Week 11: Hematology Flashcards
1
Q
Blood is a fluid composed of?
A
Plasma
RBC
WBC
Platelets
2
Q
physical characteristics of blood
A
- Heavier, thicker, and 3-4 X more viscous than water
- 38o C (100.4oF)
- pH : 7.35 – 7.45
- 4-6 liters in an adult
- Varies with electrolyte concentration and amount of adipose tissue
3
Q
plasma
A
- 92 % Water
- 8% Solutes – organic and inorganic
- Plasma proteins – largest proportion of solutes
- Albumins – 58 % of the proteins – maintain osmotic (oncotic) pressure – hold water in the blood
- Globulins – 38 % - antibodies synthesized by plasma cells
- Clotting factors – fibrinogen – 4 %
4
Q
other components of plasma
A
- Nutrients
- Hormones
- Electrolytes
- Waste products
- Dissolved gases
5
Q
Erythrocytes
A
red blood cells- RBC’s
6
Q
Leukocytes
A
white blood cells – WBC’s
7
Q
Thrombocytes
A
platelets – cell fragments
8
Q
hemapoeisis (hematopoeisis)
A
- All blood cells common from a common stem cell – Hemocytoblast
- These are in the bone marrow (red) and develop into blood cells as needed by the body
- Mitosis is signaled by biochemicals released from the body →
- Stem cell is signaled to differentiate into the needed type of blood cell
- Hematopoiesis / cell breakdown continue through life.
9
Q
erythrocytes (RBC’s)
A
*Most abundant blood cell type
*Transport gases
Shape is important
- Large surface to volume ratio
- Reversible deformability – can change shape
Development is called erythopoiesis
- Erythropoietin is a hormone produced by the kidneys in response to low blood oxygen levels; signals bone marrow to increase RBC production
*RBC’s travel through the body delivering oxygen and removing waste.
*RBC’s are red because they contain a protein chemical called hemoglobin which is bright red in color.
*Hemoglobin contains iron, making it an excellent vehicle for transporting oxygen and carbon dioxide.
*Average life cycle is 120 days.
*The bones are continually producing new cells.
10
Q
Cytoplasm is mostly
A
- hemoglobin (lacks organelles)
- Made up of 4 peptide chains that form the globin portion and four molecules of the pigment heme which contains an atom of iron
- If there is a problem with any part of the molecule it may not be functional.
11
Q
RBC breaksdown
A
- Healthy RBC’s live about 120 days; we break down about 174 million per minute
- RBC’s are removed from circulation by the liver and spleen
- Broken down into heme and globin portions
- Globin is broken down into amino acids
- Iron is removed from heme and stored or recycled
- Heme is broken down into biliverdin and then into bilirubin
12
Q
white blood cells
A
- The battling blood cells.
- The white blood cells are continually on the look out for signs of disease.
- When a germ appears the WBC will:: Produce protective antibodies.Surround it and devour the bacteria.
- WBC life span is from a few days to a few weeks.
- WBC’s will increase when fighting infection.
13
Q
Platelets
A
- Platelets are irregularly-shaped, colorless bodies that are present in blood.
- Their sticky surface lets them form clots to stop bleeding.
14
Q
CBC with differential and platelet count.
A
- Hgb:
- Normal levels are 11 to 16 g / dl
- Panic levels are:
- Less than 5 g / dl
- More than 20 g / dl
15
Q
Normal hematocrit levels
A
- 35 to 44%.
- Panic levels:
- Hmct less than 15 %
- Hmct greater than 60%
16
Q
hemaglobin and hematocrit
A
- Can be used as a simple blood test to screen for anemia.
- The CBC with differential would be used to help diagnose a specific disorder.
- A bone marrow aspiration would be the most conclusive in determining cause of anemia – aplastic / leukemia.
17
Q
bone marrow
A
- Bone marrow is the spongy substance found in the center of the bones.
- It manufactures bone marrow stem cells, which in turn produce blood cells.
- Red blood cells – carry oxygen to tissue
- Platelets – help blood to clot
- White blood cells – fight infection
18
Q
Transfusion
A
- Packed red blood cells – anemia
- Platelets – platelet dysfunction
- Fresh frozen plasma – coagulation factors
19
Q
hemolytic reaction
A
- Refers to an immune response against transfused blood cells.
- Antigens, on the surface of red blood cells, are recognized as “foreign proteins” and can stimulate B lymphocytes to produce antibodies to the red blood cell antigens.
-
Symptoms: Flank pain
Fever
Chills
Bloody urine
Rash
Low blood pressure
Dizziness / fainting
20
Q
nursing management of hemolytic reaction
A
- Stop the blood transfusion.
- Start normal saline infusion. (with new tubing)
- Take vital signs with blood pressure
- Call the MD
- Obtain blood sample and urine specimen.
