Hematological system Flashcards
1
Q
Bone marrow biopsy
A
coring out an area of bone marrow with a large-bore needle ; iliac crest ( sternum ) ; anesthesia or sedation ; apply pressure; observe ! 24 hrs - bleeding & infection; analgesic ( aspirin free) ; ice packs
2
Q
Bence-Jones Protein
A
urine test; single sample or 24 hrs urine collection; positive 75 % pts with multiple myeloma + neoplasms affecting bone, blood, lymphatic system
3
Q
Schilling’s test
A
to determine vitamin B12 absorption ; pernicious anemia = Stage 1 abnormal + stage 2 normal ; Malabsorption = both stages abnormal ; NPO ( 8-12) - oral B12 - 1-2 hrs later IM B12 - Eat and drink + 24 hrs urine collection
4
Q
RBC count - Men & Women
A
M 4.7-6.1
W 4.2-5.4
5
Q
Reticulocyte count
A
immature RBCs - reflects bone marrow activity
6
Q
Hemoglobin - M & W
A
M 13.5-18 gm/dL
W 12-16 gm/dL
gas carrying capacity of RBCs ; below 6 gm/dL - severe
7
Q
Hematocrit - M & W - RBCs as %
A
M 40-54 %
W - 38-47 %
8
Q
WBC differential
A
5000 - 10000 mm3
9
Q
Platelet count - thrombocytes
A
150000-400000
10
Q
Coombs test - Direct vs Indirect
A
- Direct - used to detect antibodies that are stuck to the surface of red blood cells. These antibodies sometimes destroy red blood cells and cause anemia.
- Indirect - looks for free-flowing antibodies against certain red blood cells. It is is most often done to determine if you may have a reaction to a blood transfusion.
11
Q
Bilirubin
A
increased with hemolytic problems; reflects liver function
12
Q
PT
A
11-12.5 seconds
13
Q
aPTT
A
30-40 seconds ; therapeutic 1.5-2.5 x control
14
Q
Therapeutic INR
A
2-3.5
15
Q
Disseminated Intravascular Coagulation - DIC
A
complication of another disorder : diffuse clotting + hemorrhage
s/s: ecchymosis, petechiae, purpura fulminans
16
Q
Triggers for DIC
A
- Massive trauma
- Shock
- Sepsis or infection - gram negative; meningococcal
- Acute promyelocytic leukemia
- Metastatic cancers
- Obstetrical emergency
- Transfusion reaction
- Severe liver disease
17
Q
DIC - pathophysiology
A
Underlying disorder - Interleukins and TNF ( tumor necrosis factors) - Systemic activation of coagulation -
- widespread intravascular fibrin deposition - thrombosis and organ failure
- consumption of platelets and clotting factors - severe bleeding
18
Q
DIC - complications
A
- Renal failure
- Gangrene
- PE
- Hemorrhage
- CVA
- ARDS
- MODS
- Death
19
Q
DIC - elevated labs
A
- PT/INR
- aPTT
- FSP ( fibrin split products ); FDP ( fibrin degradation products); D-dimer
20
Q
DIC - decreased labs
A
- Platelet count
2. Fibrinogen level
21
Q
Fibrinogen
A
is a protein produced by the liver. This protein helps stop bleeding by helping blood clots to form
22
Q
DIC: TX
A
- Supportive care
- Blood products - platelets, fresh frozen plasma, cryoprecipitate ( replace fibrinogen)
- Heparin therapy (prevent more clots)
- Epsilon-aminocaproic acid ( inhibitor of fibrinolysis) or Activated protein C
23
Q
Activated protein C
A
enzyme that helps prevent inappropriate clot formation; its activated when it binds to healthy endothelial cells - injured ( sepsis …) - cannot activate protein C - clots are formed
24
Q
Leukemia - acute or chronic - myelogenous or lymphocytic
A
- Increase in immature non-functional WBCs - blasts
- Decrease in mature, healthy WBCs, RBCs and platelets
- stem cells - bone marrow problem
25
Philadelphia chromosome - chromosome analysis
1. major feature - CML
| 2. hallmark ALL
26
Leukemia S/s
1. early - none
2. Fever, generalized bone pain
3. Infections, weigh loss + anorexia
4. S/s of anemia and thrombocytopenia
27
"7 plus 3" - cytosine arabinoside + daunorubicin
Tx acute leukemia - severe bone marrow suppression - induction therapy
28
TX acute leukemia -
| SE - Infection + Bleeding
1. Induction
2, Consolidation - cure
3. Maintenance - 2-5 years
29
Imatinib mesylate (Gleevec) - SE
CML+ Philadelphia chromosome
SE - N/V - take with meal + large glass of water
No grapefruit juice
Muscle cramps - may need Ca
Increase risk for bleeding, diarrhea, rash, fluid retention
30
Hematopoietic Stem Cell Transplantation - Bone marrow transplant - Indications
1. for leukemia patients in remission after induction therapy that have closed matched donor
2. lymphoma
3. multiple myeloma
4. aplastic anemia
5. sickle cell disease and many solid tumors
31
Human leukocyte antigen - HLA
matched stem cells may be obtained from a family member or unrelated donor ( 1 in 5000 ).
