Hematology/Oncology Flashcards
What could cause disturbances in the hematologic system?
Decreased number of cells during hematopoiesis (the production & development of blood cells, normally in the bone marrow)
Over production of normal or abnormal cells during erythropoiesis (formation of red blood cells)
Clotting defects
Disorders of the spleen
Aging results in lower blood volume and plasma proteins; the total RBC and WBC level lower, antigen/antibody responses are lower and slower
What could cause disturbances in the lymphatic system?
Enlargement and swelling of soft tissues, usually caused by infection, inflammation, neoplasm, or obstruction
What is the most prevalent anemia world wide?
Iron deficiency anemia
What are some lab findings we see in iron deficiency anemia?
Chronic, microcytic, hypochromic anemia (cells are small and pale)
Without iron there is decreased production of hemoglobin
Levels of hemoglobin usually lower than 10 and RBC 3-4 million
Hematocrit <47 in males and <42 in females
Mean Corpuscular hemoglobin <27 (measures concentration of hemoglobin in a volume of PRBC, low in microcytic anemia, normal in normocytic anemia and high in macrocytic anemia). How pale or dark cells are.
Serum iron levels as low as 10 (normal is 50-170)
Iron binding capacity increased (nothing to bind to)
Ferritin level (form that iron is stored in body) is decreased
What would we assess for with a patient that has iron deficiency anemia?
Assess for underlying cause (GI bleeding etc) and address the cause
What are some Hematinic agents we would use to increase iron level?
Chromygen, Ferrous sulfate, Ferrous gluconate, Iron Dextran, and ascorbic acid to increase absorption
What are some ways we could assist the patient manage Iron deficiency anemia?
Provide safe environment; assist with ambulation if dizzy
Allow for frequent rest periods
Frequent oral hygiene with saline mouth washes and lubricate lips. May even need viscous Lidocaine to swish and spit out
Administer medication as ordered
Give iron with orange juice or ascorbic acid but not milk, if iron liquid give through a straw to prevent discoloration of teeth. Best if given before or between meals. Do not give with milk or antacids
IV route has high rate of anaphylaxis.
If IM give Z-track as will stain the skin.
Observe stools as iron may cause constipation; black stools
Soft foods high in iron
If severe anemia, may need supplemental oxygen
Which anemia has an unknown cause and that may be hereditary?
Pernicious Anemia
What population do we tend to see more with Pernicious Anemia?
Men and women over age 50 and blue eyed people of Scandinavian origin
When do we use the Schilling test?
specific for Pernicious anemia, radioactive tagged vitamin B12 is not absorbed in the stomach & if ↓ 10% of tagged B12 is excreted in the urine = positive test for presence of pernicious anemia; not used very often anymore.
What are some manifestations of Pernicious anemia?
Pallor & jaundice, waxy, fatigue, weakness, dyspnea
Glossitis (smooth beefy red tongue), gingivitis, indigestion, epigastric pain. Loss of appetite, diarrhea, constipation, weight loss
Tachycardia, wide pulse pressure, palpitations
Peripheral neurological changes with tingling, numbness and paresthesias to hands and feet
If untreated neurological symptoms worsen with loss of vibratory sense, ataxia, spasticity, and disturbances in bowel and bladder function. Depression, paranoia, poor memory with impaired judgment; delirium may follow.
Eventually there may be splenomegaly and hepatomegaly, organ failure, neuro degeneration or infection and eventual death
What replacement therapy is needed for Pernicious anemia?
Life long B12 (cyanocobalamin) replacement therapy, given IM. Begin with 2-3 times weekly for 10 doses and then 200 mg monthly or 100 mg every two weeks
What safety precautions should we advise patients with Pernicious Anemia to take?
Safety consideration due to neurological manifestations (assist with ambulation, adjust hot water heater, no heating pads or hot water bottles, bed cradle to keep pressure off extremities, avoid people with infection)
What are some management we need to tell our Aplastic Anemia patients of?
Corticosteroids to stimulate granulocyte production
Bone marrow transplant
Antibiotics for infection
Androgens to stimulate bone marrow
Removal of causative agent
Blood transfusion, FFP, Platelets
Bed rest with oxygen
Stool softeners
Bleeding precautions (soft tooth brush, electric razor)
Avoid injections
Monitor for bleeding, infection, change in V/S, LOC
Reverse isolation when WBCs low
No raw food, cooked food only
Which anemia can lead to renal failure?
Hemolytic and Sickle cell anemia
What would trigger a hemolytic crisis?
For chronic cases, a physiological or emotional stress
What symptoms would we see for a patient in an acute hemolytic crisis?
there are severe chills, fever, headache, back pain, abdomen and joint pain, splenomegaly, hepatomegaly, lymphadenopathy and reduced urinary output
What is the management of hemolytic anemia?
Splenectomy if steroids fail to arrest RBC destruction by the spleen
Corticosteroids to suppress extracorpusuclar factors such as inflammation
Diuretics to prevent tubular necrosis
Folic acid replacement
Remove causative factors
Maintain fluid and electrolyte balance (hydration)
Maintain renal function, using sodium bicarbonate or lactate to alkalize the blood to prevent overload and failure
Blood transfusion
Strict I&O and monitor BUN and Creatinine.
Bed rest and oxygen
What population group is most affected by Thallassemia?
Autosomal dominant inherited disorder most frequently affecting people of Mediterranean (beta form) or Southern Chinese or Asian ancestry (alpha or milder form)
What are the three types of Thallassemia?
major (Cooley’s anemia), intermedia, and minor (mild)
What is one of the biggest manifestations of Thallassemia?
