Hematology

Question 1

Common signs and symptoms of hematologic disorders:

Answer 1

Weakness, fatigue, and general malaise, pallor of the skin and mucous membranes (conjunctivae, oral mucosa)

Question 2

In hematological disorders, when the hemoglobin level is low, the heart attempts to compensate by?

Answer 2

pumping faster and harder to deliver more blood to hypoxic tissue.

Question 3

In hematological disorders, increased cardiac workload can result in

Answer 3

tachycardia, palpitations, dyspnea, dizziness, orthopnea, and exertional dyspnea

Question 4

In hematological disorders, heart failure may eventually develop d/t

Answer 4

an enlarged heart (cardiomegaly) and liver (hepatomegaly) and by peripheral edema.

Question 5

In hematological disorders, pernicious anemia affects the:

Answer 5

central and peripheral nervous systems

Question 6

Neuro assessments in hematological disorders should include:

Answer 6

the presence and extent of peripheral numbness, paresthesias, ataxia, poor coordination, and confusion.

Question 7

In hematological disorders, delirium can sometimes occur from:

Answer 7

other types of anemia, particularly in older adults

Question 8

This hematological disorder is congenital but typically idiopathic:

Answer 8

Aplastic anemia

Question 9

Aplastic anemia is a disorder caused by

Answer 9

a decrease in or damage to marrow stem cells, damage to the microenvironment within the marrow, and replacement of the marrow with fat.

Question 10

In aplastic anemia, Stem cell damage is caused by the body’s T cells

Answer 10

mediating an inappropriate attack against the bone marrow, resulting in bone marrow aplasia (i.e., markedly reduced hematopoiesis).

Question 11

insidious- bone marrow failure (may be first real knowledge), purpurus, renal hemorrhage, splenomegaly are all symptoms of

Answer 11

Aplastic Anemia

Question 12

Pernicious Anemia is an absence of

Answer 12

intrinsic factor

Question 13

In pernicious anemia, Intrinsic factor is normally secreted by

Answer 13

cells within the gastric mucosa; it binds with dietary vitamin B12 and travels with it to the ileum, where the vitamin is absorbed

Question 14

In pernicious anemia, without intrinsic factor, orally consumed vitamin B12 cannot be

Answer 14

adequately absorbed, and erythrocyte production is eventually diminished.

Question 15

bleeding from ulcers, gastritis, inflammatory bowel disease, or GI tumors in men and postmenopausal women is most commonly caused by:

Answer 15

iron deficiency anemia

Question 16

smooth, red tongue, brittle and ridged nails, and angular cheilitis: these are all signs of?

Answer 16

Severe or prolonged iron deficient anemia

Question 17

A health history should be obtained for individuals with iron deficient anemia when they have a history of:

Answer 17

multiple pregnancies, GI bleeding, and pica

Question 18

Mortality rate for this disorder can exceed 80%

Answer 18

DIC

Question 19

Causes of DIC:

Answer 19

Sepsis, trauma, cancer, abruptio placentae, allergic reactions

Question 20

2/3 of DIC cases are initiated by:

Answer 20

an infection or a malignancy

Question 21

an infection or a malignancy

Answer 21

inflammation and coagulation within the vasculature

Question 22

In DIC, the excessive clotting triggers the fibrinolytic system to

Answer 22

release fibrin degradation products, which are potent anticoagulants

Question 23

Compromised organ function or failure, Ischemia, and bleeding (less common) are clinical manifestations of:

Answer 23

DIC

Question 24

What will be tested to diagnose DIC?

Answer 24

low platelet and fibrinogen levels; prolonged PT, aPTT, and thrombin time; D-dimer

Question 25

Because of bacterial proliferation, blood administration should not exceed _ hours:

Answer 25

4

Question 26

How often does blood tubing need to be changed in order to decease chances or bacterial contamination?

Answer 26

after every 2 units transfused

Question 27

How many mL of blood and anticoagulants does a single unit of whole blood contain?

Answer 27

450mL whole blood, 50mL of an anticoagulant

Question 28

What % of PRBCs are made up of hematocrit?

Answer 28

70% (very concentrated)

Question 29

What temperature are PRBCs stored at?

Answer 29

4C, 39.2F

Question 30

How long can PRBCs be stored before they can be discarded?

