Hematology Flashcards
Anemias can be put into one of what three classifications?
iron deficiency
vitamin deficiency
pernicious anemia
Blood loss anemia like from surgery can also play a factor in here but these 3 are the types we are responsible for.
You’ll ask the pt if they’ve noted any swelling and you can tell them where the lymph nodes are found. Which is ______, ______, and ______? Assess for enlarged glands (lymph nodes). This is something to assess during a what type of Hematological Disorder assessment?
Neck
Groin
middle of their chest.
History Assessment
Have they had any increased pain?
Have they had any above normal fatigue and weakness that can’t be accredited to maybe longer work days or due to something, it’s just unexplained fatigue and weakness. This is something to assess during a what type of Hematological Disorder assessment?
History Assessment
Any bleeding, pallor that they’ve noticed, any shortness of breath, fainting, or vertigo. Vertigo is different than being dizzy, it’s probably close enough that you probably don’t have to go into too much detail but it is a little different than being dizzy. This is something to assess during a what type of Hematological Disorder assessment?
History Assessment
You can ask them if they’ve noticed any jaundice, night sweats, fever, or weight loss and those three (night sweats, fever, and weight loss) are called B category symptoms because it has a lot to do w/ your ______. This is something to assess during a what type of Hematological Disorder assessment?
B-cells
History Assessment
Tachycardia (you wouldn’t ask them if they have tachycardia) you’d say have you noticed your heart racing or pounding or anything like that. Ask about activity intolerance, frequent infections, and headaches. This is something to assess during a what type of Hematological Disorder assessment?
History Assessment
Follow up and palpate for lymph node enlargement. You’ll look at labs to see if there is anemia.
Assess for Ecchymosis which is bruising.
Assess for skin pallor, cyanosis, jaundice, and petechiae.
Assess for Gingivitis inflammation of the gums.
This is something to assess during a what type of Hematological Disorder assessment?
Physical Examination
On Opthalmoscopic examination (bleeding fundi) they might see bleeding in the eyes.
Sclera: jaundice, capillary hemorrhage so the whites of the eyes are red.
This is something to assess during a what type of Hematological Disorder assessment?
Physical Examination
Hepatomegaly, and sometimes splenomegaly, sometimes the cellular activity gets so frantic that the spleen and the liver might start doing some of the work and they make it congested, it gets painful, and enlarged.
This is something to assess during a what type of Hematological Disorder assessment?
Physical Examination
Sternal tenderness because there are some lymph nodes there also.
Myocardial hypertrophy.
Epistaxis Meaning nose bleeds.
This is something to assess during a what type of Hematological Disorder assessment?
Physical Examination
Dyspnea on exertion, dyspnea is really a subjective symptom so you can describe what you see but if you’re going to ask, you’d have to ask them if they have shortness of breath.
This is something to assess during a what type of Hematological Disorder assessment?
Physical Examination
This is considered Anemia: decreased production of RBCs, increased RBC destruction, or blood loss.
What red blood cell disorder is this?
Hypoproliferation
Normal hemoglobin for a female is 12-16 g per deciliter, and 14-18 for a male. Hematocrit is rule of thumb usually 3 times the amount of hemoglobin, so normal for a female is 36-48, for male 42-54% and she is just going to give the rest of the lab results and they’re on the lab template we got at the beginning of the semester and posted on canvas?
WBCs 5-10,000
Platelets 150-400,000.
A normal INR is 1, someone on Coumadin you would want to be 2-4. If it gets over 5 the risk of bleeding is too great and outweighs the benefit of anti-coagulation.
What red blood cell disorder is this?
Hypoproliferation
The 3 types of anemia are iron deficient, vitamin deficient, and pernicious. What red blood cell disorder is this?
Hypoproliferation
We will just briefly talk about polycythemia. Polycythemia: results from hypoxia (when hypoxia occurs more RBCs will be made to carry more O2 around).
What red blood cell disorder is this?
Hyperproliferation
Polycythemia results from hypoxia (when hypoxia occurs more RBCs will be made to carry more O2 around. People that live in higher altitudes can have this since their body adapts to the lower amount of O2 that’s in their air.)
