Test 2 AH Hemo Flashcards
Normal WBC
4-11
Normal RBC
4.3-6
Hemoglobin
13-18
Hematocrit
40-53%
MCV
78-100
MCH
27-34
MCHC
31-37
RDW
11.5-14.5
Platelet Count
130-450
Function of the Hematologic System
- bone marrow
- blood
- normal iron metabolism
- normal clotting
Red Blood Cells
- start as stem cells
- live 120 days
- produce hemoglobin
- hemoglobin loosely binds with oxygen and provides it to the tissues
Anemia
not enough RBC’s
Causes of Anemia
- Decreased RBC Production
- Blood Loss
- Increased RBC Destruction
Anemia: Assessment
- fatigue/tired
- pallor
- sob w/ activity
- VS changes
- weight loss
Anemia: Elderly Patients
- common in older adults
- chronic disease
- nutritional deficiencies
- may go unrecognized or mistaken for normal aging changes
Anemia: Implementation
- dietary and lifestyle changes
- blood or blood product transfusions
- drug therapy
- oxygen therapy
- patient teaching
Iron Deficiency Anemia (Micro)
- most common
- blood loss, poor GI absorption, poor diet
- weakness, pallor, fatigue, fissures at corners of mouth, spooning, low levels of HGB, burning tongue and numbness of appendages (fingers and toes)
Management of Iron Deficiency Anemia
- adequate dietary intake
- supplemental vitamins
- healthy diet selection
Pernicious Anemia (Macro)
- vitamin b12 deficiency
- no intrinsic factor which absorbs B12 (in stomach)
- large RBC’s (megaloblasts)
- folate deficiency which is essential for formation of RBC’s
- take folate orally and B12 injections for life increase proteins, vitamins and minerals
- sore burning tongue, tingling (Nerve Problems)
Hemolytic Anemia
- destruction or hemolysis of RBC’s at a rate that exceeds production
- jaundice, destroyed RBC’s caused increase in bilirubin
Causes of Hemolytic Anemia
- blood transfusion Reaction
- Infection
- Drugs
- Sickle Cell
- G6PD enzyme deficiency
Hemorrhage
- hypovolemic shock
- reduced plasma volume
- diminished O2
- Trauma, complications of surgery
- STOP, replace blood loss
Sickle Cell Anemia Treatments
- Fluids and O2 **
- rest
- analgesics
- blood transfusions
- folic acid
- hydroxyurea (antisickling agent)
- erythropoietin in patient unresponsive to hydroxyurea
- bone marrow transpant
Sickle Cell Pains
- abdominal and long bones
- hands and feet
- joints and back
- Due to hypoxia
Sickle Cell Complications
- infections
- stroke
- UTIs
- Splenomegaly
Aplastic Anemia
- Pancytopenia (decrease of all blood cell types)
- decrease in function of bone marrow resulting in not enough new blood cells
- exposure to carcinogenic agents, chemotherapy cause this
- very rare, effects 4 of 1 million persons
- erythropoeitin (promotes formation of EBC’s)/ blood/ bone marrow transplant
Treatment: Neutropenia precautions, bone marrow transplant
Erythropoietin
- glycoprotein primarily produced in the kidneys
- increases number of stem cells committed to RBC production
- shortens the time to mature RBC’s
Polycythemia Vera
- too many RBC’s
- causes blood to thicken causing viscosity, increased heart compensation
- headace, tired, vision problems
- a proliferative disorder in which the myeloid stem cells escape normal control mechanisms
Secondary Polycythemia
caused by excessive production of erythropoietin from chronic hypoxia
Polycythemia Manifestations
-thick, sticky blood which causes tissue ischemia and infarction, increased BP and angina
Polycythemia Treatment
- Fluids, steroids, remove one unit of blood away monthly
- remove cause (tumor), Phlebotomy, hydration to minimize complications, give immunosuppressants
Thrombocytopenia
- decreased production of platelets
- increased destruction of platelets
- increased consumption of platelets
- TTP rare
Thrombotic Thrombocytopenic Purpura (TTP) Treatment
- immunosuppressants
- soft tooth brushes
- steroids
- immunogobulin
- plasmapheresis
- meds to in inhibit platelet aggregation
Autonimmune or Idiopathic Thrombocytopenic purpura (ITP) Treatment
- drug therapy to prevent production of antiplatelet antibodies
- platelet transfusions
- maintain safe environment
Leukocytosis
- increase in white blood cells
- usually a sign of infection
Leukopenia
decrease in functional WBC’s
Leukemia
-over production of WBC’s
- cancer of immature WBC’s
- excessive leukocytes
Treatment: corticosteriods, hydroxyurea, bone marrow transplant, cytoxin (chemo and immunosuppressant), radiation
AML
most common adult leukemia (frequently caused by previous chemotherapy)
ALL
most common in children
CML
- includes polycythemia vera
- presence of Philadelphia Chromosome in leukemic cells
- progresses in three stages
CLL
rare type of leukemia that occurs most often in people older than 50
Acute Leukemia
- early arrest of cell maturation
- block of cell production precursor
- many blast cells
Chronic Leukemia
mature of near mature cells with function
Causes of Leukemia
- combination of genetic and environmental influences
- chemical agents
- chemotherapeutic agents
- viruses
- radiation
- immunologic deficiencies
Leukemia: clinical manifestations
anemia, bleeding, infection, weight loss, bone pain, liver/spleen enlargement
Leukemia: Diagnosis
blood tests, bone marrow biopsy
Leukemia: Treatment
- bone marrow transplantation
- stem cell transplant
- combination chemotherapy
- radiation therapy
Multiple Myeloma
- immunodeficiency of the bone marrow
Multiple Myeloma: Manifestations
- hypercalcemia, caused by calcium being lost though bone seaping into blood.
- Bence Jones Proteins, renal failure, bone pain and weakness due to loss of calcium
Multiple Myeloma: Treatment
- chemotherapy
- fluids
- pain meds
- not curable
Malignant Lymphoma
solid tumors - particularly affecting lymph nodes and spleen
Hodgkin Disease
- Lymphoma in lymph glands
- positive Reed-sternberg cells
- arises from a single node and spreads
- night sweats
- often early diagnosis (fever of unknown origin)
- 75% cure, 20 year survival
- stages 1 and 2, radiation
- stages 3 and 4, chemo and radiation
When Taking iron…
- take supplements with vitamin C
- z track injection
- eggs
Sickle Cell Anemia
- herditary, uncurable, rigid and sticky and are shaped like sickles or crescent moons
- altitude and cold make it worse
Vasoocclusive Crisis
- fluids
- oxygen
- analgesics
- rest
Sequestration Crisis
- sickle cells clump together and the organs (spleen) enlarge
- splenectomy
Agranulocytosis
- absent components of WBC
- Meds to cause it: chemoterapy, radiation
- a deficiency of granulocytes in the blood, causing increased vulnerability to infection.
- neutropenic precautions
Hodgkin Disease: Who gets it?
- peaks in mid to late 20’s
- >50 (males affected more)
Hodgkins: Causes
- probably viral or chemical
- usually originates in a single or chain of nodes
- Reed-Sterberg Cells
Hodgkins: Assessment
- enlarged painless node or nodes
- fever
- malaise
- night sweats
Non-Hodgkin Lymphoma
- cancer of the lymph tissue that are not hodgkin’s
- no reed sternberg cells
- ages 50+
Symptoms of anemia
-yellowing of eyes
-SOB
-weakness
-change is stool color
-fatigue
-low BP
-spleen enlargment
-cold skin
Sever anemia
-fainting
-angina
-MI