32
Bone marrow transplant and leukemia
Additional chemo with or without whole body radiation is given ( lethal to the bone marrow ) - new cell are given - go to the marrow - if function properly - produce permanent cure
!!! Graft vs Host - immunossupresant for the rest of the life - graft attacks host ; 15 % die
33
Leukemia - Risk
1. any age
2. genetic
3. chemical agents
4. hx of chemo
5. radiation exposure
34
Chemotherapeutic agents - SE
1. hair loss
2. N/V
3. toxicities and interfere with growth of many tissues
4. myelosuppression
5. birth defects and potential sterility
35
Chemotherapy - action
destroy the cells that are rapidly dividing ( malignant) ; any other cells that are reproducing at that time - destroyed as well.
36
Antineoplastic agents
1. Alkylating - interfere with mitosis and cell division usually at any stage of the growth cycle
2. Cytotoxic - "cin-mycin" - antibiotic neoplastics - interfere with DNA and or RNA and protein synthesis
3. Antimetabolites - interfere with biosynthesis - used for solid tumors
37
Lymphoma
1. Solid tumor
2. Abnormal overgrowth of lymphocytes
3. Lymph nodes + spleen problem
38
Reed-Sternberg cells
Hodgkin's lymphoma
39
Hodgkin's lymphoma - Risk
1. young adults and those over age 50 - men
2. genetic
3. viral - Epstain-Barr virus
4. occupational toxins
40
Hodgkin's lymphoma S/s
1. Enlarged cervical lymph nodes - painless
| 2. fatigue, weakness, tachycardia
41
B symptoms
1. Weigh loss
2. Fever, chills
3. Night sweats
* poorer prognosis
Hodgkin's
42
Hodgkin's lymphoma TX
1. Chemotherapy - ABVD, MOPP
2. Radiation
3. Bone marrow or stem cell support
43
Malignant B or T cells in the lymph tissue
Nonhodgkin's lymphoma
1. older adults
2. aggressive and indolent
44
Nonhodgkin's lymphoma - risk and TX
1. long term immunosuppressive tx;
2. hx of tx for Hodgkin's
3. RA and HIV
TX: CHOP-R chemo ; radiation; bone marrow or stem support
45
Multiple Myeloma
1. Overgrowth of B-lymphocyte plasma cells in the bone marrow - increase
Antibodies - released into blood - increase serum protein levels - clogging blood vessels
Cytokines - increase cancer cell growth rates and destroy bone
46
Multiple Myeloma - Risk
1. Afro-american men after 40 ( 65)
2. Chemical exposure
3. Genetic and viral
47
Multiple Myeloma S/s
| Pain, hydration, injury !!!
