lecture 15 - classification and treatment of haematological disorders Flashcards
what are the components of blood?
plasma 55%
blood cells 45%
three types
- erythrocytes/ RBCs
- leukocytes/ WBCs
thrombocytes/ platelets
describe erythrocytes/ red blood cells composed of? what is erythropoiesis?
composed of haemoglobin
erythropoiesis
- = RBC production
- stimulated by hypoxia
- controlled by erythropoietin - hormone synthesised in kidney
what is haemolytic anaemia ?
haemolytic
-destruction of RBCs
- Releases bilirubin into the blood stream
- normal lifespan of RBC = 120 days
what is the haemostasis - aim of thrombocytes/ platelets and describe factors which carry this out
haemostasis: the stoppage of blood flow
goal is to minimise blood loss when injured
- vascular response
- vasoconstriction - platelet response
- activated during injury
- form clumps (agglutination) - plasma clotting factors
- factors I - XIII
- intrinsic pathway
- extrinsic pathway
what is anticoagulation?
elements that interfere with blood clotting
counter mechanism to blood clotting - keeps blood liquid able to flow
- aspirin
- clopidogrel
- warfarin
- heparin
-NOACs/ DOACs
how is the assessment of haemotologic system (risk of patient clotting or bleeding) carried out?
subjective data
- important health information:
past health history
medications
surgery or other treatments
objective data:
- physical examination
skin
eyes
mouth
lymph nodes
heart and chest
abdomen
nervous system
musculoskeletal system
what is examined in the diagnostic studies of the haemotologic system: whole blood count?
white blood cells
red blood cells
haematocrit
platelet count
pancytopenia
describe anaemia - what is it? function? drives?
anaemia is a reduction in the number of RBCs, the quantity of haemoglobin or the volume of RBCs
because the main function of RBCs is oxygenation, anaemia results in varying degrees of hypoxia
drives ischemiac pathologies
what are common conditions in anaemia?
blood loss
decreased production of erythrocytes
increased destruction of erythrocytes
what are clinical ways that anaemia can appear in a patient?
pallor
fatigue, weakness
dyspnea
palpitations, tachycardia
headache, dizziness, and restlessness
slowing of thought
parenthesia
describe ways in the management of anaemia.
- direct general management toward addressing the cause of anaemia and replacing blood loss as need to sustain adequate oxygenation
- promote optimal activity and protect from injury
- reduce activities and stimuli that cause tachycardia and increase cardiac output
- provide nutritional needs
- prescribed nutritional supplements
what are actions for a patient who is anaemia or suffered blood loss?
oxygen (prescribed)
blood products (prescribed)
erythropoietin (prescribed)
diet advice
iron, folic acid, B12 supplementation
what are the causes of decreased erythrocyte production or iron deficiency anaemia ?
- inadequate dietary intake
- malabsorption
- absorbed in duodenum
-GI surgery - blood loss
- 2mls blood contain 1mg iron
- GI, GU losses - haemolysis
what are ways that a patient can present iron deficiency anaemia?
most common: pallor
second most common: inflammation of the tongue (glossitis)
chelations = inflammation/ fissures of lips
weakness and fatigue
how is iron deficiency treated?
collaborative care
- treatment of underlying disease/ problem
- replacing iron
- diet
- drug therapy
iron replacement
- oral iron such as ferrous fumurate, absorbed best in acidic environment, GI effects
parenteral iron
- IM or IV
less desirable than PO
how is iron deficiency managed?
assess cardiovascular and respiratory status
monitor vitals signs
recognising s/s/ bleeding
- monitor stool, uine and emesis for occult blood
diet teaching - foods rich in iron
provide periods of rest
supplemental iron
discuss diagnostic studies
emphasise compliance
iron therapy for 2-3 months after the haemoglobin levels return to normal
what are megaloblastic anaemias? and what are common forms of it?
characterized by large RBCs which are fragile and easily destroyed
common forms of megaloblastic anaemia are
1. cobalamin deficiency
2. folic acid deficiency
what is cobalamin vitamin B12 deficiency?
cobalamin deficiency also known as pernicious anaemia
vitamin B12 is an important water-soluble vitamin
intrinsic factor is required for cobalamin absorption
what are causes of cobalamin deficiency?
gastric mucosa not secreting IF
GI surgery –> loss of IF secreting gastric mucosal cells
long term use of H2 histamine receptor blockers cause atrophy or loss of gastric mucosa
nutritional deficiency
hereditary defects of cobalamin utilisation
what are clinical manifestations of cobalamin vitamin B12 deficiency?
general symptoms of anaemia
sore tongue
anorexia
weakness
parenthesis of the feet and hands
altered through processes
confusion –> pseudo dementia
what are the diagnostic studies of cobalamin deficiency?
RBCs appear large
abnormal shapes
structure contributes to erythrocyte destruction
how is collaborative care used in cobalamin deficiency ?
parenteral administration of cobalamin
increased dietary cobalamin does not correct the anaemia - still important to emphasise adequate dietary intake
intranasal form of cyanocobalaim (nascobal) is available
high dose oral cobalamin and SL cobalamin can be used
how is cobalamin deficiency managed?
Familial disposition
- Early detection and treatment can lead to reversal of symptoms
- Potential for Injury related to patient’s diminished sensations to heat and pain
Compliance with medication regime
Ongoing evaluation of GI and neuro status
Evaluate patient for gastric carcinoma frequently
what does folic acid deficiency cause? what are the causes of folic acid deficiency?
folic acid deficiency also causes megaloblastic anaemia (RBCs that are large and fewer in number)
folic acid required for RBC formation and maturation
causes
poor dietary intake
malabsorption syndromes
drugs that inhibit absorption
alcohol abuse
hemodialysis
