Hematologic Problems Flashcards
What is a Hemogram blood test?
The Hemogram blood test is a complete blood count (CBC) that measures the cells that make up blood, including red blood cells, white blood cells, hemoglobin, hematocrit, and platelets.
Why is a complete blood count (CBC) test ordered?
A complete blood count (CBC) test is routinely ordered by healthcare providers to measure how healthy someone is at any given time.
What components does a complete blood count (CBC) measure?
Several different components of a person’s blood composition:
1. including red blood cells,
2. white blood cells,
3. hemoglobin,
4. hematocrit, and
5. platelets.
What does the Hemogram blood test indicate about a person’s health?
The overall health of a person by measuring different blood components and their levels.
How often is the Hemogram blood test performed?
The Hemogram blood test is routinely ordered by healthcare providers, indicating it is performed regularly as part of health assessments.
What is the reference range for Red Blood Cells (RBC) in females and males?
4.2-5.4 million/µL for females
4.7-6.1 million/µL for males.
What is the normal range for Hemoglobin (HgB) in females and males?
12-16 g/dL for females
14-18 g/dL for males.
What are the normal Hematocrit (HCT) levels for females and males?
37%-47% for females
42%-52% for males.
Abnormal fid
What do decreased and increased levels of RBC, HgB, HCT suggest?
Decreased levels - indicate possible anemia or hemorrhage.
Increased levels - suggest possible chronic hypoxia or polycythemia vera (rare form of blood cancer).
High RBC - risk for blood clots
What does Mean Corpuscular Volume (MCV) measure in relation to red blood cells (RBCs)?
MCV measures the average size of individual RBCs and is useful for classifying anemias.
What does a decreased and an elevated MCV indicate about red blood cells?
A decreased MCV indicates that the red blood cells are smaller than normal (microcytic), such as in iron deficiency anemia.
An elevated MCV indicates that the red blood cells are larger than normal (macrocytic), which is seen in megaloblastic anemias such as vitamin B12 deficiency, pernicious anemia, and folate deficiency.
What is the normal range for Mean Corpuscular Volume (MCV)?
The normal range for MCV is 80-95 fL.
How is MCV useful in the context of anemia?
For classifying different types of anemia based on the size of the red blood cells.
What does Mean Corpuscular Hemoglobin (MCH) measure?
Average amount of HgB by weight in a single RBC.
What does Mean Corpuscular Hemoglobin Concentration (MCHC) measure?
Average amount of HgB by percentage in a single RBC.
What happens when MCHC is decreased?
Cell has HgB deficiency and is hypochromic (lighter color).
What condition is associated with decreased MCHC?
Iron deficiency anemia.
What does RDW stand for?
RBC Distribution Width
What is the normal range for RDW?
11.5% to 15%
What does a high RDW indicate?
Possible macrocytic or microcytic anemia
What is the purpose of a reticulocyte count?
Measures how fast reticulocytes made by bone marrow are released into the blood.
What is the normal range for reticulocyte count?
0.5% to 2.5%
What can a high reticulocyte count indicate?
Possible anemia
How is RDW used in conjunction with MCV?
To determine the type of anemia
What does TIBC stand for?
Total Iron Binding Capacity
What does a TIBC test measure?
How much iron is in the blood
What is the normal range for TIBC?
240 to 450 mcg/dL
What does a TIBC value above 450 mcg/dL indicate?
Low level of iron in the blood
When is TIBC typically increased?
When iron stores are diminished
When is TIBC typically decreased?
When iron stores are elevated
What is ferritin?
A blood cell protein that contains iron
What does a ferritin test measure?
How much iron the body is storing
What does low ferritin indicate?
Body’s iron stores are low and iron deficiency
What is anemia?
Reduction in either the number of Red Blood Cells (RBC), amount of hemoglobin, or hematocrit.
What does hematocrit measure?
Percentage of packed red blood cells per deciliter of blood.
What is anemia a clinical indicator of?
Manifestation of several abnormal conditions.
What are the components that can be reduced in anemia?
Red Blood Cells (RBC)
Hemoglobin
Hematocrit
What are 3 causes of anemia?
hemolysis, production, loss
What is a cause of hemolysis in anemia?
