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Med/Surg > Hematology > Flashcards

Hematology Flashcards

1
Q

What is Anemia?

A

lower hgb concentration- fewer RBC in circulation

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2
Q

Male Hgb range

A

14-18 g/dL

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3
Q

Female Hgb range

A

12-16 g/dL

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4
Q

Male HCT range

A

39-55%

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5
Q

Female HCT range

A

36-48%

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6
Q

What is bilirubin?

A

byproduct of RBC metabolism

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7
Q

What is the most common type of Anemia?

A

Iron Deficient Anemia
- b/c of diet

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8
Q

Why is iron important for blood?

A

iron makes hgb and gives RBC the big/puffy shape- important for oxygen carrying and delivering to cells.

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9
Q

What is the MCV lab?

A

width of an RBC

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10
Q

Anemia with decreased MCV and reticulocytes indicates what treatment?

A

Iron supplement would be appropriate treatment

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11
Q

What are the 5 causes of anemia?

A

-hypo-proliferation- not enough production
-hemorrhage- loss of total blood cells
-hemolysis- increased destruction of RBC
-reticulocytes- immature RBCs
-decreased erythropoietin/erythrocyte production- due to lack of nutrients: folic acid, iron, Vitamin B12

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12
Q

What is sickle cell disease?

A

an autosomal recessive disorder with defective hemoglobin that results in a concave, rigid cell shape- associated with hemolytic anemia
-common in africa due to its ability to resist malaria

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13
Q

complications of sickle cells?

A

-sickle cells age/decay at a quicker rate due to the repeated oxygen binding/separating- these cells age faster: increase in bilirubin
-easily adhere to vessel walls, and accumulate- decreased blood flow to tissues- risk for infarction

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14
Q

Sickle Cell anemia manifestations:

A

tachycardia: >100
murmurs: s3 and s4
Cardiomegaly: enlarged heart bc it has to work harder to perfuse
ischemia and infarction: all organs affected
*sickling -> hypoxia -> tissue damage -> necrosis

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15
Q

What is sickle cell crisis?

A

restricted blood flow that can happen anywhere in the body due to sickle accumulation, manifested as fever >38, pain (neuropathic-dull/stabbing/throbbing/sharp), and swelling in the area.

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16
Q

what triggers sickle cell crisis?

A

-cold temperatures- vasoconstriction- increased risk for sickle cells to get caught
-dehydration- vasoconstriction
-altitude- hypoxia and tachy
-ETOH- diuretic causes dehydration, inflammatory marker
-Tobacco- vasoconstriction/HTN
-Infection- inflammation
-stress- HTN increased risk for clot getting stuck
-hypovolemia: blood loss

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17
Q

Sickle cell crisis treatment

A

Acute: O2, rest, fluids, blood transfusions (increase oxygen carrying capacity), abx, pain mgmt: PCA (morphine/hydromorphone), hydroxyurea (chemo Rx)

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18
Q

Blood transfusion process

A

MD obtains consent
-verify consent
-gather equipment: blood tubing, saline, blood
-verify pt allergies, blood type and cross match
-2 RNs- ID checks: name, MRN, blood component tag, type and Rh
-access: at lease 20 gauge, 18 is ideal
-blood quality
-pre-vitals and assessment (heart, lungs, skin) and hx of infusion (meds, warmer, rate, reactions etc)
-educate pt s/s of reaction
-infuse slow for first 15 mins (stay in room)
-recheck vitals, then advance to hourly until infusion is complete
-change tubing with each unit of blood

19
Q

What is febrile non-hemolytic reaction

A

abx from donor leukocytes remained in the blood
s/s: chills, fever 2 hrs after infusion begins

20
Q

What is a hemolytic reaction?

A

wrong blood type given- allergic reaction
-only takes 10 mL to cause reaction

21
Q

What is a transfusion-associate circulatory overload reaction? TACO

A

Too much blood, too quickly (MTP)- most common timeframe w/in 2 hrs
-always give Ca chloride with transfusions: Ca binds to preservative in lab blood- pt dumps Ca
pt at high risk: HF, Renal dysfunction, >65 yrs, hx of MI
*high risk for MI

22
Q

What is a transfusion-related acute lung injury reaction? TRALI

A

MOST SEVERE- highest mortality rates- rxn within 2 hrs
-leukocytes in plasma are attacked: happens in lung tissues and causes injury
ex injury: interalveolar edema, pulm capillaries, interstitial
*high risk for MI