What red blood cell disorder is this?
Hyperproliferation
This can be caused by erythropoietin secreting tumors, kidney disease, and genetic defects.
What red blood cell disorder is this?
Hyperproliferation
This woman has very marked pallor, this type of anemia means there’s not enough RBCs in the body so there is not enough RBCs to carry O2 to the tissues. What type of anemia is this?
Iron Deficient Anemia
There are a lot of different types, this is the most common form of anemia. 20% of women have this type of anemia , 50% of pregnant woman have it, and only 3% of men. Iron is very essential as a part of hemoglobin and it’s normally obtained through diet and without it the body can’t carry O2 effectively.
What type of anemia is this?
Iron Deficient Anemia
Causes are inadequate dietary intake of iron, loss of blood including heavy menstrual bleeding.
What type of anemia is this?
Iron Deficient Anemia
Usually what happens in your body is your RBCs have a lifespan of 90-120 days and then they are broken down and the body recycles that iron when you lose blood as w/ heavy menstrual bleeding or other types of hemorrhage like surgery or something, you also lose the iron that’s in those blood cells so you then have less iron than you actually need.
What type of anemia is this?
Iron Deficient Anemia
Bone marrow suppression and chemotherapy can also cause this type of anemia. In men and post-menopausal women this is usually caused by GI bleed, use of aspirin, NSAIDs, or certain cancers particularly esophageal, stomach, and colon. What type of anemia is this?
Iron Deficient Anemia
Pregnant or lactating women because iron requirements go up.
Infants, children, and adolescents in rapid growth phases because the body can’t keep up.
What type of anemia is high risk in these groups?
Iron Deficient Anemia
People with poor dietary intake of iron.
People with blood loss r/t PUD (peptic ulcer diseases), long term ASA (aspirin) use, and colon cancer.
What type of anemia is high risk in these groups?
Iron Deficient Anemia
Pallor- very pale complexion and not someone who is fair it’s an odd color.
What type of anemia has these signs and symptoms?
Iron Deficient Anemia
Fatigue
Weakness
Dyspnea r/t hypoxemia
Brittle nails
Pica which is eating non-food substances Headache
What type of anemia has these signs and symptoms?
Iron Deficient Anemia
Labs will be Low: Low Hgb Low Hct Low serum ferritin Low serum iron. What type of anemia has these lab values?
Iron Deficient Anemia
Study Tip: In order for this to be treated we have to identify the cause so that’s one of the 1st steps is to identify what’s going on.
Recommended daily allowances and this is from the National Institute of Health’s website for ages 19-50 and that’s the age group we will focus on. For women the minimum daily requirement is 18 mg a day and for men it’s 8 mg a day, so women need ___ more mg a day then men.
10
Dark Green, Leafy Vegetables, Dried Beans Peas Dried Fruits Eggs Enriched Breads Iron-Fortified Cereal Lean Meats Nuts Raisins Seafood/Shellfish Spinach Tofu Wheat Germ Whole-Grain Breads This is a list of dietary sources of \_\_\_\_.
Answer: Iron
Sometimes there are issues w/ people who are _______ but iron should not be a problem and there are certainly some vegetable that contain more iron than some meats.
vegetarian or vegan
It’s better if you replace iron with your natural diet, the more natural the better it’s utilized by the body and the better the outcome. If we have to we can use oral supplements. Iron is given to orthopedic patient’s since they lose blood during _____.
surgery
They will put surgical patients on iron supplements and they are best taken on an empty stomach however a lot of people can’t tolerate that because it causes severe gastric upset, really painful. If they can’t tolerate it on an empty stomach then they can take it w/ meal but it drastically __\\ the amount of iron that’s absorbed. Vitamin C _______ the absorption of iron.
reduces
decrease
Increases
Iron is essential in the production of hemoglobin. ______ and _______ should not be taken at the same time as an iron supplement since it will interfere w/ the absorption.
Milk & antacids
Iron can also be given IV & IM the liquid solution it comes in can be very dark and can stain tissues and clothes so that’s a medication when you give it IM you MUST always give it _____. Available in both IV and IM forms.
