Week 8 Haematology

Question 1

Haematological conditions can be categorised as

Answer 1

malignant or non-malignant.

Non-malignant conditions include conditions that are not cancerous such as coagulopathies and cellular and myeloproliferative disorders.

When discussing malignant haematological conditions, we refer to cancers of the blood, bone marrow and the lymphatic system. A key difference to note is that non-malignant can be autoimmune or inherited whereas malignant is caused by the uncontrolled proliferation of red blood cells throughout their development. However, the non-malignant disorders do have the potential to transform into cancer in the future.

Question 2

There are 3 broad classifications of malignant haematological conditions

Answer 2

Leukaemia – cancer of the bone marrow. Can be acute or chronic. Can be classified as either lymphoid or myeloid.

Lymphoma – diseases that affect the lymphocytes throughout the lymphatic system. Two categories Hodgkin’s lymphoma and non-Hodgkin’s lymphoma.

Myeloma – cancer of the plasma cells. Usually occurs in people over 60 and is more common in men.

Question 3

Non-malignant haematological

Answer 3

Red-cell disorders
Anaemia – 5 different types of anaemia: iron deficiency, pernicious anaemia, aplastic anaemia, haemolytic anaemia, and anaemia of chronic diseases.
Polycythaemia
Thalassaemia
Sickle cell anaemia

White-cell disorders
Leukopenia, leucocytosis

Platelet disorders
Immune Thrombocytopenia
Von Willebrand disease

Hereditary
Haemophilia

Question 4

Risk Factors
Malignant haematological conditions

Answer 4

Environmental factors – exposure to toxins, high levels of radiation

Viruses/diseases - exposure to HIV for example

Previous cancer treatments and immunosuppression – chemotherapy, radiation therapy or immunotherapy

Question 5

Risk Factors
Non-Malignant haematological conditions

Answer 5

Will be dependent on the condition.

Anaemia

Blood loss through trauma, blood vessel rupture, splenic injuries, gastritis, menstrual flow, haemorrhoids.

Decreased RBC production

Increased RBC destruction

Sickle cell disease

Inherited.

Haemochromatosis

Genetic defect

Can be secondary to other conditions

Question 6

Signs and Symptoms
Leukaemia

Answer 6

Tiredness, breathlessness, and pale skin

Fever

Infections that do not clear

Abnormal bruising

A petechial rash

Question 7

Signs and Symptoms
Lymphoma

Answer 7

Swollen lymph nodes

Fevers

Unexplained weight loss

Drenching sweats, especially at night

Fatigue

Generalised itching

Question 8

Signs and Symptoms
Myeloma

Answer 8

Bone plain or bone fracture without obvious cause

Hypercalcaemia

Fatigue

Susceptibility to infection

Anaemia

Kidney impairment/failure

Question 9

Signs and Symptoms
Anaemia

Answer 9

Fatigue

Lack of energy

Palpitations

Dyspnoea

Pallor

Jaundice

Puritis

Question 10

Signs and Symptoms
Sickle Cell Disease

Answer 10

Haemorrhage

Retinal detachment

Heart failure

Priapism

Ulcers on skin

Acute chest syndrome

Pneumonia

Renal failure

Haematuria

Question 11

Signs and Symptoms
Haemochromatosis

Answer 11

Fatigue

Joint pain

Depression

Shortness of breath

High blood sugar

Memory problems

Question 12

Nursing Management
Leukemia and lymphomas

Answer 12

Prevention of infection
→ Hand washing
→ Protective isolation
→ Prophylactic antibiotics and antifungal agents
→ 4-hourly vital signs while neutropenic (or as per hospital polocy and Q-ADDS score)
→ Blood cultures when pyrexial
→ Monitoring for signs of infection
→ Dietary restrictions
→ Patient education

Fatigue/anaemia
→ If anaemic - use blood transfusions and drug therapy.
→ Patient education

Bleeding/thrombocytopenia
→ Platelet transfusion
→ Patient education

Fertility
→ Sperm banking
→ Oocyte/embryo cryopreservation

Psychosocial care
→ Anxiety
→ Education

Nausea/vomiting
→ Antiemtics prior to treatment
→ Nausea control at home
→ Patient education

Hair loss
→ Referral to wig services (if available)
→ Patient education

Sore throat/mouth (mucositis)
→ Monitor for signs of infection
→ Pain management
→ Regular mouth cares
→ Patient education

Question 13

Nursing Management
Myeloma

Answer 13

Spinal cord compression
→ This is regarding as an emergency and requires prompt medical managment.

