Hematology Flashcards
Reduction in either the number of red blood cells, the amount of hemoglobin or the hematocrit
Anemia
Measure of the immature RBCs; reflection of bone marrow activity in producing RBCs
Reticulocyte count
What is the normal reticulocyte count?
0.5 - 2.0% of the total RBCs
What are the normal iron levels?
60-160 mcg/dL (F) and 80-180 mcg/dL (M)
What are the normal serum ferritin levels?
10-50 ng/mL (F) and 12-300 ng/mL (M)
What is the normal total iron binding capacity level?
250-460 mcg/dL
Measure of the gas-carrying capacity of the RBCs
Hemoglobin
Measure of the packed cell volume of RBCs, expressed as a percent of the total blood volume
Hematocrit
Amount of iron combined with proteins in serum; accurate indicator of status of iron storage and use
Iron
Major iron storage protein; normally present in blood in concentrations directly related to iron storage
Serum Ferritin
What should the bone marrow of an anemic patient be doing?
Producing lots and lots of RBCs
Measurement of all proteins available for binding iron; evaluation of the amount of extra iron that can be carried
Total Iron Binding Capacity
The ITBC is an indirect measurement of what?
Trasnferrin
What are the causes of anemia?
Blood loss, an impaired production of erythrocytes, and an impaired destruction of erythrocytes
What are many of the symptoms of anemia caused by?
The hypoxia created by the decreased oxygen being carried to tissues
What is the function of the RBC?
Transport oxygen from the lungs to systemic tissue and carry CO2 from the tissue to the lungs
How is anemia diagnosed?
CBC, Reticulocyte count, and peripheral blood smear
Which types of trauma can cause RBC destruction?
Ecmo, bypass, or left ventricular assist device
What is the physiological manifestation of anemia?
Reduced O2 carrying capacity
What are the classic signs of anemia?
Fatigue, weakness, dyspnea, pallor, and tachycardia
Why do anemic patients experience tachycardia?
Because their bodies are trying to increase cardiac output to compensate for the decreased oxygen levels
What determines the severity of the anemia?
Hemoglobin
Which severity of anemia leaves patients with few symptoms, including possible palpitations, dyspnea, and diaphoresis?
Mild (Hemoglobin 10-14)
Which severity of anemia causes increased cardiopulmonary symptoms at rest and activity with a roaring in the ears?
Moderate (Hemoglobin 6-10)
Which severity of anemia involves multiple body systems, causing pallor, glossitis, angina, HF, MI, tachycardia, a systolic murmur, orthostatic hypotension, SOB, DOE, decreased SpO2, vertigo, depression, headaches, anorexia, sore mouth, enlarged liver and spleen, fatigue, weight loss, bone pain and sensitivity to cold?
Severe (Hemoglobin
Why is anemia so dangerous?
It can speed up a lot of disease processes
Glycoprotein primarily produced in the kidneys that increase the number of stem cells commented to RBC production and shortens the time to mature RBCs
Erythropoietin
What are the side effects of taking epogen?
Hypertension and bone pain
What is the life cycle of a RBC?
120 days
What three alterations in erythropoiesis decrease RBC production?
Decreased hemoglobin synthesis, defective DNA synthesis in RBCs, and diminished availability of erythrocyte precursors
What kind of anemia results from a decrease in hemoglobin synthesis?
Iron-Deficiency Anemia
What kinds of anemias result from defective DNA synthesis in the RBCs?
Pernicious Anemia and Folic Acid Deficiency Anemia
What kind of anemia results from a diminished availability of erythrocyte precursors?
Aplastic Anemia
What would the Serum Ferritin values of a person with Iron-Deficiency Anemia be?
Less than 12 g/L
What are the symptoms of Iron-Deficiency Anemia?
Mild manifestations such as pallor, glossitis, koilonychia, and angular stomatitis
What does Iron-Deficiency Anemia result from?
Blood loss, poor intestinal absorption, or inadequate diet
At what stage is Iron-Defiency Anemia symptomatic?
