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MedSurg Test 1 > Hmatologic Disorders (30,31) > Flashcards

Hmatologic Disorders (30,31) Flashcards

1
Q

What are the blood forming tissues?

A

Bone marrow, blood, spleen, lymph systems.

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2
Q

What are the BIG gerontologic considerations for hematologic disorders?

A

1) Very few!! all counts should be within normal limits.
* **exception is hgb
2) Have a diminshed capacity
3) Decreased reticulocytes

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3
Q

Anemia is not a normal finding in adults. What are some reasons anemia is caused in older adults?

A

1) 1/3 is nutritional (Fe, B12, Folic Acid)
2) 1/3 is renal insufficiency or chronic inflammation (EPO,Kidneys)
3) 1/3 nis unexplained (Still add supplement)

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4
Q

What medications effect blood?

A 
Salicylates
NSAIDS
Herbs
Oral Contraceptives
Immunosuppressants
Chemo
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5
Q

What three nutrients are required to develope a healthy bood cell?

A

Iorn
Cobalamin (B12)
Folic Acid

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6
Q

Hemolytic anemia

A

Autoimmune disorder. Killing RBC before 120 days. This immature breakdown results in the release of uric acid that gets deposited in the joints. GOUT

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7
Q

Why does anemia cause achy joints?

A

Because of the pressure from explanding bone in leukemia. We have hyperproliferation of RBC’s but never ending production.

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8
Q

What sensory symptoms are associated with pernicious anemia?

A

parasthesias, numbness, and tingling.

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9
Q

When looking at pt with suspected anemia. What will their color look like
?

A

Palor-moderate anemia

cyanosis-severe anemia

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10
Q

What stage af anemia do you see clubbing?

A

Severe

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11
Q

Why does anemia cause petechiae, bruising, purpura?

A

Blood is oozing out of capillaries. Usu. indicative of a platelet disorder.

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12
Q

What is the function of the spleen?

A
  • Filter blood
  • Clear out microorganisms and pathogens
  • Remove abnormal or old RBC’s
  • Store platlets and WBC’s
  • fight bacteria of meningitis and pneumonia
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13
Q

What percentage of platelets does the spleen store?

A

30%

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14
Q

What affects does the spleen have on the blood if removed?

A

Higher circulating number of platlets and clotting potential.

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15
Q

If the spleen is inflammed how does that effect the blood?

A
  • decrease in blood cellls
  • increase risk for rupture
  • abdominal pain (pressure on N)
  • early satiety
  • anemia
  • thrombocytopenia
  • leukopenia.
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16
Q

What would we ever give someone a splenectomy if the spleen was not about to rupture?

A

To increase the blood cell count. The spleen hold 300mL of blood.

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17
Q

What are the three major blood cells formed in the blood marrow?

A

1) Hemoglobin 12-16 N
2) Hematocrit 35-45N
3) Total RBC’s 4-5N

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18
Q

Hemoglobin

When is it increased and when is it decreased?

A

12-16N

  • decreased in anemia, hemorrhage, fluid overload
  • Increased in polycythemia and dehydrations
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19
Q

Hematocrit

When is it increased and when is it decreased?

A

35-45N
Percentage of RBC’s in the total blood volume
Decreased in anemia, hemorrhage, and fluid overload
Increased in polycythmia and dehydration

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20
Q

What blood test would we ask for if we wanted to see the percentage of each granulocyte (WBC)?

A

CBC with Differential

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21
Q

If hemoglobin, hematocrite, and RBC’s are low then the patient has

A

pancytopenia

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22
Q

WBC’s Normal Range

A

4,000-11,000N

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23
Q

If WBC’s counts are high that is indicative of?

A

infection, iflammation, or leukemia

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24
Q

Platelet Normal Range
Below 100,000
Above 400,000

A

150,000-400,000N
Thrombocytopenia
Thrombocytosis - Next we would want a peripheral smear to look at the shape of the platelets.

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25
Q

What is a peripheral smear?

A

Indicates the presence of abnormal or immature cells.

Looks more closely at the types of cells, shapes of cells, maturity of cells.

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26
Q

Neutrophils:
Normal Value
When are you very cautious?
How do you calculate the neutrophil count?

A

1500-7000N
Cautious if below 1000
Neutrophil Count= WBC X (%seg + %bands)

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27
Q

What three values do you look at for coagulation?

