Hematology Flashcards by Sydney Book

What is yellow bone marrow also known as?

Adipose

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What is hematopoiesis?

Production of blood cells

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What is a stem cell?

Inmatture blood cell that is able to self renew

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What are the 3 major functions of blood?

Transport oxygen, nutrition, hormones and waste
Protect coagulation and infection
Regulate fluid and electrolytes, acid bases, and thermoregulation

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What are the 2 major components of blood?

Plasma (serum)
Cells (RBC, WBC, Platelets)

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What are RBC’S?

erythrocytes

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what are WBC’s?

leukocytes

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what are platelets?

thrombocytes

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what does erythrocytes (RBC) do?

transport and acid base regulation of oxygen and carbon dioxide

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what is erythropoietin?

production of RBC in response to tissue hypoxia

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what is hemolysis?

destruction of RBC

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what are the two type of WBC?

Granulocytes
Agranulocytes

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what are the 3 granulocytes (WBC)?

Neutrophils
Basophils
Eosinophils

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what do neutrophils do?

Increase during inflamation and infection

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what do basophils do?

Increase duriing inflammation and allergic rx

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what do eosinophils do?

Increase during allergic rx or parastie infections

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what are the 2 agranulocytes?

lymphocytes
monocytes

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what do lymphocytes do?

regulate cellular and humoral immune response
regulate B&T cells

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what do monocytes consume?

bacteria
dead cells
tissue
debris
old RBC

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what are thrombocytes and what do they originate from?

platelets
stem cells within the bone marrow

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what is the clotting process regulated by?

thrombopoietin (production of platelets)

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where is normal iron metabolism obtained from?

food and dietary supplements

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what carries plasma proteins for iron?

transferrin

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what are the normal clotting mechanisms?

vascular injury and subendothelial exposure
platelet adhesion
platelet activation
platelet aggregation
platelet plug fomration
clot retraction and dissolution

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what is the spleen?

2nd largest secondary lymphoid organ

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what are the 4 functions of the spleen?

Hematopoietic: produce RBC during fetal development
Filtration: remove old RBC and reuse iron
Immunologic: has a rich supply of lymphocytes, monocytes and immunoglobins
Storage: holds RBC and platelets

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what does the liver do?

makes proagulants
secretes billirubin and bile
stores iron
makes hepcidin (key regulator of iron balence)

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what is lymphatic fluid and when does it occur?

lymphedema
-occurs when to much interstitual fluid develops

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what does a left shift and a right shift refer to?

WBC differential

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what is a left shift?

indicates increased number of inmatture neutrophils (bands)
-infection or inflammation

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what is a right shift?

indicates a high number of mature neutrophils (segs)
-anemia or liver disease

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what can low platelet count lead to?

<100,000: thrombocytopenia and bleeding
<10,000: spontaneous hemmoraging

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what can a high platelet count lead to?

> 400,000: thrombocytosis or excessive clotting

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what is the procedure for a bone marrow aspiration?

sign consent
prone or side laying
time out
conscious sedation
clean skin aseptically (posteior illec crest)
bone marrow needle inserted into cortex
5-10ml aspirated
apply pressure for 5-10 min with sterile gauze
cover with sterile dressing

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what can kidney problems cause r/t hematology?

it can cause problems producing RBC (erythropoiesis)

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if a patient has a splenectomy, what are the nursing interventions post op?

monitor platelt count to prevent clotting
give blood thinners

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what are signs of low HGB?

Pale
fatigue
confusion
increased RR
decreased o2
pruritis due to increased bile salts

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what should the nurse do for low platelets?

put on bleeding precautions
watch for bleeding

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if a patient has fallen and is pale which lab should you check?

HGB

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what could neutropenia (low WBC) mean?

<1000
sepsis or infection

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what are the symptoms of low platelets?

bruising
blood in urine and stool
nosebleeds
bleeding gums
petechie eye
pruritis
purpura

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if platelets are lower than 100,000 what should the nurse hold?

lovenox

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what side should a pt lay on for a bone marrow aspiration?

if the biospsy is on the right side, then lay on the right side for 30-60 min to decrease risk of bleeding

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what are the blood transfusion guidlines?