Greatly elevated urine, serum, and fecal Bilirubin
What population group is most affected by Sickle Cell Anemia?
Prevalent in tropical Africa and in those of African descent, those from the Mediterranean, Puerto Rico, Turkey, India and Middle East may also be affected
What is the most common X linked genetic disease in the US?
Hemophilia. Sons of men who are hemophiliacs are normal where as daughters are 100% obligatory carriers.
Sons of women who are carriers have a 50% chance of being hemophilic and daughters have a 50% chance of being carriers
Who would need to follow this management: No surgery; any procedure even dental cleaning with extreme care
Avoid ASA and IM injections
Hepatitis B immunizations
FFP during episodes of bleeding
Cryoprecipitate to replace factor VIII or Factor IX concentrate
Immunosuppressive, DDAVP or Amicar to treat developing antibody inhibitors against a specific coagulation factor
Safety at all times
No contact sports
Ice to painful joints and splinting or casting
Monitor for hematuria, melena, change in LOC
Bed rest during episode of bleeding
Those who received plasma in the early 1980s were infected with HIV
and Genetic counseling?
Hemophiliacs
What population develops Polycythemia vera?
develops in middle age, particularly in Jewish men, is an overproduction of RBCs and thrombocytes by the bone marrow. Results in increased blood viscosity, blood volume, and congestion of tissues and organs
What is some of the management needed for Polycythemia?
Splenectomy if splenomegaly resistant to treatment
Chemotherapeutic agents to induce myelosuppresion in some forms of polycythemia vera
Allopurinol for hyperuricemia
Analgesics for joint pain
Phlebotomy or removal of 500-2000cc of blood or until hematocrit is 45%, this reduces RBC mass. May be needed every 2-3 months to prevent circulatory overload
Exercise to promote circulation
Avoid smoking
Vasodilators
Low sodium diet to prevent further fluid retention
In secondary polycythemia treat underlying cause
In relative polycythemia, fluid and electrolyte replacement
How is AIDS diagnosed?
Initial stage asymptomatic but will have HIV antibodies detected by protein electrophoresis
Positive ELISA that then must be confirmed by Western blot
AIDS diagnosis
CD4 count less than 200/microliter (indicates very low immune status)
HIV viral load determines level of disease in the body, used to monitor progression and treatment effectiveness
Indicator condition manifested (PCP pneumonia, Kaposi sarcoma, CMV, invasive cervical cancer, candidiasis, TB, etc.)
What level of IgG would warrant immunoglobulin infusion?
Less than 300mg/dl
What disease is characterized by the earliest sign of painless lymphadenopathy in one side of the neck?
Malignant lymphomas
What disease is characterized by “Reed-Sternberg” cells?
Hodgkin’s Disease
What is the prognosis for patients with Hodgkin’s Disease?
Prognosis if untreated is about 5 years and those with stage I or II have a 95% cure rate, while those with stages III and IV have a poor prognosis
What are some primary prevention tools to use for Cancer prevention?
education of community about risks, known carcinogens & dietary & lifestyle changes. Medications such as tamoxifen for breast cancer
What are some primary prevention tools to use for Cancer prevention?
genetic screening & risk evaluation; race, cultural influences, level of education, age, knowledge & attitudes about cancer, etc.
Examples of screening is mammography, pap smear, stool for OB, screening colonoscopy, testicular self exam, prostate exam, breast self exam)
What are some management steps for patients undergoing Radiation?
-Radiation therapy (external beam)
Skin manifestations may occur
Assess skin condition (dryness, tautness, erythema, desquamation, telangiectasis; at times even blisters)
Apply bland cream or oil to site only if ordered; usually even if ordered are avoided for at least 2 hours prior to therapy.
Bath with mild soap and lukewarm water, no powder
Protect skin from sunlight, heat, trauma, constricting clothing, heat
Radiation to the head will cause hair loss
-GI (radiation enteritis with atrophy intestinal villa) and Diet
Antiemetics as needed for nausea and vomiting
Gluten, protein, lactose free with adequate fluids
May require IV fluids and in severe cases TPN
Antidiarrheal agents
Weigh weekly
-Mucous Membrane Damage
Good oral hygiene due to possible change or loss of taste and soreness of mouth
Avoid alcohol mouth washes, and spicy foods
-Systemic
Protect from injury and infection
Observe for signs of bleeding
Sedatives for pain
Cancer management: what kind of meds do we see for chemotherapy patients?
N/V is most common side effect & usually persists for 24 hours.
Antiemetics, such as Zofran (ondansetron) used.
Delayed N/V & diarrhea may occur 3-5 days after treatment along with stomatitis or mucositis.
Oncologists now use marinol, phenothiazines, sedatives, corticosteroids & histamines along with the chemo to diminish side effects. Certain chemo agents, such as daunorubicin & doxorubicin are known to cause irreversible cumulative cardiac toxicities
How long after a bone marrow transplant does “engraftment” occur?
2-3 weeks to take place/new marrow becomes functional
What are patients at a high risk for prior to engraftment?
Infection, sepsis, bleeding, and Venous Occlusive Disease (VOD) which is from high-dose chemo that can lead to liver failure
What are some oncological emergencies?
Hypercalcemia, Super vena cava syndrome, Tumor lysis syndrome, organ toxicities, spinal cord compressions, Neutropenic entercolitis, and Hemorrhagic cystitis
