Hematologic Problems Flashcards
Anemia
Low RBCs/Hgb or Hct
Mild: Hgb 10-12
Moderate: Hgb 6-10
Severe: Hgb <6
Anemia symptoms
Fatigue
Palpitations
Dyspnea
Tachycardia/hypotension
Can progress into HF
Symptoms depend on severity and onset
(If chronic may have Hgb of 7 with no s/s
Iron deficiency anemia ***
Vegetarians are most susceptible
Causes:
Inadequate intake
Malabsorption
Chronic GI bleed
Pregnancy/menses
Iron deficiency anemia clinical manifestation ***
Mild may be asymptomatic
Pallor
Glossitis (thick red tongue)
Cheilitis (chapped lips)
Symptoms of lack of oxygen in tissue:
*HA, paresthesia, burning of tongue
Iron deficiency anemia :***
Diagnostic studies
Labs:
CBC (low RBCs)
Iron studies (transferring, ferritin)
Hemoccult/guaic stool
MCV (low<80) *called microcytic (small RBCs)
Endoscopy/colonoscopy, bone marrow biopsy
Iron deficiency anemia:***
Nursing management
Treat cause:
Iron rich foods (leafy greens, red meats, liver)
Iron supplementation:
PO: ferrous sulfate
IV/IM: iron dextrase
If severe: PRBC transfusion (usually less than 6 Hgb)
PRBC: packed RBCs
Iron deficiency Oral iron ***
Adverse reactions:
GI common
staining of teeth liquid iron
dark stools
constipation
Take 1 hour before meals with orange juice
Do not take with coffee, tea, or dairy
How to tx iron deficiency anemia oral meds ARs ***
Stay upright for 30min after dose
Constipation: give laxative or stool softeners
Dilute liquid and use straw: to prevent staining
Iron deficiency anemia: parenteral iron (IV/IM) ***
Used if :
malabsorption
PO intolerance
poor pt adherence
need for higher dose
IM can stain skin so use Z track method
Monitor for anaphylaxis
Megaloblastic anemias ***
Large RBCs
MCV high > 100
Caused by folic acid/b12 deficiency
B12 deficiency ***
Inadequate intake
Lack of intrinsic factor (pernicious anemia)
*GI surgery: bowel resection
*Crohn’s disease (bowel disease (lack of intrinsic factor)
*insidious onset after age 40 (stop making as much intrinsic factor)
Folic acid deficiency anemia ***
Associated with:
ETOH
Medications
Malabsorption
Syomptoms:
Similar to B12 deficiency/pernicious anemia
Megaloblastic anemia***
Folic acid/b12 deficiency
Clinical manifestations and diagnostic tests
Sore/red/beefy tongue (Glossitis)
B12 deficiency: neuromuscular symptoms
*weakness, paresthesia, confusion/dementia
CBC(MCV, Hgb/Hct), B12/folate levels
Megaloblastic anemia***
Folic acid/b12 deficiency
Nursing management
B12 supplementation:
PO unless decreased intrinsic factor (malabsorption)
Parenteral (IM/SQ)
Folate:
PO, diet (green veggies/liver)
Anemia of chronic disease (ACD) ***
R/T kidney disease, chronic inflammation
Diagnosis of exclusion
Treat underlying disorder/manage symptoms
Sickle cell anemia ***
Genetic disorder: autosomal recessive
*if both parents have sickle cell trait 1/4 chance baby will have it
Life expectancy 42-47 years
Abnormal form of Hgb causes RBC to stiffen and elongate (sickle shape) when O2 levels are low
If inherited from one parent then it will be less severe
Sickling episodes ***
Triggered by hypoxia:
*high altitudes, stress, surgery, infections
*dehydration
RBCs become sickled and cannot pass thru small vessels and cause occlusion
Self-perpetuating cycle(more cells deoxygenated) bc it blocks other cells
Sickled cells are hemolyzed by the spleen
Sickling episodes***
How early sickling can be reveres
Hallmarks
What it can progress into
Early sickling can be reversed with oxygenation
Hallmarks: vaso-occlusion, hemolysis
Can progress to sickle cell crisis:
*pain in:
Chest, back, extremities, abdomen(where the blockage occurs)
*tissue ischemia, infarction(damage), and necrosis (death) can occur
Sickle cell anemia symptoms ***
Asymptomatic outside of episodes
Pain during sickling episodes:
Pain in joins and other places