16yo with parent consent
110lbs
not donated blood in the last 56 days

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What is the first thing you ask your pateint when educating about blood transfusion?

“Have you had a blood transfusion before?”

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What can the PCT do r/t blood transfusions?

Get vitals

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What are the s/s of an allergic reaction r/t blood transfusions?

Itching
Hives
Flushing

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What do you do if a pateint has an allergic reaction to a blood transfusion?

Slow infusion
Get vitals
Notify HCP

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What do you anticipate to give for an allergic reaction to a blood transfusion?

Antihistamines
Antipyretcs
Steroids

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What are the s/s of a febrile, nonhemolytic reaction to a blood transfusion?

Chills, fever
N/V
Flushing
Anxiety
Tachycardia
Muscle aches

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What do you do for a febrile, nonhemolytic reaction to a blood transfusion?

Stop infusion
Keep IV site open with NS (need new tubing)
Get vitals
Notify HCP
Send blood and tubing to the lab

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What do you anticipate for a febrile nonhemolytic reaction to a blood transfusion?

Antipyretic
Blood and urine sample

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What are the s/s of an acute hemolytic reaction to a blood trasfusion?

Fever
Flushing
SOB
Anxiety
Chest and abdominal pain
Tachycardia
Tachypnea
Hypotension
Bronchospasms
Shock
Renal failure
Cardiac arrest or death

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What do you do for an acute hemolytic reaction to a blood transfusion?

Stop transfusion
Keep IV open with NS
Stay with pateint
Call for help
Get vitals
call HCP
Start CPR
Send blood and tubing to the lab

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What would you anticipate for an acute hemolytic reaction to a blood transfusion?

Bolus
Diuretic
Foley
Epinephrine
Blood and urine sample

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What are the s/s of a delayed hemolytic reaction to a blood transfusion?

Fever
Jaundice
Decreased HGB

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What is the treatment for a delayed hemolytic reaction to a blood transfusion?

No treatment is needed

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When does a delayed hemolytic reaction to a blood transfusion occur?

After the blood is transfused

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What are the s/s of an anaphylatic reaction to a blood transfusion?

Wheezing
Cyanosis
Restless
Anxiety
Shock
Cardiac arrest

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What do you do for an anaphylatic reaction to a blood transfusion?

Stop infusion
Keep IV open with NS
Stay with pateint
Call HCP
Call a code or CPR
Send tubing and blood to lab

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What would you anticipate for an anaphylatic reaction to a blood transfusion?

Epinephrine
Urine and blood sample

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What are the s/s of a circulatory overload r/t blood transfusions?

Cough
Frothy speutum
Distended neck veins
SOB
Crackles
HA
Tachycardia
HTN

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What do you do for a circulatory overload r/t blood transfusions?

Stop infusion
Place in high fowelers
Call HCP

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What would you expect for a circulatory overload due to blood transfusions?

Chest xray
Diuretics
O2
Morphine

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what is anemia?

decreased erythrocytes (RBC)
decreased quality of HgB

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what does anemia do?

reduces O2 capacity

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what level is low with anemia?

HgB

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what are the symptoms of anemia?

Pallor, jaundice, pruritis
increased HR and RR
angia
fatigue
dyspnea on exertion
night cramps
heart failure
edema, ascites
HA, dizzy, dim vision

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what are the 3 major causes of anemia?

decreased RBC production
blood loss
increased RBC destruction (hemolysis)

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what chronic disease or disorders can cause anemia?

kidney disease
cancer
autoimmune

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what is sideroblastic anemia?

production of sideroblast instead of erthrocytes
-fatugue
-SOB
-enlarged liver and spleen

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what happens when kidneys are diseased or damaged?

they dont make enough erythropoietin
so bone marrow makes less RBC causing anemia

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what can defective DNA synthesis lead to?

defiencey of Vit B12 and folate

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what can cause acute blood loss?

trauma
ruptured vessels
splenic sequestration crisis

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what can cause chronic blood loss?

Gastritis
menstruation
hemmorids

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what stimulates erythropoiesis?