Increased destruction (Immunohemolytic anemia)
Shortened life span (<120 days) (sickle cell)
Hemolysis (hemolytic anemias)
What genetic conditions can cause hemolysis?
Thalassemia (alpha and beta)
G6PD deficiency
Sickle cell (HbS)
What is immunohemolytic anemia?
A type of anemia caused by the immune system destroying red blood cells.
What is the cause of production issues in anemia?
Hypoproliferation of RBCs
Bone marrow suppression
What is aplastic anemia?
A type of anemia caused by bone marrow suppression, which can be drug-induced or idiopathic.
What nutritional deficiencies can lead to anemia?
Vitamin B12
Folic acid
What causes acute hemorrhage in anemia?
A sudden drop in hemoglobin (Hgb) and hematocrit (Hct).
What can cause chronic iron deficiency anemia?
GI malignancy
Heavy menses
Erosive gastritis
What is anemia of chronic disease?
inflamation, infection, malignancy
What is G6PD deficiency anemia?
A condition causing RBCs to break down due to certain medications, infections, or stressors.
What causes immunohemolytic anemia?
The body’s immune system attacks and destroys red blood cells
What is sickle cell disease?
A genetic disorder that leads to the production of abnormal hemoglobin, causing RBCs to become sickle-shaped.
What is the inherited red blood cell disorder?
Abnormal hemoglobin (HgbS instead of HgbA)
What is the pattern of inheritance for this disorder?
Autosomal recessive
What is the chance of a child inheriting the disease if both parents have the trait?
¼ chance
What is sickle cell disease (SCD)?
A genetic blood disorder affecting red blood cells.
Which regions have a high prevalence of SCD?
Sub-Saharan Africa
Spanish-speaking regions
Saudi Arabia
India
Mediterranean countries
How many people are affected by sickle cell disease?
Millions worldwide.
How many Americans are affected by Sickle Cell Disease (SCD)?
Approximately 100,000
What is the occurrence rate of SCD among Black or African-American births?
About 1 out of every 365
What is the occurrence rate of SCD among Hispanic-American births?
About 1 out of every 16,300
What is the rate of sickle cell trait (SCT) in Black or African-American babies?
About 1 in 13 babies
What type of hemoglobin is involved in SCD?
Hemoglobin S
What shape do red blood cells take in SCD?
Sickle or crescent shape
What happens to sickled cells in SCD?
They become rigid and clump together
What is a consequence of clumped sickled RBCs?
They block blood flow
What event can clumped sickled RBCs cause?
Vaso-occlusive event (VOE)
What can VOE lead to?
Tissue ischemia and pain
What does VOE lead to in SCD?
Further tissue hypoxia
More sickle-shaped cells
What results from more sickle-shaped cells?
More blood vessel obstruction
Ischemia in affected tissues
What does repeated ischemia cause?
Progressive organ damage
Anoxia
Infarction
What organs can be affected by SCD?
all major organs
Spleen
Lungs
Kidneys
Brain
Heart
skin
eyes
What conditions cause sickling in SCD?
Hypoxia
Dehydration
Infection
Venous stasis
Pregnancy
Alcohol consumption
High altitudes
What can affect SCD pathophysiology?
Low environmental temperatures
High environmental temperatures
Body temperatures
Other: acidosis, strenuous exercise, emotional stress, anesthesia.
What happens to sickled cells when the precipitating condition is removed?
They usually return to normal shape, blood oxygen normalize and proper tissue perfusion resumes.
What affects the flexibility of sickled cells?
Some of the HgB remains twisted.
What happens to cell membranes over time in sickled cells?
They become damaged and cells are permanently sickled.
Why are membranes of HbS cells more fragile?
They are more easily broken.
What is the average life span of an RBC with 40% or more of HbS?
About 10-20 days
What condition does reduced RBC life span cause in SCD patients?
Hemolytic anemia
What does HbS stand for in SCD context?
Hemoglobin S
What is the effect of HbS on RBC life span?
Causes reduced life span
What is the health status of SCD patients most of the time?
Patients can be in relatively good health
What is a crisis in SCD?
Extensive cellular sickling
What is the onset of a crisis in SCD?