Answer 30

42 days with a special preservative

Question 31

To prevent clumping, platelets are:

Answer 31

gently agitated while stored

Question 32

What temperature are platelets stored at?

Answer 32

must be stored at room temperature because they cannot withstand cold temperatures

Question 33

Why is plasma immediately frozen?

Answer 33

to maintain the clotting factors

Question 34

How long does plasma last?

Answer 34

1 year if it remains frozen

Question 35

The blood product can be further pooled and processed into blood derivatives of albumin, immune globulin, factor VIII, and factor IX.

Answer 35

Plasma

Question 36

When is FFP given?

Answer 36

planned surgery or invasive procedure in the presence of abnormal coagulation tests, for the reversal of warfarin in the presence of active bleeding or planned procedure when vitamin K is inadequate For thrombotic thrombocytopenic purpura, and congenital or acquired factor deficiency with no alternative therapy. trauma patients requiring massive transfusion and warfarin-related intracranial hemorrhage

Question 37

What is the greatest cause of transfusion reactions?

Answer 37

patient is transfused an incompatible unit of blood product

Question 38

Transfusion reactions are most frequently due to:

Answer 38

presence of donor leukocytes within the blood component unit (PRBCs or platelets)

Question 39

What should the RN do when a transfusion reaction occurs?

Answer 39

•Assess •Stop •Notify the primary provider and implement prescribed treatments. Continue to monitor Notify blood bank •Return blood and tubing to lab (or blood bank as per policy) •Obtain any samples needed •Document

Question 40

The majority of anemias are considered:

Answer 40

benign

Question 41

iron deficiency, renal disease anemia, and aplastic anemia are considered:

Answer 41

proliferative anemias (all involve decreased production)

Question 42

Hemolytic anemias are characterized by

Answer 42

break down

Question 43

plasma is yellow because

Answer 43

there are no red blood cells

Question 44

albumin is a

Answer 44

plasma protein

Question 45

Hematopoiesis is the complex process of:

Answer 45

the formation and maturation of blood cells

Question 46

the primary site for hematopoiesis is:

Answer 46

bone marrow

Question 47

Glucose is carried by

Answer 47

erythrocytes

Question 48

Hematopoietic stem cells break down in which cells?

Answer 48

blood cells, myeloid stem cells, and lymph stem cells

Question 49

the average average lifespan of a RBC is?

Answer 49

120 days

Question 50

Eosinophils are released during:

Answer 50

inflammatory response to fight infection

Question 51

Eosinophils are elevated with:

Answer 51

allergies, autoimmune disorders, infections, tumors, fungus, virus

Question 52

alpha, beta, and gamma cells make up:

Answer 52

globulin cells

Question 53

used to form red blood cells when there is a low number

Answer 53

epogen (medication)

Question 54

Iron deficiency occurs in bariatric surgery because?

Answer 54

there is less stomach acid following bariatric surgery and iron needs acid to aid in its absorption

Question 55

Vitamin K is given to patients with:

Answer 55

very high INR level

Question 56

In DIC, fingertips die from?

Answer 56

clotting

Question 57

D dimer is drawn a lot to determine if patient has:

Answer 57

pulmonary embolism

Question 58

aPTT needs to be drawn every _ hours to assess if the rate needs to be changed

Answer 58

6

Question 59

Therapeutic phlebotomy is used to treat:

Answer 59

polycythemia vera (this causes an elevated RBC volume- causes lower perfusion and blood clots because its too thick)

Question 60

Apheresis is the removal of:

Answer 60

blood plasma from the body by the withdrawal of blood, its separation into plasma and cells, and the reintroduction of the cells, used especially to remove antibodies in treating autoimmune disease

Question 61

PRBC infusion should always be done using a __ gauge needle or large for insertion in large vein

Answer 61

20 (pink tip)

Question 62

criteria for PRBC infusion

Answer 62

use normal saline transfusion because it is isotonic, check VS frequently for reaction, always check hospital policy for run time

Question 63

normal hemoglobin Lab levels:

Answer 63

10-14 female, 12-16 male

Question 64

Chronically high hemoglobin is caused by:

Answer 64

dehydration, burns (fluid volume deficit), polycythemia (blood removal)

Question 65

normal Prothrombin time- INR:

Answer 65

10-13 seconds

Question 66

INR needs to be 3-4 seconds in patients with an

Answer 66

artificial heart valve

Question 67

Myelo- means:

