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Nursing 280 > Hematology > Flashcards

Hematology Flashcards

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1
Q

Anemia Definition

A

A reduction in the number of RBCs, the amount of hgb, or the hematocrit

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2
Q

Alternate term for WBCs?

A

Leukocytes

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3
Q

What does MCV measure?

A

The average RBC size

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4
Q

What does MCH measure?

A

The amount of Hgb per RBC

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5
Q

How long do RBCs live for in the body?

A

120 days

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6
Q

Where does O2 attach to the RBC?

A

To the heme binding sites on hemoglobin

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7
Q

These labs help define anemias by cell size and amount of Hgb

A

MCV and MCH

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8
Q

What does MCHC measure?

A

Concentration of hemoglobin

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9
Q

What does hematocrit measure?

A

Percentage of packed RBCs per deciliter of blood

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10
Q

What determines whether anemia is micro, macro or normocytic?

A

MCV

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11
Q

What is a reticulocyte?

A

An immature RBC without a nucleus

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12
Q

What could a high reticulocyte count with anemia indicate?

A

Potentially blood loss, hemolysis, kidney disease (with increased erythropoetin), or sickle cell.

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13
Q

What could a low reticulocyte count with pancytopenia indicate?

A

Aplastic anemia, bone marrow failure, cirrhosis of the liver, anemia d/t low iron/B12/folate, or CKD

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14
Q

What would a retic count of zero indicate?

A

Pure red cell aplasia

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15
Q

Normal reticulocyte lab values

A

0.5%-1.5%

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16
Q

Microcytic anemia is usually caused by

A
  • Inadequate production

- ex: low iron, lead poisoning, thalassemia, or inflammation, anemia d/t chronic disease

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17
Q

Normocytic anemia is usually caused by

A
  • blood loss

- could also be sepsis, chronic disease, kidney failure, or prosthetic heart valves

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18
Q

Macrocytic anemia is usually caused by

A
  • destruction of RBCs (caused by chemo and vitamin deficiencies. DNA messed up)
  • **Alcoholism has chronic macrocytosis
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19
Q

What is hemolytic anemia?

A

Anemia where RBCs are being destroyed. Often inherited.

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20
Q

General symptoms of all anemias

A

Yellowing of eyes, skin pale/cold/yellow, SOB, weakness, change in stool color, fatigue, dizziness/OH, low blood pressure, palpitations, tachycardia, spleen enlargement, decreased O2 sats, headache

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21
Q

Symptoms of severe anemia

A

Chest pain, angina, heart attack, murmers and gallops, fainting

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22
Q

Classification of Folic acid deficiency anemia

A

Macrocytic & lacking a substance

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23
Q

Causes of folic acid deficiency anemia

A
  • Dietary deficiency (lacking in fruits and veggies)
  • Malabsorption syndromes (crohns, celiac)
  • Alcohol use/abuse
  • Certain meds (bactrim, oral contraceptives, anticonvulsants, methotrexate)
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24
Q

Symptoms of folic acid deficiency

A
  • may be without symptoms
  • all of the usual anemia symptoms
  • poor growth, especially of fetuses
  • mouth sores
  • swollen tongue
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25
Q

Role of folic acid

A

Aids in synthesis of DNA, production of RBCs, digestion and use of proteins, and neural tube formation

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26
Q

Is folic acid water soluble? How does this affect its storage in the body?

A

Yes, easily excreted because it can’t be stored in fat so the body has no folic acid reserves

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27
Q

Assessment items of folic acid def

A
  • Diet recall
  • Med list
  • Hx of malabsorptive disorders
  • Hair and nails (may be brittle)
  • O2 sat, cap refill, skin color
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28
Q

Folic acid labs and tests

A
  • Folic acid levels
  • CBC
  • MCV (high)
  • Retic count (low)
  • Vit B12 and Iron to compare or r/o
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29
Q

Treatment of folic acid def

A
  • increase folic acid in diet
  • folic acid supplements (400 mcg daily rec)
  • treat long term alcoholism
  • stop or monitor medications
  • monitor labs over time (folate and RBCs)
  • outcomes usually good with tx
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30
Q

Meds that can cause low folate levels

A
  • phenytoin, methotrexate, sulfasalazine, triamterene, pyrimethamine, trimeth-sulfameth (bactrim), barbiturates
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31
Q

Good sources of folic acid

A
  • Fruits and veggies

- specifically green leafies, citrus, beans and nuts.

