Module 4: Blood Flashcards
What are the 3 functions of blood?
• protection; (maintains homeostasis of blood coagulation, combats invasion of pathogens through phagocytosis)
• regulation; (F&E balance, acid base balance, temperature regulation, maintains oncotic pressure)
•Transportation; (02, nutrients, hormones, metabolic wastes—> to kidney to filter/excrete)
What is hematopoiesis? Where does it occur?
•Blood cell production
•Occurs within the red bone marrow of long, flat bones
•Blood cells develop from a common hematopoietic stem cell
•Produced in response to the need for specific cells by cytokines
What is erythropoiesis, what is it stimulated/controlled by, & What are the nutrients needed?
•RED blood cell production
•Stimulated by hypoxia
•Controlled by erythropoietin
•Nutrients needed:
•Protein, iron, folic acid, vitamin B12
What are reticulocytes & how long do they take to mature? What is hemolysis?
•Reticulocytes = immature red blood cells
•up to 48 hours
•Hemolysis = destruction of cells (by monocytes/macrophages)
What is hemoglobin? How many iron/heme groups (approximately) are in each RBC?
•Iron containing substance in red blood cell
•millions
What is the normal range of red blood cells?
RBCs = 4.5-5.5
What is the normal lab value of hemoglobin in males and females?
•Hgb =
•Female 12-16g/dL
•Male 13-18 g/dL
What is the normal lab value of hematocrit in males and females?
Hct =
•Female 36-48%
•Male 39-54%
Define hemodilution and the percent of HCT in this condition
Hemodilution : too much fluid in the body leading to an imbalance of plasma vs. blood (27% HCT)
Define normal hematocrit and hemoglobin in the blood in relation to hydration status
Normal balance of hgb vs hct:
(HCT = 3xHgb)
•12gm Hgb
•36% Hct
Define Hemoconcentration and the associated values of hgb/hct in regards to hydration status
Hemoconcentration = very dehydrated leading to less plasma and higher levels of blood. (12gm hgb, 47% hct)
What are the 5 types of leukocytes in order of their abundance?
- Neutrophils
- Lymphocytes
- Monocytes/macrophages
- Eosinophils
- Basophils
(Never Let Monkeys Eat Bananas)
Which leukocytes are granulocytes?
- Basophils
- Eosinophils
- Neutrophils
(Think of the name “Ben”)
Which leukocytes are agranulocytes?
- Lymphocytes
- Monocytes
What is the normal lab value for Total WBC’s, what is elevated, what is severe?
5-10,000u/L is normal
15-20,000 is significantly elevated
> 30,000 is severe infection (sepsis)
What lab values would indicate Leukemia? Leukopenia?
Leukemia 100,000+
Leukopenia < 4000
Define polymorphonuclear leukocytes, and what their main job is.
The term means that the cells can change the shape of their nucleus to fit/squeeze into different places.
Main job: phagocytosis
(Basophils, eosinophils, neutrophils)
Define Neutrophils, their %, values, and Job
Think Bacterial/Fungus
•Neutrophils are the biggest leukocyte/most abundant: 50–70% of total WBC’s.
• 3,000-7,500
•Segmented neutrophils (”segs”) – nucleus has 3-5 lobes connected by strands
•Immature neutrophils = “bands”( 0-8%)
•Phagocytosis (infection) & acute inflammatory responses – 1st line responders
Define neutropenia and how this happens
Neutropenia = 1,000
•chemo/ compromised immune system
•Decrease: Viral infections, bone marrow suppression
•Reverse or protective isolation to protect Pt
no flowers or fresh fruit in Pt rooms, too much bacteria
Define Eosinophils, their %, values, and Job
- Think Allergies and parasites*
•Eosinophils: 2-4% of total WBCs
• Normal: 50-400
•Engulf Antigen/antibody complexes
•Hypersensitivity reactions, allergies & defense against parasites
Define Basophils, their %, values, and Job
Think 1st line acute allergic inflammatory response/vasodilation (histamine!!)
