Hemotology Flashcards
Hgb values
12-16 females
13.5-18 males
RBC values
4-5 females
4.5-6 males
Hemoglobin and anemia values
10-14 mild
6-10 moderate
<6 severe
3 signs symptoms of severe anemia
Fatigue
Palpitations
Dyspnea
Hct values
3 times the Hgb value
If Hct is elevated then the patient is experiencing…
Fluid volume deficiet
If Hct is decreased then the patient is experiencing…
Fluid volume overload/ excess
WBC values
4000-11000
Neutrophils should be….
50-78% of wBCs
Neutropenia actions
Temp greater 100.4/38C report immediately and start IV antibiotic
Shift to left is high neutrophil= severe infection
Platelet values
100,000-250,000
Thrombocytopenia platelet count
Less than 100,000
Thrombocytopenia critical values
Critical less than 50,000
Hemorrhage if less than 20,000
Need platelet transfusion if less than 10,000
INR values for Coumadin therapy
INR values for No therapy
Coumadin = 2-3
No therapy= 1-2
Antidote for Coumadin therapy
Intramuscular injection Vitamin K
Coumadin is part of the ——–pathway for coagulation
Extrinsic
aPTT values for heparin therapy
aPTT vales for no therapy
aPTT Heparin critical value
Heparin therapy 75-112
1.5-2.5 times normal
No therapy 25-35 seconds
Critical greater than 130–heparin protocol
Antidote to heparin therapy
Protamine sulfate
Heparin is part of the——–pathway
Intrinsic
Patient teaching for iron liquid supplement
Where is IM iron injections given, by which method?
Acidic stomach, empty stomach, vitamin C increases absorption, causes black tarry stools and constipation. Stains teeth, drink with straw.
Deep gluteus with z-track
What is hydroxyurea (Hydrea)?
Medications used to increase fetal hemoglobin in sickle cell and leukemia patients
What is cyanocobalamin?
Medication for vitamin b12 deficient anemia. Available PO and IM.
What is the side effects of cyanocobalamin medication?
Decreased K+, secondary to improved RBC production and may need supplemental K+
What is the action of folic acid?
Increases production of RBCs; also prevents neural tube defects.
What are Epogen and Procrit used for?
Increase production of RBC in bone marrow for chemo and renal failure patients.
Watch for HTN secondary to increased Hct.
What are the uses of Neupogen?
Stimulate bone marrow production of neutrophils /WBC to decrease Risk of infection.
Watch for nine pain, notify mad and give Tylenol
What lab values are reduced in anemia?
Decreased RBC, Hgb and Hct
Patients with pernicious anemia lack what?
Intrinsic factor needed in the stomach to absorb vitamin b12
Define vitamin b12 anemia.
Decreased RBCs secondary to decreased b12. But have large RBCs.
Decreased cobalamin serum levels
Vitamin b12 is water soluble.
Define folic acid anemia
Decreased RBCs secondary to decreased serum folate.
What is the shillings test? How performed? How to interpret results?
Shillings is radioactive urine test for determining absorption of vitamin b12. 24 hour urine collection. If b12 found in urine then not absorbing it-lack intrinsic factors.
What are sources of dietary vitamin b 12?
Eggs, dairy, animal proteins
What are dietary sources of folic acid?
Fruits green leafy vegetables.
What are symptoms of vitamin b12 anemia
Fatigue, dyspnea, palpations
Parathesias, swollen red tongue, confusion.
What are some common causes of vitamin b12 anemia?
Decreased diet intake Alcoholism Digestive disorders (chroma/celiac) Wt loss surgery Antacids (PPIs ⬇️acid needed to absorb iron).
HOP is used for the treatment of ——
Sickle cell anemia.
Hydration
Oxygenation
Pain
What are triggers for sickle cell anemia?
Anything that decreased oxygen -hypoxemia
Infection
Dehydration
Hypoxemia
What organs are damaged in sickle cell anemia?
Spleen-RBCs get caught up
Liver-jaundice from hemolysis of Hgb
Define polycythemia Vera.
Distinguish between primary and secondary.
Too many RBCs and WBCs and platelets
Primary: increased RBCs, WBCs, and platelets-hypercoagulability- clotting
Secondary: related to increased erythropoietin from hypoxia- body wants more 02 so kidneys secrete more.
What are symptoms of polycythemia?
HA, dizziness, tinnitus, itchy, thrombus
HTN secondary to increased viscosity of blood.
RBCs WBCs and platelets have shorter life span. Lysis if cells spills contents leading to—Increased Uric acid and K+
Define thrombocytopenia.
Decreased platelets. <100,000
What are some indicators of thrombocytopenia ?
Bruising
Petechia -no blanching of skin
Increased bleeding.
What is HITTS -thrombocytopenia
Heparin induced thrombolytic thrombocytopenia syndrome
NEVER heparin again or lovenox. Start Coumadin and thrombolytics.
Platelets decrease 50% from baseline after injection as immune system attacks platelets.