A

aPTT
PT
INR

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28
Q

aPTT

A

Measures clotting time. (25-35 sec)
Focuses on the intrinsic pathway
Monitors the affects of heparin.

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29
Q

PT

A

Measures clotting time (11-13 sec)
Focuses on the extrinsic pathway
Monitors the affects of coumadin

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30
Q

INR

A

Standardized way of reporting the PT

0.9-1.1N

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31
Q

When do you test for a D-Dimer

A

To test for the breakdwon/dissolveing of clot and this is they by products.

  • shows hypercoagulability
  • d-dimer is the degradation product of cross-linked fibrin.
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32
Q

What does hypercoagulability help diagnose? (D-Dimer)

A

PE

DIC

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33
Q

What is FSP and FDP?

A
  • showS bleeding risk

- FSP and FDP are the products of a dissolving clot

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34
Q

What is special about FDP?

A

FDP can be increased if plamin has been activated somewhere without there being a clot AND can suggest DIC.

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35
Q

What does low fibrinogen suggest?

A

Bleeding risk/ hypercoagulability.

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36
Q

What does a hemoglobin electrophoresis identify?

A

Sickle Cell Anemia and Thalassemia by measuring the different types of hemoglobin the blood.
HGB S = Sickle Cell Anemia
HGB C = hemolytic anemias, thalassemia

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37
Q

What does the reticulocyte count measure?

A

Reticulocyte count measures the amount of immature RBC’s. This represents if the bone marrow is producing RBC’s at the correct rate.
** THE ELDERLY HAVE DECREASED RETICULOCYTES

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38
Q

When do you see an increase of immature RBC’S?

A

Hemolytic Anemia= the abnormal breakdown of red blood cells.

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39
Q

Explain ESR (Erythrocyte Sedimentation Rate)

A

ESR measures the settling rate of RBC’s.
-shows increased cell destruction
-usually indicative of inflammation
~Increased in inflammation.

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40
Q

What are four things you can test for Iorn?

A

Iorn
TIBC
Ferritin
Transferrin Sautration

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41
Q

What is TIBC?

A

Total Iorn Body Capacity

-All protiens that bind or transport iron between the tissues and bone marrow.

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42
Q

2/3 of TIBC is bound to what?

A

erythrocytes and muscle cells

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43
Q

What is ferritin?

A

Body Iron stores:

  • Bone marrow
  • Spleen
  • Liver
  • Macrophages
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44
Q

What is transferrin Saturation?

A

Best indicator of iron availability then just testing iron levels. Because this reflects the amount of iron that is bound and ready to be used.

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45
Q

What is the Schilling Test?

A

It is a urine test that tell us how much B12 we are absorbing.

  • Client is given an oral dose of radioactive B12 and then 2-6 hours later is given a non-radioactive injection of B12
  • low, they are properly absorbing B12,
  • high, they are no absorbing enought 12.
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46
Q

Summarise bone marrow examination.

A
  • May use conscious sedation or local anesthectic
  • Post. iliac crest is the preferred site.
  • Very painful
  • Gives a full evaluation of heatopoiesis
  • Pressure dressing over site that needs to be evaluated
  • Lie on a rolled towel for additional pressure for 30-60 min post procedure.
  • May be sore up to 3-4 days post procedure. Anything over 4 days is abnormal.
  • Usually done with a peripheral blood smear and helps determine the most appropriate treatment.
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47
Q

What could cause low RBC production?

A
  • deficiencies
  • aplastic anemia
  • anemia of chronic disease.
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48
Q

What can cause high RBC destruction?

A
  • SCD
  • G6PD (enzyme that makes RBC firm)
  • external damage
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49
Q

What disorders can cause anemia?

A
  • Low RBC production/impaired
  • Blood loss
  • High risk of RBC destruction
  • result of a chronic condition
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50
Q

What are some examples of thrombocytopenia disorder?

Iow platelets

A

Hemophilia
Von Willebrands
DIC

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51
Q

What are patients with anemia at risk for?

A

Fatigue and hypoxia

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52
Q

What are patienst with thrombocytopenia at risk for?

low platelets

A

Bleeding

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53
Q

What are patients with neutropenia at risk for?

low neutrophils, WBC’s

A

infection

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54
Q

What are patients with panocytopenia at risk for?