Answer 67

marrow of the spinal cord

Question 68

Lympho- means:

Answer 68

fluid that contains white blood cells

Question 69

Acute leukemias occur in ________ population

Answer 69

younger

Question 70

Chronic leukemia occurs in ______ population

Answer 70

older

Question 71

Normal value of Hct

Answer 71

male 42-52%, female 35-47%

Question 72

Normal value of WBC

Answer 72

4500-110,000 (mm3)

Question 73

Normal value of platelets

Answer 73

150,000-450,000 (mm3)

Question 74

Normal value of Hgb

Answer 74

male 13-18g/dL, female 12-16g/dL

Question 75

Clinical Manifestations of ___________ include: Bleeding from mucous membranes, venipuncture sites, GI and GU tracts. Bleeding ranges from minimal occult internal bleeding to profuse hemorrhage from all orifices

Answer 75

DIC

Question 76

What is the treatment for DIC?

Answer 76

Treatment Treat underlying cause Oxygenation Replace fluids Correct electrolyte imbalances Vasopressors FFP & PLATELETS Heparin (questionable)

Question 77

The following labs are used to diagnose which condition? ``` Platelets (drop) Clotting factors (drop) D-dimer (increase) PT & aPTT (increase) Lab values + scoring system ```

Answer 77

DIC

Question 78

This kind of anemia is genetic; Inability to properly utilize vitamin B12 (needed for development of RBC's) d/t lack of intrinsic factor from GI tract - cannot absorb B12

Answer 78

Pernicious anemia

Question 79

This kind of anemia is caused by a decrease in/damage to marrow stem cells, leading to a replacement of marrow with FAT; Usually idiopathic, toxic materials, viral infection or pregnancy can trigger

Answer 79

Aplastic anemia

Question 80

Symptoms of anemia:

Answer 80

fatigue, pallor, dyspnea, bruising

Question 81

Stem cell transplant and immunosuppressive therapy are involved in the treatment of:

Answer 81

aplastic anemia

Question 82

Diagnostics for aplastic anemia include:

Answer 82

``` Diagnostics CBC revealing pancytopenia Neutrophil count <1500 Hgb <10g/dL Platelets <50,000 Bone marrow aspirate showing marrow replaced with fat ```

Question 83

____________ needed for RBC formation; Low intake, high demand for _________ in the body, malabsorption can lead to deficiency

Answer 83

folic acid

Question 84

Folic acid levels in serum and within the red blood cells

Answer 84

folic acid deficiency diagnostics

Question 85

This kind of anemia is characterized by erythrocytes losing its round, pliable, biconcave disc shape; adheres to endothelium of small vessels and each other Increased blood viscosity Decreased oxygen

Answer 85

Sickle cell anemia

Question 86

Genetic - caused by inheritance of the hemoglobin gene. Usually from African descent.

Answer 86

sickle cell anemia

Question 87

Treatment for sickle cell anemia

Answer 87

Treatment Hydroxyurea Folic acid replacement RBC transfusions

Question 88

The following symptoms are manifestations for? ``` Anemia Jaundice Enlargement of bones of face/skull Tachycardia Cardiac murmurs Cardiomegaly Dysrhythmias Heart failure Thrombus formation ```

Answer 88

Sickle cell anemia

Question 89

________ is characterized by increased volume of RBC’s Primarily; secondary – Reduced oxygen/neoplasms, excessive production of erythropoietin, more RBC’s

Answer 89

Polycythemia

Question 90

``` In ___________ you can see: Can be asymptomatic Fatigue Headache Dizziness SOB Inability to concentrate ```

Answer 90

Polycythemia

Question 91

In order to be diagnosed with polycythemia:

Answer 91

Hct >55% in males and 50% in females

Question 92

Treating the primary condition and | therapeutic phlebotomy are treatments for which blood disorder?

Answer 92

Polycythemia

Question 93

``` This blood disorder is inherited: Subclass A & B A caused by deficient/defective factor VIII B caused by deficient/defective factor IX ```

Answer 93

Hemophilia

Question 94

Clinical manifestations of hemophilia include:

Answer 94

BLEEDING | Hemorrhages in various parts of the body but 75% occurs in joints

Question 95

``` Treatment of ___________ includes: Recombinant forms of factor VIII and X FFP Neutralizing antibodies to factor concentrate Immunosuppression therapy ```

Answer 95

Hemophilia