Hematologic Disorders Flashcards
Elevated RBC
Polycythemia
Decreased RBC
Anemia
Elevated WBC
Infection/Leukemia
Decreased WBC
All 5 WBC low
Leukopenia
How many WBC do we have
5
PLT Elevated
Thrombocytosis
PLT Low
Thrombocytopenia
Sickle Cell Anemia
Usually round and spongey!
Hemoglobin S - Hard and Long
Bad things for sickle cell anemia
Cold temperatures High altitudes Infection Acidosis Stress
what do sickle cells do?!
Block capillary beds - PAIIIINNNNN!
What can sickle cell do to men?
Priapism - blood stuck in penis
Tx for Sickle Cell
Pain
NSAIDs/Opioids/Toradol
Heat for painful areas
What drug for Sickle Cell Anemia
Hydroxyurea - prevents formation of sickle cell shape
Other Tx for Sickle Cell
IV rehydration
O2
Transfusion
Abx for infection
Dc Tx for Sickle Cell
Apply warm Moist heat to affected areas to reduce pain and swelling Well hydrated Exercise Avoid high altitudes (helicopters) Limit exposure to cold
Thrombocytosis can be due to
Chronic Hypoxia (overactive bone marrow)
Splenic Disorders
Bone Marrow Disorders
What is erythromelalgia
Severe redness and burning in hands and feet (thrombocytosis)
Tx for thrombocytosis
Low-dose ASA
Treat underlying condition
Thrombyoctopenia usually related to
Immune conditions
After viral infection in a child
Why do you bruise with low PLT?
Need PLT for clotting!
PLT 30-50
Brusing
PLT 10-30
Petechia/Gum bleeding
PLT <10
Internal Bleeding
Tx for thrombyoctopenia
Prednisone for immune causes
Possible PLT transfusion for <30
DIC is
Disseminated intravascular coagulation
DIC is a what type of syndrome?
paradoxical!! Two different things at the same time
BLEEDING and CLOTTING
First stage of DIC
Clotting stage!
Factors that can cause PLT abnormal clotting? (4 eg)
- Metabolic acidosis
- Pregnancy - much higher clotting factors
- Cold Body
- Trauma
DIC Abnormal Clotting problems
Metabolic acidosis
Mottling
Gangrene
Organ Failure
Second stage of DIC
Bleeding stage!
How can you bleed with clotting? DIC?
Every clot produces fibrin degradation products - help to break down the clot - cause you don’t want to keep the clot!
Number of clots being formed + fibrin degradation (anticoagulant) = so many FDPs (only so many PLT - consuming all clotting factors and you run out - can’t clot)
BEGIN TO BLEED.
OCCUR AT SAME TIME.
Lab values of DIC
PLT = LOW
PT/PTT = High (no clotting factors)
Fibrinogen levels = Low (clotting factor being consumed)
D-Dimer = High (FDP)
H/H = Low (actively bleeding)
Tx for DIC
Call the priest
Chance of survival Low
Control pokes!
Handle gently
Apply direct pressure to bleeding sites
DIC in pregnancy can be caused by the
placenta
DIC Pharmacological Interventions (Controversial)
Heparin
TXA
Amicar
Due to paradox.
DIC Blood Products
PRBC for bleeding
PLT for thromcocytopenia
Cryoprecipitate for low fibrinogen levels
FFP for dec PT/PTT
Hemophilia
Affects males
Cannot form a clot
One clotting factor that doesn’t work decreases ability to form clot
3 Forms of Hemophilia
Factor VIII (Hemophilia A)
Factor IX (Hemophilia B - Christmas Disease)
Factor XI (Hemophilia C - Rosenthal’s syndrome) usually africa
How do hemophilia tx at home?
Clotting factors at home
Tx for Hemophilia
Give the factor
DDAVP - stimulates release of Factor VIII
Treat Hemophilia Hematoma
Ice
Compression Dressing
Immobilization
Elevation
Treat Hemophilia lac
Administer replacement factor before suturing or cast to avoid compartment syndrome
Treat Hemophilia nosebleed
Topical Thrombin
Treat Hemophilia venipuncture
Hold pressure minimum 5 minutes
NEVER GIVE IM INJECTION
Why do immunocompromised not have symptoms?
Already lack the WBC that show the redness/swelling/puss
Immunocompromised BAD BAD SIGN
FEVER
Fever in child under 28 days?
Poor immune system
Sign of life threatening bacterial infection
28 - 6 month child w/ fever
Risk of bacterial infection decreases
after 6 months w/ fever
Most common cause is viral
Three most common life-threatening causes of fever in young adult
- Sepsis
- Pneumonia
- Peritonitis
Fever in the elderly (or chronically ill)
Immune system weans
Older we get the less immune system response we have
May lack a fever - hypothermia
Febrile seizures are most common between
6 months and 5 years of age
After one febrile seizure
risk of recurrent febrile seizures are high
HR increases how with fever?
0.5 C elevation HR increases 10 BPM
RR increase how with fever?
1 C elevation RR
5 BPM