A 
Fatigue
hypoxia
bleeding
infection
~ all cell types are low
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55
Q

Splenomeglay causes…..

A

thrombocytopenia (low platelets)
anemia
leukopenia

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56
Q

What is the primary cause of polycythemia? (too much iron)

A

Hypoxia

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57
Q

What is hemachromaatosis?

A

Too much iron

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58
Q

Is anemia a disease?

A

No, it is amanisfestation of a pthologic process

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59
Q

What are the two main issues with anemia?

A

1) Too few RBC’s

2) not enough hemoglobin

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60
Q

Normocytic, normochromic
Microcytic, hypochromic
Marolytic, normochromic

A

Normal size/ normal color
small size/ pale color
Large size/ normal color

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61
Q

What is the etiology of Normocytic, Normochromic?

A 
Acute blood loss
CKD
Sideroblastic anemia
Refractory anemia
Aplastic anemia
Sickle cell anemia
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62
Q

What is the etiology of microcytic, hypochromic?

A

Iorn-deficiency anemia

Thalassemia

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63
Q

What is the etiology of macrocytic, normochromic?

A

Cobalamin Vit B12 deficiency

Folic acid deficiency

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64
Q

What are the sign and symotoms of mild anemia

A
  • none

Hgb 6-10

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65
Q

What are the signs and symptoms of moderate anemia

A
  • palptiations, dyspnea, mild fatigue WITH activity AND at rest. These symptoms are because the body is trying to compensate for a decrease of O2
    Hgb 6-10
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66
Q

What are the signs and symptoms of severe anemia?

A

-Viscosity so low and thin that its basically plasma flow through
-Tachycardia, murmur, bruits, angina, HF, MI
-Tachypena, orthopnea, dyspnea at rest
-Headache, iriitability
-Anorexia, hepatomegaly, splenomegaly
-Bone pain, weight loss, lethargy
Hgb less than 6

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67
Q

Why do you see murmurs and buits with severe anemia?

A

Because of the low viscosity of the blood. Blood is thin like water. Therefore the heart has to work harder to pump blood through your body. This leads to CHF and organ damage.

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68
Q

What are the treament goals for anemia?

A
  • be able to do ADL’s
  • maintain nutrition
  • have no complications
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69
Q

What types of anemia are caused by a decrease in RBC production

A 
Iron deficiency anemia (dietary, blood loss)
cobalamin deficiency (dietary, lack of IF-parietal cells)
folic acid deficiency (dietary)
Thalassemia (genetic)
Aplastic Anemia (genetic, acquired)
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70
Q

What is hemoglobin composed of ?

A

Iorn

71
Q

Panocytopenia is apart of what type of anemia?

A

Aplastic Anemia

72
Q

What is the most common type of anemia?

A

Iron deficiency anemia

73
Q

What is iron deficiency anemia?

A

Iron stores drop too low to support normal RBC production

74
Q

What are the causes of Iron deficiency anemia?

A

Inadequate diet
Malabsorption
GI/Intestional surgeries
Blood loss

75
Q

What are the signs and symptoms of iron deficiency?

A
  1. Pallor
  2. Glossitis
  3. Cheilitis
  4. Headache
  5. Parasthesias
  6. Burning sensation on the tongue
76
Q

Where is iron absorbed?

A

In the duodenum

77
Q

How many mL of blood has 1 mg of Fe?

A

2mL

78
Q

What is the treatment for iron deficiency anemia?

A
  • Treat the underlying problem

- Increase Fe intake

79
Q

What is the best iron supplementation?

A

Ferrous sulfate or ferrous gluconate if GI upset.

80
Q

How beneficial is sustained release or enteric coated iron?

A

Not! Iron is absorbed in the duodenum. These release iron too far in the GI Tract.

81
Q

What can you take with iron to increase the absorption?

A

Vit C

82
Q

If you are supplementing with Fe and you have dark black stools what do you do?

A

Notihng, this is expected

83
Q

What is the duration of Iron Therapy?

A

2-3 months are hgb levels return to normal (12-16). This is to put back iron stores.

84
Q

What are the major causes of cobalamin deficiency?

A
  • No IF
  • Pernicious anemia (autoimmune)
  • nutritional defiiencies (B12)
  • Long term users of stomach acid blockers
  • Herediary (dont make IF properly)
85
Q

What are the signs and symptoms of cobalamin deficiency?

