Hematology Disorders

  1. Causes of blood loss?
    • Acute hemorrhage 250cc loss=decrease in Hgb by 1pt and Hct by 3 pt. GI bleeding is the most common cause of this.
    • chronic bleed-Heavy menses, slow bleeds from GI/ulcers/hemorrhoids.
    • Dilution decrease-IV fluid overload/ pregnancy
  2. S&S of Anemia (Reduction of Hgb, RBC, Hct%)
    • Integumentary: Pallor, Peripheral cyanosis,
    • CV: Paraesthesia, Cx pain, arrhythmias, cold hands and feet, petechiae.
    • Resp: SOB, perioral cyanosis a possibility, malaise.
    • Neuro: Dizziness, Headache
  3. PRBC Indication?
    Anemia/ blood loss due to surgery or trauma
  4. Platelets Indication?
    thrombocytopenia with symptoms
  5. Fresh Frozen Plasma (FFP) indications?
    Deficiency of clotting factor
  6. Cryoprecipitate (factor VIII or IX) indications?
    Hereditary hemophilia
  7. Albumin indications?
    • Expand plasma volume (provides oncotic pressure)
    • temporary replacement for kidney or liver disease.
  8. Risk factors for blood transfusion
    • Circulatory overload
    • iron overload
    • sensitivity to foreign antibodies
    • blood borne disease such as HIV, Hep, West nile, Chagas disease...anything living in blood potentially.
  9. Circulatory overload S&S? and Treatments.
    • S&S of HF will be the same.
    • Treatments: Lasix, infusion of blood over 2-4 hours, monitor vitals to check for increase in BP, bounding pulse, JVD, dyspnea (HF-S&S), morphine is also considered for pulmonary edema, O2, positioning for fluid balance.
  10. Blood type is based on?
    the Antigen
  11. Febrile, non hemolytic reaction?
    • develops usually after multiple transfusion-reaction to donors WBC.
    • S&S: —chills, tachycardia, fever, hypo-tension, tachypnea
    • Can use leukocyte filters on IV line, treat symptoms of fever-tylenol
  12. Alternatives to blood transfusion?
    —EPO, Epogen, Procrit  [erythropoietin]  + iron + vitamin C stimulate RBC production.
  13. Platelet transfusions?
    • 5 day shelf life
    • expensive, 4-6 donations= one unit for a patient with thrombocytopenia-not ABO dependent, but ccan become sensitized to platelet antigens of transfused blood, platelet antibodies.
  14. FFP transfusion?
    • One year shelf life
    • Used sometimes to reverse High INR-coumadin. those that need clotting factor/ shocks/burns
  15. Albumin transfusion?
    • Stable for 3 years
    • given for hypovolemic shock
  16. Cryoprecipitate factors VIII and IX
    Factor VIII concentrates(recombinant technique), and fresh frozen plasma are also given.
    Von williebrand disease/hemophillia.
  17. TIBC=Total Iron Binding capacity?
    • Normal: 250-450 mcg/dl 
    • Serum Transferrin: 200-430mg/ dl and is responsible for transporting iron to the bone marrow for the purpose of hemoglobin synthesis.
    • High value (TIBC) indicates an iron deficiency.
    • Iron and stored form of ferritin are essential for RBC creation.
  18. Serum Iron?
    • Normal 50-150 mcg/dl
    • Lack of iron leads to anemia
  19. WBC count?
    4,500-10,000 uL (mm^3)
  20. What makes up 95% of a RBC?
    • Hemoglobin Which is predominately made of iron which carries O2.
    • Globin=protein carries the CO2
  21. Erythropoietin ?
    hormone produced by kidneys-stimulates bone marrow to produce more RBC.
  22. Thrombopoietin ?
    stimulates production of platelets and is created in the liver, kidneys, and stromal cells of bone marrow.
  23. Essential components of RBC?
    Iron, Folic acid, and B12
  24. Dietary sources of Iron?
    Leafy greens/Meat, OJ can double the absorption from the meal.
  25. Dietary source of Folic acid?
    Green leafy vegetables, legumes, beets, citrus fruits, fortified grains, sweet potatoes.
  26. Dietary source of B12?
    synthesized by GI bacteria, obtained from milk, meat, eggs, and yeast.
  27. H/H? Range for male and female?
    • Hgb:
    • Male: 13.5-18g/Dl 
    • Female: 12-15g/Dl
    • Hct:
    • Male: 40-54% 
    • Female: 36-46%

    Hct should be 3 times the Hgb
  28. MCV? 
    Mean Corpuscular Volume=RBC size
    Most useful lab for diagnosing anemias.
    • Measures average volume of RBC
    • (80-98 um^3) 
    • Low value indicates iron deficiency anemia. (chronic blood loss, cancers of GI)
    • High value indicates B12 deficiency anemia ( pernicious/ folic acid)

