Screening for Hematologic Conditions Flashcards
1
Q
primary vs secondary hematologic dz
A
primary - bc of hematologic system
secondary - primary dz has caused sx relating to hematologic sx
- ex: pt w CA undergoing chemo that is impacting ability to produce blood cells
2
Q
what % is plasma of the total blood volume
A
55-65%
3
Q
what is contained in the plasma
A
clotting factors
albumin/proteins
humeral immunity
electrolytes
4
Q
what pt sx should make you consider the plasma levels
A
cramping - hydration status?
5
Q
what % is the cellular components of the total blood volume
A
35-45%
6
Q
what is contained in the cellular components of the blood
A
erythrocytes - RBCs
leukocytes - WBCs
thrombocytes - platelets
7
Q
what cells are included in a CBC
A
WBC
Hgb
Hct
Plt
8
Q
norms for WBC
A
5k-10k
9
Q
norms for Hgb
A
female: 12-16
male: 14-17
10
Q
norms for Hct
A
female: 36-48%
male: 42-52%
11
Q
norms for plts
A
150k-450k
12
Q
what does a CBC panel chicken foot layout look like
A
\ Hgb /
WBC ——- Plt
/ Hct \
13
Q
what is Hct
A
hematocrit
% of RBCs in total volume of blood
14
Q
who should be screened via a CBC
A
chronic NSAIDs
chemo
recent surgery
15
Q
why do you want a CBC w chronic NSAID usage
A
chronic NSAID use can lead to GI bleeding
- aspirin is a blood thinner and can be linked to microscopic bleeding
- can lead to inc blood loss
16
Q
why do you want a CBC w someone undergoing chemo
A
impacts total cell volume
17
Q
what pt reports would indicate a need for a CBC screen (5)
A
- spontaneous bleeding (nosebleed, urine, stool, gums)
- transfusions
- rapid onset dyspnea, chest pain, weakness, fatigue w palpitations
- changes in nails, changes in skin tone
- more easily bruising/bleeding
18
Q
what are hematology specific sx (6)
A
- problems w exertion
- dyspnea
- chest pain
- palpitations
- severe weakness
- fatigue - neurologic sx
- HA
- drowsiness
- dizziness
- syncope
- polyneuropathy - skin/fingernail bed changes
- GI/GU changes
- severe pain and swelling joints or ms
- wounds or easy bruising/bleeding of skin, gums, mucous membranes, esp without trauma
19
Q
what in a family hx are you looking for when doing a hematologic screening
A
CV or pulm dz
sickle cell anemia
20
Q
what are screening Qs for a hematologic screen
A
problems w exertion
- any hx of CV/P system dysfunction or dz
- changes in activity to accommodate?
recent change in altitude?
hx of recurrent infections?
21
Q
what is the function of erythrocytes
A
key role in transport of O2 and CO2
22
Q
what is the total amt of erythrocytes affected by
A
male>female
inc w higher altitude over time
athletes > sedentary (higher demand)
23
Q
what are erythrocyte pathology
A
anemia - too few
polycythemia - too many
sickle cell anemia - wrong shape / dec effectiveness
24
Q
what is anemia
A
dec O2 carrying capacity
- dec quantity
- dec quality
25
what is a considerations of anemia's pathology
sx not necessarily a dz
26
what patients will you frequently see anemia in (5)
1. iron deficiency related to chronic GI blood loss (NSAID use, postop status)
2. chronic or inflammatory dz
3. neurologic conditions (pernicious anemia)
4. infectious dz (TB or AIDS)
5. neoplastic dz or cancer (bone marrow failure)
27
when does anemia typically present
when 1/2 of normal values
- slower changes may go unnoticed
28
what are clinical s/sx of rapid onset anemia (3)
dyspnea
weakness and fatigue
palpitations
29
what are observable signs of anemia (3)
pale palms w normal colored creases
pale/yellow mouth/eyes/mucus membranes
brittle or concave nails
30
what are objective measures of anemia
dec diastolic BP
inc HR
DEC EXERCISE TOLERANCE
31
what flag is anemia
emergent red - unknown, severe sx
