Hematology Flashcards
1
Q
What are the four major causes of Anemia?
A
- Inadequate RBC production - nutritional deficiencies, bone marrow disorders (leukemia), medication (chemotherapy)
- Increased RBC destruction - sickle cell anemia
- Excessive RBC loss - hemorrhage
-
Nutritional deficiency
- Decreased iron consumption
- Excess milk consumption
2
Q
How do you assess for Anemia in the lab?
A
- Routine screening for anemia: 1 year
- CBC with differential (Differential-classification of WBCs)
- Hemoglobin electrophoresis - type of hemoglobin being produced
- Reticulocyte Count
- Immature RBCs
- Indicates the rate and production of RBCs
- Ferritin
- Protein that stores iron
- Indirectly measures iron
3
Q
Anemia Severe and Acute manifestations?
A
- Tachypnea
- Tachycardia-heart beats faster to get oxygen to vital organs
- Pallor
- Prolonged capillary refill
- Weak pulses
- Systolic heart murmur
4
Q
Anemia Chronic manifestations?
A
- Pallor
- Jaundice-RBC destruction-bilirubin released
- Fatigue
- Delayed growth
5
Q
How is Anemia treated?
A
Treat underlying cause:
- Nutritional intervention (Iron-rich diet)
- Vitamins/Supplements (Oral iron supplements)
- Transfusions
Supportive Care:
- Oxygen
- IV fluids
- Rest
6
Q
Blood transfusion nursing considerations?
A
- Informed consent
- Two RNs verify blood product prior to administration
- Administer within 30 minutes of delivery
- Filter tubing
- Slower infusion rate the first 15 minutes
- Max infusion time over 4 hours
- Vitals at baseline, at 15 minutes, then per institution policy
7
Q
What adverse effects should you monitor for during and after blood transfusions?
A
- Fever
- Chills
- Pruritus
- Dyspnea
- Pain
- Decreased level of consciousness
- Change in vital signs from baseline
8
Q
Describe the etiology of Sickle Cell Disease.
A
- Autosomal recessive inherited blood disorder
- Characterized by abnormal hemoglobin in the RBC (HbS).
- Deoxygenated conditions (dehydration, high altitude, psychological stress), hemoglobin becomes a hard stiff rod.
9
Q
Describe the etiology of Sickle Cell Disease in relation to genetics.
A
- 25% chance will inherit two genes for sickle cell or two genes for Hemoglobin A
- 50% chance will inherit one gene for sickle cell and one normal gene, carrier state
10
Q
How is Sickle Cell Disease diagnosed?
A
- Newborn screening
- Hemoglobin electrophoresis-type of hemoglobin being produced
11
Q
Compare RBC vs. Sickle-Shaped RBC.
A
RBC:
- Soft, biconcave
- Lifespan: 120 days
Sickle-Shaped RBC:
- RBC polymerize, forming stiff rods
- Lifespan: 20 days or less
12
Q
Sickle Cell Disease acute complications?
A
- Acute Pain Episodes
- Acute Chest Syndrome
- Infection
- Acute Anemia
13
Q
What are Acute Pain Episodes (sickle cell disease)?
A
- Most common acute complication
- Recurrent vaso-occlusion with ischemia
14
Q
How are Acute Pain Episodes (sickle cell disease) diagnosed?
A
client’s reported pain
15
Q
How are Acute Pain Episodes (sickle cell disease) managed?
A
- IV opioids: morphine, hydromorphone
- Non-steroidal anti-inflammatory agent (NSAID): ibuprofen or ketorolac
- Integrative therapies: warm compress, massage
16
Q
What is Acute Chest Syndrome (sickle cell disease)?
A
- Pulmonary vascular vaso-occlusion
- New infiltrate on chest imaging
- Plus 2 of the following
- Chest pain
- Decreased oxygen saturation
- Tachypnea
- Fever
17
Q
What causes Acute Chest Syndrome (sickle cell disease)?
A
- Infection
- Acute pain episode
18
Q
How is Acute Chest Syndrome (sickle cell disease) managed?
A
- Frequent assessment
- Chest imaging
- Oxygenation
- IV Fluids
- Antibiotics
- Analgesia (NSAIDs & Opioids)
- Blood transfusion if indicated
- Blood cultures CBCD Reticulocyte count
- Incentive spirometry
19
Q
What is Infection (sickle cell disease)?
A
Risk for pneumonia, sepsis, and osteomyelitis
20
Q
How does infection affect the spleen?
A
- Spleen plays a role in preventing infection
- Filtering abnormal RBCs causes spleen to not function properly
21
Q
How does Anemia affect RBCs?
A
- Shorter RBC lifespan
- Reduced oxygen carrying capacity
22
Q
What immunizations are used to manage Sickle Cell Disease?
A
- Pneumococcal
- Meningococcal
- Haemophilus influenzae type B (Hib)
23
Q
How is Penicillin prophylaxis used to manage Sickle Cell Disease?
A
- All children with SCD from 2 months to 5 years of age
- Daily dose
24
Q
How is Hydroxyurea used to manage Sickle Cell Disease?
A
- Increases hemoglobin F
- HbF reduces HbS polymerization
- Decrease risk:
- ACS
- Acute pain
25
What are some lifestyle modifications that can be used to manage Sickle Cell Disease?
Avoid:
- Dehydration
- Cold temperatures
- High altitudes
26
Describe Sickle Cell Disease (CF) in relation to Structural Racism.
- Sickle Cell Disease and Cystic Fibrosis (CF)
- CF affects one third fewer Americans than SCD, but receives 7-11 times the research funding
- Unequal development of medications
- National network of specialty clinics
- Sickle Cell Disease
- Fewer centers available
- Centers less likely to be utilized
27
Describe Sickle Cell Disease (patients with SCD) in relation to Structural Racism.
- Patients with SCD
- Marginalized and dismissed while seeking medical care for life-threatening complications
- Stigmatized as drug-seeking and exaggerating their pain
- Inadequate treatment and increased suffering
- Often avoid medical care because of the perceived racial stigma
28
Describe Sickle Cell Disease (healthcare professionals) in relation to Structural Racism.
- Open-minded
- Self-aware
- Recognize own implicit biases
- Treat patients equitably, regardless of race
- Report any unequitable treatment
29
What are the different types of Hemophilia?
- X-linked genetic disorder
- Hemophilia A
- Hemophilia B
30
Describe X-linked genetic disorder.
- Characterized by a deficiency or absence of clotting factors
- Prolonged bleeding
31
Describe Hemophilia A.
- Factor VIII deficiency
- Treat with Factor VIII
- Desmopressin
- Desmopressin - increases Factor VIII and von Willebrand factor
32
Describe Hemophilia B.
- Factor IX deficiency
- Treat with Factor IX
- Desmopressin
33
Hemophilia manifestations?
Bleeding:
- With or without trauma
- Common sites:
- Joint
- Muscle
- Mouth
- GI sites
- Hematuria
34
How is Hemophilia managed?
- Prophylactic: Factor VIII or IX
- Hemophilia A: Emicizumab administered subq every 4 weeks
- Hold pressure after all punctures
- Avoid contact sports
35
Hemophilia acute injury nursing interventions?
- Acute injury- Administration of Factor VIII or IX
- Never delay factor administration
- RICE (rest, ice, compression, elevation)