A
  • megaloblastic anemia (RBC are very large, abnormal, fragile)
  • Glossitis
  • GI problems
  • Neuromuscular problems- Tingling all over
86
Q

How do you diagnose cobalamin deficiency ?

A

Schilling test

87
Q

What is the treamtent for cobalamin deficiency?

A

IM or intranasal cobalamin. Dietary wont help because we cant absorb it without intrinsic factor secreted from the parietal cells.

88
Q

What is pernicious anemia?

A

The body cannot make enough RBC’s becuase it dosent have enough B12. Parietal cells cannot absorb B12. Without B12 RBC’s cannot divide normally and are too large in size. They get stuck in the bone marrow .

89
Q

What is megaloblastic anemia?

A

RBC’s are large, abnormal, and fragile. The gastric mucosa atrophy from autoimmune destruction causing a decrease in surface are of the illeum or destroy IF/parietal cells.

90
Q

What causes Folic Acid deficiency?

A 
Dietary deficiency
Malabsorption syndromes
Drugs (methotextrate, Dilantin)
Alcohol Abuse (affects absorption)
Hemodialysis
91
Q

Why is folic acid important?

A

Folic acid is required for DNA synthesis leading to RBC formation and maturation

92
Q

What are the signs and symptoms of folic acid deficiency?

A

Megaloblastic anemia
Glossitis
NO NEUROLOGICAL IMPAIRMENT
Low serum folate

93
Q

What distinguishes folic acid deficiency from colbalmin deficiency?

A

Neurological impairment. Neurological impairment is seen in colbalmin deficiency.

94
Q

What is the tx for folic acid deficiency?

A

Folic acid replacement/ You increase supplements because of malabsorption

95
Q

What is thalassemia?

A

Autosomal recessive genetic disorder (You need a gene from both parents). The gene to properly make Hgb is missing. This causes

  • RBC;s to from incorrectly or not carry oxygen
  • hemolysis also occurs
  • *Decreased production of Hgb is the primary problem
96
Q

What causes thalassemia?

A

Genetics

Mediterranean descent

97
Q

How do the blood cells look in thalassemia?

A

microcytosis, hypochomia

small and pale

98
Q

What are the signs and symptoms of thalassemia?

A

-Severe mental and physical retardation= decrease oxygenation
-Pallor
-Pronounced spleomegaly and heptomegaly=
~Splenomegaly= eating up all the small cells
~hepatomegaly= Main place for iron stoage after the spleen destroys the cell
-Jaundice= hemolytic billirubin in breakdown
-Skeletal deformaties = not having proper perfusion so the body starts making more RBC’s to compensate

99
Q

What is the tx for thalassemia?

A
  • No effective tx
  • No iron- they already have way to much
  • Blood transfusions- q 2-4 weeks to give them healthy RBC’s with hemoglobin but furthers Iron overload
  • Splenectomy- Stops eating and breaking down the RBC’s/ Give pt exta 300mL’s
  • HSCT
  • Usu have fatal cardiac failure
100
Q

What chronic disease result in anemia?

Normochromic Normocytic just a lesser amount

A
  • End stage Renal disease = Cant make EPO
  • Chronic Liver Disease = Clotting factor disturbed
  • Hepatitis
  • Immune disorders = Lupus attacks RBC’s
  • Endocrine disorders= Cellular metabolism destryoed ie thyroid.
101
Q

What are the signs and symptoms of chronic disease anemia?

A

mild fatgiue with activity and rest.

dyspnea

102
Q

How do you treat chronic disease anemia?

A

Correct the underlying disorder
Epogen/Procit = synthetic EPO
IV iron

103
Q

What is EPOGEN/PROCIT?

A

Synthetic EPO. used in

Chronic disease anemia

104
Q

What is aplastic anemia?

A

When you have a decarease of all blood cell types and haev hypocellurlar bone marrow.
=Body stops making RBC’S
=You have a decrease in red bone marrow

105
Q

What causes aplastic anemia?

A
  • Fanconi Syndrome = Congenital
  • Aquired through chemical agents, drugs, pregnancy, radiation, infection
    • 75% idopathic**
106
Q

What are the signs and symptoms of aplastic anemia?