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32
Q

Vitamin B12 Deficiency - classification

A

Macrocytic

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33
Q

Role of Vitamin B12

A

Needed to transport folic acid into cell, aid in DNA replication

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34
Q

Common causes of B12 Def

A
  • Dietary deficiency (vegan/vgtrn)
  • Failure to absorb B12 d/t:
    - Partial gastrectomy, pernicious anemia, malabsorption syndromes, alcohol use, immune system disorders, LT use of acid reducing drugs, gastritis
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35
Q

Symptoms of B12 Def

A
  • may be without symptoms
  • all the typical anemia sx
  • Easy bruising, bleeding
  • mouth sores, bleeding gums
  • swollen red beefy tongue
  • upset stomach or diarrhea
  • paresthesia, neurological changes (numbness/tingling)
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36
Q

Nerve damage may be permanent with this type of anemia

A

B12 Deficiency

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37
Q

B12 Labs

A
  • B12 levels
  • CBC
  • MCV (high)
  • Retic count (low)
  • Folic acid and iron to compare or r/o
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38
Q

A subtype of B12 deficiency anemia caused by a lack of intrinsic factor in gastric secretions

A

Pernicious anemia

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39
Q

Role of intrinsic factor

A

Necessary for absorption of vitamin B12

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40
Q

Causes of pernicious anemia

A

Chronic gastritis or gastrectomy, autoimmune conditions, DM I, thyroid disease, family Hx

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41
Q

Treatment of pernicious anemia

A
  • B12 injections, oral or nasal spray B12
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42
Q

Symptoms of B12

A
  • All the norms plus…
  • Red beefy tongue, mouth sores, bleeding gums, fissured/ cracked tongue
  • fatigue
  • paresthesias
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43
Q

This type of deficiency has been linked to alzheimer’s, CAD, ADHD, and autoimmune diseases

A

Vitamin B12

44
Q

Foods that contain B12

A
  • Meat, dairy

- not found in plant foods

45
Q

Causes of normocytic anemia

A
  • chronic infections or inflammation (cancer, renal failure, liver disease…)
  • iron stays in stores and is not used adequately d/t chronic inflammation blocking it
46
Q

Where is erythropoetin (EPO) produced? What stimulates its production?

A

In the kidneys, the cells release more EPO in response to low blood oxygen levels

47
Q

Pt may will adapt to lower RBCs and physicians may choose not to treat in anemia of this type

A

Anemia of chronic illness

48
Q

Is iron replacement recommended for anemia of chronic illness?

A

No! They are not low in iron, it’s just being blocked.

49
Q

Treatment of chronic illness anemia

A
  • Possible blood transfusion
  • Possible epoetin injections (esp. if CRF or CKD related)
  • May not treat
  • Monitor labs
50
Q

Aplastic anemia classification

A

Normocytic

51
Q

Causes of aplastic anemia

A
  • production shut down of WBCs, RBCs and PLTs
  • meds like Bactrim
  • Ratiation, chemo, virus, autoimmune disease, exposure to pesticides and benzene
52
Q

Dx of aplastic anemia

A

Bone marrow biopsy

53
Q

Aplastic anemia symptoms

A

The usual plus Infection and bleeding

54
Q

Labs for aplastic anemia

A
  • WBC (low)
  • Platelets (low)
  • watch retic count to check for formation of RBCs
55
Q

Aplastic anemia treatment

A
  • immunosuppresant meds
  • corticosteroids
  • blood transfusions
  • stem cell transplant
  • bone marrow transplant
  • splenectomy
56
Q

Rationale for using immunosuppresants with aplastic anemia

A
  • suppresses activity of immune cells that may be damaging bone marrow
  • gives the bone time to recover and generate new blood cells
57
Q

What is the most common cause of anemia?

A

Iron deficiency

58
Q

Where is iron stored?

A

2/3 in hgb, 1/3 in bone marrow/spleen/muscle stores

59
Q

Most common cause of iron deficiency anemia?

A

GI bleed

60
Q

Classification of iron def anemia

A

Microcytic

61
Q

Symptoms of iron def anemia

A
  • The usual plus…
  • Pika
  • RLS
  • GI bleeding if that is the cause
  • may show no sypmtoms
62
Q

Iron Def Anemia Labs

A

Ferritin, total iron, TIBC, Serum Iron, RBC studies, MCV is LOW

63
Q

Treatment of Iron Df. Anemia

A
  • iron supplements, increase in diet
  • locate source of bleed and treat
  • monitor labs, check over 2-6 mos of tx
64
Q

Sickle cell disease classification

A

Hemolytic

65
Q

Cause of sickle cell disease

A

Genetic condition in which abnormal hgb causes their RBCs to form a sickle shape

66
Q

Treatment of sickle cell anemia

A
  • Blood transfusions
  • Pain control
  • Prevention of clots
  • Watch for MI, CVA, kidney infarct
  • O2
67
Q

Classification of G6PD anemia

A

Hemolytic

68
Q

What causes G6PD anemia?

