Hematologic Meds

Question 1

Blood Products

Answer 1

Whole Blood:
- Time to complete: 2 to 4 hours
- Treats: hemorrhage, surgery, trauma, burns, shock

Packed RBCs:
- Time to complete: 2 to 4 hours
- Treats: severe anemia, bleeding

Platelets:
- Time to complete: 15 to 30 mins
- Treats: thrombocytopenia, bone marrow suppression active bleeding, aplastic anemia

Fresh Frozen Platelets (FFP):
- Time to complete: 30 to 60 mins
- Treats: hemorrhage, burns, shock, reverse effects of warfarin, thrombotic, thrombocytopenia purpura (TTP) (tiny blood clots everywhere)

Pheresed Granulocytes:
- Time to complete: 45 to 60 mins
- Treats: severe neutropenia, neutrophil dysfunction, neonatal sepsis

Albumin:
- Time to complete: 5% (1 to 10 mL/min)
- Treats: burns, hypovolemia, hemolytic disease of newborn, hypoalbuminemia

Facts:
-18 to 20 gauge needle
-basline vital signs (including temp)
- 0.9% saline primed
- steps:
1. first 15 mins, stay with client
2. if reaction occurs, stop the infusion and perform vitals
3. infuse saline
4. notify dr

Question 1

Hematopoietic Growth Factors

Answer 1

All stimulate bone marrow production to synthesize (create) specific blood cells

Epoetin alfa (stimulates RBC production)
- used for anemia related to kidney disease, retrovir therapy (HIV/AIDS), chemotherapy
-can cause hypertension

filgrastim (stimulates WBC production)
- used for neutropenia related to cancer
- can cause bone pain and leukocytosis

Oprelvekin (stimulates platelet production)
- used for thrombocytopenia related to cancer
- can cause fluid retention, blurred vision, and cardiac dysrythmias

Question 2

Iron

Answer 2

Oral:
- Ferrous sulfate
- ferrous gluconate
- ferrous fumerate

Parental:
- Iron dextran

Facts:
-dilate with orange juice or water and give with straw
- avoid antacids, coffee, tea, dairy, whole grain breads 1 hour after
- can cause constipation and GI upset
- use 19-20 gauge needle and change needle after drawing
- z track method, never use deltoid
- IV is preferred over IM (watch for first 5 mins, 25 mg)

Question 3

Anticoagulants

Answer 3

Parental:
- Heparin
- low dose heparin (enoxaparin/lovenox)

Facts:
- modify or inhibits clotting properties to prevent clot formation
- used for strokes, pulmonary embolisms, DVTs, cardiac caths, MI, DIC
-avoid NSAIDs, aspirin, or salicylates
- monitor aPTT every 4-6 hours (30 to 40 seconds is normal aPTT, Therapeutic aPTT is 1.5 to 2 times normal value so about 60-80)
- antidote: protamine sulfate

Oral:
- Warfarin
-dabigatran
- rivaroxaban

Facts:
- prevents synthesis of coagulation factors VII, IX, X, and prothrombin
- used for venous thrombosis, prevents thrombosis in patients with AFib, prevent recurrent MI, prevent TIA
- do not give to patients with vitamin K deficiencies, thrombocytopenia, liver disease, or alcohol abuse
- longer half life than heparin, discontinue 5 days before procedure and take heparin instead
- monitor INR or PT (Normal Range: 0.7 to 1.8, therapeutic INR is 2 to 3) (INR = patient PT/average PT)
- antidote: vitamin K

Question 4

Antiplatelets

Answer 4

• Aspirin
• Abciximab
• Clopidogrel

Facts:
-prevent platelets from aggregating
- prevention for acute MI
- prevention of stroke
- used for intermittent claudication (leg pain while exercising)
- can cause bleeding
- report tarry stool and bruising
- acute salicylate poisoning from longterm aspirin use = hyperventillation due to respiratory alkalosis
- diarrhea
- stop taking clopidogrel 5 days before procedure

Question 5

Thrombolytics

Answer 5

• Alteplase
  -Tenecteplase
• Reteplase

Facts:
- clot busters (give within 4-6 hours of symptoms)
- used for stroke (ischemic), PEs, MI, DVTS
- do not give to people with brain tumors, intracranial hemorrhage, hypertension
-afterwards, clients will begin anticoagulant therapy to prevent thrombotic event