A
  • developes gradually
  • pancytopenia
  • hypocellular bone marrow
  • General manifestations of anemia (fatigue, dyspnea, cv and neuro responses)
  • neutropenia
  • thrombocytopenia
107
Q

How do we test for aplastic anemia?

A

Test for pancytopenia
Bone marrow aspiration
-hypocellular bone marrow and increase in yellow bone marrow

108
Q

What is the treatment for aplastic anemia?

A 
Supportive care ( Vent,)
Remove causative agent
High dose corticosteroids = immunosupressed
109
Q

What do the RBS of a person with anemia due to blood loss look like?

A

normochromic and normocytic

110
Q

What causes anemia due to blood loss?

A

Acute hemmorhage

Chronic blood loss

111
Q

What are signs and symptoms of anemia due to blood loss?

A 
CLINICAL SYMPTOMS ARE MORE RELIABLE THAN LAB VALUES/ MAY TAKE A WHILE FOR THE HGB AND HCT TO SHOW A DECREASE.
-symptoms of hypovolemic shock
•Anxiety or agitation
•Cool, clammy skin
•Confusion
•Decreased or no urine output
•General weakness
•Pale skin color (pallor)
•Rapid breathing
112
Q

What are the labs that we would run for anemia due to blood loss?

A
  • RBC’s
  • HGB
  • HCT ( wont drop for 2-3 days)
113
Q

How do you treat anemia due to blood loss?
Acute
Chronic

A 
Acute- no long term treatment
Chronic- treat like iron deficency anemia 
                     -Treat the underlying problem
                     -Increase Fe intake
Prevent shock
Identify source of hemmorhage
Hetastarch
LR 
Albumin
Dextran
Supplemental Iron
Transfusion
Shift from aerobic to anaerobic metabolism
114
Q

What is Hetastarch

A

Hetastarch is a synthetic glucose that helps draw fluid back into the intravascular space. Plasma expander

115
Q

How long does it take the body to make healthy RBC’s?

A

2-5 days

116
Q

Why would we want to shift a patient from aerobic metabolism to anaerobic metabolism in anemia due to acute blood loss?

A

Because the shift would make hgb have a less afffinity to O2 which will increase spo2.

117
Q

What is hemolytic Anemia

A

An increased in RBC destruction.

118
Q

What are the two types of hemolytic Anemia?

A

Intrinsic (genetic defects in the RBC’s)
-Abnormal hemoglobin ((Sickle cell))
-Enzyme deficiency ((G6PD))
Extrinsic (external damgage to RBC’s)
-Physical trauma : Hemodialysis, prosthetic heart valves, narrowed vessels
-Antibodies : Blood transfusion reactions, SLE, Leukemia, certian medications
-Infectious agents/toxins: Malaria, clostridium, arsenic, lead, copper, snake venom

119
Q

What does G6PD do?

A

Make proper size and shape (inflate) of RBC’s

120
Q

What are the general effects of hemolsysis?

A

1) Jaundice- Billrubin overwhelms the liver, need to check billirubin levels
2) Haptomegaly and Splenomegaly- due to sequestrations of RBC’s, increase in reticulocytes as bonne marrow tries to compensate.

121
Q

What is the major focus of treatment for hemolytic anemia?

A 
Maintain Kidney fuction
Prevent ATN (Acute tubular necrosis)
122
Q

Why are the kidneys affected in hemolytic anemia?

A

When RBC’s are destroyed, Iron will come up and can easily clog the kidneys.

123
Q

What is Sickle Cell Disease SCD?

A

An incurable disease that often causes death by middle age due to renal failure, pulmonary failure, or stroke. SCD has abnormal Hgb (Hgb S) in the RBC. When there is hypoxia the RBC sickles.

124
Q

What are the types of SCD (Sickle Cell Disease)

A

1) Sickle Cell - Thalassemia ( Hgb s and Hgb C)
2) Sickle Cell Hgb C
3) Sickle Cell Trait

125
Q

What happens during sickle cell crisis

A

Severe, painful , acute exacerbations with vaso-occlusion.

Pain, fever, tachypnea, HTN, n/v

126
Q

What triggers SCD?

A

Anything that lowers the O2 of the blood: Infection, high altitude, stress, surgery, blood loss, dehydration, acidosis, and low body temp.

