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NURS 2501 > Hematological system > Flashcards

Hematological system Flashcards

1
Q

Bone marrow biopsy

A

coring out an area of bone marrow with a large-bore needle ; iliac crest ( sternum ) ; anesthesia or sedation ; apply pressure; observe ! 24 hrs - bleeding & infection; analgesic ( aspirin free) ; ice packs

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2
Q

Bence-Jones Protein

A

urine test; single sample or 24 hrs urine collection; positive 75 % pts with multiple myeloma + neoplasms affecting bone, blood, lymphatic system

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3
Q

Schilling’s test

A

to determine vitamin B12 absorption ; pernicious anemia = Stage 1 abnormal + stage 2 normal ; Malabsorption = both stages abnormal ; NPO ( 8-12) - oral B12 - 1-2 hrs later IM B12 - Eat and drink + 24 hrs urine collection

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4
Q

RBC count - Men & Women

A

M 4.7-6.1

W 4.2-5.4

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5
Q

Reticulocyte count

A

immature RBCs - reflects bone marrow activity

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6
Q

Hemoglobin - M & W

A

M 13.5-18 gm/dL
W 12-16 gm/dL
gas carrying capacity of RBCs ; below 6 gm/dL - severe

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7
Q

Hematocrit - M & W - RBCs as %

A

M 40-54 %

W - 38-47 %

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8
Q

WBC differential

A

5000 - 10000 mm3

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9
Q

Platelet count - thrombocytes

A

150000-400000

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10
Q

Coombs test - Direct vs Indirect

A
  1. Direct - used to detect antibodies that are stuck to the surface of red blood cells. These antibodies sometimes destroy red blood cells and cause anemia.
  2. Indirect - looks for free-flowing antibodies against certain red blood cells. It is is most often done to determine if you may have a reaction to a blood transfusion.
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11
Q

Bilirubin

A

increased with hemolytic problems; reflects liver function

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12
Q

PT

A

11-12.5 seconds

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13
Q

aPTT

A

30-40 seconds ; therapeutic 1.5-2.5 x control

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14
Q

Therapeutic INR

A

2-3.5

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15
Q

Disseminated Intravascular Coagulation - DIC

A

complication of another disorder : diffuse clotting + hemorrhage
s/s: ecchymosis, petechiae, purpura fulminans

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16
Q

Triggers for DIC

A
  1. Massive trauma
  2. Shock
  3. Sepsis or infection - gram negative; meningococcal
  4. Acute promyelocytic leukemia
  5. Metastatic cancers
  6. Obstetrical emergency
  7. Transfusion reaction
  8. Severe liver disease
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17
Q

DIC - pathophysiology

A

Underlying disorder - Interleukins and TNF ( tumor necrosis factors) - Systemic activation of coagulation -

  1. widespread intravascular fibrin deposition - thrombosis and organ failure
  2. consumption of platelets and clotting factors - severe bleeding
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18
Q

DIC - complications

A
  1. Renal failure
  2. Gangrene
  3. PE
  4. Hemorrhage
  5. CVA
  6. ARDS
  7. MODS
  8. Death
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19
Q

DIC - elevated labs

A
  1. PT/INR
  2. aPTT
  3. FSP ( fibrin split products ); FDP ( fibrin degradation products); D-dimer
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20
Q

DIC - decreased labs

A
  1. Platelet count

2. Fibrinogen level

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21
Q

Fibrinogen

A

is a protein produced by the liver. This protein helps stop bleeding by helping blood clots to form

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22
Q

DIC: TX

A
  1. Supportive care
  2. Blood products - platelets, fresh frozen plasma, cryoprecipitate ( replace fibrinogen)
  3. Heparin therapy (prevent more clots)
  4. Epsilon-aminocaproic acid ( inhibitor of fibrinolysis) or Activated protein C
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23
Q

Activated protein C

A

enzyme that helps prevent inappropriate clot formation; its activated when it binds to healthy endothelial cells - injured ( sepsis …) - cannot activate protein C - clots are formed

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24
Q

Leukemia - acute or chronic - myelogenous or lymphocytic

A
  1. Increase in immature non-functional WBCs - blasts
  2. Decrease in mature, healthy WBCs, RBCs and platelets
  3. stem cells - bone marrow problem
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25
Q

Philadelphia chromosome - chromosome analysis

A
  1. major feature - CML

2. hallmark ALL

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26
Q

Leukemia S/s

A
  1. early - none
  2. Fever, generalized bone pain
  3. Infections, weigh loss + anorexia
  4. S/s of anemia and thrombocytopenia
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27
Q