•Basophils 0-2% of total WBCs
•Normal: 0-150)
•Granules contain heparin, serotonin & histamine
•Released w/ allergic or non-specific inflammatory reactions or injury
Define Monocytes, their %, values, and Job
•Monocytes : 3-8% total WBC’s
•Normal (0-600)
•Increase with all types of infection, inflammatory disorders
•Phagocytosis: removes bacteria, cellular debris, old RBCs
•can move in and out of bloodstream. (When out they become macrophages)
Define Lymphocytes, their %, values, and Job
- Think Viruses*
•Lymphocytes : 20-25% total WBC’s • Normal (1-4,000)
•Increase: viral infections, or cancers of the blood
•found in blood stream and lymphatic system
•T-cells (mature in thymus. T cells function to actively destroy infected cells, as well as to signal other immune cells to participate in the immune response)
• B-cells (turn to plasma cells when they see invaders. Produce antibodies that attach to foreign antigen tagging them for destruction. B cells remember this antigen to better protect the body in the future)
•Natural killer cells (fight/kill cancer cells. Also produce cytokines to send signals for macrophages to respond to enhance the immune response)
What do T-Cells do?
They remember viruses to help the body protect itself from invaders and make the immune system stronger against a future attack.
What do B-Cells do?
They’re a part of the Humoral immune system. They have surface receptor cells that create antibodies and bind with the invading antigens - tagging them for destruction
What to Natural Killer Cells do?
They send signals with cytokines (proteins) to find and kill virus’s of infected cells.
What are platelets, their value, and where are they made/stored?
•Platelets (thrombocytes) provide protection and create clots/plugs for an injured area to stop bleeding.
•Normal: 150-450
•created in liver, stored in spleen
What is the deficiency and excess of platelets called and what are the risks?
•Deficiency: Thrombocytopenia (risk for bleeding)
•Excess: Thrombocytosis (blood clots)
Define thrombocytopenia, the causes, diagnosis, clinical manifestations, and nursing implementation
•Pathology: decreased platelets
•Causes: Impaired production, increased destruction, or abnormal distribution
•Diagnosis:
• <100,000 at risk for bleeds
•<10,000 risk for fatal bleeds
•Clinical manifestations: Petechiae, purpura, ecchymosis
•Nursing Implementation: monitor for bleeding, perform patient teaching (avoid injury/decrease bleeding risks-use electric shaver)
What is petechiae and Purpura?
•Petechiae: break in capillaries- small pinpoint rash/dots on skin (most common on chest, abdomen, legs)
•Purpura: Break in bigger vessels creating bigger rash/dots
Name the 6 phases of the clotting process
1.Vascular injury
2.adhesion
3.activation
4.aggregation
5.platelet plug formation
6.clot retraction and dissolution
What happens in the vascular injury phase of the clotting process? 
Internal/external injury, vasoconstriction response to keep from bleeding
What happens in the adhesion phase of the clotting process?
Endothelial cells lining the vessel are now gone d/t injury, proteins are exposed and secreting a sticky substance to attract platelets to form clot
What happens in the Activation phase of the clotting process?
The platelets start doing their job and create a plug to fill the injury site
What happens in the Aggregation phase of the clotting process?
Several elements come together including fibrin and platelets to seal the plug called the clotting cascade
What happens in the Clot retraction and dissolution phase of the clotting process?
Natural process in which clots are broken down (heparin-like cells) 
What is a basic explanation of the clotting cascade?
Two paths coming together at factor X.
Prothrombin turns to thrombin which activates fibrinogen to turn to fibrin to form a blood clot
What is thrombin and what does it do?
Thrombin is an enzyme that starts a feedback loop in the clotting cascade to make sure the cycle continues to stop bleeding
What is fibrin and what does it do?
Fibrin is a protein. it’s basically a sticky net that helps hold together platelets to form the clot/plug and stop the bleeding at the injury site.
What is TPA and what does it do?
Total plasminogen activator starts the process of clot dissolution
What is fibrinolysis and what labs should you look at?
The breakdown of fibrin and therefore clots.
•Labs: FDP, FSP, D-dimer
* Patient may be susceptible to bleeding due to the degree of fibrinolysis
What coagulation studies would you look for for intrinsic and extrinsic pathways? 
Clotting studies:
•Intrinsic : aPTT
•Extrinsic: PT/INR
Which medications are considered the small, medium & large of the coagulation modifiers? 
•Small = Antiplatelets
•Medium = Anticoagulants
•Large = Thrombolytics
What do antiplatelets do, medication examples, labs to look for? 