Z track
Study Tip: F/U (follow up) as necessary as iron deficiency anemia may recur.
Nausea Constipation Dark stool Epigastric pain. These are the side affects of what medication?
Oral Iron supplements
After 2 months of oral iron supplements the ____ should return to normal but it’s recommended that people take iron supplements for _____ months to fully replenish the body stores of iron.
Hct
6-12
Caused by low amounts of: Folate Vitamin B-12 Vitamin C What type of anemia is caused by this?
vitamin deficiency anemia
Someone will develop __\\ if they don’t eat enough of specific vitamins or also they are eating enough but for some reason their body isn’t absorbing or processing them. It can cause weakness and shortness of breath the Symptoms: look the same as Iron Deficient anemia.
vitamin deficiency anemia
The Treatment for _______ is vitamin supplements & dietary changes. Usually vitamin deficiencies develop slowly and take months to years and the symptoms might be very subtle and as it worsens the symptoms will increase.
vitamin deficiency anemia
We will talk about some dietary sources of folate, the recommended daily allowance from the National Institute of Health’s website is _______ for both men and women.
400mcg
A lot of times deficiency of folate is seen in people who are poorly nourished especially those who are alcoholics, infants, and pregnant women. Folate does help form _______ so it’s necessary in their production.
RBCs
Sources are leafy green vegetables like spinach, citrus fruits, and dried beans and peas.
These are the dietary sources of what vitamin?
Folate/iron
In 1996, the food and drug administration published regulations that required the addition of folic acid to enriched bread, cereals, flours, cornmeal, pasta, rice, and other grain products.
These are the dietary sources of what vitamin?
Folate
Enriched foods are helpful because people who are vegetarian or vegan have a problem getting Vitamin ______but fortunately Folate is abundant in vegetable products. You have to take into consideration what type of diet does your patient prefer.
B-12
These are almost exclusively animal either flesh or products like milk, cheese, and eggs. These are the dietary sources of what vitamin?
B-12
The recommended daily allowance is _____ mcg/day for men and women. People at risk for Vitamin B12 deficiency are _______ because they might not have the substance that’s necessary for B12 absorption due to atrophy of their GI tract.
2.4 mcg/day
Older adults
People w/ pernicious anemia are vitamin ______ deficient; vegetarians, vegans, and pregnant and lactating women are also at a high risk.
B-12
Since most of the sources for Vitamin B12 are _____based a lot of time someone that is a vegan especially since vegetarians can still do cheese and milk and maybe eggs but vegan sources are yeast so they can add that to their food, fortified cereals, fortified soy milk, meat substitutes that could be fortified, and then there are C vegetables like agar agar, nori, and sea palm. Although those 3 sea vegetables are less reliable sources.
animal
People who ____ have pernicious anemia can take oral B12 supplements, that cannot be done w/ people w/ pernicious anemia.
don’t
Vitamin C is an antioxidant and it also plays a very important role in immune function, and it helps w/ the absorption of iron especially non-heme iron which is present in plant based foods.
The recommended daily allowance is ___ mg for men and ____ mg for women, and people who smoke require an additional ____ mg/day as opposed to people who do not smoke.
90
75
35
Citrus fruits tomatoes tomato juice potatoes red & green peppers kiwi fruits broccoli strawberries Brussel sprouts cantaloupe These are the dietary sources of what vitamin?
Vitamin C
Vitamin C in the content of food is _____ by cooking, fortunately a lot of these foods are eaten raw.
Decreased
200mg/day
Chronic, progressive macrocytic anemia and that macrocytic means that the cells are larger.
What type of anemia is this?
Pernicious Anemia
The Reason for lack of intrinsic factor (IF) in the GI tract is because IF is produced by the lining of the stomach so they might not have enough secreted by the stomach, because they may have atrophy of the gastric mucosa, or they have an autoimmune disease against gastric parietal cells, or they have an autoimmunity against IF, or if they have absence of IF (most common) NO INTRINSIC FACTOR AT ALL. What type of anemia is this?
