Week 10 Hematology/Oncology Flashcards
Platelet
small, colorless, disc shaped cell fragment without nucleus, found in large numbers in blood and involved in clotting
Eosinophil
WBC type; granulocyte that is release during infections, allergic reactions, and asthma
Basophil
WBC type; least common granulocyte; plays a role in allergy induced inflammation
Leukocyte
Colorless cell that circulates int eh blood and body fluids and is involved in counteracting foreign substances and disease
Neutrophil
Most abundant WBC; phagocyte and a granulocyte
Monocyte
Large, phagocytic WBC with a simple oval nucleus and clear, grayish cytoplasm; becomes a macrophage to surround and kill microorganisms
Lymphocyte
Form of a small leukocyte (WBC) with single round nucleus, occurring especially in the lymphatic system
The primary care pediatric nurse practitioner sees a 12-month-old infant who is being fed goat’s milk and a vegetarian diet. The child is pale and has a beefy-red, with sore tongue and oral mucous membranes. Which tests will the nurse practitioner order to evaluate this child’s condition?
A. Hemoglobin electrophoresis
B. RBC folate, iron, and B12 levels
C. Reticulocyte levels
D. Serum lead levels
B. RBC folate, iron, and B12 levels
Infants and children who are fed goat’s milk or who are on a strict vegetarian diet are at risk for folic acid and vitamin B12 deficiency. These should be evaluated, along with iron, to rule out IDA. Hemoglobin electrophoresis is used to evaluate diseases associated with altered hemoglobin, such as beta-thalassemia and sickle cell anemia, neither of which is indicated by this child’s history. Reticulocyte levels are evaluated to evaluate transient erythroblastopenia of childhood, a condition that frequently follows a viral infection. Serum lead levels are not indicated based on this history.
A patient reports recent mild fatigue and palpitations. A complete blood count reveals a decreased hemoglobin level and a normal ferritin level. What other findings are likely to be present?
A. Decreased hematocrit
B. Decreased MCV, MCH, and MCHC
C. Elevated total iron-binding capacity
D. Paresthesias, koilonychia, and pica
A. Decreased HCT
This patient has signs of milder iron-deficiency anemia and will also have a low hematocrit level. The RBC indexes are the last to change as the anemia becomes more severe. When the ferritin level drops, the TIBC will become elevated. Paresthesias, koilonychia, and pica occur with more severe anemia.
The primary care pediatric nurse practitioner evaluates a 5-year-old child who presents with pallor and obtains labs revealing a hemoglobin of 8.5 g/dL and a hematocrit of 31%. How will the nurse practitioner manage this patient?
A. Prescribe elemental iron and recheck labs in 1 month
B. Reassure the parent that this represents mild anemia
C. Recommend a diet high in iron rich foods
D. refer to hematologist for further evaluation
A. Prescribe Elemental iron and recheck labs in 1 month
The child has mild to moderate iron-deficiency anemia and will need iron supplementation. The hemoglobin, hematocrit, and reticulocytes should be reevaluated in 4 weeks after initiation of treatment. The child needs iron supplementation, so reassurance alone is not indicated. It is difficult to get iron from foods, so supplementation will be needed. Children with hemoglobin levels less than 4 g/dL and some children with hemoglobin levels less than 7 g/dL must be referred.
A complete blood count on a 12-month-old infant reveals microcytic, hypochromic anemia with a hemoglobin of 9.5 g/dL. The infant has mild pallor with no hepatosplenomegaly. The primary care pediatric nurse practitioner suspects what disorder?
A. Hereditary spherocytosis
B. Iron-deficiency anemia
C. Lead Intoxication
D. Sickle-cell anemia
B. Iron Deficiency Anemia
Iron-deficiency anemia is the most common type of anemia in infants and children, accounting for approximately 90% of cases. It is characterized by decreased hemoglobin, with microcytic, hypochromic RBCs. Hereditary spherocytosis is characterized by pallor and jaundice with splenomegaly. Lead intoxication is accompanied by neurobehavioral problems. Sickle-cell anemia involves the presence of HgbS.
During a well-child examination of a 2-year-old child, the primary care pediatric nurse practitioner palpates a unilateral, smooth, firm abdominal mass which does not cross the midline. What is the next course of action?
A. Order a CT scan of the chest, abdomen, and pelvis
B. Perform urinalysis, CBC, and renal function tests
C. Reevaluate the mass in 1–2 weeks
D. Refer the child to an oncologist immediately
D. refer to oncologist immediately
The finding is consistent with Wilms tumor, and referral, diagnosis, and treatment are urgent. Palpating a mass too vigorously could lead to the rupture of a large tumor into the peritoneal cavity so care should be taking in conducting the physical examination. The other tests may be ordered by the oncology team. Treatment and diagnosis must occur immediately.
