Hematology Flashcards
Why do we need blood?
To deliver oxygen to all the body tissues
Destroys abnormal and forgein cells (i.e. bacteria, virus, parasites)
Blood Clotting
Transport fluid, nutrients, and electrolytes
Help maintain homeostasis
What’s in the blood?
Plasma 55%
RBC’s 40-45%
WBC’s/Platelets >1%
Plasma consists of
Mostly Water
Proteins
Electrolytes
Nutrients
Hormones
Vitamins
Waste
Which protein maintains the volume?
Albumin
Which protein contributes the most in clotting?
Fibrinogen
What is serum?
Plasma minus fibrinogen and other clotting factors
What is needed to make RBC’s
Iron
Other metals
Vitamins (B12, folic acid B9, pyridoxine B6)
Life span of a RBC
120 days
What is hemolysis and where does it occur?
“old” or damaged cells are destroyed; in the spleen, liver, bone marrow, and lymph nodes
Function of hemoglobin in RBC’s
Millions of hemoglobin molecules attached to a molecule of iron
Iron which carries oxygen to tissue and CO2 back to lungs
Shape of RBC’s
Biconcave discs and very flexible to fid through capillaries, as they fit 1 RBC at a time.
5 Kinds of WBC’s
Granulocytes
Neutrophils
Eosinophils
Basophils
Agranulocytes
Monocytes
Lymphocytes
First WBC responder to infection
Neutrophils
Which WBC produces antibodies?
Plasma Cells (B-lymphocytes)
Subjective Assessment (10)
Recent changes in energy levels/ability to perform ADL’s
Bleeding/easy bruising
Pain, burning, tingling of extremities
Changes in skin color/temp
Usual diet (getting adequate nutrition)
Current meds (Rx, OTC, street drugs)
Surgeries
Blood transfusion (hx of reaction?)
Hx of chronic diseases, cancer, heart disease, COPD, kidney disease, blood disorders
Objective Assessment: Physical Exam
VS!!!
Skin and mucous membranes
Lymph nodes
Elimination
What do you inspect the skin and mucous membranes for?
Pallor
Cyanosis
Jaundice
Bleeding in/under the skin (petechiae, purport, ecchymoses)
Temp
Capillary Refill
Edema
How do you inspect the lymph nodes?
Check the neck, axillae, and groin for tenderness (usually indicates infection)
What do you look for when inspecting bowel elimination?
Melena stools, bleeding with stools (+FOB), diarrhea
What noninvasive test is commonly done for GI bleeding?
FOBT (fecal occult blood test)
Objective Assessment: Labs
CBC
PT/INR - Coumadin
aPTT - Heparin
Serum Iron tests
Schiling’s test (Vit B test)
Coombs’ test
Bone Marrow Biopsy
What is a WBC count >10,000 called?
Leukocytosis - usually a sign of infection
Life-threatening WBC condition
Leukopenia (Neutropenia; Agranulocytosis)
What is the critical level to indicate this? WBC<5,000
What is the level indicating thrombocytopenia?
reduction of platelets below 150,000
Anemia - level to give blood transfusion
Hgb <6
Anemia is a deficiency in
number of RBC’s,
quantity of Hbg, and/or
Hct
Causes of Anemia
Hemorrhage
Ineffective erythropoiesis (Impaired production of RBC’s)
Increased hemolysis
Gerontologic Considerations with Anemia
Poor Nutrition
Cobalamin deficiency d/t decreased absorption
Overlooked S/S: AMS, pallor, ataxia (unsteady gait), fatigue, worsening angina and HF
Adminstration of Blood Products precaution
ALWAYS check the blood product at the bedside with another RN (or MD)
When administering PRBC (packed RBC’s), they
Must ALWAYS be given with 0.9% NS
Must be typed and crossmatched
May need leukocyte filter to prevent febrile reaction
Clients with massive hemorrhage are given
FFP (Fresh Frozen Plasma) to replace clotting factors
What blood product is administered for blood clotting disorders?
Platelets
Blood products must be administered _________ of obtaining from blood bank, otherwise, it must ________.
within 30 minutes
be returned to the blood bank
Types of Transfusion Reactions
Acute Hemolytic
Febrile Nonhemolytic
Allergic
Bacterial
Circulatory Overload
TRALI (transfusion-related acute lung injury)
Delayed Hemolytic Reaction
Disease Acquisition (rare)
What should you do when client is experiencing a transfusion reaction?