yellow - known dx, change in status, discuss w provider
32
what is polycythemia
inc number of RBCs and concentration of Hgb
- inc total blood volume & inc viscosity
- inc clotting tendency, can limit flow to brain/vital tissues
can be primary or secondary
33
what are clinical s/sx of polycythemia (6)
1. SOB, fatigue, HA, pruritis (rash)
2. inc BP
3. peripheral vascular neuropathy
- small vessel occlusion
4. gout (w primary)
5. sx inc after dehydration or w altitude training
6. dx after stroke or thrombosis
34
what flag is polycythemia
yellow - more urgent referral than anemia
35
what is sickle cell anemia
inherited autosomal recessive condition
abnormal form of Hgb
36
what is the impact of the abnormal form of Hgb seen in sickle cell anemia
curved shape limits O2 carrying capacity and flexibility of cell
- vasoocclusion and chronic hemolytic anemia
chronic hemolytic anemia = RBCs are destroyed much faster bc dec ability of cells to function
37
clinical s/sx of sickle cell anemia (4)
1. occurs w series of "crises"
2. anemia
3. pain from clotting (any organ)
4. over time, progressive damage to organs from vasoocclusion and inflammation
38
what organs do you see progressive damage to d/t sickle cell anemia
kidneys
lungs
**bones/joints (HIPS, SHOULDER)
heart/lungs
brain (CVAs, cog impairment)
39
what flag is sickle cell anemia
yellow flag - pt likely aware of dx
- just have to determine if currently emergent
40
what is the function of leukocytes (WBCs)
key role in inflammatory and immune response
41
what are types of leukocytes
lymphocytes - viral infections
granulocytes
- neutrophils (bacterial)
- eosinophils (parasitic)
monocytes
42
what dictates the # of leukocytes at any given time
changes in reaction to dz process or chronic conditions
43
what pathology is associated w leukocytes
leukopenia - dec WBCs
leukocytosis - inc WBCs
leukemia - immature/don't work correctly
44
what is leukopenia dx at
dec WBCs <5k
45
leukopenia occurs d/t (4)
bone marrow failure
overwhelming infection
dietary deficiency
autoimmune dz
46
what are clinical s/sx of leukopenia (5)
sore throat/cough
high fever, chills, sweating
ulceration of mucous membranes
dysuria
persistent infections
47
what are PT clinical implications of leukopenia
WBC count typically lowest 1-2wks post chemo/radiation tx
- consider when booking sessions
any constitutional sx in immunocompromised pts warrants immediate medical referral
48
what flag is leukopenia
yellow - be aware of WBC count
- referral pattern depends on pt specifically
49
what is leukocytosis dx at
inc WBCs >10k
50
leukocytosis is a common finding related to what (8)
bacterial infection
inflammation
tissue necrosis
cancer
splenectomy
acute appendicitis
pneumonia
hemorrhage
51
how would a hemorrhage lead to leukocytosis
lot of blood loss
- body is recreating blood bringing cell number up
52
what are clinical s/sx of leukocytosis (5)
fever
chills
local inflammation
local tissue trauma
aware of risk of infection post-op
53
what flag is leukocytosis
yellow - varying levels
- need to monitor
- make MD aware
54
what is leukemia
malignant dz of blood forming organs
develops in bone marrow -> replication and release of immature WBCs
production of immature WBCs can result in poor production of normal blood cells (RBCs, Plts)
- see inc risk of bleeding
55
what types of leukemia are there
ALL (acute lymphoblastic)
AML (acute myelogenous)
CLL (chronic lymphocytic)
CML (chronic myelogenous)
56
what population do you see ALL in? prognosis?
3-7yo and >65yo
- children good px w active tx
57
what population do you see AML in? prognosis?
inc incidence in 40+yo
- poor px w tx
58
what population do you see CLL in? prognosis?
