Screening for Hematologic Disease Flashcards
what does blood consist of?
- Plasma
- Erythrocytes
- Leukocytes
- Platelets
what does plasma do?
carries antibodies and nutrients to tissues and removes wastes from tissues
what is the role of erythrocytes?
carry oxygen to tissues and remove CO2 from them
what is the role of leukocytes?
act in inflammatory/immune responses
what is the role platelets (thrombocytes)?
together with coagulation factors in plasma, control the clotting of the blood
S/S of hematologic disorders with minimal exertion
- dyspnea
- chest pain
- palpations
- severe weakness
- fatigue
Neurological symptoms of hematologic disorders
- HA
- Drowsiness
- Dizziness
- Syncope
- Polyneuropathy
S/S of hematologic disorders
- neurological symptoms
- skin fingernail changes
- pallor of the face, hands, nail beds, and lips
- cyanosis of clubbing of nail beds
- presence of blood in stool
- easy bruising
what is included in the hematologic review of systems?
- skin color or nail bed changes
- bleeding: nose, gums, easy bruising, melena
- fatigue, dyspnea, weakness
- rapid pulse, palpitations
- confusion, irritability
- HA
List Hematologic Disorders
- Anemia
- Polycythemia
- Sickle Cell Anemia
- Leukocytosis
- Leukopenia
- Thrombocytosis
- Thrombocytopenia
- Hemophilia
what is anemia?
a reduction in oxygen-carrying capacity of blood
results of abnormality in quality or quantity or RBCs
what are the most common causes of anemia?
- excessive blood loss
- increased destruction of erythrocytes
- decreased production of erythrocytes
PT considerations for anemia
- diminished exercise tolerance is expected in pts with anemia and exercise should be approved by MD
what is polycythemia?
increase in number of RBCs and concentration of hemoglobin
increased whole blood viscosity and increased blood volume
PT considerations for polycythemia
results in thickening of blood and increased risk for clotting
what is sickle cell anemia
an inherited, autosomal recessive disorder characterized by presence of abnormal form of hemoglobin (altered shape of cell to sickled or curved shape)
populations that sickle cell anemia is more prominent in
- more common in African Americans
- also in individuals from:
- India
- Mediterranean countries
- Saudi Arabia
- Caribbean islands
- South and Central America
sickle cell anemia is characterized by what?
a series of “crises” or acute manifestations of symptoms
Clinical S/S of sickle cell anemia
- Pain caused by blockage of sickled RBCs
- May be in organ, bone, or joint of the body
- joint pain most often occurs in shoulder or hip
- painful episodes may last hours or up to 5-6 days
- may cause Hand-foot syndrome
what is hand-foot syndrome?
painful swelling in dorsum of hands and feet
list factors that may cause a crisis
- viral or bacterial infection
- hypoxia
- dehydration
- emotional disturbances
- extreme temperatures
- fever
- strenuous physical exertion
- fatigue
what is leukocytosis
a sign of an inflammatory response
WBC count of 10,000k
Leukocytosis is helpful in aiding the body’s response to:
- Bacterial infection
- Inflammation or tissue necrosis
- Metabolic intoxications
- neoplasms
- acute hemorrhage
- splenectomy
- acute appendicitis
- pneumonia
- intoxication by chemicals
- acute rheumatic fever
what is leukopenia
a reduction in number of leukocytes in blood
below 5000
what can cause leukopenia?
can occur due to chemo/radiation, in overwhelming infections, in dietary deficiencies and in autoimmune disease
PT considerations for leukopenia
- good hand washing practices so important in this population
- pt with known leukopenia presenting with constitutional symptoms (fever, chills, sweats) requires immediate medical referral
what is thrombocytosis?
increase in platelet count
usually temporary
PT implications for thrombocytosis
increased clotting risk
(secondary to high platelet count and increased blood viscosity)
what is thrombocytopenia
decrease in number of platelets
results form of decreased or defective platelet production or form accelerated platelet destruction
PT considerations for thrombcytopenia
- PT needs to be alert for:
- severe bruising
- external hematomas
- joint swelling
- multiple petechiae
- strenuous exercise or exercise that involves straining/bearing down could cause hemorrhage
- particularly of eyes and brain
- avoid Valsalva
Causes of thrombocytopenia
- bone marrow failure
- radiation
- aplastic anemia
- leukemia
- metastatic carcinoma
- chemotherapy
- medications
what meds can cause thrombocytopenia
- NSAIDs
- Methotrexate
- Coumadin/Warfarin
Clinical S/S of thrombocytopenia
- bleeding after minor trauma
- Spontaneous bleeding
- petechiae
- bruises
- pupura spots (bleeding under the skin)
- epistaxis (nosebleeds)
- excessive menstruation
- gingival bleeding
- melena
what is Hemophilia?
- a hereditary blood-clotting disorder
- caused by abnormality of functional plasma-clotting proteins
- bleed longer but not faster than those without the condition
what is most common clinical manifestation of hemophilia?
acute hemarthrosis
what is the second most common clinical manifestation hemophilia?
muscle hemorrhage
Clinical S/S of acute hemarthrosis
- bleeding into the joint is one of the most common clinical manifestations of hemophilia
- may be result of trauma or may be spontaneous
- most often affects knee, elbow, ankle, hip and shoulder
- stiffening into position of comfort
- decreased ROM
- pain
- swelling
- tenderness
- heat
Clinical S/S of muscle hemorrhage
- gradually intensifying pain
- protective spasm of the muscle
- limitation of movement at the surrounding joints
- muscle assumes the position of comfort (usually shortened)
- loss of sensation
- common in flexor muscle groups
T/F: bleeding into muscles can be more insidious and massive than joint hemorrhages
TRUE
List clues to screening for hematologic disease
- previous history of chemotherapy or radiation therapy
- chronic or long-term use of aspirin or other NSAIDs
- spontaneous bleeding of any kind
- especially w/history of hemophilia
- Recent major surgery or previous transplantation
guidelines for immediate medical attention
S/S of thrombocytopenia
guidelines for medical referral
new episodes of muscle or joint pain in pts with hemophilia
what hematologic disorders are associated with increased clotting risk?
- polycythemia
- sickle cell anemia
- thrombocytosis
what hematologic disorders are associated with patients receiving chemo/radiation?
- leukopenia
- thrombocytopenia
complications of overuse of NSAIDs can result in what hematologic disoders?
thrombocytopenia
