Week 8 Haematology Flashcards
This week covers Hematological conditions along with introducing you to Blood products and transfusions and all of the elements involved with administration
Haematological conditions can be categorised as
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.
There are 3 broad classifications of malignant haematological conditions
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.
Non-malignant haematological
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
Risk Factors
Malignant haematological conditions
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
Risk Factors
Non-Malignant haematological conditions
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
Signs and Symptoms
Leukaemia
Tiredness, breathlessness, and pale skin
Fever
Infections that do not clear
Abnormal bruising
A petechial rash
Signs and Symptoms
Lymphoma
Swollen lymph nodes
Fevers
Unexplained weight loss
Drenching sweats, especially at night
Fatigue
Generalised itching
Signs and Symptoms
Myeloma
Bone plain or bone fracture without obvious cause
Hypercalcaemia
Fatigue
Susceptibility to infection
Anaemia
Kidney impairment/failure
Signs and Symptoms
Anaemia
Fatigue
Lack of energy
Palpitations
Dyspnoea
Pallor
Jaundice
Puritis
Signs and Symptoms
Sickle Cell Disease
Haemorrhage
Retinal detachment
Heart failure
Priapism
Ulcers on skin
Acute chest syndrome
Pneumonia
Renal failure
Haematuria
Signs and Symptoms
Haemochromatosis
Fatigue
Joint pain
Depression
Shortness of breath
High blood sugar
Memory problems
Nursing Management
Leukemia and lymphomas
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
Nursing Management
Myeloma
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
Nursing Management
Anaemia
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
Nursing Management
Sickle Cell Disease
Prevention of sequale from disease
Alleviating manifestations from complications
Minimising end-organ damage
Promptly treating serious sequelae.
Febrile reactions
- 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
Hypersensitivity reactions
- results when antibodies in a person’s blood reacts against proteins, such as immunoglobulin A in the donor blood.
Haemolytic reaction
- the most dangerous transfusion reaction and is usually results from an ABO incompatibility
A transfusion of incompatible blood causes
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.
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
2 and 5
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
Aplastic anaemia
Deficiency of which of the following blood cells is known to cause a bleeding disorder?
Platelets
Red blood cells
Monocytes
Neutrophils
Lymphocytes
Platelets
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.
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.
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
Crossmatch
Group and Hold
Blood pack label and _______are all identical and correct.
Correct: compatibility label
The blood pack and ______ details are identical and correct.
Correct answer: patient
Patient name- ask them to state/spell their name and clarify their ________.
Correct: DOB
______ and time of blood pack (ensure cross-match specimen current).
Correct: expiry date
Bag intact. No evidence of tampering or ________.
Correct: leaks
No clots of significant differences in ________ between tube segments and blood in bag.
Correct: colouration
Ensure all documentation is completed and placed in the patient’s medical record with two nurses checking full printed names and ________.
Correct: signatures
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
Respiratory rate
temperature
pulse rate
blood pressure
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
O-ve
O+ve
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
All of the above
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
Iron-deficiency anaemia
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
Megaloblastic anemia
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
30 minutes
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
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
T/F
Von Willebrand factor (VWF) is a coagulation protein?
True
