Nonmalignant Hematologic Disorders Flashcards
Type of anemia in which not enough erythrocytes are being produced or erythrocytes production is defective
hypoproliferative
Symptom of an underlying disorder that is characterized by lower than normal hemoglobin and erythrocytes circulating in the body
Anemia
Causes of hypoproliferative anemias
Deficiencies of iron, vitamin b12, or folate causing decreaased erythropoietin production, cancer, or bone marrow damage
Type of anemia in which there is excess destruction of erythrocytes
Hemolytic
Causes of hemolytic anemias
Altered erythropoiesis like sickle cell or direct injury to the erythrocytes
Type of anemia caused by loss of RBCs
Bleeding anemias
What do the manifestations of anemia depend on?
Rapidity of the development, duration, metabolic requirements of the patient, concurrent and concomitant features
Describe the general manifestations of anemia
Fatigue, weakness, malaise
Pallor, jaundice
Tongue changes - red, beefy, swollen
Nail changes - spoon nails or brittle, rigid nails
Angular cheilitis
Pica
Cardiac
GI
Neuro
Respiratory
What does the nurse assess for the patient with anemia?
H&P
Labs
Symptoms and impact of symptoms
Nutrition - are they getting vitamins?
Medications
Cardiac
GI - blood loss
Blood loss
Neuro
What labs are assessed for anemia?
Hemoglobin
Hematocrit
RBC indices
Iron levels
Vit B12
Folate
Haptoglobin and erythropoietin levels
How are anemias managed?
Correct/control cause - stop/change meds, stop bleed
Transfusion of RBCs
Dietary or vitamin supplements
Immunosuppression
Balance of activity and rest
Adequate nutrition and perfusion
Education to promote compliance
Monitor VS and pulse ox - provide O2 as needed
Monitor for complications
List the types of hemolytic anemias
Sickle cell disease
Thalassemia
Glucose-6-phosphate dehydrogenase deficiency
Immune hemolytic anemia
Hereditary hemochromatosis
Type of anemia in which cells ‘sickle’ and become clumped together
Sickle cell disease
Describe the signs and symptoms of sickle cell diease
Anemia
Jaundice
High risk for arrhythmias
Risk for thrombosis
What are possible complications of sickle cell disease?
sickle cell crisis
acute chest syndrome
stroke
pulmonary HTN
Reproductive disorders
Lung infiltrates
What is the cause of sickle cell crises?
Decreased blood flow during times of stress or cold causing ischemia and cut off circulation and severe pain
What does the nurse asses in the patient with SCD?
H&P
Pain
Lab - S shaped hgb
Presence of symptoms and impact on life
Sickle cell crises
Blood loss
CV and neuro
What are the nursing interventions for SCD?
Pain management
Manage fatigue
Infection prevention - open sores/ulcerations
Promote coping
Education on disease process
Monitor for complications
Anemia that is characterized by hypochromia and small erythrocytes due to cell destruction
Thalassemia
An abnormal decrease in hemoglobin content of erythrocytes
Hypochromia
What are the s/s of thalassemia?
severe anemia
hemolysis
ineffective erythropoiesis
How is thalassemia treated?
Regular transfusions and chelation therapy
What is chelation therapy?
A drug is used to bind a substance and excrete it from the body
Type of anemia caused by a mutation of the G-6-PD gene that helps to stabilize cell membranes resulting in varying degrees of hemolysis
glucose-6-phosphate dehydrogenase deficiency
What can cause G-6-PD mutation?
oxidant drugs, fava beans, tonic water, and Chinese herbs
What are the s/s of G-6-PD?
pallor, jaundice, and hemoglobinuria
How is G-6-PD managed?
Treated by discontinuing the offending agent and transfusing if severe
Type of anemia characterized by low H & H and spherocytes
Immune hemolytic anemia
What is the cause of immune hemolytic anemia?
Exposure of erythrocytes to antibodies or a lack of suppressor lymphocytes
What are the manifestations of immune hemolytic anemia?
Fatigue
Dizziness
Splenomegaly
How is immune hemolytic anemia managed?
Corticosteroids or transfusion if needed
Anemia that is characterized by a genetic increase in iron absorption from the GI tract and deposits into various organs
hemochromatosis
What are the manifestations of hemochromatosis?
Weakness
Weight loss
Lethargy
Bronze colored skin
Arrhythmias
Endocrine dysfunction
Cirrhosis
How is hemochromatosis managed?
Therapeutic phlebotomy
Limit iron intake
List the hypoproliferative anemias
Anemia in renal disease
Anemia of inflammation
Aplastic anemia
Megaloblastic anemia - Folic acid deficiency and Vitamin B12 deficiency
iron deficiency
When is anemia seen in renal disease?
When GFR drops below <30
When is anemia of inflammation seen?
In inflammatory disorders like RA
Type of anemia caused by damage to bone marrow stem cells leading to neutropenia, thrombocytopenia and can become life-threatening if not treated?
