Hematological

Question 1

what is anemia?

Answer 1

deficiency in # of erythrocytes aka RBC, quantity of RBC, volume of packed RBC

Question 2

what can low erythrocytes lead to?

Answer 2

tissue hypoxia because RBCs transport oxygen

Question 3

what causes anemia?

Answer 3

caused by the body response to tissue hypoxia

Question 4

what are the ranges of Hgb in terms of severity?

Answer 4

1) mild: 100-120 g/L (may not produce symptoms)

2) Moderate: 60-100 g/L (causes cardiopulmonary symptoms in order to compensate)

3) Severe: < 60 g/L (multiple body systems)

Question 5

discuss alterations in erythropoiesis

Answer 5

decrease in RBC production.

cause:
- decrease Hgb synthesis which will lead to iron deficiency anemia
- defection DNA synthesis in RBCs
- diminished availability of erythrocyte precursors may result in aplastic anemia and anemia is a chronic disease

Question 6

what is the most common nutritional disorder in the world?

Answer 6

iron-deficiency anemia

decrease in RBC production due to inadequate supplies of iron needed to synthesize Hgb. could me dietary intake, malabsorption, blood loss or hemolysis

Question 7

what symptom is most common for iron-deficiency anemia

Answer 7

pallor and glossitis (inflammation of tongue)

Question 8

what is the treatment for iron-deficiency anemia?

Answer 8

medication therapy. oral iron for 2-3 months to replenish body’s iron stores

Question 9

what is thalassemia?

Answer 9

basically inherited and your body has less RBC production and low hemoglobin

• Has a genetic basis (autosomal recessive)

Question 10

what is megaloblastic anemias?

Answer 10

group of disorders caused by impaired DNA synthesis and characterized by the presence of large RBCs

• Mostly a result from cobalamin (vitamin B12) and folic acid deficiencies

Question 11

what is aplastic anemia?

Answer 11

peripheral pancytopenia (decreased of all blood cell
types – RBCs, WBCs, and platelets) and hypocellular bone marrow
* Autoimmune

Question 12

can anemia cause blood loss?

Answer 12

occurs as a result of sudden hemorrhage. this sudden loss can lead to hypovolemic shock

Question 13

what are symptoms of anemia caused by blood loss?

Answer 13

symptoms depend on volume of blood lost and rate of blood loss

when blood volume loss is sudden, plasma volume has not yet had a chance to increase, the loss of RBCs is not reflected in lab data

Question 14

what are clinical nursing management for anemia caused by blood loss?

Answer 14

stop bleeding, replace blood volume (body needs 2-5 days to manufacture RBC so blood transfusions will be needed)

Question 15

discuss chronic blood loss

Answer 15

usually related to chronic blood loss are usually related to depletion of iron stores

Question 16

discuss hemolytic anemia and key symptom

Answer 16

a condition caused by the destruction or hemolysis of RBC at a rate that exceeds production

symptoms are the same as general anemia symptoms but key focus on jaundice as a symptom

Question 17

what are the 2 causes of hemolytic anemia?

Answer 17

1) Intrinsic hemolytic anemias – heredity, result from defects in the RBCs themselves

2) Extrinsic acquired hemolytic anemias – patient’s RBCs are normal, but external factors are causing damage

Question 18

what is sickle cell disease?

Answer 18

inherited abnormal form of Hgb in the RBC

Question 19

what is hemochromatosis?

Answer 19

genetic defect where there is an iron overload but this can also happen from secondary diseases too so not only genetic

Question 20

what is polycythemia?

Answer 20

increased RBCs that can increase blood viscosity and volume
- can be genetic or secondary

Question 21

what is hemostasis?

Answer 21

Hemostasis involves the vascular endothelium, platelets and coagulation factors

• Normally function together to stop hemorrhage and repair vascular injury
• Impairment in any of these components may result in bleeding or thrombotic
  disorders

Question 22

discuss thrombocytopenia

Answer 22

when theres a Reduction of platelets to an amount below 150 x 10^9/L. many patients are asymptomatic and the most common symptoms is bleeding and petechiae

basically no clotting so u can bleed out and die looool

Question 23

what is heparin induced thrombocytopenia?

Answer 23

develops 5-10 days after onset of heparin therapy (platelet count falls by more than 50
5 or fall below 150 x 10^9L)

Question 24

discuss neutropenia

Answer 24

Leukopenia - decrease in total WBC count
Neutropenia - reduction in neutrophils
range:
normal: 2.2-7.7 x 10^9/L
severe: <0.5 x 10^9/L

Question 25

does neutropenia produce symptoms?

Answer 25

no it does NOT.minor infections can rapidly lead to sepsis or death

Question 26

when does neutropenia become a medical emergency?

Answer 26

T > 39 + neutropenia = medical emergency

Question 27

what are the 3 types of cancer?

Answer 27

1) leukaemia : malignant disease that affects the blood and blood forming tissues of the bone marrow, lymph and spleen
- no single causative agent but multiple

2) lymphoma : cancer originating in the bone marrow and lymphatic structures
- proliferation of lymphocytes
- Hodgkins and non Hodgkins lymphome

3) multiple myeloma
- cancerous plasma cells infiltrate the bone marrow and destroy bone

Question 28

what is blood component therapy?

Answer 28

blood transfusions

• only works temporarily until the underlying condition is resolved

Question 29

what are blood products?

Answer 29

1) albumin - used for hypovolemic shock
2) cryoprecipitate - replacement for fibrinogen deficiency
3) fresh frozen plasma - bleeding caused by deficiency in clotting factor
4) frozen red blood cells - to usually used because it takes out WBCs
5) pack RBCs - used for severe or symptomatic anemia
6)platelets - used when range is < 10-20 x 10^9/L

Question 30

why are dextrose solutions or LR solutions NOT used for administering blood?

Answer 30

they will cause RBC hemolysis .

you must ALSO never give meds in the same tubing as the blood units unless the tubing is first cleared with saline solution first

Question 31

what needle gauge is used for transfusions?

Answer 31

16-18G for rapid transfusions
20-22 G for slowed transfusion, albumin, clotting factor replacements or platelets

Question 32

what type of tubing is used?

Answer 32

Y-type tubing with 170-260 micron filter

Question 33

what are the 2 branches in the Y tube?

Answer 33

one branch for isotonic saline
other bench is for blood product

Question 34

what are IMPORTANT things to know before giving blood?

Answer 34

1) DUAL CHECKING - 2 people verifying the pt
2) take vital signs before giving blood AND RECHECK VITALS EVERY 15 MINUTES
3) blood needs to be administered within 30 MINUTES of receiving it
4) time LIMIT on transfusions is no more than 4 hours
5) You HAVE to remain with the patient fr the first 15 minutes OR 50 mL of the blood transfusion

Question 35

what to do if pt has reaction?

Answer 35

STOP the transfusion
maintain saline flush
notify HCP
Monitor vital signs

Question 36

what are the 3 types of reactions?

Answer 36

1) acute hemolytic reactions
- caused by ABO incomptability
- the RBC ruptutres and releases potassium in blood.
- symptoms; chills and lower black pain

2) Febrile reactions
- caused by leukocyte incompatibility
- mild allergic reaction

3) Circulatory overload
- too much fluid given at once. risk of cardiac issue
- SLOW down the infusion