Epetin Alfa
may also need iron preparation

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what is the Epoietin alfa used to treat?

anemia associated with renal disease, chemo induced anemia, and zidovuudine therapy

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when do you not give epoetin alfa?

if a pateint is on dialysis
HgB is above 11

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when do you not give iron?

with meals, milk, or antacids

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what doyou do or not do when administering erythropoiesis stimulating agents?

do not admin with other products
do not shake the vial
vit b12 can be given

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which lab level needs to be assessed before giving epoietin?

HgB

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what is the long acting form of epoeitin for erythropoiesis?

Dorbepoeitin

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what is hyperchromic?

dark and cellular

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what is hypochromic?

pale or light

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what is associated with microcytic RBC?

Thalassemia
iron deficency anemia
chronic anemia
sideroblastic anemia

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what is associated with macrocytic RBC?

Vit B12 or folate deficiency
Liver disease
MDS
chemo (methotrexate)

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what must dietary iron be converted by in order to be absorbed?

gastric juices

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what are the symptoms or iron deficency anemia?

pallor
glossitis
cheilitis

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what are the diagnostics for iron deficency anemia?

Hgb and Hct
ferritin levels
bone marrow aspiration
hemocult stool
colonoscopy

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what foods are high in iron?

spinach
whole grain breads

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what foods enchance iron absorption?

orange juice
veal
fish
ascorbic acid

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what foods impair iron absorption?

eggs
beans
corn
cereal containing phytates

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what are oral iron preparations available as?

Ferrous salts

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when should oral iron supplements be taken?

2hr before or 1 hour after milk or antacids

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how should a pateint take liquid oral iron preparations?

through a straw to avoid staining teeth

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what are the parenteral iron preperations?

Iron dextran
iron sucrose
ferric gluconate
ferumoxytol

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what should a pateint do after having a parenteral iron supplement?

lay in recumbant position for 30 min to prevent orthostatic hypotension

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what can iron preperations cause?

black tarry stools

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what are the contradictions of iron supplements?

Hemochromatosis (to much iron)
Hemoltyic anemia (thalassemia)

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what is thalassemia?

Microcytic and hypochromic
decreased HgB and RBC

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what is Cooleys anemia?

Thalassemia Major
life threatening
symptoms develop by age 2

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what are the symptoms of thalassemia?

growth deficits
splenomagaly, cardiomegaly, and hepatomegaly
bone marrow hyperplasia
pulmonary disease
HTN
jaundice

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what can cause jaundice in thalassemia?

hemolysis of RBC

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what do you not give for thalassemia?

iron supplements

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what is used in the treatment of thalassemia?

pRBC transfussions
chelating agents
folic acid
splenectomy

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what are the chelating agents used for thalassemia?

Deferasirox
Deferiprone
Deferoxamine

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what is the only cure for thalassemia?

HSCT

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which hematoligic problem are microcytic and hypochromic?

iron deficient anemia
thalassemia

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which hematologic disorder is macrolytic?

megaloblastic anemia

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what is megaloblastic anemia?

B12 (cobalmin) defiency
folate defiency

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what is pernicuous anemia?

most common cause of cobalmin (B12) deficency
60 yo is common age of diagnosis
another name for megaloblastic anemia

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what is the difference in pernicuous anemia and megaloblastic anemia?

pernicuous doesnt have an intrinsic factor to absorb B12
megaloblastic is just low b12

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how would B12 be administered to a pateint with pernicuous anemia?

nasal spray or injection because stomach cant absorb it

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what are the symptoms of megaloblastic anemia vitamin B12?

mild jaundice
weakness
sore, smooth, beefy, red shiny tounge
paresthsia
confusion
ataxia
anorexia
vitiligo
premature greying

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what are the diagnostic studies for megaloblastic anemia?

