Lecture 15: Classification and Treatment of Haematological disorders Flashcards
What are the components of the blood?
- Plasma 55%
- Blood cells 45%
What are the three types of blood cells?
- Erythrocytes
- Leukocytes
- Thrombocytes/ Platelets
What are erythrocytes composed of?
Haemoglobin
What is erythropoisis?
Red blood cell production
What is erythropoisis stimulated by?
Hypoxia
What is erythropoisis controlled by?
Erythropoietin
What is erythropoietin?
A hormone synthesixed in kidneys
What are the normal haemoglobin levels in a male?
135 - 180g/L
What are the normal haemoglobin levels in a female?
115-160 g/L
What are the normal WBC levels in a male and female?
4-11 x10^9 / L
What are the normal platelet levels in male and females?
150-400
What is the goal of haemostasis?
To minimize blood loss when injured
What are the steps in haemostasis?
- Vascular response - vasoconstriction
- Platelet response - Activated during injury and form clumps (agglutination)
- Plasma clotting factors; Factors I-XII, Intrinsic pathway, Extrinsic pathway
What is anticoagulation?
Elements that interfere with blood clotting - they keep blood liquid and able to flow
Give examples of anticoagulant? (5)
- Aspirin
- Clopidogrel
- Warfarin
- Heparin
- NoAC’s/ DOA
What is the assessment for haematologic system?
- Past health history
- Medication
- Surgery or other treatment
What is the physical examination for haematologic system?
- Skin
- Eyes
- Mouth
- Lymph nodes
- Heart
- Chest
- Abdomomen
- Nervous system
- Muscosketalal system
What are WBC associated with? (4)
- Infection
- Inflammation
- Tissue injury
- Death
How does leukopenia affected white blood cell?
Reduces white blood cells
How does neutopenia affect neautrophil count?
Decreased neutrophil count
What is the haematocrit?
The percent of whole blood that is composed of red blood cells
What is thrombocytopenia?
A decrease in platelet count
What happens when platelet count is below 20,000?
A spontaneous hemorrhage
What is pancytopenia?
A decrease in number of RBC and WBC and platelets
What is anaemia
A reduction in the number of RBC, the quantity of haemoglobin or the volume of RBS
What is the main function of RBC?
Oxygenation
What conditions does anaemia cause?
- Blood loss
- Decreased production of erythrocytes
- Increased destruction of erythrocytes
What are the clinical manifestation of anaemia? (7)
- Pallor
- Fatique, weakness
- Dyspnea
- Palpitations, tachycardia
- Headache, dizziness, reslessness
- Slowing of though
- Paresthesia
What is the management of anaemia?
- Direct general management toward addressing the cause of anaemia and replacing blood loss as needed to sustain adequate oxygenation
- Promote optimal activity and protect from injuruy
- Reduce activities and stimuli that cause tachycardia and increase cardiac output
- Provide nutritional needs
- Prescribes nutrtional supplemenyts
- Pateint and family eductaion
What do you prescribe to a pateint who is anaemic or suffered blood loss?
- Oxygen
- Blood products
- Erythropoietic
What are the causes of iron deficiency anaemia? (4)
- Inadequate dietary intake
- Malabsorption
- Blood loss
- Haemolsis
What are the clinical manifestaions of iron deficiency anaemia? (5)
- Most common: pallor
- Second most common: Inflammation of the tongue (glossistis)
- Cheilitis: Inflamation/ fissures of the lips
- Sesnsitivity to cold
- Weakness and fatique
What are the diagnostic studies for iron deficiency anaemia? (3)
- Full blood count
- Iron levels: total iron binding capacity, serum ferritin
- Endoscopy/ Colonscopy
What is the collaborative care for iron deficiency anaemia? (4)
- Treatment of underlying disease/ problem
- Diet
- Drug therapy
- Iron replacement
Give examples of iron replacement?
- Oral iron: ferrous sulphate
- Parental iron: IM or IV
Where is ferrous sulphate best absorbed?
Acidic environment
How is iron deficiency anaemia managed?