Pernicious Anemia
This process of a decrease in intrinsic factor in the GI tract can occur over decades and it has a very slow onset and doesn’t usually appear in people until over the age of 30. The older someone gets the more likely this type of anemia will occur.
What type of anemia is this?
Pernicious Anemia
Family history, people of Scandinavian or Northern European descent, & a history of autoimmune endocrine disease.
These are the risk factors for what type of anemia?
pernicious anemia
Symptoms might be seen before diagnosis. It affects: their sensory and motor nerves, GI system, & CV system.
These are the signs and symptoms of what type of anemia?
Pernicious Anemia
This is caused by a deficiency of intrinsic factor & that inhibits the ability to absorb vitamin B12 so in this anemia people cannot take an oral Vitamin B12 supplement because their body won’t be able to absorb it.
What type of anemia is this?
Pernicious Anemia
So as far as sensory and motor they may have numbness and tingling of the hands & feet, an unsteady gait, positive Babinski’s sign, and a loss of deep tendon reflexes. These are the signs and symptoms of what type of anemia?
Pernicious Anemia
GI system they might have a loss of appetite, diarrhea, a sore mouth, tongue problems, impaired sense of smell, and bleeding gums. These are the signs and symptoms of what type of anemia?
Pernicious Anemia
CV they might have SOB, pallor, tachycardia, & fatigue. These symptoms here line up w/ the other symptoms of anemia.
These are the signs and symptoms of what type of anemia?
Pernicious Anemia
The goal of treatment of ______is to increase Vitamin B12 levels and that would be obtained through Vitamin B-12 injections because remember they cannot take an oral supplement because they can’t absorb it since they don’t have IF.
Pernicious Anemia
The patient with _______ might start out w/ taking B12 shots daily just to get their levels up then they go to a Vitamin B12 injection once a month. That’s really what we need to remember is that usual treatment is a Vitamin B 12 injection once a month. Saw something that said they could take some kind of B12 vitamin orally, really high doses but generally they will get injections.
Pernicious Anemia
Study Tip: There is some work being done on a nasal form of B12 and then of course they still need to have a balanced diet even though they won’t be absorbing the B12.
With your patient that has any type of anemia you want to do a thorough ______, which includes a history & a physical exam.
assessment
You are going to identify problems:
Fatigue r/t decreased oxygenation.
Impaired gas exchange r/t deficient RBCs to carry the O2 around.
Altered nutrition.
Activity intolerance r/t O2 deficiency.
These are the nursing diagnoses related to what Hematological disorder?
Anemia
Help the patient to set goals and help them to reach their goal through education, particularly about diet and whatever it is that led them to being deficient and becoming anemic.
This what part of the nursing process related to the Hematological anemia?
Planning
This is a myeloproliferative disorder. It is the increased production of white cells, red blood cells, and platelets. Overproduction causes increased blood viscosity, increased total blood volume, and severe congestion of all tissues and organs.
This develops slowly, it may lead to myelocyctic leukemia they are at increased risk for clot formation so CVA or MI may occur. They could also have abnormal platelets and have an issue w/ bleeding.
Polycythemia Vera
FYI- doesn’t expect us to memorize, may be on NCLEX or HESI though. NOT ON EXAM.
S/Sx are headache, dizziness, or SOB and it’s treated by bleeding them.
They go for phlebotomy and get a unit a week taken off until their Hct is below ___ and it’s done as needed. These are the signs and symptoms of what RBC disorder?
45
Polycythemia Vera
Study Tip: Occasionally they need to have chemotherapy for this and the prognosis is very good w/ treatment, w/o treatment it’s not so good.
Temporary increase in WBCs is a Normal increase in response to inflammation, infection, and stress and after it should revert back to ________.
Normal
Increase in _______ with accumulation in ______ or ______ is sign of leukemia and w/ certain types of leukemia we will see an overabundance of blast cells and if you remember back to the content on cancer, blast is an immature cell and it’s not capable of doing the work a mature WBC can do. That puts the patient at risk.
WBC precursors (meaning baby WBCs) bone marrow or lymph tissue
Neutropenia (most common)
Lymphocytopenia (less common)
These are what kind of WBC disorder?
Decrease in WBCs.
