Hematology Flashcards
What is Anemia?
lower hgb concentration- fewer RBC in circulation
Male Hgb range
14-18 g/dL
Female Hgb range
12-16 g/dL
Male HCT range
39-55%
Female HCT range
36-48%
What is bilirubin?
byproduct of RBC metabolism
What is the most common type of Anemia?
Iron Deficient Anemia
- b/c of diet
Why is iron important for blood?
iron makes hgb and gives RBC the big/puffy shape- important for oxygen carrying and delivering to cells.
What is the MCV lab?
width of an RBC
Anemia with decreased MCV and reticulocytes indicates what treatment?
Iron supplement would be appropriate treatment
What are the 5 causes of anemia?
-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
What is sickle cell disease?
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
complications of sickle cells?
-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
Sickle Cell anemia manifestations:
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
What is sickle cell crisis?
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.
what triggers sickle cell crisis?
-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
Sickle cell crisis treatment
Acute: O2, rest, fluids, blood transfusions (increase oxygen carrying capacity), abx, pain mgmt: PCA (morphine/hydromorphone), hydroxyurea (chemo Rx)
Blood transfusion process
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
What is febrile non-hemolytic reaction
abx from donor leukocytes remained in the blood
s/s: chills, fever 2 hrs after infusion begins
What is a hemolytic reaction?
wrong blood type given- allergic reaction
-only takes 10 mL to cause reaction
What is a transfusion-associate circulatory overload reaction? TACO
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
What is a transfusion-related acute lung injury reaction? TRALI
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
S/S of hemolytic reaction
HYPOTENSION, BRONCHOSPASM, VASCULAR COLLAPSE
-chills, fever, low back pain (kidney injury), nausea, tight chest, dyspnea, anxiety
S/S of TRALI
HoTN, SOB, hypoxia, fever, pulmonary edema (seen on CXR)
S/s of TACO
(similar to hypervolemia)- dyspnea, orthopnea, achy, HTN, anxiety, pull edema (pink frothy sputum)
Tx TACO
remove volume: diuretics, possibly CRRT/HD
Prevention of TACO
admin blood slowly
give diuretics in between units of blood
morphine and oxygen to tx dyspnea
Universal blood donor (also most limited recipient)
O-
Universal recipient
AB+
In the event of a reaction:
-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
What is neutropenia?
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
When should nurse request Absolute neutrophil count?
WBC <5
Neutropenia precautions
precautions sign, hand washing, non-infective assignment, no fresh flowers/veggies, minimize foot traffic/visitors (mask if necessary)
Neutropenic fevers
> 38 C and <500/mm3
Pan culture: blood, urine, sputum, sensitivity, CXR –> start broad spectrum
S/S of DIC
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
What is Disseminated Intravascular coagulation?
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
DIC mgmt includes:
Treat possible shock and ischemia
-oxygenation
-replace fluids -> pressors
-correct e-
-infuse: coat factors, platelets, cryoprecipitate- fibrinogen
-heparin controversial tx
What are the S/s of thrombocytopenia
Bleeding!
<50k- excessive bleeding, easy bruising, lacerations need extra pressure
<20K- petechiae, bleeding (teeth, nasal, menstrual)
<5k- spontaneous bleeding (GI-bloody stools, abdomen)
Thrombocytopenia mgmt
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
What is thrombocytopenia?
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
Early indications of heparin induced thrombocytopenia include:
50% drop in platelets in 5-10 days
(normal: 150,000-450,000)
Heparin induced thrombocytopenia mgmt includes:
*Argatroban gtts - ideal tx for HIT
-NO WARFARIN
-need a bridge to prevent thrombi formation
What electrolyte do we give after multiple blood transfusions?
Calcium chloride- the preservative in lab blood (citrate) binds to the calcium in the body and renders it inactive, must be replaced
Interventions with febrile blood transfusions:
s/s: chills, muscle stiffness, fever >38, 2 hrs after infusion
-stop infusion, tell MD, anti-histamine, tylenol
