Hematology

Question 1

Anemia

Answer 1

Dec. RBC, Blood Loss, Inc. RBC destruction

• Deficient nutrients (iron/folic acid), Dec. erythropoietin, dec. iron availability.
• Chronic versus Acute (duodenal ulcer/liver disease versus acute trauma)
• HGB

Question 2

Manifestations of Anemia

Answer 2

Tissue Hypoxia
In effect of how quickly anemia occured.
Mild: 10-12
Mod: 6-10
Severe: 0-6

Skin-pale and jaundiced and puritis and cold
Cardio-tachycardia, inc. pulse pressure, HF, claudication

Question 3

Iron Deficiency Anemia

Answer 3

Gi patients
Chronic Kidney
GI bleeds

Manifest: sx later on, lips and tongue swell.
Dx: Hgb & Hmct
Endoscopy/Colonoscopy

Implement: bleed=cauterize, nutrient=iron dense food! (beans), take with orange juice…better absorbed. Laxative.

Evaluation: hgb? 2-3 months to go back to normal.

Question 4

Anemia of Chronic Disease

Answer 4

1-2 months after disease, underproduction of RBC.
becomes
Anemia of inflammation…cancer, infectious disease, hepatitis, TB,

Dx-underproduction of RBC…usually mild…1-2 months after.

Implementation: treat underlying condition.

Evaluation: Labs

Question 5

Aplastic Anemia

Answer 5

Peripheral blood pancytopenia and drop in platelets. Deadly.
Caused by autoimmune disorder…caused by medications and radiation.

Manifest: Happens over a few days or flowly.
Signs of bruising, neutropenia, bleeding, fatigue,

Dx: check labs!
Risk for bleeding and infection

Implementation: Identify and prevent….hematapoetic stem cell transplant or steroids.

Eval: WBC, hgb, platelets.

Question 6

Anemia caused by blood loss

Answer 6

Assoc. with shock/surgery/hemorrhage.

Signs: Clammy cool skin,

Dx: Hgb, WBC, platelet

Do: Restore fluid, albumin, add volume, iron supplements,

Question 7

Thrombocytopenia

Answer 7

BLEEDING AND BRUISING.
Worst case- brain bleed….internal bleeding anywhere.
Prolonged bleeding anywhere.

Dx- platelets below 20,000 (spont. bleed), below 10,000 (transfusion).
Massive bleeding- body will try to stop and overly produce thrombosis and then you have clotting.
Ddimer is a common dx.
Risk for bleeding
Deficient knowledge.
Impaired tissue perfusion.

Planning- vascular integrity and no bleeding.

Implementation: no aspirin or NSAIDS.
Black tarry stools.
Blacck vomit
Blood in urine
Abnormal bleeding
Bruising
Sudden headache (911)
Prevent falling/no contact sports. 
If bleed = apply pressure for 10 min.
No razor...gentle flossing and blowing nose. 
No suppositories/rectal temp! (don't damage rectal mucosa. 

Prevent constipation and bleeding!!
Hgb, Hmct

Question 8

ITP

Answer 8

Immune Thrombocytopenia!

• Most common acquired.
• Body attacks itself, destroys platelets.
• Steroids

Question 9

TTP

Answer 9

Thrombotic Thrombocytopenic Purpura

• Uncommon
• Anemia associated
• fever, no infection, renal abnormalities.
• caused by medication
• women prego…
• dangerous d/t clotting and bleeding.

Treatment: remove causative agent. Steroids, plasma pheresis.

Question 10

HIT

Answer 10

Heparin-Induced Thrombocytopenia.

• r/t long term use of heparin.
• Thrombosis element.
• Monitor platelets before giving heparin.
• DVT–>PE
• NEVER get heparin again.

Question 11

Neutropenia

Answer 11

Neutropenia-form of WBC.
Theme: pt. can’t fight infection and is at HIGH risk for infection. Leukopenia is drop in all WBC but neutropenia is a form of a WBC called neutrophils (phagocytosis).
Neutropenic-isolation!!
-Consequence of something else…chemotherapy, immunosuppressant therapy,

@ Risk if you…. have a fever, and abnormal flora.

Low-grade fever & neutropenia = medical emergency > 100.4

DX Blood culture from 2 sites of body BEFORE infusing antibiotics. 
Sore throat, 
diarrhea, 
SOB, 
cough, 

WBC <4,000
neut<1,000
ANC <500 (actual neut)

Bone marrow Aspiration? Throat culture!

*Risk for infection

Intervene: start antibiotic therapy, get cultures. HAND hygiene, monitor signs/sx… screen visitors for infection. Educate pt. to contact provider if fever is over 100.4 and educate family on hygiene, avoid alcohol mouthwash (dry out mouth), no unwashed fruit or seafood or unwashed veggies or moldy cheese.