NP Certification

• - Cause is unknown, may have viral etiology
• - Often presents with lymphadenopathy
• -Most common neoplasm between ages 20 and 40
• -Classified as low, intermediate or high-grade based on histologic type
• - less predictable pattern of spread than Hodgkin's disease
• - Advanced stage disease is usually apparent

• - Cause is unknown
• - More common in males, avarage age is 32
• - Usually presents with cervical adenopathby and spreads in a predicatable fashion amond lymph node groups
• -Characteristic Reed-STernberg cells differentiate from non-Hodgkin's disease

• 1. CT, x-rays, ultrasonography, MRI used to locate and stage the disease
• 1. Biopsy, histopathologic examination confirms diagnosis
• Management:
• 1. Radiation
• 2. Chemotherapy
• 3. Bone marrow transplantation

• Signs/smyptoms: may be asymptomatic
• - Fatigue
• - Weakness
• -anorexia
• -generalized lymphadeopathy
• - weight loss
• Laboratory/diagnostics:
• 1. CBC with subnormal RBCs and neutrophils
• 2. Elevated sedimentation rate
• 3. Peripheral blood smear usually distinguishes acute and chronic leukemia, but a bone marrow aspiration is required to confirm the diagnosis

• - constitues 80% of acute leukemias in adults
• -Remission rates from 50 to 85%
• - Long term survival 40%

• - More difficult to cure in adults taht children (90% remission rate in children)
• - Pancytopenia with circulating blasts (hallmark of disease)

• - Most common leukemia in adults
• - Occurs in both middle and old age
• -Median survival is 10 years
• - Lymphcytosis (hallmark of disease)

• - Occurs most often in persons aged 40 and older
• - Median survival is 3 to 4 years
• - Phidadelphia chromosome seen in leukemic cells (hallmark of disease)

• Normal: 14-18 in males
• 12-16 in females

• Measures of % of a given volume of whole blood that is occupied by erythrocytes; the amount of plasma to total RBC
• Normal: 40-54 in males
• 37-47 in females

250-450 ug/dl

50-150

• Expression of the average volume and size of individual erythrocytes
• Normal 80-100
• (Microcytic <80, normocytic 80-100, macrocytic >100)

• expression of the average amount and weight of Hgb contaned in a single erythrocyte
• Normal 26-34

• Expression of the average Hgb concentration or proportion of each RBC occupied by Hgb as a percentage. More accurate measure than MCH
• Normal 32-36

• Iron Deficiency anemia
• Thalassemia

B12 deficiency, folate deficiency, alcoholism, liver failurea nd drug effects

Anemia of chronic disease, sickle cell disease, renal failure, blood loss and hemolysis

• - In adults, is usually chronic, causing mild to severe thrombocytopenia
• - Only occasionally patients develop bleeding that requires hospitalization
• _ Women outnumber men in incidence by a ration of 3:1
• Laboratory:
• - bone marrow analysis
• - Low Platelet count with other causes of thrombocytopenia ruled out. Hystory of easy bruising or bleeding

• Management
• - May not be necessary until the platelet count is <20,000
• - High dose corticosteroids may help to elevate the platelet count within 2-3 days
• - IV gamma globulin usually produces a responce within 2-3 sYA
• - gamma globulin is preferred to steroids in HIV -related ITP
• -Platelet transfusion may occasionally benefit
• - Thrombocytopenic precautions:
• - avoid constipation (increase fiber, laxatives)
• - no flossing, no shaving
• - hold pressure for 5 minutes or more for cuts, line incertion, ets.
• - Heparin - induced thrombocytopenia purpura (HIT)
• - Argartoban
• Lepirudin

DIC results from the intravascular activation of both the coagulation and fibrinolytic systems (thrombin and plasmin are acitvated), causing simultaneous thrombosis and hemorrhage. Mortality rate is 50-85%

• - Malignant neoplasms
• - infection/sepsis
• -liver disease
• -massive trauma
• - extensive burns
• - Shocks
• - Obstetrical complications
• - Acute Leukemia

• - Thrombin causes conversion of fibrinogen to fibrin, producing fibrin clots int the microcoagulatio
• - coagulation factors (fibrinogen, prothrombin, platelets, factors V and VIII) are thus reduced
• _Circulating thrombin activates the fibrinolytic system which lyses fibrin clotes into fibrin degradation products (FDPs)
• - Hemorrhage results from the anticoagulatn activity of FDPs and the depletion of coagulation factors)

• - varies greatly in clinical severity (bleeding vs thrombosis)
• - Profound dissturbances in hemostasis with ecchymosis, oozing from venipunctures sites, petechiae to mucous membranes

• 1. Thrombocytopenia (platelets <150,000)
• 2. Hypofibrinogemia (fibrinogen <170)
• 3. Decreased RBCs
• 4. Increased fibrin degradation products (FDPs) (>45 mcg/ml or present at .1:100 dilution)
• 5. Prolonged PT(>19 sec)
• 6. Prolonged PTT (>42 seconds)
• D-Dimer reflects simultaneous activation of thrombin and plasmin
• With increased FKPs, gives a predictive accuracy of 96% for diagnosing DIC

• 1. Goal: treat the underlying condition and control bleeding
• 2. Platelet transfusion for thrombocytopenia, FFP to replace clotting factors, and cryoprecipitate to naintain fibrongen levels are given if bleeding is severe
• 3. The use of heparin to decrease thrombin generation remains controversial.
• 4. consider: antithrombin
• Drotrecogin alfa-activated (Xigris) 24 mcg/kb/hr IV continous
• After all therapeutic agents fail, antifibrinolytics such as amicar or tranexamic acid
• 5. Therapy is aimed at cessation fo bleeding, increasing plasma fibriogen and the platelet count, and decreasing FDPs