Sickle cell anemia complications ***
Embolic events:
MI
VTE
CVA (stroke)
PE
Issue related to decrease circulation:
Chronic leg ulcers( due to lack of O2 for healing)
Renal failure
Spleen infarction:
Increased risk for infection (build up of RBCs their trying to destroy)
Sickle cell anemia ***
Diagnostic studies
Peripheral blood smear:
sickled cells
Increased reticulocytes
Hgb electrophoresis:
Hgb S
Sickle cell anemia***
Nursing management
Oxygen therapy
Hydroxyurea
Fluids (dilute and help blood flow)
VTE prophylaxis (no SCD bc itll cut off blood flow more)
Rest
Pain managment:
*PCA
*opioids, NSAIDS, nerve blocks
*NO ICE PACKS (causes vasoconstriction)
Monitor for infection and emboli
Sickle cell anemia ***
Patient education
Avoid dehydration
hypoxia
High altitudes
Seek medical attention early for infections (can cause crisis)
Immunizations up to date
thrmobocytopenia ***
under 150,000
causes:
-Immune thrombocytopenia (ITP) most common
*autoimmune issue causing destruction of plts
-Heparin induced thrombocytopenia
*immune response to heparin effecting clotting
* can develop 1-2 weeks after treatment
-Thrombotic thrombocytopenic purpura (TTP)
thrombocytopenia
clinical manifestations ***
petechiae, purpura, ecchymoses
gingival bleeding, epistaxis
hemorrhage:
-cerebral, joints, GI, internal blood loss
depending on type look for signs of thrombosis:
chest pain, restlessness, hypoxia, leg swelling
thrombocytopenia
diagnostic testing ***
plt count
prolonged pt/inr
bone marrow biopsy
test stool for occult blood
plt count ***
prolonged bleeding starts at <50,000
<20,000 spontaneous life threatening hemorrhage
<10,000 expect plt transfusion
150,000-50,000 mostly asymptomatic
thrombocytopenia
collaborative care ***
ITP:
*asymptomatic may just monitor
*corticosteroids, IV immunoglobin, plt transfusion
*splenectomy
TTP:
*treat infection/stop drug
*plasma exchange
HIT:
*discontinue all Heparin
*argatroban (antidote to HIT)
thrombocytopenia
nursing management
Pt education ***
plt transfusion
monitor for bleeding
avoid IM infections
avoid rectal temps/exams
avoid invasive procedures
pt/family teaching:
-symptoms of bleeding
-shaving
-avoid asparin
-what to do for nose bleeding:
*call if last 15mins and go to hospital if goes to 30mins
Neutropenia ***
Absolute neutrophil count (ANC) under 1000
severe = <500
ANC = WBC x % of neutrophils
sudden onset is most concerning
most common cause: chemo/immunosuppressive therapy
neutropenia
clinical manifestation/complications ***
risk of infections
*oppotunistic, pt own flora
may not have normal s/s due to low WBC
low grade fever very concering if neutropeic
*emergency: 100.4 or high with ANC <500
*need blood culture ASAP
*ABX within 1 hour
neutropenia
pt education ***
prevent infection:
avoid cleaning up after pets
freq hand washing
avoid crowds
food safety
report symptoms of infection (esp. fever)
good oral hygiene
bathing daily and moisturize
hemophilia ***
xlinked recessive genetic disorder
*mostly males get it
*female carriers give to 50% of sons
*males give to no sons, but all females are carriers
defective or deficient coagulation factors:
hemophilia A: factor VIII deficiency (more common)
hemophilia B: factor IX deficiency
hemophilia
clinical manifestations ***
bleed risk:
persistent bleeding from minor trauma
nosebleeds
hemarthrosis (joint bleeding)
GI bleeding
risk for splenic rupture
hemophilia
collaborative care (tx)***
TX:
replacement of clot factors (cryoprecipitate)
bedrest during bleeding episodes
treat hemarthrosis with RICE (vasoconstriction), analgesia, immobilization
hemophilia
pt education ***
how to control bleeding
severe pain/swelling of muscle joint call HCP
head injury, melena, abdominal pain
noncontact sports
medical alert tag
its good to exercise still just dont cause bleeding
