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Flashcards in Exam 3 Hematology Deck (44):
1

Disorders of Blood Cell Amount or Volume (2)

Iron Deficiency Anemia
Aplastic Anemia

2

Iron Deficiency Anemia =

Is it preventable/reversible?
Not a disease of?

= decreased amount of rbc's, bone marrow produces smaller rbc's bc contains less iron

Yes
Malnutrition- child can still be big

3

Causes of Iron Deficiency Anemia (3)

- Caused by diet insufficiency in iron "white food" (pasta, milk bread)
- Vegetarian
- From formula -> cow's milk (Ca interferes with absorption of iron, also makes you full easily)

4

S/S of Iron Deficiency Anemia (3)

- Pallor (inside eye is pale/pink instead of dark pink/red)
- Weakness/Fatigue
- Altered CBC: Decreased Rbc's, H/H, reticulocyte count

5

Prevention/Teaching for Iron Deficiency Anemia
1) Breast feed/iron fortified milk until __ months
2) Iron fortified food intro at ___ months
3) Limit ___ milk to __-__ oz/day
4) ____ diet through _____

1) 6 months
2) 6 months
3) Cow's milk, 16-24 oz/day
4) Varied, Adulthood

6

Supplementation for iron deficiency anemia
- Give in ____ doses, on an ___ stomach
- Give with? why?
- Can ____ teeth, so educate to?

When do we do transfusions?

- divided doses bc can cause upset stomach, empty
- Vitamin C (orange juice) to help with absorption
- stain -> good oral hygiene

Only in extreme situations, or pt has cardiac compromise

7

Aplastic Anemia =

It causes *

= Abnormality of bone marrow stem cells

Pancytopenia* = decreased wbc's, rbc's, platelets

8

Causes of Aplastic Anemia (3)

1) Autoimmune Disorders
2) Infectious Processes (viral hepatitis)
3) Radiation

9

S/S of Aplastic Anemia (3)

1) Anemia
- weakness, fatigue, pallor
2) Leukopenia
- Fever, frequent infections
3) Thrombocytopenia
- abnormal bleeding

10

Aplastic Anemia Prevention and Teaching
1) _____ _____ to cause
2) Keep ____ away by (2)

1) Prevent exposure
2) Infections (wash hands, immunizations)

11

Tx for Aplastic Anemia
- Transfusion ->
- Cure =

- Replaces but does not cure
- Bone marrow transplant - find donor

12

Coagulopathy Abnormalities (3)

Immune Thrombocytopenia
Hemophilia
Von Willebrand's Disease

13

Immune Thrombocytopenia =

= Decreased # of platelets from decreased production, shorter lifespan dt immune mediated response -> antibodies cause platelet breakdown

14

Immune Thrombocytopenia
- Tx only if?
- Is it life threatening?
- S/S (2)

- Only if significant bleeding
- No, around 6 months, then goes away
- petachiae, purpura (don't blanch)

15

Hemophilia =

= missing a clotting factor which participates in the clotting cascade -> inability to clot

16

Cause of Hemophilia = *

Recessive, X linked (greater in males)

17

Two types of Hemophilia

Hemophilia A = factor VIII deficiency
Hemophilia B = factor IX deficiency

18

Hemophilia may be
- Mild =
- Severe =

- May go undiagnosed for awhile
- Bleeding in joint, can occur after trauma

19

Von Willebrand's Disease =

-Factor _____ carrier protein and ____ abnormalities cause changes in _____

= Genetic Disorder with missing/abnormal Von Willebrand factor (VIII)

- VIII, platelet, clotting

20

Causes of Von Willebrand's Disease (2)

Autosomal Dominant or Autosomal Recessive

21

S/S of Decreased Clotting
1) Epistaxis =
2) _____ bleeding when (2)
3) ____ menses (1)
4) _____ pain dt -> esp in _____ (3)

Increased Abnormal Bleeding
1) Nose bleeds
2) Gingival bleeding when brushing teeth, dental procedure
3) Heavy, # of pads, tampons
4) Joint pain dt swelling of blood in joints (ankles, knees, elbows)

22

Decreased Clotting Nursing Interventions Teaching (3)


Transfusions =


- Medical Alert Bracelet
- Signs of decreased platelets
- Sneeze with mouth open (less chance of blood vessels bursting)

- as needed

23

Acute Injury Nursing Interventions (4)


- Apply constant pressure
- elevate extremity above heart ( to prevent pooling)
- cool compress (to vasoconstrict to stop bleeding)
- avoid moving injured area

24

Tx for Von Willebrand's Disease (2)*

- Factor VIII or IV administration
- Desmopressin (synthetic vasopressin) = stimulates release of Von Willebrand factor

25

Disorders of Blood Cell Function or Anatomy (3)

Thalassemia
Hereditary Spherocytosis
Sickle Cell Disease

26

Thalassemia =

A ____ illness
Highest in what races?