    MCV: Hct x10/RBC count
  29. MCH?
    Mean Corpuscular Hemoglobin
    Weight of Hgb in RBC regardless of size.
    • 27-31 pg-picogram
    • Macrocytic cells have increase in MCH
    • Microcytic cells have decrease in MCH

    • Bigger is Better?
    • MCH: Hgb x10/ RBC count
  30. MCHC?
    Mean Corpuscular Hemoglobin Concentration
    Hgb concentration
    • 32-36%% (0.32-0.36 g/dL)
    • High value: indicates higher concentration of Hgb in RBC.
    • Low value: low concentration of hgb in rbc(hypochromic-anemias where the RBC is more pale than normal)
  31. Anemia is a?
    Symptom caused by a loss of blood, decrease in production of RBC or increase in destruction of RBC.
  32. What causes a decrease in RBC production?
    • Lack of Fe-Iron, B12=cyanocobalamins, Folic acid-B vitamin.
    • Bone marrow damage-chemotherapy, aplastic anemia.
    • Decreased erythropoietin production
    • Hypothyroidism
    • defective Hgh synthesis-thalassemia, SCA-sickle cell anemia.
  33. What causes an increased destruction of RBC?
    • Hereditary disease: SCA,Thalassemia-defect in creating Hgb.
    • Autoimmune: lupus
    • Cancer: leukemia, lymphomas
    • Acquired destruction: Blood transfusion, drug reactions, Dialysis
    • Trauma
    • Burns
  34. Whole Blood transfusion?
    used mainly in traumas or surgery with large amounts of blood loss. Provides everything, but WBC are normally filtered out to prevent reactions.
  35. Blood type matching?
    A+, A-, O+, O-

  36. Blood type matching?
    A-, O-

    REACTION: B, + 
  37. Blood type matching?
    B+, B-, O+, O-

  38. Blood type matching?
    A +/-, B +/-. O+/-

    REACTION: None
  39. Blood type matching?

    REACTION: A and B
  40. Blood type matching?
    B-, O-

    REACTION: A, +
  41. Blood type matching?
    A-, B-, AB-, O-

    REACTION: (Rh+)=+ blood type
  42. Blood type matching?

    REACTION: A, B, +
  43. Rh typing? info?
    Rh (positive) indicates an antigen is present on RBC.

    —To prevent Rh antibodies (fetus with an Rh-positive blood group), the Rh – woman is given Rho(D) immune globulin (RhoGAM) to neutralize any antibodies.
  44. Universal donor of blood?
  45. Universal recipient of blood?
  46. Blood donor restrictions?
    Common sense (healthy blood)
  47. RDW=size differences?
    • 11.5-14.5%
    • high value indicates the more abnormal the RBC. 
    • High RDW= early factor deficiency (iron, folate B9, B12), Hemolysis(RBC fragmentation), SCA, SC-trait.
  48. Platelet count?
    • 150,000-400,000 uL
    • 0.15-0.4 x 10^12/L (SI units)

    A decrease in circulating platelets of less than 50% of normal value will cause bleeding: if the decrease is severe (<50,000 uL) hemorrhaging might occur.
  49. aPTT=activated partial thromboplastin time, info?
    • Used for monitoring Heparin therapy
    • Measures how long blood takes to clot
    • Reflects VIII,IX,XI,XII
    • Normal value without therapy: 25-35 sec
    • Heparin therapy value: 2x normal value (50-70) sec

    Antidote for Heparin: Protamine Sulfate
  50. PT=Prothrombin time, Info?
    • Used for monitoring Warfarin (coumadin) therapy
    • Measures how long blood takes to clot
    • Reflects II, V, VII, X
    • Normal value without therapy: 10-13 sec
    • Warfarin therapy value: 1.5x normal value (15-19.5) sec

    Antidote for Warfarin: Vitamin K
  51. INR=International normalized ratio, Info?
    • Used to monitor Warfarin (coumadin)
    • Normal value without therapy: <2 sec
    • Pt. with venous thrombosis (DVT), PE, Valvular heart: anticoagulant therapy: 2.0-3.0 is ideal
    • Mechanical heart valve replacement: 2.5-3.5 is ideal.
  52. Where are blood clotting factors made?
  53. RBC count for men and women?
    • Men: 4.6 million/uL-6.0 million/ul
    • Women: 4.0-5.0 million/ul
  54. Neutrophils? Range?
    • Associated with bacterial infections
    • 50-70%
    • 2,500-7,000 uL (mm^3)
  55. Eosinophils? range?
    • act against infestation of parasitic larvae and increased in allergic reactions, think: Drug allergies
    • 1-3%
    • 100-300 uL (mm^3)
  56. Basopils? range?
    contains granules with chemical that act upon blood vessels (◦Heparin, histamine, serotonin, kinins, & leukotrienes)-manifestation of inflammation. 