Vit B12 and folate levels
serum b12
serum methylmalonic acid (MMA)
serum homocysteine
schilling test

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what diagnostic differentiates btwn pernicuous anemia and megaloblastic anemia?

shilling test for intrinsic factor

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what foods should you eat with megaloblastic anemia but not pernicuous?

red meat
liver
eggs
dairy
grain

not pernicuous because intrinsic factor cant absorb b12 from foods

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what medication is given for megaloblastic anemia (pernicous anemia)?

cyanocobalamin - lifelong

what are the drug interactions of cyanocobalamin?

dont give with cimetidine, colchicine, or potassium
dont mix with other drugs
IM or subQ
burning at injection site

what are the nursing responsibliites for megaloblastic anemia?

gait and stablity
small amounts of soft bland foods
frequent mouth care

what are the symptoms of megaloblastic anemia folate deficency?

same as B12 but no neuro symptoms

what will folate levels look like with megaloblastic anemia folate deficency?

low folate
normla coalbumin

what can decrease folate?

alcohol

what causes folate defiency?

malabsorption

what can untreated pernicuous anemia progress to?

neurologic damage

what is folic acid essential for?

erythropoesis

when should folic acid be given?

not until the cause of anemia is determined because it is contradicted in pt with pernicuous anemia

what hematoligic problem is normocytic and normochromic?

aplastic anemia

what is aplastic anemia?

body stops producing new blood cells (RBC, WBC, and platelets)
-panctopenia
-hypocellular bone marrow

what is pancytopenia?

decrease in RBC, WBC, and platelets

what are the nursing interventions for aplastic anemia?

dont share room with a pateint who has an infection such as pneumonia because they cant fight off infections

what are the diagnostic for aplastic anemia?

CBC
iron studies
H/H
bone marrow biopsy

what are the symptoms of aplastic anemia?

fatigue
pallor
weakness
exertional dyspnea
petechieae
echymosis
tachycardia
susceptible to infections

what is the treatment of aplatic anemia?

HSCT
-hematopoietic stem cell transplant
cyclosporin
cyclophosphamide
ATG
-antihymocyte globulin

what is ATG (treatment for aplastic anemia)?

antithymocyte globuliin
hoarse serum
can delay immune response, fever, rash, anaphyaxis

what is acquired hemolytic anemia?

lysis (destruction) of RBC by extrinsic factors

what is the treatment for aquired hemolytic anemia?

preserve kidney function
-immunosuppresants
-folate
-hydration
-corticosteroids
-blood transfusion
-splenectomy

what are the signs of a severly anemic patient ?

dyspnea
tachycardia

What is hemochromatosis?

To much iron in the body
Genetic

What foods should you avoid with hemochromatosis?

Vitamin C
Uncooked seafood
Iron rich foods

What are the symptoms of hemochromatosis?

Fatigue
Arthralgia
Impotence
Abdominal pain
Wt loss

Late:
Enlarged liver
Cirrhosis
Heart disease
Arthrirtis
Testicular atrophy
Diabetes

What are the diagnostics for hemochromatosis?

Iron studies: serum iron, ferritin, TIBC
Genetic testing
Liver biopsy

How do you treat hemochromatosis?

Blood removal
Chelating agents
Manage organ involvement

What is chelating therapy?

Decreases red blood cell production by binding with iron and then removes iron from the bloodstream

What medication is a type of parenteral chelation therapy?

deferoxamine

What should you monitor when recieving chelating therapy of deferoxamine?

Platelet count

What type of meds can you not give to a pregant or patient with renal disease?

Chelating agents

What is an oral chelating agent?

Deferiprone

What can the chelating agent deferiprone cause?

Reddish, brown urine

what is polycythemia?

Erythrocytosis
abnormally high RBC
HCT>50

what can polycythemia lead to?

stroke

what is a complication of the hyperviscosity of polycythemia?

thrombosis

what is polycythemia often confused with and why?

dehydration because they have the same lab levels (increased HgB and HCT)

what are the nusing actions for polycythemia?

TED hose (DVT)
ambulate
monitor I/O
no iron supplements

what is polycythemia vera (primary)?

elevated erythrocytes, leukocytes, and thrombocytes
Genetic not inherited

what are the symptoms of polycythemia vera?

HTN
HA
dizzy
decreased concentration
tinnitis
visual disturbnaces
paresthsia
erythromelagia
dusky reddness and cyanosis of lips, nails, and mucous membranes

what are the lab levels for polycythemia vera (primary)?