127
Q

What is vaso-occlusive Disorder in SCD

A

caused by ischemic tissue injury resulting from the occlusion of microvascular beds by sickled erythrocytes during an acute crisis. Chronic pain occurs because of the destruction of bones, joints and visceral organs as a result of recurrent crises.

128
Q

What causes the most mortality rates in SCD?

A

Infection

129
Q

What happens to the spleen in SCD?

A

It shrinks

130
Q

How do you diagnose SCD?

A

Hgb electrophoresis
Peripheral blood smear
Sickling Test (deoxygenating agent added to blood)

131
Q

What is the treatment for SCD?

A 
Avoid/ Prevent symptoms
Fluids
Oxygen
Aggressive opioid pain management (neurotins)
Monitor resp status (PE, Acute chest syndrome)
Rest
Transfusion
chelation Therapy
Hydroxyurea
132
Q

What is Chelation Therapy

A

Chelation therapy is a medical procedure that involves the administration of chelating agents to remove heavy metals from the body.

133
Q

What is Hydroxyurea?

A

Increases the production of hemoglobin F, this seems to help by decreases hemolysis and sickle cell

134
Q

What is hemachromatosis?

A

IRON OVERLOAD, storing Fe anywhere you can imagine.

135
Q

What are signs and sympotoms of hemachromatosis?

A 
Fatigue
Arthralgia
Impotence
Abd Pain
BRONZE SKIN
CARDIAC CHANGES
weight loss 
liver problems
136
Q

How do you test for hemachromatosis?

A

Labs;

  • Increase in Fe
  • increase in TIBC
  • increase in ferritin
137
Q

What is the total body Fe (TBI) ? What is it in hemachromatosis?

A

2-6N

50 in hemachromatosis

138
Q

What is the treatment for hemachromatosis?

A

Phlebotomy: Remove excess Iron (remove 500mL blood weekly for 2-3 years.

139
Q

What is the most common cause of death in patients with hemachromatosis?

A 
Cirrhosis
Liver Failure
Liver Cancer
Heart Failure
**This is where our bodies are storing extra Fe**
140
Q

What is polycythemia?

A

The increased production of RBC’s leading to increased blood viscosity and volume

141
Q

What is polycythemia vera?

A

Chromosomal mutation: Increased production of RBC’s leading to increased blood viscosity and volume because our bodies do not know whaen to stop.

142
Q

What are the signs and symptoms of polycythemia?
Think massive fluid overload.
S/S are often due to an increase blood thickness and clotting.

A 
HTN
headache
vertigo
dizziness
pruritus (increased basophils/histamine)
parasthesias
Painful burning and redness of the hands/feet (histamine)
angina/HF
intermittent claudication
hemorrhage (inc. P blows them up)
hepatomegaly
splenomegaly
143
Q

How do you treat polycythemia?

A 
Phlebotomy (Remove extra Fe)
No Iron
Hydration
Low dose ASA
Chelation Therapy with Transfusions
144
Q

What is secondary polycythemia?

A

Can be hypoxia driven (physiological response) rather than a pathological response.
Tumor

145
Q

What are the three types of thrombocytopenias?

A

ITP: Immune Thrombocytopenia Purpura
TTP: Thrombotic Thrombocytopenic Prupura
HIT: Heparin-INduced Thrombocytopenia

146
Q

Thrombocytopenia

A

Decrease in platelets >150,000

147
Q

What is splenic sequestration?

A

Taking platlets out of circulation. This is seen in thrombocytopenias

148
Q

What are the s/s of thrombocytopenia?

A

usu. asymptomatic

bleeding( nosebleeds, gums, purpura, petechiae,bruising)

149
Q

Would a pt have a nomal PT and aPTT during thrombocytopenia?

A

Yes

150
Q

When do you give a patient platelets

A

When platelet count is under 10,000 or when a pt is actively bleeding.

151
Q

If a pts PT and aPTT are increased, what is that indicative of ?

A

DIC

152
Q

What are complications of thrombocytopenia?

A
  1. Spontaneous hemorrhage
  2. Internal bleeding
  3. Cerebral hemorrhage
  4. Vascular thrombosis
153
Q

What is the platelet level at spontaeous hemorrhage?

A
154
Q

What is the treatment for thrombocytopenia?

A
  1. Platelet transfusion if under 10,000
  2. Identify the cause
  3. Remove the causative agent
  4. Give corticosteroids if cause is unknown
  5. Platlet growth factor and thrombopoietin
  6. May use Neumega for chemo-induced thrombocytopenia
155
Q

What treatment do you give chemo inducted thrombocytopenia?