23
Q

S/S of hemolytic reaction

A

HYPOTENSION, BRONCHOSPASM, VASCULAR COLLAPSE
-chills, fever, low back pain (kidney injury), nausea, tight chest, dyspnea, anxiety

24
Q

S/S of TRALI

A

HoTN, SOB, hypoxia, fever, pulmonary edema (seen on CXR)

25
Q

S/s of TACO

A

(similar to hypervolemia)- dyspnea, orthopnea, achy, HTN, anxiety, pull edema (pink frothy sputum)

26
Q

Tx TACO

A

remove volume: diuretics, possibly CRRT/HD

27
Q

Prevention of TACO

A

admin blood slowly
give diuretics in between units of blood
morphine and oxygen to tx dyspnea

28
Q

Universal blood donor (also most limited recipient)

A

O-

29
Q

Universal recipient

A

AB+

30
Q

In the event of a reaction:

A

-stop transfusion
-notify MD
-antihistamine: benadryl and tylenol 1000 mg (fever)
-maintain IV line with saline
-assess pt, vitals, rest
-send all supplies to blood bank

31
Q

What is neutropenia?

A

deficient neutrophil (type of WBC) count (<2000/mm3)- puts pt at higher risk for sepsis
-low risk for sepsis <1000
-high risk for sepsis <500
-great risk for sepsis <100

32
Q

When should nurse request Absolute neutrophil count?

A

WBC <5

33
Q

Neutropenia precautions

A

precautions sign, hand washing, non-infective assignment, no fresh flowers/veggies, minimize foot traffic/visitors (mask if necessary)

34
Q

Neutropenic fevers

A

> 38 C and <500/mm3
Pan culture: blood, urine, sputum, sensitivity, CXR –> start broad spectrum

35
Q

S/S of DIC

A

integumentary: decreased temp/sensation, petechiae, bleeding gums, ecchymoses
circulatory: decreased pulses and cap refill time >3 sec. Tachycardia
resp: hypoxia, dyspnea, decreased lung sounds over large embolisms. High pitch bronchial breath sounds, tachypnea, s/s of ARDS
GI: heartburn, bloody stools and emesis
Renal: decreased UO, increase creat and BUN, hematuria
Neuro: decrease A&O, strength and mobility. anxiety, restless, AMS

36
Q

What is Disseminated Intravascular coagulation?

A

systemic micro-thromboses and bleeding at the same time
-due to high usage of clotting factors/platelets for many clots throughout the body, bleeding occurs just beneath the skin or in the nose/mouth

37
Q

DIC mgmt includes:

A

Treat possible shock and ischemia
-oxygenation
-replace fluids -> pressors
-correct e-
-infuse: coat factors, platelets, cryoprecipitate- fibrinogen
-heparin controversial tx

38
Q

What are the S/s of thrombocytopenia

A

Bleeding!
<50k- excessive bleeding, easy bruising, lacerations need extra pressure
<20K- petechiae, bleeding (teeth, nasal, menstrual)
<5k- spontaneous bleeding (GI-bloody stools, abdomen)

39
Q

Thrombocytopenia mgmt

A

Platelet transfusion (ITP), IV immunoglobulin (ITP), corticosteroids- suppresses immunity, plasmapheresis and plasma exchange (TTP), splenectomy (ITP only)-young pt, danazol (androgenic hormone), prevent/control hemorrhage

40
Q

What is thrombocytopenia?

A

Low platelet count (<150,000) due to:
-low production: leukemia, aplastic anemia, sulfas, ETOH
-high destruction: lymphoma, idiopathic thrombocytopenia purport (ITP), sepsis
-high consumption: DIC, bleeding, PE, intravascular devices

41
Q

Early indications of heparin induced thrombocytopenia include:

A

50% drop in platelets in 5-10 days
(normal: 150,000-450,000)

42
Q

Heparin induced thrombocytopenia mgmt includes:

A

*Argatroban gtts - ideal tx for HIT
-NO WARFARIN
-need a bridge to prevent thrombi formation

43
Q

What electrolyte do we give after multiple blood transfusions?

A

Calcium chloride- the preservative in lab blood (citrate) binds to the calcium in the body and renders it inactive, must be replaced

44
Q

Interventions with febrile blood transfusions:

A

s/s: chills, muscle stiffness, fever >38, 2 hrs after infusion
-stop infusion, tell MD, anti-histamine, tylenol

Med/Surg (6 decks)

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