“7 plus 3” - cytosine arabinoside + daunorubicin

A

Tx acute leukemia - severe bone marrow suppression - induction therapy

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28
Q

TX acute leukemia -

SE - Infection + Bleeding

A
  1. Induction
    2, Consolidation - cure
  2. Maintenance - 2-5 years
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29
Q

Imatinib mesylate (Gleevec) - SE

A

CML+ Philadelphia chromosome
SE - N/V - take with meal + large glass of water
No grapefruit juice
Muscle cramps - may need Ca
Increase risk for bleeding, diarrhea, rash, fluid retention

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30
Q

Hematopoietic Stem Cell Transplantation - Bone marrow transplant - Indications

A
  1. for leukemia patients in remission after induction therapy that have closed matched donor
  2. lymphoma
  3. multiple myeloma
  4. aplastic anemia
  5. sickle cell disease and many solid tumors
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31
Q

Human leukocyte antigen - HLA

A

matched stem cells may be obtained from a family member or unrelated donor ( 1 in 5000 ).

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32
Q

Bone marrow transplant and leukemia

A

Additional chemo with or without whole body radiation is given ( lethal to the bone marrow ) - new cell are given - go to the marrow - if function properly - produce permanent cure
!!! Graft vs Host - immunossupresant for the rest of the life - graft attacks host ; 15 % die

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33
Q

Leukemia - Risk

A
  1. any age
  2. genetic
  3. chemical agents
  4. hx of chemo
  5. radiation exposure
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34
Q

Chemotherapeutic agents - SE

A
  1. hair loss
  2. N/V
  3. toxicities and interfere with growth of many tissues
  4. myelosuppression
  5. birth defects and potential sterility
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35
Q

Chemotherapy - action

A

destroy the cells that are rapidly dividing ( malignant) ; any other cells that are reproducing at that time - destroyed as well.

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36
Q

Antineoplastic agents

A
  1. Alkylating - interfere with mitosis and cell division usually at any stage of the growth cycle
  2. Cytotoxic - “cin-mycin” - antibiotic neoplastics - interfere with DNA and or RNA and protein synthesis
  3. Antimetabolites - interfere with biosynthesis - used for solid tumors
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37
Q

Lymphoma

A
  1. Solid tumor
  2. Abnormal overgrowth of lymphocytes
  3. Lymph nodes + spleen problem
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38
Q

Reed-Sternberg cells

A

Hodgkin’s lymphoma

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39
Q

Hodgkin’s lymphoma - Risk

A
  1. young adults and those over age 50 - men
  2. genetic
  3. viral - Epstain-Barr virus
  4. occupational toxins
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40
Q

Hodgkin’s lymphoma S/s

A
  1. Enlarged cervical lymph nodes - painless

2. fatigue, weakness, tachycardia

41
Q

B symptoms

A
  1. Weigh loss
  2. Fever, chills
  3. Night sweats
    * poorer prognosis
    Hodgkin’s
42
Q

Hodgkin’s lymphoma TX

A
  1. Chemotherapy - ABVD, MOPP
  2. Radiation
  3. Bone marrow or stem cell support
43
Q

Malignant B or T cells in the lymph tissue

A

Nonhodgkin’s lymphoma

  1. older adults
  2. aggressive and indolent
44
Q

Nonhodgkin’s lymphoma - risk and TX

A
  1. long term immunosuppressive tx;
  2. hx of tx for Hodgkin’s
  3. RA and HIV
    TX: CHOP-R chemo ; radiation; bone marrow or stem support
45
Q

Multiple Myeloma

A
  1. Overgrowth of B-lymphocyte plasma cells in the bone marrow - increase
    Antibodies - released into blood - increase serum protein levels - clogging blood vessels
    Cytokines - increase cancer cell growth rates and destroy bone
46
Q

Multiple Myeloma - Risk

A
  1. Afro-american men after 40 ( 65)
  2. Chemical exposure
  3. Genetic and viral
47
Q

Multiple Myeloma S/s

Pain, hydration, injury !!!