A
  • defect in G6PD enzyme production
  • hereditary
  • can also be caused by meds and some foods
  • is episodic
69
Q

How does G6PD deficiency affect cells?

A

It is a protective enzyme, so being deficient makes cells more susceptible to damage

70
Q

Drugs that can cause G6PD problems

A

Sulfas, ASA, thiazides, macrodantin

71
Q

Assessment for G6PD

A
  • drug hx
  • spleen enlargement
  • diet assessment for fava, soy
  • travel assessment (occurs with malaria)
  • jaundice
  • all other signs of anemia
72
Q

G6PD labs

A
  • increased bilirubin
  • retic count elevated
  • dark urinex
  • CBC - hgb and haptoglobin
73
Q

G6PD tx

A
  • Avoid cause
  • episodic, should spont. resolve in 7-12 days
  • counsel to avoid giving blood
  • monitor labs
  • mannitol may be needed to help w/ kidney excretion
  • may need a transfusion if kidney fx is normal
74
Q

Leukemia pathology

A

Overproduction of a specific WBC type usually at an immature stage, because of shut down in production of normal bone marrow

75
Q

Risk factors for Leukemia

A
  • Previous cancers, environmental exposure to toxins, family hx, genetics
76
Q

Diagnostic for Leukemia

A

Bone marrow biopsy

77
Q

Prognosis for leukemia

A

70-80% go into complete remission when under age 60

78
Q

Symptoms of acute leukemia

A

fatigue, fever, bleeding, infection, joint pain, pancytopenia, 90% blasts in peripheral smear

79
Q

This type of leukemia is more common in people over 50 yrs

A

Chronic Lymphocytic Leukemia (WBCs over 20,000)

80
Q

Most common leukemia throughout the life span

A

Acute myelogenous leukemia (AML)

81
Q

Rarest type of leukemia

A

Chronic lymphocytic leukemia

82
Q

Most common leukemia in children

A

Acute lymphocytic leukemia

83
Q

Leukemia Treatment

A
  • Bone marrow transplant

- Chemotherapy

84
Q

Syngenetic transplant

A

From an identical twin

85
Q

Allogenic transplant

A

From family or unrelated donor

86
Q

Autologous transplant

A

Self donation

87
Q

Where does lymphoma occur?

A

Blood related cancer of many organs, wherever lymph system/blood travels

88
Q

Lymphoma is characterized by…

A
  • lymphocytes (T cells/ B Cells) becoming malignant/going rogue. these cells can accumulate into tumors
  • enlarged lymph nodes in the absence of infection
89
Q

Where all does the lymph system exist/travel?

A

Lymph nodes, liver, lungs, bone marrow, spleen, bone, skin, mucosal linings

90
Q

Lymphoma Dx

A

Biopsy of lymph nodes

91
Q

Lymphoma Tx

A
  • Targeted therapy - substances that attack cancer cells without harming normal cells
  • Chemo, radiation, biologic therapy (boosts body’s ability to fight)
  • therapy that removes proteins from the blood
  • may do watchful waiting if there are no symptoms
92
Q

Symptoms of lymphoma

A
  • night sweats
  • enlarged lymph nodes w/out other signs of infection
  • fever
  • wt loss
93
Q

What are the most common types of lymphoma?

A

Hodgkins and non-hodgkins

94
Q

Non-Hodgkins arises most frequently from this type of cell

A

B cells

95
Q

Function of T cells

A

Help kill foreign invaders directly

96
Q

Function of B cells

A

Produces antibodies that neutralize foreign invaders

97
Q

What is the difference between Hodgkin’s and non-Hodgkin’s lymphoma?

A
  • Non-Hodgkin’s has no Sternberg cells unlike Hodgkins

- Non-Hodgkin’s is more common

98
Q

Symptoms of non-Hodgkins

A
  • painless, swollen lymph nodes
  • abd pain/swelling
  • chest pain, coughing, or dyspnea
  • fatigue, fever, night sweats, wt loss
99
Q

Risk factors for non-hodg

A
  • Immunosuppressive meds (organ transplant)
  • infection with certain viruses and bacteria (HIV, Epstein barr, H pylori)
  • Chemicals
  • Older age
100
Q

Indolent phase

A

Slow growing

101
Q

Stage I lymphoma

A

Single lymph node region

102
Q

Stage II lymphoma

A

Two or more lymph node regions on same side of diaphragm

103
Q

Stage III lymphoma

A

Lymph node involvement on both sides of the diaphragm, may include spleen

104
Q

Stage IV lymphoma

A

Diffuse extralymphatic disease

105
Q

Platelet deficiency

A

Thrombocytopenia (several types)

Nursing 280 (4 decks)

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