Inncreased platelets
increased HgB and Hct
increased BP

*dont call physician

if a patient with polycythemia vara (primary) suddenly has pain in their legs, what do you do?

notify HCP, could be a clot

what are the diagnostics of polycythemia vera?

increased RBC, WBC and platelets
uric acid
cobalamin and histamine
decreased erythropoietin
splenomegaly

what is the non-medication treatment for polycythemia vera (primary)?

phlebotomy (300-500ml)
hydration

why can aspirin be given for polycythemia vera (primary)?

helps prevent clotting

why is allopurinol given for polycythemia vera (primary)?

prevent gout

what is the first line treatment for polycythemia?

Hydroxyurea

if previoius meds dont work for polycythemia, what is the 2nd line of treatment?

Ruxolitnib

what does Ruxolitnib do for the treatment of polycythemia?

helps control the number of blood cells the body makes

what does anagrelide do for the treatment of polycythemia?

decreases the number of platelets

what does allopurinol do for the treatment of polycythmia?

prevents uric acid production

what is secondary polycythemia?

hypoxia driven or hypoxia independent

what is the difference between polycythemia vera (primary) and secondary polycythemia?

secondary polycthemia doesnt enlarge the spleen

what is the main treatment for secondary polycythemia?

relieve hypoxia

what kind of disease is sickle cell?

the most severe anemia
inherited autosomal resessive

what can sickle cell lead to?

renal failure and stroke

what are sickle cell episodes cause by?

low 02 in the blood

what is the primary symptom of sickle cell?

pain

what are the nursing interventions for a sickle cell crisis?

increase fluids and provide rest due to decreased blood flow
avoid crowds because of increased risk of infection
treat pain

what is the most importnat factor for assessing a pateint with sickle cell?

the pain that the patient states their in

what is the main cause of death in sickle cell patients?

infection

what is the treatment of sickle cell?

o2 to prevent tissue damage
morphine
rest
F/E
keep pt warm
transfusion when aplastic occurs

*relieve hypoxia

if o2 is normal in a patient with sickle cell, what do you do?

still give more o2

what medication can be used for treatment of sickle cell?

Hydroxyurea

what is hemostasis?

control of bleeding
interactions between platelets and clotting mechanisms

what can thrombocytopenia lead to?

bleeding and hemmorage
petechiae
purpura
-mucous membranes of mouth nose and GI

what happens to blood pressure when bleeding?

it decreases

what is immune thrombocytopenia purpura (ITP)?

autoimmune
platelets are coated with antibodies, so they are attacked when they reach the spleen
platelet life is shortened 8-10 days

what do you do is you have an order to give platelets for a pateint with immune thrombocytopenia purpura (ITP)?

check platelet count
if normal, notify HCP

what are signs that a platelet transfusion may be appropriate?

bleeding from IV
decreased blood pressure
petecheia

what is thrombotic thrombocytopenia purpura (TTP)?

medical emergency

what is thrombotic thrombocytopenia purpura (TTP) associated with?

Hemolytic uremic syndrome (HUS)

what can cause thrombotic thrombocytopenic purpura (TTP)?

autoimmune disorders
-lupus
-scleroderma
-drug toxicites
-preclampsia

what is heperin induced thrombocytopenia (HIT)?

veneous and arterial thrombi form leading to infarctions, strokes, and necrosis
pateint will rarely bleed
happens 5-10 days after heparin therapy

what can signal heparin induced thrombocytopenia (HIT)?

if platlets fall less than 50%
or less than 150,000

what do you do for a heperin induced thrombocytopenia (HIT)?

stop heparin
maintain anticoagulation with thrombin (give Argatroban)
plasmaphereisis- clears platelet aggregatingg IgG from blood

what do you not do for treatment of heperin induced thrombocytopenia (HIT)?

platelet transfusion bc it could cause thrombosis

when can you start warafrin if a patient has heparin induced thrombocytopenia (HIT)?

when platelet count reaches 150,000

what are the diagnostics for all thrombocytopenias?