A
  1. Slow onset
  2. Bone pain - triggered by movement
  3. Diffuse osteoporosis - pathological fracture
  4. Hypercalcemia
  5. Increased protein levels may cause renal failure
  6. S/s related to anemia, thrombocytopenia + agranulocytopenia
48
Q

Multiple Myeloma - Dx

A
  1. X-ray - Swiss cheese
  2. Bence-Jones protein in urine
  3. Bone marrow biopsy
49
Q

Multiple Myeloma - TX

A
  1. No cure
  2. Chemo, radiation
  3. Corticosteroids
  4. Biphosphonates - to help prevent bone loss and tx of hypercalcemia
  5. Allopurinol - for increased uric acid
50
Q

Colony stimulating factors ( biological response modifiers )

A

proteins that stimulate or regulate the growth, maturation, and differentiation of bone marrow stem cells; Given subcut or IV

51
Q

Erythropoietin - Stimulating Agents - Erythropoietin ( EPO, Procrit )

A

glucoprotein produced by the kidney; it stimulates RBCs production in response to hypoxia
* Hgb never exceed 12 g/dl - risk for death

52
Q

Erythropoietin ( EPO, Procrit ) - SE and AR

A

SE: hypertension, headache, arthralgias (joint pain), weakness, dizziness, thrombosis (clots)
AR: seizures, hyperkalemia, cerebrovasc. accident, MI.

53
Q

Erythropoietin ( EPO, Procrit ) for …

A

anemia

54
Q

Granulocyte Colony - Stimulating Factor - Filgrastim (Neupogen)

A

regulates production of neutrophils within bone marrow

55
Q

Filgrastim (Neupogen) for …

A

neutropenia

56
Q

Filgrastim (Neupogen) - SE and AR

A

SE: N&V, skeletal pain, alopecia, diarrhea, skin rash, anorexia, bone pain
AR: thrombocytopenia, MI

57
Q

Granulocyte Macrophage Colony - Stimulating Factor - Sagramostim ( Leukine )

A

increase production and functional activity of eosinophils, macrophages, monocytes and neutrophils

58
Q

Sagramostim ( Leukine ) - AR

A

AR: pleural/pericardial effusion, GI, hemorrhage, dyspnea.

59
Q

Thrombopoietic Growth Factor - Oprelvekin ( Neumega ) - SE

A

platelet growth factor
Fluid retention
Cardiovascular events
with diuretics - risk for hypokalemia

60
Q

Colony stimulating factors - nursing considerations

A
  1. Keep vial warm
  2. Bleeding
  3. Admin 24 hrs after chemo
  4. Monitor BP and platelet count , CBC
  5. Do not shake
61
Q

Aplastic anemia vs Pancytopenia

Risk - congenital, acquired ( radiation, meds), idiopathic

A
  1. decrease of RBCs because of failure of the bone marrow to produce this cells
  2. decrease RBCs, WBCs, platelets
62
Q

Aplastic anemia , Pancytopenia S/s :

A

of anemia, infection, potential bleeding

63
Q

Aplastic anemia , Pancytopenia Tx:

A
  1. Blood transfusions
  2. Stem cell transplant
  3. Splenectomy
  4. Bone marrow stimulants - biological response modifiers - colony stimulating factors
64
Q

B12 - cobalamin

A

activate enzyme that move folic acid into the cell where DNA synthesis occurs ; stored in liver

65
Q

Vitamin B12 deficiency anemia - macrocytic - types

A
  1. Dietary or due to malabsorption - GI surgery, bowel resection, long term use of H2 ( histamine) blockers
  2. Pernicious anemia - lack intrinsic factor - cant absorb B12
66
Q

Pernicious anemia - TX

A

B12 IM - daily, weekly - Hb normal - for life/ 1 mo ;

Colomist - nasal spray

67
Q

Vitamin B12 deficiency anemia S/s

A
  1. anemia s/s
  2. sore tongue, N/V, anorexia, abdominal pain
  3. altered thought processes - dementia , neurological/neuromascular deficits ; gastric cancer - some are not reversible
68
Q

Vitamin B12 - foods

A

meat, eggs, dairy products

* vegans - high folic acid may mask B12 deficiency.

69
Q

Iron supplementation - ferrous sulfate 300 mg = 60 mg elemental iron ; Dose tx - 150-200 mg in 3-4 doses/daily - elemental

A 
Absorbed from duodenum + jejunum 
\+ OJ or Vitamin C 
1 hour before eating ( with food if upset stomach) 
Straw for liquid iron - stain teeth 
2-3 mo even after Hg normalizes 
SE: dark black stools ! constipation 
Toxic !!!
70
Q

Iron deficiency anemia - foods

A

red meats, organ meats, beans + peas, fortified cereals, green leafy veggies + Vitamin C

71
Q

Iron deficiency anemia - Risk !!!

