Hematological Assessment 2 Flashcards
What are the 3 functions of the hematology system
perfusion, clotting, immunity
what is perfusion
blood is the oxygen delivery system
what does bone marrow make
red blood cells, white blood cells, platelets
what is another name for red blood cells
erythrocytes
what is another name for white blood cells
leukocytes
what is another name for platelets
thrombocytes
what is bone marrow also involved in
immune response
what is the spleens white pulp do
storage of WBC, major site of antibody production
what is the spleens red pulp do
storage site for RBC and platelets
what is the spleens function
regulate RBC production, destroys old/imperfect RBCs, filters out bacteria
what does the liver form
factor IIV, IX, and X
what does the liver store
extra whole blood cells and ferritin
proper liver function is important for the production of…
vitamin K
what does albumin do
maintains the osmotic pressure in the circulatory system and prevents plasma from leaking into the tissues
what does albumin carry
hormones, enzymes, and medications
what is plasma
extra cellular fluid where blood cells are suspended
what does plasma consist of
albumin, globulin, and fibrinogen
what does globulins do
play a role in fighting infection
what does fibrinogen do
critical to the clotting process
what is the largest portion of blood
red blood cells
what do RBC look like
red, smooth, biconcave
what are some WBC granulocytes
neutrophils, basophils and eosinophils
what are some WBC agranulocytes
lymphocytes and monocytes
what is the smallest blood cell
platelets
what do platelets do
stick to injured site and form clot to control bleeding, can repair small vessels
where are platelets stored
20% in spleen 80% circulating
what is platelet production controlled by
substance called thrombopoietin
what is erythropoiesis
process of RBC production
how long do RBC live
120 day life cycle
where is erythropoietin made
kidneys production remains steady to keep up with RBC life cycle
what doe hypoxia stimulate
increase release of erythropoietin
what does hyperoxia stimulate
slow down of erythropoietin
what is hemostasis
multi-stepped process of controlled blood clotting
how does hemostatsis balance clotting
anticoagulants
where does the extrinsic clotting pathway work
abnormal condition outside the blood vessels
where does the intrinsic clotting pathway work
changes within the blood
how does the extrinsic and intrinsic pathway work together
the point where the meet results in a stable clot for hemostasis
what is fibrinolysis
anticlotting factors that circulate in small amounts in response to the formation of a fibrin clot
what does fibrinolysis prevent
over enlargement of the fibrin clot
what changes occur from aging
Decrease in blood volume, Bone marrow produces fewer blood cells, Total RBC, WBC counts lower, Lymphocytes are less reactive
when do hemoglobins levels fall
after middle-age
what is included in the patient history
Age, gender, Liver function, Occupation and hobbies, and home location, Drug use (prescribed, OTC, illicit), Nutrition status, Finances and social support, Family history and genetic risk, Current health problems
what is included in the physical assessment
Skin, Head and neck, Respiratory, Cardiovascular, Kidney and urinary, Musculoskeletal, Abdominal, Central nervous system, Psychosocial
what does a peripheral blood smear test
used to exam red and white blood cells and platelets - gives a clear picture of changes
what does a CBC include
RBCs, WBCs, Platelets, Hgb/Hct
what does reticulocyte count test
total percentage of RBC in the blood sample
what does low platelet count mean
thrombocytopenia
what does high platelet count mean
thrombocytosis
what does hemoglobin electrophoresis test
detects different types of hemoglobin
what is Hgb A
normal
what is Hgb S
sickle cell
what does coombs test test
detects antibodies that act against the hemoglobin
what is antibodies that act against hemoglobin known to cause
hemolytic anemia
what does serum ferrtin test
the level of iron in the blood, transferrin or TIBC - how much iron can your body transport, ferritin the amount of stored iron in the body
what is the follow up care included for bone marrow aspiration and biopsy
check site every 2 hours for 24 hours avoid activity that could result in trauma - asprin free analgesic can use ice packs
what is anemia
reduction in either the number of RBCs, amount of hemoglobin, or hematocrit
what are some common causes for anemia
dietary problems, genetic disorders, bone marrow disease, excessive bleeding
what is mild hemoglobin
less then 11
what is moderate hemoglobin
less then 9
what is severe hemoglobin
less then 7
what does MCV indicate
size of RBC
what does MCH indicate
color of RBC
what is abnormal hemoglobin s sensitive to
hypoxia - traveling to higher altitudes and dehydration
how long do RBCs last for sickle cell anemia
20 days - bone marrow cant keep up
what is sickle cell anemia
blood cells shaped like a sickle, abnormal hemoglobin chain
what happens to the spleen from sickle cell
enlarged/overworked
splenomegaly, increased risk for infection
is sickle cell dominate or recessive
recessive
when is sickle cell diagnosed
about 6 months when fetal hemoglobin beings to replaced by abnormal hemoglobin
what are some ss of sickle cell
pain and swelling in the joints
what race is sickle cell more prominent
african americans - but can affect all races
sickle cell crisis - SICKLE
significant blood loss, illness/infection, climbing ot flying to high altitudes, keeping continued stress, low fluid intake, extreme temp changes
what is vaso-occlusive sickle cell
RBCs sticking in vessels, meaning decreased blood flow to organs/tissues
what is hyperhemolytic sickle cell
rapid destruction of RBCs- jaundice
what is aplastic anemia
bone marrow cannot keep up with RBC production
ss of sickle cell
anemia ss: Fatigue, pallor, weakness, SOB, increase HR, cold hands and feet
**what is dactylitis and where is it seen
pain in back, joint related to inflammation - sickle cell
why is hydration important for sickle cell