Sudden onset
How would you describe the pain during a crisis?
Painful
How often can crises occur in SCD patients?
Can occur weekly or as infrequently as once yearly
What usually triggers a crisis in SCD?
Conditions that cause local or systemic hypoxemia
What are the clinical manifestations of SCD?
Pain
Cardiovascular changes
Priapism
Skin changes
Abdominal changes
Kidney and urinary changes
What are the cardiovascular changes associated with SCD?
Check for signs and symptoms of Heart Failure (HF)
What skin changes occur in SCD?
Pallor
Cyanosis
Jaundice
Leg ulcers
What abdominal changes are seen in SCD?
Damage to spleen and liver
What kidney and urinary changes are associated with SCD?
Changes affecting kidney and urinary function
What are the musculoskeletal changes in SCD?
Joint swelling
Pain
What CNS symptoms may occur in SCD?
Low-grade fever
Seizures
Stroke manifestations
What nursing intervention is important for SCD patients?
Assess neuro checks
What percentage of HbS indicates SCD?
80%-100% HbS
What percentage of HbS indicates SCT?
Less than 40% HbS
What is the HCT range in SCD patients?
Between 20% and 30%
What is the reticulocyte count in SCD?
High, indicating anemia of long duration
What is released by damaged RBCs?
Iron
Bilirubin
What does an increase in WBC indicate?
Related to chronic inflammation caused by tissue hypoxia and ischemia.
What are other diagnostic assessments?
ECG
Echocardiogram
What is a nursing diagnosis for acute/chronic pain?
Acute/chronic Pain r/t poor tissue oxygenation and joint destruction
What is a potential complication of infection?
Sepsis
What can multiple organ dysfunction lead to?
Death
List a type of nursing diagnosis related to psychosocial issues.
Anxiety r/t situational crisis
What is the first step in managing severe pain for patients?
Hospitalization and opioid analgesics
How long does drug therapy for acute sickle cell crisis typically start with IV analgesics?
At least 48 hours
Which medications are commonly administered IV for pain management?
Morphine
Hydromorphone
What therapy reverses hypoxia in sickle cell patients?
O2 therapy
What is the typical rate for IV hydration in pain management?
250 ml/hr for 4 hours
What is the purpose of Hydroxyurea in sickle cell disease?
Stimulates fetal hemoglobin production
What is a potential side effect of Hydroxyurea?
Increased incidence of leukemia
What should be monitored regularly for patients on Hydroxyurea?
Complete Blood Count (CBC) for drug toxicity
What is a possible risk associated with Hydroxyurea regarding pregnancy?
It is teratogenic
What is the purpose of PRBC transfusion?
Increase HbA levels
Dilute HbS levels
What should you monitor during a PRBC transfusion?
Monitor for transfusion reactions
What should you teach the patient about PRBC transfusion?
Importance of monitoring
Signs of transfusion reactions
What is iron deficiency anemia?
A condition where the body lacks enough iron to produce hemoglobin, leading to reduced red blood cell production.
What causes vitamin B12 deficiency anemia?
Insufficient vitamin B12 for red blood cell production, often due to dietary deficiency or absorption issues.
What is folic acid deficiency?
A lack of folic acid, essential for red blood cell formation, leading to anemia.
What is aplastic anemia?
A rare condition where the bone marrow fails to produce sufficient blood cells, including red blood cells.
What is iron deficiency anemia (IDA)?
A condition with decreased iron supply for developing RBCs.
Who is most commonly affected by IDA?
Women
Older adults
People with poor diets
What can cause iron deficiency anemia?
Blood loss
Poor GI absorption
Inadequate diet
What should adults with IDA be evaluated for?
Abnormal bleeding, especially from the GI tract.
What type of RBCs are seen with chronic iron deficiency?
Microcytic RBCs.
What symptoms do patients with IDA typically experience?
Mild symptoms of anemia.
What is a common symptom of IDA?
Fatigue
What does reduced exercise tolerance indicate?
Iron Deficiency Anemia (IDA)
What are fissures at the corners of the mouth a sign of?
Iron Deficiency Anemia (IDA)
What is the serum ferritin value for IDA?
Less than 10 ng/ml
What is the normal serum ferritin range?