•Prevents platelet aggregation, Used for clot prevention
Examples:
•ASA
•Clopidogrel (Plavix)
•Labs:
•Platelet count (hold meds if >100)
•Hgb
What do Anticoagulants do, medication examples, labs to look for?
•They prevent clots from
Growing
•Main Meds: Heparin, warfarin(Coumadin), Lovenox
•Others: thrombin inhibitor-Pradaxa {high risk A-fib}, Xa inhibitors-xarelto, eliquis {prevent/tx DVT/PE, A-fib}
•Labs: aPTT, PT/INR, platelet count
What is heparin & need to know information? 
•Anticoagulant with Quick onset of action but have a shorter 1/2 life
•Given IV or SQ
•For short term use
•Monitor aPTT
•Therapeutic Range 46-70
•Antidote: Protamine Sulfate (not normally given, just wait for it to wear off)
What is warfarin/Coumadin & need to know information?
• anticoagulant with Slower onset of action but Longer 1/2 life
•Given PO
•For life-long therapy
•Monitor: PT/ INR
•Therapeutic Range: 2-3 OR 2.5-3.5 for heart valve (Patient may be on heparin drip first to get to TR then stop trip)
•Antidote: Vitamin K
• consumption of vitamin K should be consistent not increasing or decreasing in patient’s diet.
What is Lovenox/Enoxaparin & need to know information?
•Enoxaparin (Lovenox) = Anticoagulant/Low molecular weight heparin
•Administered SQ (5/8needle) , 2” from umbilicus (better absorption!)
•Pre-packed with “airlock” (seals in medication to injection site)
•Monitor platelet count before administering (if less than 100 ask if it needs to be held)
What is H I T and the symptoms associated? (TEST QUESTION!!)
•Heparin induced thrombocytopenia
•It’s a response by the immune system
•Platelets decrease by 50% or more
• Activated platelets are becoming blood clots
• don’t administer transfusion of platelets- will only add fuel to the fire of HIT and forming more clots
What is your nursing plan of care and patient teaching for anticoagulants?
•PLAN:
•Know your contraindications!
•Assessment – Monitor for signs of bleeding
•Monitor labs as needed
•Educate patient regarding precautions
•TEACH:
•Teach patient to observe for signs of bleeding (gums, in stool)
•Avoid trauma or falls
•Be cautious with OTC drugs and supplements(Ibuprofen, naproxen, garlic, ginger, ginkgo, ginseng)
•Use a soft bristle toothbrush
•Use electric shavers instead of razors
•Avoid constipation (water, fiber. Straining can cause bleeds)
•Wear medical alert bracelet
What are thrombolytics, medications?
•dangerous drug /breaks
Down clots/ can cause bleeding
•Converts plasminogen to plasmin
•Plasmin breaks down proteins like fibrin & fibrinogen (substances that form clots)
• Given to patients with ischemic stroke NOT hemorrhagic stroke (causes more bleeding)
Medications:
tPA (tissue plasminogen activator)
Alteplase
What are anti-fibrinolytic drugs, Medication examples?
•Used for the prevention and treatment of excessive bleeding (helps
Make blood clots, helps with hemophilia)
•Prevents the lysis of fibrin
•Promotes clot formation
• Medication Example: desmopressin (DDAVP)
What are the 10 Antiplatelet, anticoagulation, and thrombolyticmedications Needed to know for this module?
•ASA (Aspirin)
•Clopidogrel (Plavix)
•Heparin
•Warfarin (Coumadin)
•Enoxaparin (Lovenox)
•Dabigatran (Pradaxa)
•Rivaroxaban (Xarelto)
•Apixaban (Eliquis)
•tPA
•Alteplase
Explain Macrocytic – normochromic cells and what anemias fall under that category
Macrocytic = larger cell size
Normochromic = normal color
•Pernicious anemia, B12, liver disease, alcoholism, folic acid deficiency
Explain Microcytic-hypochromic cells and what anemias fall under that category
Microcytic = smaller cell size
Hypochromic = pale cell color
•Iron deficiency anemia, thalassemia
Explain Normocytic-normochromic cells and what anemias fall under that category
Normocytic = normal cell size
normochromic = normal cell color
•Chronic kidney disease, blood loss, aplastic anemia
What are the clinical manifestations (S/S) of anemia? (general overview of all anemias)
•Labs: Decreased Hgb & RBC
•s/s Caused by bodies response to tissue hypoxia
•Dependent on severity & length of time they’ve been anemic
•General: fatigue, lethargy
•Cardiopulmonary Manifestations (heart trying to compensate)
•Tachycardia, murmurs, heart failure (long-term)
•Integumentary Manifestations: pallor (check the sclera) Jaundice -destructive anemias only
•Gerontologic Considerations
What does the lab MCV mean?