What changes in lab values do you see with DIC?
Platelets, clotting factors
PT/PTT, FSP, d-dimer
Platelets, clotting factors: decreased
PT/PTT, FSP, d-dimer: increased
Define DIC
Disseminated intravascular coaguapathy
Blood clots in small blood vessels, this ⬆️ clotting uses up platelets and clotting factors (proteins). Leads to ⬆️ bleeding.
Define hemophilia.
Hemophilia A
Hemophilia B
Von will round
Deficiency in clotting factors.
Hemophilia A: factor 8
Hemophilia B: factor 9
Von will round: Von willibrond factors.
How does DDAVP help with hemophilia?
DDAVP desmopressin helps release factors 8 stored in lining of blood vessels.
What lab value changes would you see in hemophilia?
PPT
PT
Factor assay
PPT: increased. Intrinsic pathway and is slower than extrinsic
PT: normal
Factor assay: decreased
Define neutropenia.
Decreased WBCs. Specifically neutrophils less than 1000
What are precautions for neutropenic patients?
Strict hand washing No fresh foods or raw or flowers Private room Reverse isolation Assess temp q4 hrs
What is the sign/symptom you would watch for in neutropenic patients?
Pain
As too little WBCs to produce normal inflammatory reaction ( redness, warmth, pus, elevated WBCs)
Temp greater than 100.4/38 requires IV antibiotics within an hour.
Define leukemia.
What lab value changes would you expect?
RBCs, Hgb/Hct, platelets
WBCs
Malignancy affecting blood and blood forming tissues of bone marrow, lymph system, spleen.
RBCs, Hgb/Hct, platelets: all low, body not making
WBCs: elevated at first but ineffective. Low after diagnosis.
What are some common manifestations of leukemia?
Acute: bone pain, anemia, bleeding, fever, weight loss, poor wound healing, enlarged liver or spleen.
Define lymphoma.
Distinguish between hodgkins and non Hodgkin’s lymphoma.
Malignant neoplasm in bone and lymphatic structures. Lymphoma develops when lymphocytes divide uncontrollably and crowd out healthy cells/tissues with rumors.
Hodgkins: reed sternberg cells
Non-Hodgkins: NO reed sternberg cells.
What are the common manifestations of lymphoma?
Painless enlargement of cervical, auxiliary, I guitar lymph nodes.
Fever, night sweats, and weight loss are late symptoms with poor prognosis.
Define multiple myeloma.
What lab values would you expect? Ca++
RBCs WBCs platelets
Neoplastic plasma cells infiltrate the bone marrow and destroy bone.
Hypercalcemia secondary to bone destruction. Give corticosteroids to secrete Ca++.
What lab value is assessed for intrinsic coagulation pathway?
What medication do we monitor for this value?
PTT
Heparin
Intrinsic pathway is activated via vessel damage (hemophilia)
What lab value is assessed for extrinsic coagulation pathway?
What medication do we monitor for this value?
PT/INR
Coumadin/warfarin
Extrinsic pathway activated via release of thromboplastin by tissues
What are fibrin split products?
Lab value used to measure the breakdown of clot/plug of injury to allow blood back I tot the injured area.
What is streptokinase?
Thrombolytic used to break up cots in MI, ischemic stroke, PE.
Increase perfusion, decrease viscosity and aggregation of RBCs
What is the acronym RANDI for bleeding precautions include?
R- razors electric A- aspirin-NO N- needles-small gauge D- decrease needle sticks I- injury- protect from
Least the sign and symptoms of transfusion reactions.
Allergic
Febrile
Hemolytic
Allergic: face flushing, hives/rash, anxiety,wheezing hypotension
Febrile: HA, tachycardia, tachypnea, fever, chills, anxiety
Hemolytic: hematuria, chest pain, low back pain, fever, tachycardia, hypotension, SOB, chills
What is the effect of stress on organs/systems? Heart Blood vessels Lungs Adrenal medulla Liver GI system
Heart: ⬆️ BP and HR= ⬆️CO
Blood vessels: peripheral vasodilation and central vasoconstriction
Lungs: increased RR with shallow breathing, bronchi dilation
Adrenal medulla: release epi and norepinephrine
Liver: gluconeogensis=⬆️BS
GI system: decreased peristalsis
Give an example of an emotion focused coping strategy.
Give an example of a problem focused coping strategy.
Emotion: help cope: hot bath, exercise, talking with friend
Problem: find solution: seeking advice, referral
What effects do corticoids ( cortisol) have during stress?
Increase breakdown proteins
Gluconeogensis–⬆️BS
Decreased lymphocytes and decreased WBCs
What effects does aldosterone have during stress?
Saves Na+ and H20 in kidneys
Leads to increased BV, increased BP
What effects does ADH have during stress?
Saves water only
Leads to water retention, increased BV, increased BP
What effects do catacholamines ( epi and norepinephrine) have during stress?