CBC, platelets, antinuclear antibodies (ANA)
Pt, aPTT, H/H, ITP antigen assay, PF4-heparin
bone marrow

what education may be given to a patient with thrombocytopenia?

apply pressure longer
avoid straining, picking/blowing nose
use soft toothbrush
rinse mouth with NS q 2 hr
avoid alcohol based mouthwashes

what is the treatment for immune thrombocytopenia purpura (ITP)?

platelet transfusion
splenectomy
corticosteroids
IV immunoglobin

why are corticosteroids given for the treatment of thrombocytopenia?

they inhibit the spleen which increases lifespan of platelets

what is the treatment of thrombotic thrombocytopenia purpura (TTP)?

plasmaphoresis- remove pt plasma and replace with FFP
splenectomy
corticosteroids

what does the nurse do for thrombocytopenia?

discourage OTC aspirin (can cause thrombocytpenia)
observe for s/s of thrombocytopenia in pt receiving chemo drugs
educate ways to reduce risk of bleeding
closely monitor platelet count, coagulation studies, HgB and Hct

what is disseminated intravascular coagulation (DIC)?

intravascular clotting and bleeding
life threatning
profuse bleeding

what can clotting and bleeding with disseminated intravascular coagulation (DIC) lead to?

multi-organ failure

what is the priority education/treatment for disseminated intravascular coagulation (DIC)?

DIC cannot be treated until the underlying cause is solved
*treat underlying cause

what are the signs of disseminated intravascular coagulation (DIC)?

oozing blood
occult hemmorage
tachyonea, orthopnea
tachycardia, hypotension
pulmonary emboli
cyanosis
bloody stools
hematuria
dizzy, HA
irritiable
bone/joint pain

what is the treatment of disseminated intravasculat coagulation (DIC)?

stabalize
treat underlying cause
blood products
Heparin

when can heparin be given for disseminated intravascular coagulation (DIC)?

only if there is more clotting than bleeding

what is hemophilia?

group of hereditary diseases that lead to persistant, severe bleeding
x linked recessive genetic

what is the most common type of hemophilia?

A, factor VIII
men

what happens with hemophilia?

platelet plug is formed but clotting deficit does not allow stable fibrin clot
bleeding occurs from trauma which leads to hemarthrosis (bleeding in joints)

what are the symptoms of hemophilia?

slow persistant bleeding from an injury
delayed bleeding
uncontrollable hemmorage
hemarthosis
bruising
oral and GI bleeding

what is hemarthrosis and what do you do?

bleeding in joints
immobilize that joint until bleeding stops

what is the treatment for hemophilia?

clotting factors
desmopression acetate(DDAVP)
antifibrinolytic therapy
treat minor bleeding episodes

what is the nursing management for hemophilia?

teach daily oral care
non contact sports only
wear gloves for household chores and yardwork
wear med alert tag

what 2 meds are given for hemophilia and what do they do?

Desmopressin
Tranexamic acid

you can not give desmopressin to a patient who has?

disseminated intravascular coagulation (DIC)

what is leukocytosis?

excess WBC

what is the first part of a WBC to arrive to a sight of injury?

neutrophils

what will happen to neutrophils with infection or inflammation?

they will increase

what is the formula for absolute neutrophil count?

add your polys (segs) to your bands
multiply by WBC
Mutiply by 10

what will lab levels look like for neutropenia?

decreases neutrophils
normal WBC

what is neutropenia diagnosed with?

CBC
then a bone marrow biopsy for the cause

if a patient has neutropenia and develops a low grade fever, what do you do?

Immediate interventions, bc any change could mean infection

what are the nursing interventions for neutropenia?

prevent infection, - reverse isolation
strict handwashing and hygeine
screen visitors for sickness

what should you educate a pt on with neutropenia?

Dont share personal items
use a soft toothbrush
get immunizations
avoid crowds

what foods does a patient need to avoid with neutropenia?

no raw meat
no unpeeled fruit
no fresh flowers

what medicine is used to treat neutropenia and what does it do?

FIlgrastim (Neupogen)
-stimulates neutrophils

what are the adverse effects of Neupogen thats given for neutropenia?

muscle aches, bone pain, and fever

what is myelodysplastic syndrome (MDS)?

the disruption of the production of blood cells

what is the sign of myelodysplastic syndrome (MDS)?

infection or bleeding

what is myelodysplastic also known as?

preleukemia

whatis the definitive diagnosis for myelodysplastic syndrome (MDS)?

bone marrow biopsy

what medications are used to treat low risk myelodisplastic syndrome (MDS)?

