Hematology Flashcards
erythrocytes
carry oxygen, concave disk, bendy and can fit through tight spaces in arteries, capillaries and veins
Rhesus (Rh) Factor
inherited protein attached to the surface of red blood cells, either positive or negative
Universal blood donor
O-
Rh positive can receive
positive or negative blood
Rh negative can only receive
negative blood
When giving blood can always give
only what they already OR less protein markers than what they have, blood won’t have anything for the body to respond
thrombocytes
clump together to achieve hemostasis; platelet plug and agglutination
Intrinsic coagulation
triggered by changes in the blood
extrinsic coagulation
triggered by something occurring outside the blood vessels (such as trauma)
Erythropoietin
produced by kidneys and stimulates production of erythrocytes
thrombopoietin
produced by spleen; controls thrombocyte production, 20% of thrombocytes are stored in the spleen, spleen breaks down old erythrocytes
clot is formed by
thrombin -> fibrinogen -> fibrin -> clot
clotting factors are produce in the
liver
anticoagulants
heparin, anti platelets, warfarin, factor Xa inhibitors
Heparin
anticoagulant; enhances antithrombim III which inhibits thrombin and prevents clots from forming; Intrinsic pathway
Heparin nursing considerations
monitor for bleeding- hematuria, hematemesis, bruising, monitor aPTT
heparin antidote
protamine sulfate
For a pt on heparin we want the aPTT to be
1.5-2x the normal
Heparin Induced Thrombocytopenia and Thrombosis (HITT)
heparin complication, occurs 5-10 days after heparin exposure, unexplained platelet drop and get clots, adverse response
HITT S&S and Tx
skin lesions at heparin injection sites, chills, fever dyspnea, chest pain, complications: DVT and PE
discontinue all heparin and start a different anticoagulant
Low molecular weight heparins
“parin”; prevents clots, always given SC, not interchangeable with heparin, dose is based on body size, no labs monitored, only anticoagulants that can be used in pregnancy
Warfarin
disrupts liver synthesis of vitamin K dependent clotting factors; monitor for bleeding, PT and INR (therapeutic is 2-3), contraindicated in pregnancy
low molecular weight heparins are porcine derived which means
they come from pigs and could have cultural or religious complications
warfarin antidote
vitamin K
ASA
Decrease platelet aggregation leading to decrease clotting
ASA nursing considerations
risk of bleeding , don’t give with anticoagulants, not given to pediatrics
Salicylism and S&S
ASA toxicity; nausea, tinnitus, headache, delirium, hyperventilation, pulmonary edema, Overdose; resp depression and acidosis
ASA antidote
sodium bicarbonate
Fibrinolytics/Thrombolytics
“kinase”, tPA (alteplase); break up existing clots by converting plasminogen to plasminogen
door to tPA time for a stroke
60min OR 4.5hrs since last known normal
Polycythemia vera
excessive number of erythrocytes, leukocytes, and thrombocytes, blood becomes thick/hyper viscous, thicker blood = more problems with perfusion
Polycythemia vera S&S
skin dark purple, cyanotic appearance, distended veins causing itching, htn, thrombosis, hypoxia
Polycythemia vera Tx and education
Apheresis: withdrawal of blood and removal of excessive components and reinfuse back to pt, anticoagulated (too many thrombocytes = risk for thrombi, hydration
education: clot prevention; hydration, avoid constrictive/tight clothin, compression stockings, elevate feet, no smoking, stop activity at first sign of chest pain
anemia
reduction in number of erythrocytes, can occur with many different disease processes, several types and causes
iron deficiency anemia causes
inadequate dietary intake, chronic alcholism, malabsorption syndromes, partial gastrectomy, rapid metabolic activity
Vitamin B12 deficiency anemia causes
dietary deficiency, failure to absorb vitamin B12 from intestinal tract
aplastic anemia
body stops producing enough new blood cells caused by myelotoxic agents; radiation, benzene, chloramphenicol, alkylating agents, antimetabolites, sulfonamides, insecticides
anemia S&S
tachycardia, orthostatic hypotension, dyspnea on exertion, decreased SpO2, fatigue, pallor, cool, mottled, delayed cap refill, unable to tolerate cold
anemia tx
depends on type of anemia; iron supplements, B12 increase in diet and supplements, aplastic anemia tx depends on cause, blood transfusions
sickle cell anemia
causes the red blood cells to sickle and break down, is autosomal recessive, not able to carry oxygen, due to shape can get caught in vessels and cause obstruction
Sickle cell crisis
decreased blood flow to tissues leads to hypoxia, ischemia, and infarction, severe joint pain, sequestration (blood pools, often in spleen, splenomegaly and tenderness, acute exacerbation can be caused by hypoxia, high altitude (due to low O2), and fever
Sickle cell anemia S&S
pallor, pain, fatigue, arthralgia, chest pain, respiratory distress
sickle cell anemia tx
IV fluids (dilute blood so they are not concentrated), blood transfusion (optimize perfusion), O2 (increase oxygen to tissues if hypoxic), pain management, hydroxyurea
hydroxyurea
increases production of fetal hemoglobin to reduce crises
Disseminated Intravascular Coagulation (DIC)
disorder in which the proteins that control blood clotting become overactive; caused by a precipitating event which leads excessive clotting and excessive bleeding
DIC triggers
blood transfusion, cancer, pancreatitis, liver disease, severe tissue injury (burns, head injury), pregnancy complication
DIC bleeding S&S
ecchymosis, hematomas, hemoptysis, melena, pallor, hematuria
DIC clotting S&S
depends where clot goes
Chest: chest pain, SOB, dyspnea
Legs: pain, redness, warmth, swelling
Brain: headache, speech changes, paralysis, dizziness
Lab findings in DIC
decrease in platelet count and fibrinogen; increase in PT/INR, PTT, D-dimer
DIC treatment
determine underlying cause and treat, administer clotting factor, administer platelets, bleeding precautions