Pain management
→ Pain assessments
→ Drug therapy, supportive therapies, assistive devices

Maintenance of a safe environment
→ Referals to allied health

Prevention and management of renal failure
→ Fluid balance monitoring
→ Electrolyte assessments
→ Education

Pancytopenia
→ Transfusions for low counts

Infection
→ Administer antibiotic therapy
→ Education

Hypercalcaemia
→ Results from bone desctruction and the reasle of excessive amounts of calcium into the blood.
→ Monitor for signs of confusion
→ Mobilisation reduces the release of calcium

Physiological and psychological support
→ Allied health and input from social workers and psychology teams

Discharge planning
→ Palliative care team involvement
→ Mobility assessments
→ Appropriate supports at home

Question 14

Nursing Management
Anaemia

Answer 14

Care of life-threatening complications such as cardiac failure, dyspnoea and shock.

Diagnosis and monitoring – recognising alterations in base line observations, routine blood tests, prevention of infection.

Administration of medications – preventative medications, blood transfusions, managing side effects of treatment, oxygen therapy

Dyspnoea – positioning, education

Blood transfusions – monitor fluid balance

Tiredness – group activities, support patient

Anxiety and depression

Mucositis – oral hygiene, education

Question 15

Nursing Management
Sickle Cell Disease

Answer 15

Prevention of sequale from disease

Alleviating manifestations from complications

Minimising end-organ damage

Promptly treating serious sequelae.

Question 16

Febrile reactions

Answer 16

• the most common reaction which occurs when antibodies within the person receiving the blood reacts the donors blood cells causing fever and chills. Usually begins after the commencement of the transfusion within 15 minutes and the use of leucocyte-reduced blood avoids further reactions

Question 17

Hypersensitivity reactions

Answer 17

• results when antibodies in a person’s blood reacts against proteins, such as immunoglobulin A in the donor blood.

Question 18

Haemolytic reaction

Answer 18

• the most dangerous transfusion reaction and is usually results from an ABO incompatibility

Question 19

A transfusion of incompatible blood causes

Answer 19

haemolysis (breakdown) of the red blood cells and agglutination of erythrocytes which is clumping of cells that results from their interaction with specific antibodies. If a reaction does occur it is important to stop the infusion.

Question 20

Which of the below abnormalities are most likely to occur in disseminated intravascular coagulation?

1) Esophageal disorders

2) Gastric disorders

3) Duodenal disorders

4) Jejunum disorders

5) Ileum disorders

1 and 3

2 and 4

3 and 5

2 and 5

3 and 4

Answer 20

2 and 5

Question 21

Below laboratory data is obtained from a 14-year-old boy who was admitted to the hospital with several symptoms.

Iron-deficiency anaemia

Thalassaemia

Aplastic anaemia

Megaloblastic anaemia

Answer 21

Aplastic anaemia

Question 22

Deficiency of which of the following blood cells is known to cause a bleeding disorder?

Platelets

Red blood cells

Monocytes

Neutrophils

Lymphocytes

Answer 22

Platelets

Question 23

Are these results suggestive of disseminated intravascular coagulation (DIC)?

Yes due to low platelet count, prolonged PT & PTT, low fibrinogen level indicates decreased platelets and clotting factors in the blood. Positive D-dimer test indicates presence of excessive microthrombi and their breakdown.

No due to low platelet count, high PT and high PTT, low fibrinogen level indicates increased platelets and clotting factors in the blood. Positive D-dimer test indicates no presence of microthrombi.

Answer 23

Yes due to low platelet count, prolonged PT & PTT, low fibrinogen level indicates decreased platelets and clotting factors in the blood. Positive D-dimer test indicates presence of excessive microthrombi and their breakdown.