Flight or fight
⬆️HR, increased contractility, bronchodilation, vasoconstriction to nonessential tissues,vasodilation to periphery and essential organs. Pupil dilation, inhibit GI action, decrease insulin and increased BS
Hypernatremia causes.
Hypernatremia causes Dehydration Decreased renal function HF secondary to aldosterone Cushings (increased cortisol)
Na+ gain and water loss.
Hypernatremia signs symptoms
Hypernatremia symptoms Neuro changes - altered mental status Mild muscle twitching Severe weakness Dry mouth
Hypernatremia treatments
Hypotonic solutions
Diuretics
Fluids but restrict Na+
Hyponatremia causes
Hyponatremia causes Diuretics DKA Addison's (decreased adrenal) Fluid overload Excessive sweating or GI fluid loss
Na+loss and water gain
Hyponatremia sign and symptoms
Hyponatremia symptoms Neuro-confusion General muscle weakness Decreased reflexes Increased GI motility Cardiac decreased BP, weak pulse.
Hyponatremia treatments
Hyponatremia treatments
Increase oral sodium intake
IV fluids if from FVD
Diuretics if from FVE
Hypertonic soon to increase sodium
Hyperkalemia causes
Hyperkalemia causes: Renal failure Addison's (decreased adrenal) DKA K+sparing diuretics Crush injury
Hyperkalemia symptoms
Hyperkalemia symptoms: Increased excitability so: Cardiac changes, EKG changes, v-fib, decreased BP and HR Muscle twitching Abdominal cramping-diarrhea Weakness paralysis
Hyperkalemia treatment
Hyperkalemia treatment:
Decrease K+ oral intake
Diuretics, dialysis, insulin to decrease K+
IV Ca++ to decrease excitability
Kayexalate- increased GI elimination of K+
Hypokalemia causes
Hypokalemia causes: Diuretics Cushings ( increased cortisol) Diarrhea vomiting Alkalosis Fluid overload due to increased aldosterone Insulin Digoxin toxicity
Hypokalemia symptoms
Hypokalemia symptoms: A SIC WALT. Decreased excitability Alkalosis Shallow reaps Irritability Confusion drowsiness Weakness fatigue Arrhythmias Lethargy Threads pulse
Hypokalemia treatment
Hypokalemia treatments: K+ supplement K+ sparing diuretics Dietary K+ intake Insulin to move K+ into cell
Hypercalcemia causes
Hypercalcemia causes Hyper parathyroid Acidosis Renal failure Malignancy- multiple myeloma Prolonged immobility
Hypercalcemia symptoms
Hypercalcemia symptoms Decreased excitability Muscle weakness Decreased reflexes Decreased peristalsis Blood clots
Hypercalcemia treatments
Hypercalcemia treatment Loop diuretics Isotonic fluids Ca++ binders Increased phosphate Calcitonin to decreased Ca++ absorption Dialysis Decreased dietary Ca++ Weight bearing exercises Cardiac monitoring
Hypocalcemia causes
Hypercalcemia causes: Renal failure Hypo parathyroid Alkalosis Loop diuretics Increased phosphorus intake
Hypercalcemia symptoms
Hypercalcemia symptoms: muscle excitability Parathesias around mouth/ lip tingling Muscle cramping Hypotension Osteoporosis EKG changes Positive chovsteks and trousseaus sign
Hypercalcemia treatment
Hypercalcemia treatment:
Ca++ supplements
Oral Ca++ intake
Decrease phosphate
Chvotek’s sign assesses for what electrolyte imbalance? How to perform.
Hypocalcemia
Tap cheek and notice muscle twitching from muscle excitability.
Trousseau’s sign is used to asses for what electrolyte imbalance? How to perform
Hypocalcemia
BP cuff to arm and arm cramp
What is the effect of calcitonin on Ca++ levels?
Calcitonin causes decreased GI absorption, promotes renal secretion and deposits Ca++ to bone.
What effect does parathyroid hormone have on Ca++ levels?
Is released when Ca++ levels are low.
Causes Ca++ to be released from bone, increase GI absorption and increased renal absorption
Acidosis causes K+ levels to——
Rise- hyperkalemia
Alkalosis causes K+ levels to —-
Fall- potassium enters cells and Hypokalemia in serum.
How much fluid is loss daily through insensible losses?
1000 cc
What is normal urine output?
What is the minimal urine output?
Normal = 60 cc / hour
Minimal = 30 cc/ hr
What affect does aldosterone have on Na+ and K+ levels?
Na + levels rise
K+ levels fall as it is excreted in urine.
List physical symptoms of dehydration.
Hypotension, orthostatic hypotension Tachycardia Increased RR Decreased skin turgid Dry mucous membranes Confusion Decreased urine output- high specific gravity- concentrated Elevated Hct, BUN, osmolality.
List physical symptoms of fluid overload.
Pitting edema Bounding pulses JVD Weight gain Dyspnea Crackles Confusion Enlarged liver