•MCV: Mean cell volume
•Measure of the average volume of RBCs
What does the lab MCH mean?
MCH: Mean cell hemoglobin
•Measure of the average weight of hemoglobin in individual erythrocytes
What does the lab MCHC mean?
MCHC: Mean cell hemoglobin concentration
•Average concentration of hemoglobin in RBCs (if low, cells will be pale)
what does the lab RDW mean?
RDW: Red cell distribution width
•Measure of variability of erythrocyte size
Explain Acute anemia (test question)
Acute =
•Occurs suddenly d/t hemorrhage
•Can lead to hypovolemic shock (20% lost)
•S/S related to amount of volume lost
•Diagnostic studies may be inaccurate (loss might not reflect in data right away/they’re still bleeding)
•Replace volume & stop bleeding
Explain Chronic anemia (test question)
Blood loss is gradual (slow onset)
•May show few symptoms - fatigue & tachycardia
•May be caused by RBC destruction (hemolytic anemias)
•Common cause: renal disease (not making a lot of erythropoietin) “Anemia of chronic disease”
Pathology, causes and diagnosis of Iron deficiency anemia
Pathology:
•Low or depleted iron stores
Causes -
•Inadequate dietary intake
•Malabsorption
•Blood loss
Diagnosis -
•Decreased Hgb/Hct
•decreased Iron
•decreased MCV,
•increased TIBC (total iron binding capacity)
Signs and treatment of Iron deficiency anemia
Signs -
•May not have signs until disease is chronic
•Pallor & fatigue
•Glossitis / cheilitis (pale sclera and tongue)
Treatment -
•Stop the bleeding
•May need transfusion if blood loss is acute
•Iron supplementation (Ferrous sulfate) (causes: dark stool color, constipation. PO may cause GI upset, if possible, give on empty stomach or with vitamin C- best absorbed in acidic environments)
•Iron-rich foods: Lean meats, fish, legumes, dark leafy greens
Pathology, causes and diagnosis of Thalassemia
Pathology - genetic
•Absent or reduced globulin protein
Causes -
•Autosomal recessive gene
•Thalassemia minor & thalassemia major
•Diagnosis
•Decreased hemoglobin,
•Normal or low MCV
•Microcytosis (small cells)
•Hypochromia (pale cells)
Signs and treatment of Thalassemia
Signs
•Thalassemia minor: Often asymptomatic jaundice, bronzed skin (because of lysis of immature cells)
•Thalassemia major: Jaundice, splenomegaly, hepatomegaly, cardiomyopathy (iron overload)
Treatment -
•Managed with blood transfusions or exchange
•Medications to reduce iron overload (bind iron together then excrete it)
•Stem cell transplant
•Splenectomy (last resort)
Pathology, causes, and diagnosis of megaloblastic anemias (B12 deficiency)
Pathology -
•Decreased levels of Vitamin B-12
•Causes (pernicious anemia, lack of intrinsic factor- more of an absorption issue)
•GI (gastric bypass, PPI use, Celiac disease, Crohn’s disease)
•Low dietary intake (Strict vegetarians or vegans)
•Alcoholism
Diagnosis -
•Decreased Hgb
•Decreased serum B-12
•Increased MCV (big cells)
Signs and treatment of megaloblastic anemia (B-12 deficiency)
Signs -
•Pallor, lethargy
•Red, beefy, shiny tongue **
•Neuromuscular manifestations: Paresthesias, Loss of sensation, muscle weakness
•dizzy, vision changes, pin/needle sensations
•mood changes
Treatment -
•Vitamin B-12 (injections or nasal)
•High Vitamin B-12 foods: Meat, eggs, enriched grains, milk & dairy
Pathology, causes, diagnosis of megaloblastic anemia - Folic Acid Deficiency (FAD)
Pathology-
• decrease levels of folate
Causes-
• Malabsorption (celiac disease Crohn’s disease small bowel resection)
• alcoholism
• Drugs that interfere with absorption (antiseizure, methotrexate)
• dietary deficiency
•pregnancy
Diagnosis -
• decreased folate level, normal vitamin B 12 level, elevated MCV
Signs and treatment of megaloblastic anemia - Folic Acid Deficiency
Signs
•Pallor & lethargy
•S/S related to other (GI) problems
•Neurologic symptoms