Stage 3
Spoon shaped, brittle, and concave nails
Koilonychia
What is the treatment for Iron-Deficiency Anemia?
Two weeks of iron therapy
What foods are high sources of iron?
Liver, red meat, whole grains, leafy greens, egg yolks, raisins, and red wine
What do patients with iron deficiency anemia need to be evaluated for?
Abnormal Bleeding
How are iron solutions administered?
IM using the Z-track method
What causes decreased absorption of oral iron supplements?
Antacids, eggs or milk, coffee, and tea
How should oral iron supplements be administered?
On an empty stomach with ascorbic acid and a straw
Why is a straw used when giving liquid iron supplements PO?
To avoid teeth turning black
What are the side effects of iron supplements?
Constipation and the stool turns black/green
What would be the lab findings for a patients with Iron-Deficiency Anemia?
Decreases reticulocytes, iron, ferritin, iron saturation and MCV; Increased TIBC
What does proper production of the RBCs depend on?
Adequate DNA synthesis and adequate amounts of folic acid
What is the function of B12?
To activate enzymes that transport folic acid into the cells where DNA synthesis occurs
How does B12 deficiency cause anemia?
It inhibits folic acid transport and reduces DNA synthesis in the precursor cells
What causes B12 Deficiency Anemia?
Poor intake of foods containing B12, small bowel problems, diverticulits, tapeworms, and an overgrowth of intestinal bacteria
Who is susceptible for B12 Deficiency Anemia?
Vegetarians and people on low dairy diets
What are the clinical manifestations of B12 Deficiency Anemia?
Mild or severe pallor, jaundice, glossitis, fatigue, weight loss, paresthesia, and poor balance
What are the hallmarks of B12 Deficiency Anemia?
Paresthesias and poor balance
How is B12 Deficiency Anemia treated?
Increase the dietary intake of B12 and folic acid and use supplements if severe
What foods are good sources of B12 and folic acid?
Liver, beef, chicken, pork, ham, fish, whole grains, dairy, and whole eggs
Protein secreted by the parietal cells of the gastric mucosa required for cobalamin absorption in the small intestine
Intrinsic Factor
What is Pernicious Anemia caused by?
A decrease in the secretion of intrinsic factor, leading to the malabsorption of cobalamin
What are the causes of Pernicious Anemia?
Congenital, autoimmune, gastic atrophy, change in the pH of the stomach, ETOCH abuse, gastrectomy, smoking, and hot tea
What causes a change in the pH of the stomach?
Proton Pump Inhibitors
Who is Pernicious Anemia most common in?
Females over 30
What are the signs and symptoms of Pernicious Anemia?
Infections, mood swings, GI ailments, CV ailments, renal ailments, low hemoglobin, lemon yellow skin, hepatomegaly and splenomegaly
What would the hemoglobin of a patient with Pernicious Anemia be?
7-8 g/dL
Test for determining the amount of vitamin B12 excreted in the urine through a 24 hour sample
Shilling test of B12 absorption
How is Pernicious Anemia treated?
Life-long B12 injections
What would the lab findings of a patients with Pernicious Anemia be?
Decreased B12 levels and reticulocyte count; Increased MCV, methylmalonic acid, and homocysteine levels
How are B12 Deficiency and Folic Acid Deficiency Anemias differentiated?
In Folic Acid Deficiency Anemia, the nervous system functions normally but the RBCs have a shorter life span
What are the causes of Folic Acid Deficiency Anemia?
Poor nutrition, anti-seizure medications, birth control pills, and malabsorption due to ETOH
What are the signs and symptoms of Folic Acid Deficiency Anemia?
Cheilosis, stomatitis, watery diarrhea, painful ulcers on mucous membranes, difficulty swallowing, and flatulence
A disorder of the lips marked by scaling and fissures at the corners of the mouth
Cheilosis
What is the prevention for Folic Acid Deficiency Anemia?
Diets high in folic acid and B12
What is the treatment for Folic Acid Deficiency Anemia?