A

Neumega (Platlet growth factor)

156
Q

What are thrombocytopenia precautions?

A
  • NO ASA OR NSAIDS
  • Address small bleeds( gums or nose)
  • Avoid any injections, if unavoidable apply pressure for 5-10 minutes and use a small guage needle.
  • Supression of menses
  • Soft toothbrushj
  • no flossing
  • electric razor
  • watch for black BM, black vomit or urine, bruising, petechiae, bleeding, headache, change in vision, stroke symptoms.
157
Q

What is Immune Thrombocytopenic Purpura (ITP)

A

most common acquired thrombocytopenia
Antigens are attached to platlets and the spleen destroys
Platelets survive

158
Q

What is the treatment for ITP?

A

Nothing if assymptomatic

  1. Corticosteroids( decreases the phagocytic response of the spleen)
  2. Splenectomy
  3. IVIG (IV Immunoglobins)
159
Q

What is thrombotic thrombocytopenic purpura (TTP)

A

MEDICAL EMERGENCY

Clotting and bleeding occuring at the same time!

160
Q

What is thrombotic thrombocytopenic purpura (TTP) almost always associated with?

A

HUS= Hemolytic uremic syndrome

161
Q

What causes thrombotic thrombocytopenic purpura (TTP)

A 
Ideopathic
Drug toxicity
Autoimmune disorder
Pregnancy
Infections
162
Q

What are the signs and symptoms for thrombotic thrombocytopenic purpura (TTP)

A 
Hemolytic anemia ( decrease RBC's and platlets)
Thrombocytopenia
Neuro problems (ischemia from blockage)
Fever with no infection
Renal Problems
163
Q

How do you treamt thrombotic thrombocytopenic purpura (TTP)?

A
  • Need to stop the causative agent because this will cause irreversible renal failure and death.
  • Plasmapheresis Daily
  • Corticosteroids
  • Spleenectomy
164
Q

What is plasmapheresis?

A

Remvoes that antibodies that bind with the platlets. Takes out the VonWillebrand Factors
**TTP

165
Q

What is Heparin-Induced Thrombocytopenia (HIT)?

A

Formation of abnormal antibodies that activate platlets (Heparin, platelet factor, platelet complex)
*** This is a clotting disorder not a bleeding disorder

166
Q

What is the major complication with Heparin-Inducted Thrombocytopenia (HIT)?

A

Venous Embolism

167
Q

How do you diagnose HIT (Heparin-Induced Thrombocytopenia)

A

Decreased platlet count usu 5-10 days after pt is started on Heparin.
Test postivie for heparin PF4 antibodies

168
Q

What are the signs and symptoms for Heparin-Induced Thrombocytopenia?

A

New or worseing thrombos

Decreased platelet count

169
Q

What is the treatment for Heparin-Induced Thrombocytopenia (HIT)

A

Protect from a thrombosis.

  1. Stop Heparin- Give antidote protamine sulfate
  2. Maintain anticoagulation with direct thrombin inhibitors
  3. Only start Coumadin if platlets are >150,000
  4. Plasmapheresis
  5. Surgery to remove clot
170
Q

What is disseminated intravascular coagulation DIC?

A

Complex systemic thrombo-hemorrhagic disorder caused by a secondry issue.

  • Clotting is abnormally intiated and accelerated using up all of the clotting factors and platelets leading to uncontrolled bleeding.
  • **Almost always causes organ failure
171
Q

What are the signs and symptoms of DIC?

A
  • Unexplained bleeding (oozing blood)
  • Weakness d/t lose of blood
  • Malaise (achyness) d/t blood pooling in joints
  • fever
172
Q

How do you diagnose DIC?

A

D-Dimer Assay
FSP’S
FDP’S
**SCHISOTCYES on blood smear

173
Q

How do you treat DIC?

A
  • If chronic and no bleeding then no treatment
  • if bleeding then provide support with blood products and treat the primary disoder.
  • In a life theatening hemmorhage use platlets, cryopreciitate (clotting factor) and FFP (fresh frozen plasma)
174
Q

How can chronic DIC be controlled?`

A

With long term heparin

MedSurg Test 1 (6 decks)

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