Hematological Problems Flashcards
Causes of anemia
Lack of RBC production
- Iron def, folic acid def
- Lack of erythropoiten
Blood loss
RBC destruction
Measures of anemia (labs to monitor)
Hgb
Hct
RBC
Thrombocytopenia
Def in platlets
a reduction of platelets below 150 × 109 /L
platelet disorders can be inherited, but most are acquired
Normal Platlet count
150-400 x 10 to the 9th/L
Causes of acquired
autoimmune diseases
increased platelet consumption
splenomegaly
bone marrow suppression/ failure
ingestion of certain foods, herbs, and drugs.
When are pts thrombocytopenia treated ?
Below 30x10to the 9
VERY significant if they drop below 10
We care about how quickly they are dropping
Immune Thrombocytopenic Purpura (ITP)
Most common acquired thrombocytopenia
a syndrome of abnormal destruction of circulating platelets termed immune thrombo-cytopenic purpura (ITP)
Cutaneous bleedding coming together
Non-blanchable rashes
Most common therapy for management of ITP
corticosteroids or splenectomy
Heparin-Induced Thrombocytopenia (HIT)
a life-threatening condition called heparin-induced thrombocytopenia
Heparin must be discontinued when HITTS is first recognized, which is usually if the patient’s platelet count has fallen 50% or more from its baseline or if a thrombus forms while the client is on heparin therapy.
VERY Important to know pts baseline platlet count to tell if it goes down
What IS HIT
An immune attack that involves OVER clotting while platlet count is dropping
50% drop is when we get concerned
What platlet drop is when we get conerned?
50% drop is when we get concerned
Most common onset of HIT
5-10 days after begining of therapy
Disseminated Intravascular Coagulation (DIC)
results from abnormally initiated and accelerated clotting. Subsequent decreases in clotting factors and platelets ensue, which may lead to uncontrollable hemorrhage
Always caused by undrlying condition
- Underlying ocndition must be addressed
Important to diagnose quick and stabalize pt
Overall nursing goals are that the patient with thrombocytopenia will:
(1) have no gross or occult bleeding (think abt holding antiplatlets)
(2) maintain vascular integrity
(3) manage home care to prevent any complications related to an increased risk for bleeding
Clinical manifestations of thorombocytopenia
Asymptomatic (early)
Bleeding
Mucosal
Epistaxis
Gingival bleeding
Cutaneous
Petechiae
Purpura
Ecchymoses
Pain and tenderness
Major complication: HEMORRHAGE
What is promatime sulfate NOT effective for
Reversing blooding thinning properties of LMWH
Interventions for thrombocytopenia
Treat cause
Therapy often not initiated unless Platelets <30 x 109/L
ITP:
Corticosteroids
Splenectomy
IVIG
TTP:
As above +/- plasmapheresis
Vit K if ther;s time
If urgent reversal is required d/t severe bleeding
- Transexamic Acid (TXA)
Leukemia
A group of malignant disorders affecting the blood and blood-forming tissues of the:
Bone marrow
Lymphatic system
Spleen
Origniates in Bone marrow, primarly a dx of the WBC
Acute Leukemia
Immature cancer cells produced rapidly, taking up space and vaguely resembling WBCs. Results in immunosuppression
Acute myelogenous leukemia
25% of all leukemias
80% of the acute leukemias in adults
Abrupt, dramatic onset
- serious infection or abnormal bleeding
Uncontrolled proliferation of myeloblasts
- Hyperplasia of bone marrow and spleedn
Acute Lymphocytic leukemia
Most common type of leukemia in chldren
Immature lymphocytes proliferate in the bone marrow
B-cell orig
SS
- Fever
Bleeding
- Fatifue
- CNS manifestation Especially common in ALL
Chronic Myelogenous leukemia (CML)
Excessive mature neoplastic granulocytes in bone marrow
move into peripheral blood in massive numbers.
ultimately infiltrate liver and spleen
Chronic stable phase that will be followed by acute aggressive blastic phase
CLinical manifestaitons of leukemia
usually related to:
Bone marrow failure
- Overcrowding by abnormal cells
- Inadequate production of normal marrow elements
Inadequate marrow elements cause:
anemia.
thrombo-cytopenia.
↓ number and function of WBCs.
Leukemic cells affect on rest of body
splenomegaly.
hepatomegaly.
lymphadenopathy.
bone pain.
meningeal irritation.
oral lesions.
solid masses (chloromas).
Diagnostic studies of leukemia
Complete blood count (CBC) and differential
Bone marrow biopsy
=
Goal of care is to attain
Remission
Prognosis is directly related to ability to maintain a remission.
Initial high WBC can be treated w/
hydroxyurea +/- leukapheresis
Intensification therapy
High-dose therapy
May be given after induction therapy
Same drugs at higher doses and/or other drugs
Chemotherapeutic tx of leukemia (stages)
Induction
Intensification
Consolidation
Maintenance
Maintenance therapy
Lower doses of the same drug given every 3–4 weeks
Goal is to keep the body free of leukemic cells.
Nursing Management
Assess and plan for the severe adverse effects of chemotherapy.
Assess for anemia (RBC overcroweded)
Ongoing care is necessary to monitor for signs and symptoms of disease control or relapse.
Teach client and significant other:
Diligence in disease management
Need for follow-up care
When to seek medical attention
Lymphoma can be divided into
Histological appearance (Hodgekins, non hodgekins)
Within leukemia the two cells effected are
Lymphoid or myeloid
Lymphoma location
Found within lymph nodes
- some sort of lump somewhere
Although they originate from the same stem cells