= anemia of varying severity d/t abnormally formed hemoglobin

Hereditary
Asian Americans, Mediterranean

27

Minor (_____) Thalassemia =
S/S (2)

= (Dominant) one copy of thalassemia gene and one normal gene

- May have no signs
- May resemble iron deficiency anemia

28

Major (____) Thalassemia =
S/S


- diagnosis around _ months

= (minor) two copies of thalassemia gene
PIGH
- Pallor
- Irritability
- Growth Retardation - may have bone expansion to compensate to produce more rbc's
- Hepatosplenomegaly - spleen works hard to remove damaged blood

6

29

Preventing infection for all coagulopathy abnormalities (3)

- Wash Hands
- Penicillin
- Vaccinations

30

Tx for Thalassemia (3)

1) Transfusions
2) Splenectomy
3) Iron Chelation Therapy

31

Transfusions for Thalassemia - every __-__ weeks with __-__ units of blood for how long?*

3-5 wk, 1-3 units, lifelong*

32

Thalassemia
1) Splenectomy = ____ old blood and if its is overrun may cause _____
2) Why Iron chelation?

1) = filters, splenomegaly
2) bc so much transfusion, iron is very toxic to organs

33

Sickle Cell Disease = *

= Change in genetic make-up causing sickling of RBC's , hemoglobin molecule is altered with one change to amino acid 6*

34

Cause of Sickle Cell Disease*

Highest in what ethnicities?

Autosomal Recessive*

African American, Mediterranean

35

S/S of Sickle Cell Disease (3)*

1) Acute Sequestration Crisis
2) Vaso-occlusive Crisis
3) Aplastic Crisis

36

Acute Sequestration Crisis =

- damaged/sickle cells ____ easily in spleen

= blood pools in the spleen causing blood volume loss and shock

- pool

37

Vaso-occlusive Crisis =

- ____ d/t abnormal shape -> ____ of vasculature -> altered peripheral _____, tissue ____
- Severe ____**! ____ in hands/ft, _____ disturbances, damage to _____

= stressors cause RBC's to sickle

- clumping, blockage, perfusion, hypoxia,
- PAIN*, Swelling, Visual, organs

Note: pain triggered by stressors (fatigue, stress) -> typicall on PCA pumps to manage pain

38

Aplastic Crisis =

= Fighting an infection can cause profound anemia; ABRUPT AND LIFE THREATENING!

39

Sickle Cell Teaching
How to increase RBC's (3)*

1) Folic Acid daily
2) Hydroxuria = chemo drug that activates fetal hemoglobin production, so they can be dependent on that rather than sickled RBC's
3) Water!*

40

Treatment for Vaso-occlusive crisis in Sickle Cell Disease
1) treat ____ that led to crisis
2) Administer _____ _____
3) ____ as ordered ->
4) ___ meds, as ordered,
5) _____ for patient

1) infection
2) IV fluids*
3) Oxygen -> prevents further sickling
4) Pain
5) Advocate

41

Tx for Sickle Cell Disease (2)

- Transfusions
- Splenectomy

42

Hereditary Spherocytosis =

Cause = ____ illness, autosomal _____
Spleen ___ RBC's ->

= RBC's become sphere shaped dt loss of RBC membrane protein, unable to bind to oxygen correctly

Hereditary, Dominant
Destroys -> splenomegaly d/t difficulty RBCs passing through spleen

43

S/S of Hereditary Spherocytosis (3)

1) Anemia
2) Jaundice - d/t hemolytic anemia process, bilirubin (broken down rbc's) released
3) Splenomegaly

44

Tx for Spherocytosis (2)

1) Transfusion w severe cases
2) Splenectomy