Erythropoeitin
Neupogen -G-CSF
Sargramostim (Leukine) -GM-CSF

what can increase effects of Sargramostim (leukine)?

corticosteroids
lithium

what medicines are used to treat high risk myelodisplastic syndrome (MDS)?

Antimetabolite Chemotherapy Drugs
-Azacitidine
-Decitabine

what is the difference in acute and chronic leukemias?

acute is acute onset with rapid progression
chronic is gradual onset with prolonged course

what is the major cause of death in chronic leukemia?

hemorrage or infection

what is acute myelogenous leukemia (AML)?

bone marrow is filled with myeloblast

what are the signs of acute myelogenous leukemia (AML)?

fever
infection
weakness
bleeding
petechiea
purpura
enlarged liver and spleen

what is the main interventions for all leukemias?

prevent infection
report fever, increased neutrophils or any changed r/t infection

what medications are given for acute myelogenous leukemia (AML)?

Antimetabolite (cytarbine)
Idarubicin
Daunorubicin

what is acute lymphocytic leukemia (ALL)?

uncontrolled numbers of inmatture lymphoid cells (B cells)
most common in children

what are the signs of acute lymphocytic leukemia (ALL)?

fever
bone pain
weakness
HA
CNS symptoms
enlarged liver and spleen

what commonly happens before a diagnosis of acute lymphocytic leukemia (ALL)?

kids will come in with vague symptoms and be diagnosed with a viral infection until lab test are drawn

what are the lab levels with acute lymphocytic leukemia?

decreased RBC, HgB, and HcT
increased platelts
normal WBC

what is used to treat (non-medication) acute lymphocytic leukemia (ALL)?

Chemotherapy
Radiation
HSCT
Corticosteroids

what medicines are used to treat acute lympocytic leukemia (ALL)?

methotrexate into subarachnoid
- Asoaraginase (Antimetobalite)
-clofarabine (Antimetobalite)
-doxorubicin

what is chronic myelogenous leukemia (CML)?

excess mature neoplastic granulocytes in bone marrow

what is the hallmark sign of chronic myelogenous leukemia (CML)?

Philedelphia chromosomes

what is the treatment of chronic myelogenous leukemia (CML)?

chemo with cytarbine, daunorubicin, or methotrexate (antimetabolite)

what is the most common leukemia in adults?

Chronic lymphocytic leukemia (CLL)

what is chronic lymphocytic leukemia (CLL)?

lymphocytes fill into bone marrow, spleen, and liver

what do chronic leukemias have r/t symptoms?

no symotoms until it progresses to acute leukemia

what medicines are given for chronic lymphocytic leukemia (CLL)?

Chlorambucil
Rituximab
Vincristine
Methotrexate

what is the non medication treatment for chronic lymphcytic leukemia (CLL)?

chemotherapy
steroids
radiation
splenectomy
HSCT

what are the diagnostics for leukemia?

CBC
Platelet
bone marrow exam
lumbar puncture or CT

what are used for treatment of leukemias?

Chemotherapy (induction, remission, and maintence)
corticosteroids
radiation
HSCT

what is the induction phase of chemotherapy?

severly ill patients
-anemia
-thrombocytosis
-neutropenia

what can the nurse do when a pateint has chemotherpay side effects?

symptoms can be really bad so use therapeutic communication and open ended questions

what does HSCT increase the risk for?

infection

if a patient has a fever of 101 after a HSCT, what do you do?

it requires an immediate follow up

what is the nursing managment for leukemia?

report s/s of infection
provide infection protection measures
Vitals
monitor neutrophil levels
weigh regulary
culture lesions
mouth care
give antifungal agents

what is Hodgkins lymphoma?

lymphatic tissue cancer
most common in young adults and children older than 10

what are the signs of an insidious onset of Hodgkins lymphoma?

painless, enlarged lymph nodes
fever
night sweats
fatigue
weight loss

what do you assess for in a pateint with Hodgkins lymphoma?

lymph nodes

what can cause pain in a lymph node with Hodgkins lymphoma?