- Asses cardiovascular and respirstoty status
- Monitor vital signs
- Recognize s/s bleeding:monitor stool, urine and emesis for occult blood
- Diet teaching: foods rich in iron
- Provide periods of rest
- Supplemental iron
- Discuss diagnostic studied
- Emphasise complance
- Iron therapy for 2-3 months after the haemoglobin levels return to normal
What is megaloblastic anaemia?
Characterized by large RBC which are fragile and easily destroyed
What are common forms of megalobkastic anemia?
- Cobalamin deficiency
- Folic acid deficiency
What is cobalamij deficiency known as?
Pernicious anaemia
What is vitamin b12?
An important water soluble vitamin
What is required for cobalamin absorption?
Intrinsic factor
What are the causes of cobalamain deficiency? (5)
- Gastric mucosa not secreting intrinsic factor
- GI surgery - loss of intrinsin factor
- Long term use of H2 receptor blockers causes atrophy or loss of gastric mucosa
- Nutritional deficiency
- Hereditatory defects of cobalamine utilization
What are the clinical manifestauions of cobalamain deficiency?
- General symptoms of anaemia
- Sore tongue
- Anorexia
- Weakness
- Parasthesia of the feet and hands
- Altered thought process: confusion, pseudo dementia
What are the diagnostic studies for cobalamain deficiency?
- RBC appear large
- Abnormal shapes
- Structure contributes to erythrovyte destruction
What is the collabortaive care for cobalamain deficiency?
- Parental administration of cobalamin
- Increase in dietary cobalamin does not correct the anemia: still important to empahasise adequate dietary intake
- Intranasal form of cyanobalamin (Nascobal) is avaialable
- High dose oral cobalamin and SL cobalamin can be used
What is the management for cobalamain deficiency?
- Familial disposition: Early detentection and treatment can lead to reverasal of symptoms
- Potential for injury r/t patients diminished sensations to heat and pain
- Compliance with medication regime
- Ongoing evaluation of GI and neuro status: Evaluate pateint for gastric carcinoma frequently
What is required for RBC formation and maturation
Folic acid
What causes folic acid deficiancy?
- Poor dietary intake
- Malabsorption syndromes
- Drugs that inhibit absorption
- Alcohol abuse
- Hemodialysis
What foods have large amounts of folic acid?
- Leaft green veg
- Liver
- Mushroom
- Oatmeal
- Peanut butter
- Red beans
How is folic acid defiancy treated?
Folate replacemnet therapy
What is anemia of chronic disease?
Underproduction of red blood cells, shortening of RBC survival
When does anaemia of chronic disease develop?
After 1-2 months of sustained disease
What causes anaemia of chronic disease?
- Impaired renal function
- Chronic, inflammatory, infectious or malignany diesease
- Chronic liver disease
- Folic acid deficienceis
- Spienomeglay
- Hepatitis
What causes anaemia caused acute blood loss?
Result of sudden hemmorraheg - trauma, surgery, vascular disruption
What is the collaborative care of anaemia caused acute blood loss?
- Replacing blood volume
- Identifying source of hemorraheg
- Stopping blood loss
What are the symptoms of chronic blood loss?
- GI bleeding
- Hemorrhoids
- Menstrual blood loss
What are the diagnostic studies for chronic blood loss?
- Identifying source
- Stopping bleeding
What is the collaborative care for chronic blood loss?
Supplemental iron administartion
What is haemolytic anemia?
- Destruction or haemolysis of RBC at a rate that exceeds prodcution
What is the third major cause of anaemia?
Haemolytic anaemia
What is intrinsic haemolytic anaemia?
- Abnormal haemoglobin
- Enzyme deficiencies
- RBC membrane abnormalities
What is extrinsic haemolytic anaemia?
- Normal RBC
- Damaged by external factots; liver, spleen, toxins, mechanical injury (heart valves)
Give exzamples of haemolytic anemia
- Sickle cell disease
- Acquired hemolytic anemia
- Haemochromatosis
- Polycythemia