12-300 ng/ml
What is the management for iron deficiency anemia (IDA)?
Oral intake of iron from food
Oral iron supplements if losses are mild
Parenteral iron solution for severe cases
What are examples of food sources rich in iron?
Dark green leafy veggies
Meats
Fish
Eggs
Dried beans
Whole grains
What should you teach about ferrous sulfate?
May cause dark stools
May cause constipation
Take with Vitamin C to increase absorption
What is the Z track method used for?
To administer iron solution via intramuscular injection.
How should an IV iron infusion be administered?
Infuse slowly to avoid complications.
What does Vitamin B12 deficiency anemia result in?
Failure to activate the enzyme that moves folic acid into precursor RBC cells.
What happens to precursor cells in Vitamin B12 deficiency anemia?
They undergo improper DNA synthesis and increase in size.
What type of cells are released from the bone marrow in this condition?
Only a few macrocytic or megablastic RBCs are released.
What characterizes the RBCs in Vitamin B12 deficiency anemia?
They are increased in size, macrocytic or megablastic.
What is pernicious anemia?
A type of Vitamin B12 deficiency caused by impaired uptake due to lack of intrinsic factor.
What causes pernicious anemia?
Too little Vitamin B12 in the body.
What is the role of intrinsic factor?
It is produced by the stomach lining and is essential for Vitamin B12 absorption.
What can cause Vitamin B12 deficiency anemia?
Vegan diets
Lack of dairy products
Small bowel resection
Chronic diarrhea
Diverticula
Intestinal bacteria overgrowth
What are the symptoms of Vitamin B12 deficiency?
Pallor
Jaundice
Glossitis
Fatigue
Weight loss
Paresthesia in feet and hands
Poor balance
How does Vitamin B12 deficiency usually develop?
It usually develops slowly.
What is a common symptom of pernicious anemia?
Paresthesia in feet and hands
Poor balance
What is the treatment for B12 deficiency caused by dietary deficiency?
Increase intake of foods rich in Vit B12
Supplement with Cyanocobalamin if deficiency is severe
What are some foods rich in Vitamin B12?
Meat
Fish
Dairy products
Eggs
Fortified cereals
What is the treatment for pernicious anemia?
Cyanocobalamin injections weekly at first
Monthly injections for life
Oral preparations after deficiency correction
What is Folate deficiency anemia similar to?
Vitamin B12 deficiency
What is the most common cause of Folate deficiency anemia?
Poor nutrition
What dietary components are lacking in Folate deficiency?
Green leafy vegetables
Dried nuts
What are other causes of Folate deficiency anemia?
Malabsorption (e.g. Crohn’s)
Gastrectomy
Medications (anticonvulsants, oral contraceptives)
What is the treatment for Folate deficiency anemia?
Folic acid 0.25mg-1mg daily p.o.
What is thiamine also known as?
Vitamin B1
What can cause thiamine deficiency?
Poor nutrition
Diet lacking essential vitamins
Inflammation of stomach lining due to excessive ETOH
How does excessive ETOH consumption affect vitamin absorption?
Reduces the body’s ability to absorb vitamins
What syndrome is associated with decreased thiamine?
Wernicke-Korsakoff syndrome
What is Wernicke-Korsakoff syndrome?
A life-threatening neurodegenerative brain disorder caused by severe thiamine deficiency
What is aplasticanemia?
A condition where bone marrow fails to produce circulating RBCs, leading to pancytopenia.
Is aplastic anemia life threatening?
Yes, it can be life threatening.
What leads to pancytopenia in aplastic anemia?
Bone marrow fails to produce circulating RBCs.
What are the causes of aplastic anemia?
Idiopathic
Toxic agents
Radiation
Infections
What is a treatment option for aplastic anemia?
Blood transfusion
Bone marrow transplantation
Immunosuppressive therapy
Treatment for infections
What should be administered as ordered for aplastic anemia?
Blood products
What must be assessed for in aplastic anemia patients?
Signs and symptoms of bleeding
What precautions should be taken for bleeding?
Bleeding precautions
What should be monitored in aplastic anemia patients?
Vital signs
Lab results
What is important to remember about blood transfusions?
Policies
Safety