A patient reports a neck mass that has been present intermittently for 5 or 6 weeks, which varies in size. The provider palpates a lymph node that measures 1.25 cm. Which test will provide proper histologic diagnosis for this patient?
A Bone marrow aspirate
B Computed tomography (CT) scan with intravenous (IV) contrast
C Lymph node biopsy,
D Positron emission tomography (PET) scan
C. Lymph node biopsy
The lymph node biopsy is used to provide proper histologic diagnosis and precise classification. Bone marrow aspirate identifies the presence of dysplastic cells. PET and CT scans will identify the presence of other lesions.
Which situations are considered oncologic emergencies in a patient diagnosed with cancer and require urgent referral to an oncologist? Select all that apply.
response - incorrect
A Bone marrow suppression
B Metastasis of cancer cellsMetastasis of cancer cells
C Superior vena cava syndrome,
D Syndrome of inappropriate antidiuretic hormone
E Tumor lysis syndrome
C, D, E
Superior vena cava syndrome, SIADH, and tumor lysis syndrome are all oncologic emergencies requiring urgent referral to the oncologist. Bone marrow suppression and metastasis occur with cancer but are not emergencies.
What is the most important role of the primary care provider in cancer management?
A Counseling about healthy practices to reduce risk factors
B Performing regular screenings to detect cancer
C Referring patients for genetic testing to identify those at risk
D Teaching patients about cancer management once diagnosed
A. Counseling
About three-fourths of cancer risks are related to elements that patients can control themselves and include diet, tobacco, alcohol, sun exposure, physical activity, and risky sexual behaviors. Emphasizing healthy lifestyle practices is a principle component of primary care. Screenings are next in importance and should be performed according to guidelines based on risk and age. Genetic testing is useful in a small percentage of patients; a good family history is important before referral for testing. The primary care provider may assist oncology specialists in teaching patients about cancer management.
The primary care pediatric nurse practitioner is examining a 5-year-old child who has had recurrent fevers, bone pain, and a recent loss of weight. The physical exam reveals scattered petechiae, lymphadenopathy, and bruising. A complete blood count shows thrombocytopenia, anemia, and an elevated white blood cell count. The nurse practitioner will refer this child to a specialist for what diagnostic testing?
A A bone marrow biopsy,
B Corticosteroids and intravenous immunogloblin (IVIG)
C Hemoglobin electrophoresis
D Immunoglobulin testing
A. Bone marrow biopsy
This child has symptoms and initial lab tests consistent with leukemia and should be referred to a pediatric hematologist-oncologist for a bone marrow biopsy for a definitive diagnosis. Corticosteroids and IVIG are given for severe idiopathic thrombocytopenic purpura (ITP). Hgb electrophoresis is used to diagnose sickle cell anemia (SCA). Immunoglobulins are evaluated when immune deficiency syndromes are suspected.
A patient being treated for cancer has had chemotherapy within the past 2 weeks and comes to the primary care clinic with a fever of 38.5 °C. What is the initial action?
A Obtain a STAT complete blood count (CBC) with differential
B Order a chest radiograph
C Order blood and urine cultures
D Prescribe empirical antibiotics
A. STAT CBC w/diff
Patients receiving chemotherapy who have a temperature >38°C and an absolute neutrophil count (ANC) of less than 500/mm3 require immediate hospitalization and treatment. The primary provider should order a CBC to determine this risk and plan immediate hospitalization and referral to the oncologist. Once hospitalized, the patient will have further workup to determine the cause of the infection and then antibiotics to treat the infection.
Most common causes of anemia in elderly are…
anemia of chronic disease
nutritional deficiency (iron, b12, folate)
decreased bone marrow response erythropoeitin
What are the 3 etiologies of anemia?
RBC production disorders
RBC destruction disorders
Blood loss (acute or chronic)
What are the RBC production disorders
Iron deficiency anemia (IDA)
anemia of chronic kidney disease (ACKD)
vitamin B12 & folate deficiency
Anemia of chronic disease
aplastic anemia (bone marrow stem cell failure)
The most important factor in the body’s ability to increase RBC production is…
iron
without adequate iron stores, the marrow cannot increase erythropoeisis
_____ is a glycoprotein secreted by the kidney that induces erythroid precursor cells to differentiate, thereby increasing new RBC production.
Erythropoietin
What are the RBC destruction disorders?
Sickle cell
RBC membrane defects (hereditary spherocytosis; hereditary elliptocytosis)
RBC enzyme defects (G6PD)
Autoimmune antibody production (autoimmune hemolytic anemia)
What does MCV indicate?
Mean Corpusular volume
The average size of RBC
Can be microcytic, normocytic or macrocytic
