Hematology

Question 1

Neutrophil increase vs lymphocyte increase meanings?

Answer 1

Neutrophil increase: bacterial infection likely

Lymphocyte increase: viral infection likely

Question 2

What does MCV stand for and what does it measure?

Answer 2

Mean corpuscular volume. Average size of RBC. Macrocytic: large. Microcytic: small

Question 3

What does MCH stand for and what does it measure?

Answer 3

Mean corpuscular hemoglobin. The color of RBC. Hyperchromic: dark in color. Hypochromic: light in color

Question 4

What are some foods high in iron?

Answer 4

Organ meats, green leafy vegetables, raisins, dried beans, cereal

Question 5

What is the patho behind sickle cell anemia?

Answer 5

Autosomal recessive trait: abnormal HgbS gene which results in sickle shaped RBCs that tend to clump together, leading to occluded blood vessels, impaired oxygen delivery, pain crises, premature RBC death, and anemia

Question 6

When might a child start showing symptoms of SCA?

Answer 6

4-6 months after fetal hgb disappears

Question 7

When does vasoocclusive crisis start happening (percentage of sickled cells in RBCs, volume of hgb)

Answer 7

Vasoocclusion increases when sickling RBCs account for 30%+ of total RBC volume along with less than 10g/ml volume of Hgb

Question 8

What are triggers of vasoocclusive crisis?

Answer 8

Dehydration, cold weather, acidosis, hyperthermia, hypoxia

Question 9

What are some crises related to SCA?

Answer 9

Vasoocclusive crisis: pain in the area of infarct and areas following infarct. Dactylitis in children under 5. Neurological issues if infarct is in brain -> debilitating paralysis, aphasia, seizure, headache, facial droop, death. Retinal detachment: Vasoocclusion can lead to retinal ischemia which can cause retinal disease and visual acuity changed, ending with retinal detachment

Acute chest syndrome: sickling occlusion in the pulmonary vessels, emboli from infarcted bone marrow, or an infectious change that damages the lung tissue. Leads to chest pain, hypoxemia, dyspnea, tachypnea, cough, fever, wheezing, radiographic infiltrates, and respiratory distress

Asplenia: spleen absorbs the damaged and lysed cells -> slowly becomes fibrotic and nonfunctional

Splenic or hepatic sequestration: suddenly absorbs vast volume of blood, depleting the circulatory volume -> shock and abdominal distention

Repeat infarcts of vasoocclusion and excessive absorption of cells lead to hepatomegaly, fibrotic/damaged liver (sickle hepatopathy), cirrhosis, or liver failure: CM include jaundice, amber urine, hyperbilirubinemia (13-76 mg/dL)

Question 10

What is treatment during SCA crises like?

Answer 10

HOPS: Hydration, Oxygen, Pain, Support (rest)

Question 11

What are lab values of a SCA patient like?

Answer 11

Low RBC count due to early cell death
Low Hgb levels
Increased WBC count
Elevated BUN due to decreased kidney perfusion
Elevated ALT and AST due to decreased liver perfusion
Elevated bilirubin levels
Elevated erythropoietin and reticulocytes -> Elevated RDW
Increased platelets

Question 12

Pharmacologic tx for SCA

Answer 12

Opioids (NSAIDs), hydroxyurea: increases Hbg which can decrease incidence of vasoocclusive crisis, promotes splenic function, and reduces the incidence of stroke + acute chest syndrome, Deferoxamine can be given if hemolysis results in high levels of free iron. Causes iron binding and makes it excreted through urine

Question 13

Nonpharmacologic tx for SCA?

Answer 13

Warm compress, distraction, massage, good hydration

Question 14

What is hemophilia? What is the patho in classic hemophilia?

Answer 14

When the body is unable to stop bleeding. Deficiency in Factor VIII which leads to impairment of the clotting cascade. Typically inherited by sons from mothers who are carriers.

Question 15

What are CM of hemophilia?

Answer 15

Hemarthrosis, spontaneous/traumatic bleeding, excessive bleeding from cuts/falls/injuries, excessive bruising

Question 16

What is the tx for hemarthrosis?

Answer 16

Rest-Ice-Compression-Elevation

Question 17

What medication can increase levels of factor VIII?

Answer 17

Desmopressin acetate. Synthetic anti-diuretic which can cause hyponatremia, hypertension, and CHF

Question 18

What are some education points for patients with hemophilia?

Answer 18

Use acetaminophen rather than NSAIDs if in pain. Should avoid contact sports or jobs which would increase risk of bleeding. Use an electric razor for shaving. Promote exercise to strengthen muscles and prevent bleeding

Question 19

What are high risk groups of iron deficiency anemia?

Answer 19

infants (rt shortened lifespan of RBC 80-100 days rather than 120), adolescent females (menstruation and poor diet), women of childbearing age (menstruation), toddlers drinking cows milk (lack of iron), clients living in poverty (poor diet)

Question 20

What is IDA? What are the two types? What is its patho?

Answer 20

Iron deficiency anemia. Two types: absolute (not enough iron in the body. Iron demand exceeds supply) and functional (difficulty transferring iron from storage to bone marrow to make cells)

Question 21

What are early and late CM of IDA?

Answer 21

Early, nonspecific symptoms: fatigue, weakness, SOB, pale earlobes palms or conjunctiva, PICA

Later symptoms: (koilonychia) spoon shaped nails that are brittle, and thin with coarse ridges, cheilosis (sore on side of mouth), glossitis, stomatitis, painful ulcerations of buccal mucosa and tongue, smooth red tongue, dysphagia, gastritis, neuromuscular changes (headache, irritability, tingling, numbness, vasomotor disturbances [ataxia]), splenomegaly, cardiomegaly

Question 22

What is used to diagnose IDA?

Answer 22

Bone marrow aspiration is only definitive test

Question 23

What is tx for IDA and what are some considerations?

Answer 23

Ferrous sulfate/ferrous gluconate: can be taken orally -> take on empty stomach, rinse mouth out so it doesn’t stain teeth, given with no foods-esp dairy