Alcohol
if node is pressing on a nerve

what are the diagnostics for Hodgkins disease?

CBC -mild anemia, increased neutrophils and esinophils
Increased SED rate
chest xray
chest/ abdominal CT
PET scan
* biopsy of noadal and extranodal sites (Reed Sternberg cells)

what are the stages of Hodgkins lymphoma?

single region of nodes
2 or more region of nodes above diaphram
2 or more ragion of nodes above and below diaphragm
widespres, organs, with or without nodes

A- no symptoms
B-symptoms

what is the treatment od Hodgkins lymphoma?

Chemotherpay
Radiation
ABVD regimen

what is the ABDV regimen for Hodgkins lymphoma?

Adriamycin
Bleomycin
Vinldastine
Dacarbazine

what is not needed in Hodgkins lymphoma that is needed in leukemias?

does not need maintence chemotherapy
-does not impact fertility

why is a follow up needed for Hodgkins lymphoma?

to look for a 2nd malignancy
- another cancer is possible

what is nonhodgkins lymphoma?

malignant neoplasms of B, T or natural killer cells
-Bcells invaid lymphatic system

what are the signs of nonhodgkins lymphoma?

painless nodes
airway obstruction
CNS disease
renal failure
GI complaints
fever
sweats
wt loss

what does nonhodgkins lymphoma not have?

no reed sternberg cells

what are the diagnostics for non-hodgkins lymphoma?

MRI
lumbar puncture for CNS
Endoscopies for GI
bone marrow biopsy
CBC for anemia, increased neutrophils and eosinophils
Chest/ abdominal xray or CT

what is the treatment for non hodgkins lymphoma?

Chemotherpay
Radiation
HSCT
Rituximab
CHOP regimen

what is the CHOP regimen?

Cyclophosphamide
Doxorubicin
Vincristine
Prednisone

if a patient just had a HSCT, what are the nursing interventions?

screen visitors
reverse isolation
no live plants or flowers

what can Rituximab cause and what should you do?

decreases platelets and WBC
*if patient gets any signs of infection, notify HCP

whats the difference in Hodgkins lymphoma and non Hodgkins lymphoma?

Hodgkin is localized, lymph nodes are rarely involved
Non hodgkins is peripheral nodes, nodes are involved

what is mutiple myeloma?

maligancy where plasma cells multiply uncontrollably and move into the bone marrow, lymph nodes and spleen
Bcells

what can increase the risk of multiple myeloma?

radiation
chemicals
herbacides

what happens with multiple myeloma and what should you check?

the bone is destroyed
check calcium levels

what can lead to dysfunction of immune and bone destruction r/t multiple myeloma?

M (monoclonal) proteins (IgA)

what are the signs and symptoms of multiple myeloma?

bone pain
osteoporosis- lytic lesions
hypercalcemia
neuro dysfunction
recurrent infections
renal failure
anemia, thrombocytopenia, neutropenia

what are signs of hypercalcemia?

Polyuria
constipation
bone pain
stones
decreased DTR
muscle weakness
confusion
stupor or coma
seizure

what are signs of hypocalcemia?

trousseu
chvostek
diarrhea
tingling
weak bones

what are the diagnostics of multiple myeloma?

MRI, PET, CT
bone marrow exam
CBC
urinalysis-m protein in blood and urine
Bone biposy
serum creatnine

what will a patient have in their urine with multiple myeloma?

Bense jones protein

why is a pateint with multiple myeloma a priority pateint?

increased risk for fractures which could lead to internal bleeding

what is the treatment dor multiple myeloms symptoms?

NO CURE
-corticosteroids
-chemotherapy
-immunotherapy
-HSCT

what are the nursing interventions for multiple myeloma?

control pain
avoid fractures
ambulate to absorb calcium
increase fluids to dilute calcium

what medications are used for multiple myeloma?

Cyclophosphamide
DOxorubicin
Bortezomib
Dexamethasone
*NSAIDS and acetiminophen for pain

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Hematology Flashcards

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