A
  1. Premenopausal + pregnant women
  2. Children
  3. Lower socioeconomic background
  4. Older adults
  5. Blood loss - GI
72
Q

Koilonychia

A

spoon nails - chronic anemia

73
Q

Iron deficiency anemia - S/s

A
  1. Fatigue + activity intolerance
  2. Pallor
  3. Glossitis and burning of tongue, chelitis ( mouth)
  4. Headache
  5. Paresthesias
  6. Bleeding - menstrual bleeding , melena (black tarry stool)
74
Q

Iron deficiency anemia - Dx

A
  1. Decreased - Hh/Hct , ferritin test ( free iron in the plasma)
  2. Increased - transferrin ( transports iron ) & total iron binding capacity
    Microcytic cells
75
Q

MCV - mean corpuscular volume

A

average size of RBCs - normocytic, microcytic, macrocytic

76
Q

MCHC - mean corpuscular Hgb concentration

A

average concentration of Hgb in RBC - normochromic ( RBCs normal color ) & hypochromic ( RBCs pale color )

77
Q

MCH - mean corpuscular Hgb

A

average weight of Hgb

78
Q

Agranulocytosis vs leukopenia vs neutropenia vs granulocytopenia

A

low count of neutrophils (granulocytes) vs WBC vs neutrophils (largest) vs granulocytes

79
Q

Actual neutrophil count (ANC)- normal

A

greater than 2000

80
Q

Thrombocytopenia - types (platelets live 8-10 days)

A
  1. ITP - Immune Thrombocytopenia Purpura (platelets destroyed by spleen)
  2. Heparin-Induced thrombocytopenia - most common
    * severe < 20 000 - bleed spontaneously
81
Q

Thrombocytopenia S/s

A
  1. Bleeding

2. Petechiae, purpura, ecchymosis

82
Q

Persantine
Plavix
Aspirin
Trental

A

Antiplatelets

83
Q

Glycoprotein inhibitor; prevent platelet activation and thrombus formation with recent MI, CVA … ; IV route; SE: dyspepsia , dizziness, pain at injection site, hypotension, bradycardia ; hematuria, tarry stools, bruising.

A

Abciximab (Reopro)

84
Q

Polycythemia

A

Increase of RBCs - increase blood viscosity + volume

85
Q

Primary Polycythemia Vera (PV)

A

cancer of RBCs - massive production of RBCs , excessive leukocyte production and excessive production of platelets - can develop acute myelogenous leukemia

86
Q

Secondary PV

A

due to chronic hypoxia - COPD, chronic heart conditions, high attitudes

87
Q

PV - pathophysiology

A

Increase in number of cells - abnormal RBCs - shorter life span - rapid turnover - increase amount of cell debris ( cells die) - uric acid + potassium - gout and hyperkalemia ; Oxygen-carrying capacity is impaired - hypoxia; Bleeding.

88
Q

Plethora

A

ruddy (flushed) complexion - polycythemia

89
Q

PV - S/s

A
  1. Hypertension
  2. Headache + vertigo
  3. Tinnitus + visual problems
  4. Plethora
  5. Thrombosis
  6. Hepatomegaly + splenomegaly - abdom. stomach pain
  7. Pruritus , bleeding
90
Q

PV - TX

A
  1. Prevent/ treat hypoxia
  2. Phlebotomy - 500 ml of blood 1-2/week
  3. Myelosuppresive agents - Busulfan or hydroxyurea
  4. maintain hydration - over - volume overload ; under - increased blood viscosity
91
Q

PV + nutrition

A

encourage small, frequent meals rather than three big meals

92
Q

Hemolytic anemia : causes

A
  1. Trauma
  2. Mechanical heart valves
  3. Hemodialysis
  4. Cardiopulmonary bypass
  5. Toxins, infection, blood transfusion, drugs, autoimmune disorder
93
Q

Hemolytic anemia - S/s

A

jaundice + renal damage

94
Q

Hemolytic anemia - Tx

A

remove/limit cause; splenectomy; corticosteroids; blood transfusions

95
Q

G6PD deficiency anemia (X-linked enzyme) black male

A

not anemic until a stressor causes hemolytic response - hemolytic crisis

96
Q

G6PD deficiency anemia - stressors

A
  1. Infection
  2. Antimalarial agents
  3. Nitofurantoin
  4. NSAIDs
  5. Fava beans (lima)
  6. Moth balls
97
Q

G6PD deficiency anemia - S/s

A
  1. worsening of s/s of anemia
  2. red, red-brown, tea colored urine
  3. decreased urinary output - renal failure
98
Q

G6PD deficiency anemia - Tx

A

Eliminate/treat cause
Transfusion
Hydration
Genetic counseling + newborn screening

99
Q

ITP - idiopathic thrombocytopenia purpura - tx

A

Corticosteroids, splenectomy, immunosuppresive therapies, platelet transfusion

NURS 2501 (11 decks)

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