1. Slow onset
2. Bone pain - triggered by movement
3. Diffuse osteoporosis - pathological fracture
4. Hypercalcemia
5. Increased protein levels may cause renal failure
6. S/s related to anemia, thrombocytopenia + agranulocytopenia
48
Multiple Myeloma - Dx
1. X-ray - Swiss cheese
2. Bence-Jones protein in urine
3. Bone marrow biopsy
49
Multiple Myeloma - TX
1. No cure
2. Chemo, radiation
3. Corticosteroids
4. Biphosphonates - to help prevent bone loss and tx of hypercalcemia
5. Allopurinol - for increased uric acid
50
Colony stimulating factors ( biological response modifiers )
proteins that stimulate or regulate the growth, maturation, and differentiation of bone marrow stem cells; Given subcut or IV
51
Erythropoietin - Stimulating Agents - Erythropoietin ( EPO, Procrit )
glucoprotein produced by the kidney; it stimulates RBCs production in response to hypoxia
* Hgb never exceed 12 g/dl - risk for death
52
Erythropoietin ( EPO, Procrit ) - SE and AR
SE: hypertension, headache, arthralgias (joint pain), weakness, dizziness, thrombosis (clots)
AR: seizures, hyperkalemia, cerebrovasc. accident, MI.
53
Erythropoietin ( EPO, Procrit ) for ...
anemia
54
Granulocyte Colony - Stimulating Factor - Filgrastim (Neupogen)
regulates production of neutrophils within bone marrow
55
Filgrastim (Neupogen) for ...
neutropenia
56
Filgrastim (Neupogen) - SE and AR
SE: N&V, skeletal pain, alopecia, diarrhea, skin rash, anorexia, bone pain
AR: thrombocytopenia, MI
57
Granulocyte Macrophage Colony - Stimulating Factor - Sagramostim ( Leukine )
increase production and functional activity of eosinophils, macrophages, monocytes and neutrophils
58
Sagramostim ( Leukine ) - AR
AR: pleural/pericardial effusion, GI, hemorrhage, dyspnea.
59
Thrombopoietic Growth Factor - Oprelvekin ( Neumega ) - SE
platelet growth factor
Fluid retention
Cardiovascular events
with diuretics - risk for hypokalemia
60
Colony stimulating factors - nursing considerations
1. Keep vial warm
2. Bleeding
3. Admin 24 hrs after chemo
4. Monitor BP and platelet count , CBC
5. Do not shake
61
Aplastic anemia vs Pancytopenia
| Risk - congenital, acquired ( radiation, meds), idiopathic
1. decrease of RBCs because of failure of the bone marrow to produce this cells
2. decrease RBCs, WBCs, platelets
62
Aplastic anemia , Pancytopenia S/s :
of anemia, infection, potential bleeding
63
Aplastic anemia , Pancytopenia Tx:
1. Blood transfusions
2. Stem cell transplant
3. Splenectomy
4. Bone marrow stimulants - biological response modifiers - colony stimulating factors
64
B12 - cobalamin
activate enzyme that move folic acid into the cell where DNA synthesis occurs ; stored in liver
65
Vitamin B12 deficiency anemia - macrocytic - types
1. Dietary or due to malabsorption - GI surgery, bowel resection, long term use of H2 ( histamine) blockers
2. Pernicious anemia - lack intrinsic factor - cant absorb B12
66
Pernicious anemia - TX
B12 IM - daily, weekly - Hb normal - for life/ 1 mo ;
| Colomist - nasal spray
67
Vitamin B12 deficiency anemia S/s
1. anemia s/s
2. sore tongue, N/V, anorexia, abdominal pain
3. altered thought processes - dementia , neurological/neuromascular deficits ; gastric cancer - some are not reversible
68
Vitamin B12 - foods
meat, eggs, dairy products
| * vegans - high folic acid may mask B12 deficiency.
69
Iron supplementation - ferrous sulfate 300 mg = 60 mg elemental iron ; Dose tx - 150-200 mg in 3-4 doses/daily - elemental
```
Absorbed from duodenum + jejunum
+ OJ or Vitamin C
1 hour before eating ( with food if upset stomach)
Straw for liquid iron - stain teeth
2-3 mo even after Hg normalizes
SE: dark black stools ! constipation
Toxic !!!
```
70
Iron deficiency anemia - foods
red meats, organ meats, beans + peas, fortified cereals, green leafy veggies + Vitamin C
71
Iron deficiency anemia - Risk !!!