Folic acid replacement therapy
What is an example of a Folic Acid Deficiency Anemia?
Megaloblastic Anemia
What would the lab values of a patients with Folic Acid Deficiency Anemia be?
Decreased folate levels and increased MCV
Deficiency of circulating RBCs due to the failure of the bone marrow in producing them
Aplastic Anemia
Which stem cell is injured in patients with Aplastic Anemia?
Pluripotent stem cell
What should patients with Aplastic Anemia be assessed for?
Pallor, Petechiae, and Ecchymosis indicated bone marrow failure
What diseases does Aplastic Anemia generally occur with?
Leukopenia, thrombocytopenia, or pancytopenia
What can cause Aplastic Anemia?
Long time exposure to toxic agents, ionizing radiation, pesticides, or infection
What would the lab values of someone with Aplastic Anemia be?
Decreased reticulocyte found, WBC, Hgb, Hct, and platelets
What is the immune response of Aplastic Anemia regulated by?
Cytotoxic T Cells
What are the treatments for Aplastic Anemia?
Immunosuppressive Therapy, Splenectomy, or Bone Marrow Transplantation
What is the treatment of choice for Aplastic Anemia?
Bone Marrow Transplant
What do patients post splenectomy need to be supported with?
Platelets, FFP, RBCs and WBCs
Stimulates the bone marrow to come back in patients with Aplastic Anemia
Immunosuppressive Therapy
Anemia caused by renal disease
Decreased Erythropoietin Production
Anemia marked by three defects: decreased erythrocyte life span, ineffective bone marrow response to erythropoietin, and altered iron metabolism
Anemia of Chronic Disease
Anemia caused by hemolysis within blood vessels or lymphoid tissues
Autoimmune Hemolytic Anemia
Anemias caused by cellular abnormalities of the hemoglobin structure, marked by an imbalance between the beta chain and the alpha chain of hemoglobin, resulting in RBC membrane damage, ineffective RBC production, and hemolysis
Thalassemias
A chronic myleoproliferative disorder arising from ma chromosomal mutation in a single Pluripotent cell characterized by an abnormal proliferation of bone marrow stem cells with self destructive expansion of RBCs
Polycythemia Vera
What are the erythropoietin levels in a patient with Polycythemia Vera?
Normal
What would the CBC reveal in a patient with Polycythemia Vera?
Increased hemoglobin, RBCs, WBCs, and platelets
How is Polycythemia Vera Treated?
Draining the bad blood and throwing it away, increasing hydration, and anticoagulants
Why is Polycythemia Vera very bad?
The increase in all of the cells is so severe that blood circulation is impaired as a result of the increased blood viscosity and volume
What would the hemoglobin of a person with Polycythemia Vera be?
18 g/dL
What would the RBC of a person with Polycythemia Vera be?
6 million
What would the hematocrit of someone with Polycythemia Vera be?
55% or higher
What are the major hallmarks of Polycythemia Vera?
Massive RBC production, Excessive leukocyte production, and excessive platelet production
What are the signs and symptoms of Polycythemia Vera?
Hypertension, hyperkalemia, dark, flushed appearance, distended veins, weight loss, fatigue, itching, hemorrhoids, swollen, painful joins, enlarged spleen, MI, strokes, and bleeding tendencies
What causes the hyperkalemia seen in patients with Polycythemia Vera?
The breaking of RBCs
Type of cancer with uncontrolled production of immature white blood cells in the bone marrow
Leukemia
What kind of cells are seen in the peripheral blood smear of a patient with leukemia?
Blastic
What are the risk factors for leukemia?
Ionizing radiation, exposure to certain chemicals and drugs, bone marrow hypoplasia, genetic factors, immunologic factors, stress, and environmental factors
What happens to the RBCs and platelets of patients with leukemia?
The uncontrolled production of WBCs decreased their numbers
What is the childhood leukemia?
Acute Lymphocytic Leukemia
What is the adult leukemia?
Acute Myelogenous Leukemia
Why are the chronic leukemias not as bad as the acute leukemias?