50+yo
2-10yr survival
59
what population do you see CML in? prognosis?
rarest type
25-60yrs
poor px
60
what are risk factors for leukemia (5)
exposure to ionizing radiation
- occupationally, from tx
prior chemo
hereditary disorders
some viruses
some immunodeficiency disorders
61
what are clinical s/sx of leukemia (6)
think of cells lost
- infection (dec WBCs)
- bruising/bleeding (dec plts)
- fatigue (dec RBCs)
anorexia
enlarged lymph nodes
wt loss or loss of appetite
- 10% of BW in 10-14days unintentionally
enlarged spleen
arthritic joint sx in child
62
why would you see anorexia and enlarged lymph nodes in pts w leukemia
body trying to fight an infection
63
what flag is leukemia
yellow - monitor and make PCP aware of findings
64
what is the function of thrombocytes (plts)
function in hemostasis and maintain capillary integrity
65
what pathologies are associated w thrombocytes
thrombocytosis - too high
thrombocytopenia - too low
hemophilia - unable to function properly
66
when is thrombocytopenia dx
dec plts <150k
67
what are potential causes for thrombocytopenia
bone marrow failure
- d/t radiation, leukemia, cancer
meds
- NSAIDs, chemo, coumadin, warfarin
68
what is the danger of thrombocytopenia
bleeding in GI or CNS can become life threatening
69
when do clinical s/sx of thrombocytopenia start to present
plts <100k
70
what are clinical s/sx of thrombocytopenia (5)
1. spontaneous bleeding
- petechiae (purple pin point <2mm)
- purpura (larger 2mm-1cm)
- ecchymoses (bruising >1cm; acute dark purple/blue >> yellow - time frame tell you severity of plt ct)
- epistaxis (nose bleed)
2. joint swelling (blood in joint)
3. menorrhagia (GI bleed into stool)
4. gum bleeding
5. melena
71
what are PT clinical implications of thrombocytopenia (3)
1. avoid strenuous exercise w valsalva/bearing down
2. careful w BP cuff use
3. avoid visceral manip, mechanical compression, soft tissue mobilization prior to discussion w MD
72
why do you avoid strenuous exercise w someone w thrombocytopenia
can break a blood vessel
- esp in eye or brain
73
what flag is thrombocytopenia
red - undiagnosed is immediate referral to MD
74
what is thrombocytosis
inc platelets, usually temporary
75
primary vs secondary thrombocytosis
primary - unregulated plt production
secondary
- compensation for hemorrhage
- post surgery/splenectomy
- iron deficiency or polycythemia
- cancer
76
what are clinical s/sx of thrombocytosis (4)
pain, clotting
DVT
bruising
splenomegaly
77
why might there be pain associated w thrombocytosis
related to clotting around organs and other tissues
78
why might you see splenomegaly w thrombocytosis
spleen trying to break down excessive plt count
79
what is the flag for thrombocytosis
yellow - need to monitor
80
what is hemophilia
hereditary clotting disorder
- abnormal function of plasma clotting proteins (factors VIII and IX)
bleeding longer, not faster
81
clinical s/sx of hemophilia (3)
hemarthrosis
- sx may last 1-3 days to wks
- hemophilic arthropathy
ms hemorrhage
GI bleed
82
how can hemarthrosis present in hemophilia
bleeding into joint
- present as hot, sore joint
dec ROM
spontaneous or w trauma/stress
seen in knees, ankles, hips, shoulders, and elbows most commonly
83
what is the danger w hemarthrosis in hemophilia
can have recurrent exacerbations that damage the joint
- progressive loss of motion
- ms atrophy
- contractures
84
where is ms hemorrhage most commonly seen in hemophilia
in flexor groups >> flexion contractures
- ex: iliopsoas, gastroc, forearm
85
what is the flag for hemophilia
yellow - severity of bleed will determine referral requirements
86
what are immediate medical referrals
thrombocytopenia - excessive bleeding, not having enough plts
rebound tenderness in aabdomen
87
what are soon medical referrals
known anemia - chang in status or exercise progressions
new joint sx w known hemophilia
88
what are next regular visit
non-life threatening sx
when PT not able to address issues