1. Premenopausal + pregnant women
2. Children
3. Lower socioeconomic background
4. Older adults
5. Blood loss - GI
72
Koilonychia
spoon nails - chronic anemia
73
Iron deficiency anemia - S/s
1. Fatigue + activity intolerance
2. Pallor
3. Glossitis and burning of tongue, chelitis ( mouth)
4. Headache
5. Paresthesias
6. Bleeding - menstrual bleeding , melena (black tarry stool)
74
Iron deficiency anemia - Dx
1. Decreased - Hh/Hct , ferritin test ( free iron in the plasma)
2. Increased - transferrin ( transports iron ) & total iron binding capacity
Microcytic cells
75
MCV - mean corpuscular volume
average size of RBCs - normocytic, microcytic, macrocytic
76
MCHC - mean corpuscular Hgb concentration
average concentration of Hgb in RBC - normochromic ( RBCs normal color ) & hypochromic ( RBCs pale color )
77
MCH - mean corpuscular Hgb
average weight of Hgb
78
Agranulocytosis vs leukopenia vs neutropenia vs granulocytopenia
low count of neutrophils (granulocytes) vs WBC vs neutrophils (largest) vs granulocytes
79
Actual neutrophil count (ANC)- normal
greater than 2000
80
Thrombocytopenia - types (platelets live 8-10 days)
1. ITP - Immune Thrombocytopenia Purpura (platelets destroyed by spleen)
2. Heparin-Induced thrombocytopenia - most common
* severe < 20 000 - bleed spontaneously
81
Thrombocytopenia S/s
1. Bleeding
| 2. Petechiae, purpura, ecchymosis
82
Persantine
Plavix
Aspirin
Trental
Antiplatelets
83
Glycoprotein inhibitor; prevent platelet activation and thrombus formation with recent MI, CVA ... ; IV route; SE: dyspepsia , dizziness, pain at injection site, hypotension, bradycardia ; hematuria, tarry stools, bruising.
Abciximab (Reopro)
84
Polycythemia
Increase of RBCs - increase blood viscosity + volume
85
Primary Polycythemia Vera (PV)
cancer of RBCs - massive production of RBCs , excessive leukocyte production and excessive production of platelets - can develop acute myelogenous leukemia
86
Secondary PV
due to chronic hypoxia - COPD, chronic heart conditions, high attitudes
87
PV - pathophysiology
Increase in number of cells - abnormal RBCs - shorter life span - rapid turnover - increase amount of cell debris ( cells die) - uric acid + potassium - gout and hyperkalemia ; Oxygen-carrying capacity is impaired - hypoxia; Bleeding.
88
Plethora
ruddy (flushed) complexion - polycythemia
89
PV - S/s
1. Hypertension
2. Headache + vertigo
3. Tinnitus + visual problems
4. Plethora
5. Thrombosis
6. Hepatomegaly + splenomegaly - abdom. stomach pain
7. Pruritus , bleeding
90
PV - TX
1. Prevent/ treat hypoxia
2. Phlebotomy - 500 ml of blood 1-2/week
3. Myelosuppresive agents - Busulfan or hydroxyurea
4. maintain hydration - over - volume overload ; under - increased blood viscosity
91
PV + nutrition
encourage small, frequent meals rather than three big meals
92
Hemolytic anemia : causes
1. Trauma
2. Mechanical heart valves
3. Hemodialysis
4. Cardiopulmonary bypass
5. Toxins, infection, blood transfusion, drugs, autoimmune disorder
93
Hemolytic anemia - S/s
jaundice + renal damage
94
Hemolytic anemia - Tx
remove/limit cause; splenectomy; corticosteroids; blood transfusions
95
G6PD deficiency anemia (X-linked enzyme) black male
not anemic until a stressor causes hemolytic response - hemolytic crisis
96
G6PD deficiency anemia - stressors
1. Infection
2. Antimalarial agents
3. Nitofurantoin
4. NSAIDs
5. Fava beans (lima)
6. Moth balls
97
G6PD deficiency anemia - S/s
1. worsening of s/s of anemia
2. red, red-brown, tea colored urine
3. decreased urinary output - renal failure
98
G6PD deficiency anemia - Tx
Eliminate/treat cause
Transfusion
Hydration
Genetic counseling + newborn screening
99
ITP - idiopathic thrombocytopenia purpura - tx
Corticosteroids, splenectomy, immunosuppresive therapies, platelet transfusion