dilutes blood keeps RBC from sticking together and helps with renal function
what are some interventions for sickle cell
bed rest, hydration, O2, pain control, monitory respiratory status, folic acid, neuro checks, vision screening, remove restricting items
what does folic acid help with
RBC production
how do you prevention measures for sickle cell
vaccines, no high altitudes, prevent infection, hydration, decrease stress, no smoking, avoid over excertion
what kind of testing is done for sickle cell
newborn screening, aminocentesis, dithionite tesing
what test confirms sickle cell
Hgb electrophoresis
what is hydroxyurea used to treat and how does it work
sickle cell and some cancers
creates fetal hemoglobin, decrease sickling, helps anemia, decreased need for blood transfusion, lowers WBC
what is another treatment for sickle cell
stem cell transplants
how does someone get thalassemia
inherited blood disorder
what decent is more common for thalassemia
mediterranean decent
what is thalassemia
less hemoglobin then normal
what are the ss fo thalalssemia
fatigue, weakness, slow growth, pallor
what is the treatment for mild thalassemia
may not require treatment
what is the treatment for severe thalassemia
may require blood transfusions or donor stem cell transplant
what is iron deficiency anemia
low iron levels
what is the most common type of anemia
iron deficiency
where is the most of the bodys iron found in
70% found in hemoglobin
what does LOW IRON stand for
lethargic, overexerted easily, weird food cravings/white faced, inflammation of the tongue/increase HR, reduced hemoglobin levels, observable RBC changes, nail changes (spoon shaped),
what should you not take iron with
food, coffee, calcium, or antacids wait 2 hours inbetween
what helps absorption of iron
vitamin c
what could iron do to stool
dark green or black
how should you take liquid iron
with straw it could stain teeth
what tests evaluate iron levels
CBC, iron level, blood smear
what could be some causes for iron deficent anemia
poor intake, absorption problem (celiac, cystic fibrosis, short gut syndrome), losing iron due to blood loss
what is pernicious anemia
the body does not produce enough intrinsic factor resulting Vitamin B12 deficiency –> GI system unable to absorb B12 because of the low intrinsic factor making the body attack parietal cells
what are some ss of pernicious anemia
pale, no energy, red swollen tongue, numbness, confusion, depression, unsteady gait, loss of appetite, SOB with activity
what are the neurological symptoms for pernicious anemia
tingling, burning, numbness
what do you need to give for pernicious anemia
vitamin B12
what is thrombocytopenia
Destructive reduction of circulating platelets after normal platelet production; impaired clotting occurs
what is heparin-induced thrombocytopenia
immune mediated adverse reaction to heparin, low platlet count
stop heparin if platelet count…
less then 100,000
how do you treat thrombocytopenia
platelet transfusions, anticoagulants, splenectomy
what is hemophilla
Blood does not clot properly resulting in excessive bleeding after an injury or damage.
what are ss of hemophilla
Bruising, Joint Pain, Swelling, Unexplained Bleeding, Hematuria or Hemoccult
how do you treat hemophilla
clotting factors, plasma
what is DIC
Abnormal clotting in the body, All clotting factors are used up, Causes abnormal bleeding
what is the treatment for DIC
supportive care, fluids and blood transfusions
what is factor V leiden
A mutation of one genes that controls Factor V, Linked to an increase in blood clots
what are the ss of facor v leiden
easy bruising, nose bleeds, excessive bleeding after surgery or trauma
what is the treatment for factor v leiden
Infusion of FFP, blood, and platelets
what is von willebrand disease
Bleeding disorder caused by low levels of clotting protein in the blood
how does someone get von willebrand disease
inherited but rarely may develop later in life
what are the ss of von willebrand disease
Recurrent/prolonged nosebleeds, Bleeding from the gums, Increased menstrual flow, Excessive bleeding with surgery or trauma
what is the treatment of choice for von willebrand disease
desmopressin
what kind of cell is seen in hodgkins lymphoma
reed-sternburg cell - giant cell
what is non-hodgkins more common in
male and older adults
what are the ss of non/hodgkins lymphoma
Large, painless lymph node(s), Fevers, drenching night sweats, unplanned weight loss, Some have no symptoms at time of diagnosis
what are some treatment options for non/hodgkins lymphoma
External radiation of lymph node regions, For more extensive disease, radiation and combination chemotherapy is used, CAR-T therapy
what is multiple myeloma
WBC cancer of mature b-lymphocytes
what are the ss of multiple myeloma
fatigue, easy bruising, bone pain
what is the treatment for multiple myeloma
involves watchful waiting, Proteasome Inhibitors, Immunomodulating drugs, HSCT
what is leukemia
Blood cancer – uncontrolled production of WBCs (blast cells) in bone marrow
how is leukemia classified
by cell type – lymphocytic or lymphoblastic
what are some risk factors of leukemia
Ionizing radiation, Viral infection, Exposure to chemicals and drugs
what are some transfusion reactions
Acute hemolytic, Febrile, Allergic, Circulatory Overload, Sepsis
what does warfarin do
long term anticoagulant
how does warfarin work
prevents clotting factors in the liver
what tests should you monitor when taking warfarin
PT, INR
what is normal Prothrombin time
10-12 seconds
what is normal international normalized ratio
0.75-1.25
what is the INR therapeutic range when taking warfarin
2-3
what ss shoul you monitor when taking warfarin
ss of bleeding
who should not take warfarin
active bleeding, wounds, ulcers, spinal/eye/brain surgery, renal or liver failure
what is warfarins antidote
vitamin K
what is heparin used for
short term anticoagulant
how does heparin work
Prevents clotting by activating antithrombin, which indirectly inactivates thrombin and factor Xa, inhibiting fibrin formation
what is heparins antidote
protamine