Decreases in _____ can result from inadequate production, drug reactions, radiations, cancer, congenital defects, folic acid deficiency, and hypersplenism.
WBCs
A white cell lives from _____ days and then they’re destroyed by the lymphatic system. When WBCs are first released from the bone marrow into the peripheral blood they’re called ____ or ______.
13-20
bands or stabs
When you look at a CBC W/ differential count, you know a CBC tells you how many RBCs, the Hgb and Hct, how many WBCs and then a differential lab test is telling you the details about the different ______ of WBCs.
types
What are the 5 types of WBCs?
lymphocytes, monocytes, eosinophils, basophils, and neutrophils.
Just look at this picture for a little bit, the 3 on the right are really speckled, those are granules, and they are also referred to as granulocytes, cells w/ granules. What types of white blood cells are these?
lymphocytes
monocytes
eosinophils
The two types on the left don’t have all those granules so they’re called agranulocytes. What types of white blood cells are these?
basophils
neutrophils
White cells serve to fight infection through a process known as ______, the leukocytes surround and destroy the foreign organisms. WBCs also produce, transport, and distribute antibodies.
phagocytosis
Study Tip: Looking at the total number of WBCs, we will also look at the differential or diff and you might see order CBC w/ diff.
The neutrophil is broken up into 5 pieces, that makes it a mature neutrophil. As the neutrophil is developing that piece has gone from being kind of solid and looking like a C to _____ into 5 different blobs.
segmented
Study Tip: Before the neutrophil becomes segmented it’s called a band and it looks more like the material in the basophil but a bigger C shape.
When you look at a CBC w/ differential, on a differential report it doesn’t always say _______ sometimes it will say bands or segs or segmented neutrophils and they’re all the same thing.
neutrophils
Study Tip: neutrophils/segs/bands are all the same thing. That’s important to REMEMBER so you know what you’re looking at w/ a CBC w/ differential.
Each of the types of WBCs should exist in the CBC w/ diff at least a certain percentage of them. How they do a differential is they count 100 cells and it can be done manually which is called a ______ or they run it through a machine and the machine will count 100 cells.
manual differential
You have someone sitting at a microscope looking at the slides and they’re counting 100 cells and as they count each cell they put a little mark in the column of what kind of cell it is. Remember they do have very distinctive appearances. This is how what lab test can be done?
Manual Differential
Neutrophils (aka segs/bands) are ______ of the blood so if they count 100 cells there should be between 50 and 70 neutrophils and as they continue counting there should be Lymphocytes: ______, Monocytes: _____, Eosinophils: _____, and Basophils: ______ (not very prevalent).
50 –70%
25 – 35%
4 – 6%
1 – 3%
________ are the predominant form of granulocytes, they help devour invading organisms by phagocytosis.
Neutrophils
____________ occur as both B-cells and T-cells the B-cells are also called plasma cells, they help T-cells delay hypersensitivity rejections, they’re responsible for rejection of abnormal cells.
Lymphocytes
Ex. Cancer/HIV Lymphocytes are further divided in addition to the T-cells and the B-cells there is also Natural killer cells.
Natural killer cells are the ones that destroy damaged cells that can grow out of control.
All of those different types of _______ exist to protect your body against disease.
Lymphocytes
Monocytes along with neutrophils participate in phagocytosis, as monocytes appear they turn into _______ and help the T-cells also.
macrophages
_________ will increase in a patient with a parasitic infection, a lung infection, a skin infection and they work specifically against that.
Eosinophils
The reasons for doing a differential is if we have someone with an infection and we don’t know what it is caused by you get a differential and if it’s a parasite their _______ count will be up so it can be helpful in reaching a diagnosis.
eosinophil
_________ participate in delayed hypersensitivity reactions and they are a very small portion of the differential.
Basophils
Leukopenia is a decrease in the number of circulating WBCs to less than ______.
5,000
_______ is the decreased # of circulating WBCs. ______ is the decreased number of neutrophils.
Leukopenia
Neutropenia
Neutrophils are the 1st responders aka the EMTs to the scene of the accident so if a patient does not have enough neutrophils they are at an increased risk for _________.
infection
Study Tip: She will discuss something called absolute neutrophil count and this is something very important for you to know in your care of pts who might be neutropenic.
