Hematology + Anticoagulants, Antiplatelets, Thrombolytics

Question 1

Physiological characteristics of anemia (definition, causes, manifestations, S&S)

Answer 1

• Anemia: abnormally ↓ # of circulating RBCs or ↓ hemoglobin or both ⇒ ↓ oxygen-carrying capacity
• Causes:
  
  • Excessive loss or destruction of RBCs
  • Deficient RBC production bc of lack of nutritional elements or bone marrow failure
• Manifestations:
  
  • Impaired O2 transport w/ resulting compensatory mechanisms
  • ↓ all red cell measurements & hemoglobin lvls
• S&S:
  
  • Fatigue on exertion
  • Pallor
  • Paleness
  • Central cyanosis
  • Lightheaded
  • Brittle nails
  • Cold intolerance

Question 2

Mechanism of pernicious anemia

Answer 2

• Pernicious anemia: type of megaloblastic anemia where vit B12 deficiency ⇒ red cells produced are abnormally large bc of excess cytoplasmic growth and structural proteins
• Pathophysiology: Autoimmune disorder where body’s immune system attacks parietal cells in stomach lining that produces intrinsic factor (IF) that absorbs vit B12 → so body destroys IF and vit B12 isn’t absorbed → vit B12 needed for RBC formation in bone marrow and maturation + nucleic acid synthesis ⇒ produces abnormally large, immature RBCs (megaloblasts) that have short lifespans ⇒ anemia

Question 3

Mean corpuscular volume (MCV):

Answer 3

• average size of RBCs
• ↑ MCV: cells bigger (macrocytosis)
• ↓ MCV: cells smaller (microcytosis)

Question 4

Mean cell hemoglobin (MCH):

Answer 4

• av. amt. of hemoglobin in each RBC ⇒ red cell mass
• ↑ MCH: RBC carries more hemoglobin than normal
• ↓ MCH: RBC carries less hemoglobin than normal
  
  • Corresponds w/ ↓ MCHC ⇒ hypochromia

Question 5

Mean corpuscular hemoglobin concentration (MCHC):

Answer 5

• concentration of hemoglobin in RBCs/av. amt. of hemoglobin concentration in RBCs ⇒ tells color
• ↑ MCHC: RBCs unusually concentrated w/ hemoglobin
• ↓ MCHC: hypochromia: RBC is pale and doesn’t have lots of hemoglobin
  
  • Seen in iron deficient anemia

Question 6

Reticulocytes

Answer 6

• reticulocytes are immature RBCs ⇒ so it measures rate of RBC production
• ↑: bone marrow actively producing RBCs
• ↓: possible bone marrow suppression

Question 7

Hemoglobin/Hematocrit (Hgb/Hct):

Answer 7

measures blood volume, oxygen-carrying capacity, status of blood disorders

Question 8

Nursing management for blood transfusion reactions (if you see S&S of… + steps after)

Answer 8

• If you see S&S of:
  
  • Angioedema
  • Resp obstruction
  • Fever/Inflammatory response
  • HIVES
• Next Steps:
  
  • Stop transfusion immediately
  • Administer normal saline
  • Give histamines to block IS response
  • Notify physician and blood bank
  • Monitor pt for 15-30 mins
  • Restart blood if mild Sxs of just HIVEs resolve
  • Continue to monitor pt
• In severe hemolytic transfusion incompatibility where blood transfused is completely incompatible and causes hemolysis ⇒ can damage kidneys and pt dies

Question 9

Reversal agents for all anticoagulants and thrombolytics

Answer 9

• Heparin/Heparin Derivatives: Protamine Sulfate
• Warfarin: Vit K
• Direct Factor Xa Inhibitors: Andexxa
• Direct Thrombin Inhibitors: no reversal agents
• Aspirin: no reversal agents
• Clopidogrel (Plavix): no reversal agents
• Thrombolytics (alteplase (t-Pa) & tenecteplase (TNK)): no reversal agents