Aplastic anemia
Which anemia is characterized by a bronze skin color?
hereditary hemochromatosis
How is aplastic anemia treated?
Stem cell transplant or immunosuppression
Anemia that is characterized by a deficiency of iron due to lack of intake or bleeding
Iron deficiency anemia
When does vitamin b12 deficiency typically occur?
Vegan diet or after weight loss surgery
What are the s/s of iron deficiency anemia?
anemia
smooth, red tongue
brittle, rigid nails
angular cheilosis
What foods are rich iron sources?
Organ meats, beans; green, leafy veggies, raisins, molasses
How should a patient take PO iron?
On an empty stomach with vitamin C
Avoid calcium and antacids
Disorder classified by the decreased production or destruction of neutrophils
Neutropenia
The neutrophil count is below what to classify as neutropenia?
<2000
The patient is at highest risk for infection and should be placed on neutropenic precautions when ANC is what?
<500
How is neutropenia managed?
Close monitoring for infection
Patient education
Prevention
Management of complications
Disorder where the lymphocyte count is <1500
lymphopenia
What happens when lymphopenia is severe?
Increased risk of infection
Causes of lymphpenia
Exposure to radiation
Long-term steroid use
Infections
Neoplasms
Alcohol abuse
A disorder characterized by the increased volume of RBS due to the excessive production of erythropoietin
polycythemia
Secondary polycythemia’s excessive production of erythropoietin is caused by what?
Reduced amounts of oxygen, cyanotic heart disease, and nonpathologic conditions or neoplasms
Causes of polycythemia?
Lack of O2 -
Smoking
OSA
COPD
Severe heart disease
Living at high altitudes
Exposure to low levels of oxygen
How is polycythemia managed?
Mild - no treatment required
Severe - treat underlying cause and therapeutic phlebotomy
What is a myeloproliferative neoplasm disorder of the myeloid stem that causes increased erythrocytes, leukocytes, and platelets from bone marrow?
Polycythemia vera
Death of polycythemia vera is usually caused by what?
thrombosis, hemorrhage, or AML
Manifestations of Polycythemia Vera
Ruddy complexion
Splenomegaly
HA, dizzy, tinnitus, fatigue
Bone marrow fibrosis
Paresthesia
Blurred vision
What are the goals of polycythemia vera treatment?
Decrease risk of thrombosis, bleeding, and AML
How is polycythemia vera managed?
low dose ASA
Therapeutic phlebotomy
chemotherapy
Medications like anagrelide and interferon
Avoid iron supplements
What do you want to tell your patient with polycythemia vera to avoid?
Taking iron supplements
Causes of bleeding disorders
Trauma, platelet abnormalities, coagulation factor abnormalities
How are bleeding disorders managed?
Specific blood products
Limiting injuries
Assessing for bleeding
Preventing bleeding
Secondary thrombocytosis is what?
increased platelets
What is thrombocytopenia?
Low platelets
What is immune thromobocytopenic purpura?
destruction of platelets
What does it mean when a patient has platelet ‘defects’?
Number is normal but the function is not
Hemophilia means they are missing what?
missing clotting factor
Deficiency of vWD leading to factor VIII problems and lack of platelet adhesion?
von Willebrand disease
A significant complication of heparin-based therapy causing formation of antibodies against the heparin-platelet complex
Heparin induced thrombocytopenia (HIT)
Which has a higher risk for HIT - porcine or bovine?
Bovine
What are the risk factors for HIT?
type of heparin used, duration of therapy, surgery, women > men, bovine > porcine
HIT stands for
heparin induced thrombocytopenia
Complications of HIT
Venous/arterial thrombosis, ACS, stroke, or ischemic damage to extremities like DVT or PE
How is HIT managed?
STOP heparin therapy
Initiate argatroban
What is the drug of choice when HIT occurs?
argatroban
What drug is NEVER used in HIT?
Why?
Warfarin as it can cause promotion of thrombosis in microvasculature by depleting protein C
What is disseminated intravascular coagulation?
an altered hemostasis causing massive clotting in microcirculation. As clotting factors are consumed, massive bleeding occurs.
DIC stands for
disseminated intravascular coagulation
Causes of disseminated intravascular coagulation
sepsis, trauma, shock, cancer, abruptio placentae, toxins, and allergic reactionst
The symptoms of DIC are related to what?
tissue ischemia and bleeding
How is DIC managed?
Treat underlying cause
Correct tissue ischemia
Fluid replacement
Maintain BP, skin, perfusion
Replace coagulation factors
Use heparin or LMWH
Avoid trauma or increased bleeding
What does the nurse assess in the patient with DIC?
Assess for s/s of bleeding and progression of thrombi and bleeding
Complications of DIC
Kidney injury
Gangrene- vasculature
PE
Hemorrhage
ARDS
Stroke
S/s of SLE
Fever
Malaise
Weight loss
Anorexia
Joint pain
Skin lesions
How is SLE managed?
Control acute flare ups to prevent organ damage
Pain management
Meds - Benlysta, hydroxycholorquine, NSAIDS, immunosuppresants