ANC stands for absolute neutrophil count. The calculate this amount you take the total # of WBCs so let’s say 5,000 and multiply it by the % of Neutrophils.
Remember neutrophils should be at 50-70% so if you have 5,000 WBCs and 50% are neutrophils then you have a neutrophil count of _____ and that’s good. Where this patient gets into trouble is when they’re considered neutropenic and the ANC decreases below _______.
2,500
1,500
Study Tip: IMPORTANT. At different facilities they put patients on neutropenic precautions at different levels and different physicians use different levels to put someone on this.
What we need to remember is that someone w/ an ANC of _____ is mild neutropenia, ______ is moderate, and less than _____ is severe and that person is in danger of death and also overwhelming infection.
1,000- 1,500
500-1,000
500
All blood cell numbers are decreased (WBC, RBC, platelets) this is something we will see in patients w/ cancer quite often. What is this hematological disorder called?
Pancytopenia
Infections Viral infections HIV Autoimmune disorders Ex. Lupus can cause this These are the causes of what hematological disorder?
Leukopenia
Certain medications, especially those used in chemotherapy and some antibiotics. Radiation therapy
Bone marrow disease
Ex. Leukemia
Myelodysplastic syndromes
These are the causes of what hematological disorder?
Leukopenia
Normally you start with a stem cell and the stem cell divides into two different lines, there’s myeloid stem cells and lymphoid stem cells. The myeloid stem cell becomes a myeloid blast and remember a blast is an immature cell that can’t really do anything. Then the myeloid blast develops into _____, _______, and ________.
RBCs, platelets, and WBCs.
The ________ also produces blood cells.
bone marrow
Normally you start with a stem cell and the stem cell divides into two different lines, there’s myeloid stem cells and lymphoid stem cells. Lymphoid stem cells just become _______.
WBCs
Immature cells are called stem cells and blasts. Immature means that the cells are __________.
undifferentiated
If you’re looking at an undifferentiated cell it is going to look a lot more like that _____ cell at the top instead of like those mature cells at the bottom. If you want to use this to learn differentiation, poorly differentiated and immature is at the top and well differentiate and mature is at the bottom of the slide.
stem
There are different types of leukemia it is divided or classified in a couple of different ways. One of the ways to classify is if it’s _____ or _____.
chronic or acute
Early in disease process abnormal cells still function there are a lot of normal cells are left.
Gradual increase in number.
They’re not as abnormal as they are in the other classification.
It slowly gets worse and symptoms occur as the # of abnormal cells increase.
What classification of leukemia is this?
Chronic leukemia
The blood cells are VERY abnormal, they can’t do the work, they have a total loss of control of differentiation, and they rapidly rise in number.
There have been counts as high as 100,000 w/ 98% blast cells in someone with acute leukemia.
Those abnormal cells reproduce very rapidly and the leukemia gets worse very quickly so you get both classifications of leukemia.
What classification of leukemia is this?
Acute leukemia
If you think about those two different lines of cells both leading to lymphocytic leukemia and myelocytic leukemia. What comes out of the myelocytic line the myelocytes become RBCs, platelets, and WBCs. What comes out of the lymphocytic line they become ONLY WBCs. You can see if they have myelocytic leukemia they’re going to have problems with ______, _______, and _______. Also grouped by type of WBC affected.
white blood cells
platelets
red blood cells
_______ Leukemia affects lymphoid cells.
Lymphocytic
_______ Leukemia affects myeloid cells.
Myelocytic
Patient education Monitor lab work Assessment Evaluate Re-assess Progress towards problem resolution.
Nursing Interventions:
When you look at the CBC with this patient you will see the test labeled MCV and MCH that stands for the ________ so this lab measures the size of the cell and the _________ measures the cells for more volume and more hemoglobin than normal so if you notice that on a CBC you know that’s that means. A lot of those MCV, MCH, and MCHC are used to diagnose _______ if it’s present.
mean corpuscle volume
mean corpuscle hemoglobin
anemia
