and so the steroid will suppress the immune system
1st Line Treat for ITP w/ < 5000 platelets or internal bleeding
- pulse corticosteroids
- IV immunoglobin
Pulse Corticosteroids are given how?
in large doses in intermittent infusions
IV Immunoglobin
overwhelms the spleen w/ antibody so that it cannot recognize the antibody coated platelets
2nd Line Treatment for ITP
- splenectomy
- rituximab
After a splenectomy the patient is at risk for what?
- infection
- death related to sepsis
If fever occurs after splenectomy you should what?
immediately administer antibiotics
Prior to splenectomy surgery you should?
receive all vaccinations
Education after Splenectomy
- call provider at first sign of sickness
- temp > 100.5
- sore throat
- cough/cold lasts longer than normal
- chills that don’t go away
- malaise
Platelet Dysfunction
platelet numbers are WNL but function is altered
Medications that prevent platelets from clumping and forming clots are?
- Aspirin (lasts 7-10 days)
- NSAIDS (lasts 5-7 days)
- Plavix (lasts 2-3 days)
Von Willebrand Disease “Free Bleeder”
genetic disorder caused by missing or defective von Willebrand factor, a clotting protein
What does VWF do?
Binds w/ factor VIII, a key clotting protein, and platelets in blood vessel walls which help form a platelet plug during the clotting process at the site of vascular injury
Type I VWD
symptoms are mild
Type II VWD
symptoms are mild to moderate
Type III VWD
symptoms are severe
spontaneous bleeding often occurs w/in joints and muscles
S/S of VWD
- severe bleeding following dental procedures, surgeries, child birth
- unusually heavy menses
- large bruises that easily appear
- nosebleeds
Desmopressin for Treatment of VWD
- injection/nasal spray
- stimulate release of stored VWF
- contraindicated w/ CAD (may cause MI)
- may cause hyponatremia from fluid retention