    • 0.4-1.0%
    • 40-100 uL (mm^3)
  57. Lymphocytes? range?
    • Increased number associated with viral infections and  lymphoid leukemia. 
    • 25-35%
    • 1,700-3,500 uL (mm^3)
  58. Monocytes? range?
    • Phagocytes-bacteria and debris
    • 4-6%
    • 40-100 uL (mm^3)
  59. Blood type of an individual depends on the type of?
    Antigen on the RBC membrane
  60. Iron deficiency anemia causes?
    cancer of: stomach, small/large intestine, rectum breast; rheumatoid arthritis; bleeding peptic ulcer; chronic renal failure; pregnancy; protein malnutrition, chronic blood loss
  61. Increased in serum iron levels?
    liver damage, thalassemia, lead toxicity, hemochromatosis(body retains iron (genetic)), anemias ( hemolytic, pernicious(body can't absorb B12) and folic acid deficiency).
  62. transferrin saturation?
    • Male: 30-50%
    • Female: 20-35%
    • High values: Iron therapy over load
    • Low Values: Iron deficieny
  63. Reason for decreased RBC counts?
    Hemorrhage, anemias, chronic infections, leukemias, multiple myeloma, overhydration, chronic renal failure, pregnancy (dilution-50% increase in blood).
  64. Reason for increased RBC count?
    Polycythemia vera, hemoconcentration-dehydration, high altitude-erythropoietin production increases-lasts for up to 10-15 days at sea level, cor pulmonale, cardiovascular disease.
  65. Reasons for increased PT level?
    • Liver diseases, Clotting factor deficiencies, leukemias, HF.
    • Drugs: Antibiotics, Anticoagulants....:p
  66. Reasons for Decreased PT level?
    • thrombophlebitis, MI, PE
    • Drugs: Barbiturates, digitalis prepartions, diuretics, diphenhydramine (benadryl), oral contraceptives, rifampin, Vitamin K
  67. Reasons for increased APTT levels?
    Similar to PT levels: Factor deficiencies, Von williebrands disease (vascular hemophilia), liver disease.
  68. Reasons for decreased APTT levels?
    Extensive cancers that can trigger inflammatory responses or increase clotting.
  69. Reticulocyte range?
    • 0.5-1.5% of all RBCs
    • 25,000-75,000 uL

    Indicator for bone marrow activity
  70. Bone Marrow?
    • Red and Yellow marrow
    • Red=RBC
    • Yellow=Fat cells and connective tissue
  71. leukemias?
    • malignancy of bone marrow cells
    • Acute or chronic
    • myleocytic vs lymphocytic
  72. B-cells?
    Memory cells-recognize foreign  cells and develop antibodies.
  73. T-cells?
    secrete lymphokines that enhance immune function-tell specific cells how to respond, control inflammatory and immune response.
  74. Leukocytosis? info?
    • elevation of WBC
    • Differential determines need for antibiotics.
    • Depending on which WBC is elevated? 

    • Neutrophils=bacteria
    • Lymphocytes= virus
    • Have to rule out other diagnosis-cancers? 
  75. Leukopenia? info?
    • Decreased number of WBC
    • Neutropenia: decreased # of neutrophils which can lead to life threatening sepsis Absolute granulocyte count=Neutrophils + Bands=Less than 1000 needs neutropenic percautions. 
  76. Neutropenia? Info?
    • Decreased # of Neutrophils
    • Normal flora can lead to infections.
  77. Lymphoma? info?
    lymphocytes undergo malignant changes and produce tumors in lymphoid tissues-Hodgkin/ non-hodgkin
  78. Leukemia types?
    • AML: acute myeloid  leukemia: most common in adults
    • ALL: acute lymphoid leukemia: most common in children Best chance for remission and cure

    Chronic forms are treated, but there is no cure
  79. S&S of leukemia?
    ◦S/S: fatigue & pallor, fever, fracture, petechiae, hematuria

    • Decreased Hgb, RBC, cytokines from immune system cause fever, chills, malaise.
    • Petechiae-bleeding through capillaries.
  80. Hematuria?
    Low platelet count can cause bleeding into the tubules of kidneys
  81. Nursing care plan for neutropenia-cancers.
    • Management
    • Blood transfusions◦
    • Low-microbial diet◦
    • Septra prophylaxis for Pneum-Carinii◦
    • Nystatin for antifungal
    • ◦Vancomycin for antibacterial◦
    • Protect from bruising◦
    • Careful handwashing!!!
  82. D dimer test?
    Used to check for blood clotting problems. normally done after a thrombi has been broken up by fibrinolysis.
Card Set
Hematology Disorders