•Treatment
•Folic acid (Folate) PO
•High folate foods: Green leafy vegetables, enriched grains & cereals, OJ, peanuts, avocado
Pathology, causes, diagnosis of Aplastic Anemia
Pathology - (makes all of the cells)
•Damage to the bone marrow
Causes -
•Autoimmune diseases (70%), Toxins, Immune suppression, Infections
Diagnosis -
•Decreased RBC, Hgb, WBC, platelets
•Bone marrow biopsy
Signs and treatment of Aplastic Anemia
Signs
• General signs of anemia
•susceptible to infection
•thrombocytopenia
Treatment -
• transfusion
•stem cell transplant
• immunosuppressants
• meds to stimulate bone marrow (epoetin-Epogen {erythropoietin})
(Filgrastim - Neupogen {WBC production})
Pathology, causes and diagnosis of Polycythemia
Pathology - * major risk for clotting; genetic*
•Increased blood production
Causes -
•Primary polycythemia (polycythemia vera): Genetic
•Secondary polycythemia: Hypoxia driven & hypoxia independent
Diagnosis -
•Elevated Hbg & RBC count with MICROcytosis (small cells), high WBC, high platelets count
•EPO levels low in primary, high in secondary
Signs and treatment of Polycythemia
Signs - “hungover pounding”
• related to signs of hypertension caused by hypervolemia and hyper viscosity (HA, vertigo, dizziness, tinnitus, Visual changes - Signs of paresthesias and impaired blood flow)
Treatment -
•phlebotomy
•hydration (dilute the blood)
• myelosuppressive agents (prevents production)
What two routes of secondary polycythemia are there?
Hypoxia driven :
1. High altitude
2. Cardio pulmonary disease
3. defective O2 transport
Hypoxia- independent:
1. Renal cysts or tumors
2. Extrarenal tumors
What 5 Medications are need to know from this lecture section? (Anemias)
- Epoetin (Epogen)
- Filgrastim (Neupogen)
- Vitamin B-12
- Folic acid
- Ferrous Sulfate
What are Packed Red Blood Cells used for? How many ML‘s is a unit of blood and how much does it replace in the body?
•Used for severe or symptomatic anemia
●1 unit = 250-350mL
●Increases Hgb approximately 1g/dL per unit & Hct by 3% per unit
●Replaces 500 mL of blood loss (replaces more oxygen capacity because the plasma is taken out)
What are platelet transfusions used for?
Platelets -
●Used for bleeding caused by thrombocytopenia
●Can be pooled from multiple donors
What is Fresh Frozen Plasma (FFP) used for?
Only used in major blood transfusions
•used for bleeding caused by deficiency in clotting factors
Key points of Blood administration
•Need consent for blood
•verify client ID
•check doctor order
•check labels on blood bag and blood •bank transfusion
•record obtain baseline vitals
• Administer within 30 minutes of receiving from blood bank
•18 gauge needle
•normal saline IV solution
•blood administration set with filter •severe reactions most likely first 15 minutes and first 50 cc
What are the allergic reactions with blood transfusions and antidote?
Mild: facial flushing, hives/rash
Severe: ^anxiety, wheezing decreased BP
Tx: antihistamines, Benadryl, Tylenol
What are the “Febrile”transfusion reactions ?
•chills, fever, anxiety, headache, tachycardia, tachypnea
*most common w/platelet transfusions
What are the “Hemolytic” transfusion reactions?
- serious but rare (body starts destroying cells)*
•Hemoglobulinuria
•chest pain
•apprehension
•blood in urine (results in back pain)
•fever
• tachycardia
• decreased BP, increased RR
What do you need to know about blood types for the test?
-Different blood types can receive from different donor types
-Rh factor only occurs in some people, not everyone
•Rh- cannot receive Rh+
O- is the universal donor
AB+ is the universal recipient
What are alternatives for blood transfusion/cultural considerations?
Some medications - iron, epogen
Or do autologous (their own blood) transfusions. Can be done for planned surgeries.