They don’t really affect the patient’s life span and are acquired most frequent after the 7th decade
What are the clinical manifestations of leukemia?
Increased heart rate, decreased blood pressure, increased respiratory rate, pale and cool skin, weight loss, nausea, anorexia, and headache
What would a lab assessment of a patient with leukemia reveal about their hemoglobin and hematocrit levels?
They would be decreased
Which leukemia patients have the poorest prognosis?
Those with high white blood cells counts at diagnosis
Which acute leukemia is worse?
Acute Myelogenous Leukemia
What test confirms the diagnosis of leukemia?
Bone marrow biopsy
Where is the bone marrow biopsy taken from to confirm the diagnosis of leukemia?
The posterior iliac crest
What is the major cause of death for patients with leukemia?
Infection
Normal flora become causative agent of infection
Auto contamination
What are the priority nursing diagnoses for patients with leukemia?
Risk for infection, then risk for injury
What are the drug therapies for acute leukemia?
Induction therapy, consolidation therapy, maintenance therapy and drugs for infections
What is the goal of induction therapy?
It is given when patients are rebounding from nadir in the hopes that the new marrow will essentially cure itself
What is the goal of consolidation therapy?
Remission of leukemia stays in remission
What drugs are given to prevent infections in patients with acute leukemia?
Nystatin and bowel cleansers
What infection precautions need to be in place for patients with acute leukemia?
Hand washing, private room, HEPA filtration, masks, minimal bacteria diet, not uncooked foods, meticulous skin care
Standard treatment for leukemia, this procedure purges the present marrow of the leukemic cells and gives new, health marrow
Bone Marrow Transplant
Why does a bone marrow transplant work in curing leukemia?
Because bone marrow is the source of stem cells, and new stem cells won’t be leukemic
When are patients with leukemia given bone marrow transplants?
When they are in remission
What happens to the bone marrow doner?
If they go on iron supplements they will be back to normal in three months
What is the first sign of bone marrow rejection?
A rash on the palmar surface of the hands
Cancer that starts in a single lymph node or single chain of lymph nodes with the Reed-Sternberg cell
Hodgkin’s Lymphoma
What are the signs and symptoms of Hodgkin’s Lymphoma?
Large, painless lymph node, fever, malaise, and night sweats
What is the treatment for Hodgkin’s Lymphoma?
External radiation alone or in combination with chemotherapy
Cancer that starts in a single lymph node or single chain of lymph nodes without the Reed-Sternberg cell
Non-Hodgkin’s Lymphoma
What is the treatment for Non-Hodgkin’s Lymphoma?
Radiation therapy and chemotherapy
Which is worse, Hodgkin’s or Non-Hodgkin’s Lymphoma?
Non-Hodgkin’s Lymphoma
Uncommon white blood cell cancer that involves a more mature lymphocyte
Multiple Myeloma
What are the signs and symptoms of Multiple Myeloma?
Fatigue, easy bruising, bone pain, fractures, hypertension, increased infection, hypercalcemia, and fluid imbalance
What is the treatment for Multiple Myeloma?
Chemotherapy
Why do patients with Multiple Myeloma experience hypercalcemia?
Because calcium is being leeched from their bones
What do the bone of patients with Multiple Myeloma look like?
Swiss Cheese
Autoimmune disorder characterized by large ecchymosis or petechial rash on arms, legs, upper chest and neck
Autoimmune Thrombocytopenic Purpura
What would the lab findings of a patients with Autoimmune Thrombocytopenic Purpura show??
Decreased platelet count and large numbers of megakaryocytic in the bone marrow
How is Autoimmune Thrombocytopenic Purpura treated?
Therapy to prevent bleeding, drugs to suppress immune function, blood replacement therapy, and splenectomy
Rare disorder in which platelets clump together abnormally in the capillaries and too few remain in circulation, causing inappropriate clotting
Thrombotic Thrombocytopenic Purpura
What is the treatment for Thrombotic Thrombocytopenic Purpura?