STOP the transfusion
What is Thrombocytopenia? Risk?
Too few platelets
Risk for bleeding
What is Thrombocytosis? Risk?
Too many platelets
Risk for unnecessary blood clots
How can herbal therapies, such as ginkgo biloba, garlic, and ginseng affect the blood?
May increase the risk for bleeding
What is the Lymphatic System? (anatomical structures)
Consists of lymph vessels, nodes, and organs (spleen, thymus)
What does the Lymphatic System do?
Returns excess fluid from interstitial spaces to heart and helps protect the body from infections
Function of Lymph Nodes
remove foreign matter, infectious organisms, and tumor cells from lymph
Function of Spleen
Filters blood - removes “old” or damaged RBC’s
Produces lymphocytes
Stores blood and platelets
Lymphedema is ______ , and what are some precautions to take when a client has it?
a buildup of fluid that causes swelling d/t a malfunction in the lymphatic system
No B/P or sticks on affected side
Elevate above heart
Avoid injury
No constricting clothing
Neutropenia is ______ which increases _______.
a decrease in number of neutrophils <2,000
risk for infection
Neutropenia S/S
low-grade fever may indicate SERIOUS infection
minor infection may lead to life-threatening SEPSIS
Clients with neutropenia will most likely have a weakened immune system, and should be placed
in a reverse isolation room (positive airflow)
Neutropenia in regard to chemo
Chemo may need to be held until neutrophil count increases
Which type of leukemia is most commonly diagnosed in children?
A) Chronic lymphocytic leukemia (CLL)
B) Acute lymphoblastic leukemia (ALL)
C) Acute myeloid leukemia (AML)
D) Chronic myeloid leukemia (CML)
B
Which protein is involved in the formation of a blood clot by creating a mesh that traps blood cells?
A) Hemoglobin
B) Fibrin
C) Platelets
D) Albumin
B
What is the main cause of sickle cell anemia?
A) Iron deficiency
B) Vitamin B12 deficiency
C) Genetic mutation in hemoglobin
D) Excessive blood loss
C
Which type of white blood cell is involved in the response to bacterial infections and is characterized by a multi-lobed nucleus?
A) Neutrophils
B) Lymphocytes
C) Monocytes
D) Eosinophils
A
What is the name of the process by which white blood cells exit the bloodstream to reach an infection site?
A) Hemolysis
B) Diapedesis
C) Phagocytosis
D) Hemostasis
B
Which of the following conditions is characterized by a high number of immature white blood cells in the blood?
A) Acute myeloid leukemia (AML)
B) Chronic lymphocytic leukemia (CLL)
C) Iron-deficiency anemia
D) Thrombocythemia
A
What is the main function of bone marrow in relation to blood cells?
A) Filtering and removing old blood cells
B) Producing new blood cells
C) Storing nutrients for blood cells
D) Absorbing excess blood plasma
B
What genetic mutation is responsible for sickle cell anemia?
A) Mutation in the HBB gene
B) Mutation in the HBA gene
C) Mutation in the G6PD gene
D) Mutation in the JAK2 gene
A
Which blood disorder involves a deficiency in clotting factors leading to excessive bleeding?
A) Hemophilia
B) Thrombocytopenia
C) Polycythemia vera
D) Essential thrombocythemia
A
Which factor is known as the “Christmas factor” and is involved in blood clotting?
A) Factor VIII
B) Factor IX
C) Factor X
D) Factor VII
B
What is the primary purpose of a bone marrow biopsy in diagnosing hematologic disorders?
A) To measure blood pressure
B) To evaluate bone density
C) To assess the production of blood cells and identify abnormalities
D) To determine blood oxygen levels
C
For a patient with hemophilia, which of the following treatments is used to replace the deficient clotting factor?
A) Vitamin K supplementation
B) Fibrinogen replacement
C) Clotting factor concentrates
D) Anticoagulant medications
C
What is the primary treatment goal for patients with sickle cell disease during a vaso-occlusive crisis?
A) Administering antibiotics
B) Managing pain and hydration
C) Performing blood transfusions
D) Providing immunizations
B