- Return blood to blood bank.
- Document
21
Q
febrile reaction
A
- Often occurs after multiple blood transfusions.
- Symptoms:fever, chills, and diaphoresis.
- Interventions:
- Slow transfusion and administer antipyretic.
- Administer antipyretic prior to administration.
22
Q
allergic reaction
A
- Symptoms: rash, urticaria, respiratory distress, or anaphylaxis.
- Interventions:administer antihistamine before transfusion. Physician may order washed rbc’s
- What should you do? Stop the infusion. Call provider and ask what they want you to do.
23
Q
The following have a genetic link: implications for genetic screening and fetal diagnosis
A
- Sickle cell anemia
- Thalassemia
- Hemophilia
24
Q
Three types Hemophilia
A
- males only
- Type A most common – factor VIII deficiency
- Type B - lack of factor IX (Christmas Disease) (2nd most common)
- Type C – lack of factor XI
- Von Willebrand Disease – 1% of population – men or women – prolonged bleeding time. Significant for women who go on birthcontrol. If they have this and go on bc they end up stroking.
25
Q
hemopheilia type A
A
- is the deficiency of clotting factor VIII.
- A serious blood disorder
- Affects 1 in 10,000 males in the US
- Autoimmune disorder with lowered level of clotting factor
- All races and socio economic groups affected equally
- Hemophilia is a sex-linked hereditary bleeding disorder
- Transmitted on the X chromosome
- Female is the carrier
- Women do not suffer from the disease itself
- First recorded case in Talmud Jewish text by an Arab physician – documentation of two brothers with bleeding after circumcision.
- Queen Victoria was a carrier and spread the disease through the male English royalty.
26
Q
goals of care for hemophilia
A
- Provide factor VIII (IX) to aid blood in clotting.
- To decrease transmission of infectious agents in blood products; hepatitis & AIDS.
- Future: gene therapy to increase production of clotting factor.
27
Q
symptoms of hemophilia
A
- First identified in infancy/childhood
- Circumcision may produce prolonged bleeding.
- As child matures and becomes more active the incidence of bleeding due to trauma increases
- May be mild, moderate or severe
- Bleeding into joint spaces, hemarthrosis
- Most dangerous bleed would be intracranial.
*
28
Q
diagnosis,treatment, and nursing diagnosis/interventions of hemophilia
A
Diagnosis
- Presenting symptoms
- Prolonged activated aPTT and decreased levels of factor VIII or IX.
- Genetic testing to identify carriers
Treatment
- Fresh frozen plasma and cryoprecipitate which are from single blood donors and require special freezing.
- Second generation of factor VIII are made with animal or human proteins.
- Pt;s with severe hemophilia given helmets to prevent falling, hitting their heads, and getting a bleed
Nursing Diagnosis
- Risk for injury
- Pain with bleed especially into a joint
- Impaired physical mobility
- Knowledge deficit regarding disease and management of disease
Nursing Intervention
- No rectal temps.
- Replace the factor as ordered by physician.
- Manage pain utilizing analgesics as ordered.
- Maintaining joint integrity during acute phase: immobilization, elevation, ice.
- Physical therapy to prevent flexion contraction and to strengthen muscles and joints.
- Provide opportunities for normal growth and development.
29
Q
teaching for hemophilia
A
- Avoid aspirin which prolongs bleeding time in people with normal levels of factor VIII.
- A fresh bleeding episode can start if the clot becomes dislodged.
- Natural reactions in the body cause the clot that is no longer needed to “break down. This process occurs 5 days after the initial clot is formed.
30
Q
family education for hemophilia
A
- Medic-Alert bracelet
- Injury prevention appropriate for age
- Signs and symptoms of internal bleeding or hemarthrosis
- Dental checkups
- Medication administration
31
Q
long term complications of hemophilia
A
- 20% develop neutralizing antibodies that make replacement products less effective.
- Gene therapy providing continuous production of the deficient clotting factor could be the next major advance in hemophilia treatment.
32
Q
DIC, what is it and assessment findings
A
- DIC is an acquired coagulopathy that is characterized by both thrombosis and hemorrhage.
- DIC is not a primary disorder but occurs as a result of a variety of alterations in health.
Assessment findings
- The most obvious clinical feature of DIC is bleeding.
- Renal involvement = hematuria, oliguria, and anuria.
- Pulmonary involvement = hemoptysis, tachypnea, dyspnea and chest pain.
- Cutaneous involvement = petechiae, ecchymosis, jaundice, acrocyanosis and gangrene.
- If they survive it will be altering physically for them
56
Q
Specific manifestations of Folate deficiency
A
cheilosis (scales and fissures of the mouth), inflammation of the mouth, and ulceration of the buccal mucosa and tongue.
76
Q
A
erithromyelalgia (polycythemia finding)