Plasma pheresis, FFP, aspirin, alprostadil, plicamycin, and immunosuppressive therapy
What is plasma pheresis?
Blood letting by the unit
Deficiency of factor VIII in the blood causing the inability of the blood to clot
Hemophilia A
Deficiency of factor VIIII in the blood causing the inability of the blood to clot
Hemophilia B
Which is more common, Hemophilia A or B?
A
What is the treatment for Hemophilia A?
Blood transfusion and factor VIII therapy
What do patients with Hemophilia need to be assessed for?
Excessive hemorrhage and joint and muscle hemorrhage
What lab tests do patients with Hemophilia A need to take?
PTT
What is the most common problem for hemophiliacs?
The degeneration of joint function related to chronic bleeding into the joints
In which of the hemophiliac’s joints does excessive bleeding take place?
Hip and knee
Why are B12 injections given IM?
Because they will tattoo the skin
Which test measure how long blood takes to clot?
PT/INR
Which test assesses the intrinsic clotting cascade and the action of specific clotting factors?
PTT
What is the nursing priority after a bone marrow or aspiration?
Prevent excessive bleeding
What does multiple myeloma result in?
The overproduction of antibodies or gamma globulins
What is the pathophysiology of Autoimmune Thrombocytopenic Purpura?
The body creates an antibody which is placed upon the surface of platelets, making them more likely to be destroyed by macrophages
A client is scheduled for a bone marrow aspiration. What does the client’s nurse do before taking the client to the treatment room for the biopsy?
Verify that the client has given informed consent
When assessing an adult client endurance in performing ADLs what question should the nurse ask?
How is your energy level compared with last year?
Why is an accurate family history important when assessing a patient for a hematological disorder?
Because many disorders that affect blood and blood clotting are inherited
What decreased lab value is concerning for a nurse because it is not age related?
Platelet count
A client with a low platelet count asks why platelets are important. How does the nurse answer?
The clotting process begins with your platelets
In which anemia would the patient have an elevated reticuloctye count?
Hemolytic Anemia
What is the best way to assess the nutritional status of a client?
Ask the client to write down everything he or she has eaten for the past weak
A clinic nurse is discharging a 20-year-old client who had a bone marrow aspiration performed. What does the nurse advise the client to do?
Place an ice pack over the site to reduce bruising
A client has a bone marrow biopsy done. Which nursing intervention is the priority post procedure?
Applying pressure to the biopsy site
How does aspiring interfere with blood clotting?
It inhibits the activation of platelets
Which nursing action is most effective in reducing the potential for sepsis in clients?
Frequent and thorough hand washing
What intervention most effectively protects a client with thrombocytopenia?
Encouraging the use of an electric shaver
A patient with thrombocytopenia is being discharged. What information does the nurse incorporate into the teaching plan for this client?
Use a soft-bristled toothbrush
A client with multiple myeloma reports bone pain that is unrelieved by analgesics. How does the nurse respond to this client’s problem?
“Would you like to try some relaxation techniques?”
A nurse is caring for a client with neutropenia. Which clinical manifestation indicates that an infection is present or should be ruled out?
Wheezes or crackles
A nurse is caring for a client with neutropenia who has a suspected infection. Which intervention does the nurse implement first?
Obtains requested cultures
A nurse is assessing a newly admitted client with thrombocytopenia. What factor needs immediate intervention?
A nosebleed
A nurse is infusing platelets to a client who is scheduled for a hematopoietic stem cell transplant. What procedure does the nurse follow?
Infuses the transfusion over a 15-10 minute period
Why are patients with leukemia at extreme risk for infection even though their WBC is so high?
Their WBCs are too immature to fight infection
Which predation is most important for the nurse to teach a client with leukemia to prevent an infection by autocontamination?
Perform mouth care three times daily
Which precaution is most important for the nurse to teach a client with autoimmune thrombocytopenic purport who is receiving corticosteroid therapy to control the disease?
Avoid contact sports and any activity that could cause injury
What is the most important environmental risk for developing leukemia?
Smoking cigarettes