Question 24

Mrs Hlaing had extensive bleeding and due to her clinical presentation, had a transfusion straight away. What normally would be the two (2) blood tests required for a patient, prior to a having a blood transfusion?

Full blood count

Crossmatch

U&E’s

Group and Hold

Troponin

Blood cultures

Potassium

HbA1c

Answer 24

Crossmatch
Group and Hold

Question 25

Blood pack label and _______are all identical and correct.

Answer 25

Correct: compatibility label

Question 26

The blood pack and ______ details are identical and correct.

Answer 26

Correct answer: patient

Question 27

Patient name- ask them to state/spell their name and clarify their ________.

Answer 27

Correct: DOB

Question 28

______ and time of blood pack (ensure cross-match specimen current).

Answer 28

Correct: expiry date

Question 29

Bag intact. No evidence of tampering or ________.

Answer 29

Correct: leaks

Question 30

No clots of significant differences in ________ between tube segments and blood in bag.

Answer 30

Correct: colouration

Question 31

Ensure all documentation is completed and placed in the patient’s medical record with two nurses checking full printed names and ________.

Answer 31

Correct: signatures

Question 32

Once the blood transfusion commences, you observe Mrs Hlaing for the first 15 minutes of the transfusion and retake her observations which are very similar to the baseline observations. You then leave to attend to another patient.

A few minutes later, Mrs Hlaing’s husband runs to you and tells you to come quickly. When you return, you observe that Mrs Hlaing has started to shiver, and she is moaning and clutching her head with her hands.

From the list below, what are the four (4) cues you need to collect immediately?

Respiratory rate

Pain score

level of consciousness

skin colour

temperature

pulse rate

blood pressure

condition of the wound

Answer 32

Respiratory rate
temperature

pulse rate

blood pressure

Question 33

If someone’s blood type is O and they have the RhD factor on the membrane of their red cells, their blood group is O+ve. What 2 (two) blood groups are suitable for a transfusion for this person?

O+ve

A+ve

B+ve

AB+ve

O-ve

A-ve

B-ve

AB-ve

Answer 33

O-ve
O+ve

Question 34

How often, or for how long, should blood transfusion observations be attended?

During the transfusion of each unit according to hospital policy

15 minutes after the transfusion commences

Before the start of each unit of blood commences

When the transfusion is complete

All of the above

Answer 34

All of the above

Question 35

In Seminar 2, case study 2, Mary visits her GP due to a complaint of generalised weakness, lethargy, and occasional light-headedness, leg cramping and palpitations.

If Mary’s blood indices, mean corpuscular volume (MCH) and mean corpuscular haemoglobin concentration (MCHC) are lower than normal, then what type of anaemia is Mary most likely suffering from?

Megaloblastic anaemia

Aplastic anaemia

Haemolytic anaemia

Iron-deficiency anaemia

Answer 35

Iron-deficiency anaemia

Question 36

If Mary’s blood indices, MCV is high and MCHC is normal, identify the type of anaemia in Mary.

Megaloblastic anemia

Aplastic anaemia

Haemolytic anaemia

Iron-deficiency anaemia

Answer 36

Megaloblastic anemia

Question 37

You are ready to give a blood transfusion and go and get the blood from pathology. How long have you got to give this blood from the time it leaves the blood fridge?

15 minutes

1 hour

30 minutes

45 minutes

2 hours

20 minutes

Answer 37

30 minutes

Question 38

If a transfusion reaction is suspected, choose below, the six (6) actions you would take.

Don’t stop the transfusion however get help

Clamp the blood and unclamp the saline to KVO

Check vital signs

Check temperature only

KVO with saline using a new giving set

Don’t notify pathology, it doesn’t involve them

Collect a stool sample

Notify pathology

Save urine passed by the patient

Stop transfusion immediately

Send the patient for an x-ray

Urgent medical review or MET call if required

Answer 38

Check vital signs
KVO with saline using a new giving set
Notify pathology
Save urine passed by the patient
Stop transfusion immediately
Urgent medical review or MET call if required

Question 39

T/F
Von Willebrand factor (VWF) is a coagulation protein?

Answer 39

True