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Flashcards in Hematology Deck (179):
1

Reduction in either the number of red blood cells, the amount of hemoglobin or the hematocrit

Anemia

2

Measure of the immature RBCs; reflection of bone marrow activity in producing RBCs

Reticulocyte count

3

What is the normal reticulocyte count?

0.5 - 2.0% of the total RBCs

4

What are the normal iron levels?

60-160 mcg/dL (F) and 80-180 mcg/dL (M)

5

What are the normal serum ferritin levels?

10-50 ng/mL (F) and 12-300 ng/mL (M)

6

What is the normal total iron binding capacity level?

250-460 mcg/dL

7

Measure of the gas-carrying capacity of the RBCs

Hemoglobin

8

Measure of the packed cell volume of RBCs, expressed as a percent of the total blood volume

Hematocrit

9

Amount of iron combined with proteins in serum; accurate indicator of status of iron storage and use

Iron

10

Major iron storage protein; normally present in blood in concentrations directly related to iron storage

Serum Ferritin

11

What should the bone marrow of an anemic patient be doing?

Producing lots and lots of RBCs

12

Measurement of all proteins available for binding iron; evaluation of the amount of extra iron that can be carried

Total Iron Binding Capacity

13

The ITBC is an indirect measurement of what?

Trasnferrin

14

What are the causes of anemia?

Blood loss, an impaired production of erythrocytes, and an impaired destruction of erythrocytes

15

What are many of the symptoms of anemia caused by?

The hypoxia created by the decreased oxygen being carried to tissues

16

What is the function of the RBC?

Transport oxygen from the lungs to systemic tissue and carry CO2 from the tissue to the lungs

17

How is anemia diagnosed?

CBC, Reticulocyte count, and peripheral blood smear

18

Which types of trauma can cause RBC destruction?

Ecmo, bypass, or left ventricular assist device

19

What is the physiological manifestation of anemia?

Reduced O2 carrying capacity

20

What are the classic signs of anemia?

Fatigue, weakness, dyspnea, pallor, and tachycardia

21

Why do anemic patients experience tachycardia?

Because their bodies are trying to increase cardiac output to compensate for the decreased oxygen levels

22

What determines the severity of the anemia?

Hemoglobin

23

Which severity of anemia leaves patients with few symptoms, including possible palpitations, dyspnea, and diaphoresis?

Mild (Hemoglobin 10-14)

24

Which severity of anemia causes increased cardiopulmonary symptoms at rest and activity with a roaring in the ears?

Moderate (Hemoglobin 6-10)

25

Which severity of anemia involves multiple body systems, causing pallor, glossitis, angina, HF, MI, tachycardia, a systolic murmur, orthostatic hypotension, SOB, DOE, decreased SpO2, vertigo, depression, headaches, anorexia, sore mouth, enlarged liver and spleen, fatigue, weight loss, bone pain and sensitivity to cold?

Severe (Hemoglobin

26

Why is anemia so dangerous?

It can speed up a lot of disease processes

27

Glycoprotein primarily produced in the kidneys that increase the number of stem cells commented to RBC production and shortens the time to mature RBCs

Erythropoietin

28

What are the side effects of taking epogen?

Hypertension and bone pain

29

What is the life cycle of a RBC?

120 days

30

What three alterations in erythropoiesis decrease RBC production?

Decreased hemoglobin synthesis, defective DNA synthesis in RBCs, and diminished availability of erythrocyte precursors

31

What kind of anemia results from a decrease in hemoglobin synthesis?

Iron-Deficiency Anemia

32

What kinds of anemias result from defective DNA synthesis in the RBCs?

Pernicious Anemia and Folic Acid Deficiency Anemia

33

What kind of anemia results from a diminished availability of erythrocyte precursors?

Aplastic Anemia

34

What would the Serum Ferritin values of a person with Iron-Deficiency Anemia be?

Less than 12 g/L

35

What are the symptoms of Iron-Deficiency Anemia?

Mild manifestations such as pallor, glossitis, koilonychia, and angular stomatitis

36

What does Iron-Deficiency Anemia result from?

Blood loss, poor intestinal absorption, or inadequate diet

37

At what stage is Iron-Defiency Anemia symptomatic?

Stage 3

38

Spoon shaped, brittle, and concave nails

Koilonychia

39

What is the treatment for Iron-Deficiency Anemia?

Two weeks of iron therapy

40

What foods are high sources of iron?

Liver, red meat, whole grains, leafy greens, egg yolks, raisins, and red wine

41

What do patients with iron deficiency anemia need to be evaluated for?

Abnormal Bleeding

42

How are iron solutions administered?

IM using the Z-track method

43

What causes decreased absorption of oral iron supplements?

Antacids, eggs or milk, coffee, and tea

44

How should oral iron supplements be administered?

On an empty stomach with ascorbic acid and a straw

45

Why is a straw used when giving liquid iron supplements PO?

To avoid teeth turning black

46

What are the side effects of iron supplements?

Constipation and the stool turns black/green

47

What would be the lab findings for a patients with Iron-Deficiency Anemia?

Decreases reticulocytes, iron, ferritin, iron saturation and MCV; Increased TIBC

48

What does proper production of the RBCs depend on?

Adequate DNA synthesis and adequate amounts of folic acid

49

What is the function of B12?

To activate enzymes that transport folic acid into the cells where DNA synthesis occurs

50

How does B12 deficiency cause anemia?

It inhibits folic acid transport and reduces DNA synthesis in the precursor cells

51

What causes B12 Deficiency Anemia?

Poor intake of foods containing B12, small bowel problems, diverticulits, tapeworms, and an overgrowth of intestinal bacteria

52

Who is susceptible for B12 Deficiency Anemia?

Vegetarians and people on low dairy diets

53

What are the clinical manifestations of B12 Deficiency Anemia?

Mild or severe pallor, jaundice, glossitis, fatigue, weight loss, paresthesia, and poor balance

54

What are the hallmarks of B12 Deficiency Anemia?

Paresthesias and poor balance

55

How is B12 Deficiency Anemia treated?

Increase the dietary intake of B12 and folic acid and use supplements if severe

56

What foods are good sources of B12 and folic acid?

Liver, beef, chicken, pork, ham, fish, whole grains, dairy, and whole eggs

57

Protein secreted by the parietal cells of the gastric mucosa required for cobalamin absorption in the small intestine

Intrinsic Factor

58

What is Pernicious Anemia caused by?

A decrease in the secretion of intrinsic factor, leading to the malabsorption of cobalamin

59

What are the causes of Pernicious Anemia?

Congenital, autoimmune, gastic atrophy, change in the pH of the stomach, ETOCH abuse, gastrectomy, smoking, and hot tea

60

What causes a change in the pH of the stomach?

Proton Pump Inhibitors

61

Who is Pernicious Anemia most common in?

Females over 30

62

What are the signs and symptoms of Pernicious Anemia?

Infections, mood swings, GI ailments, CV ailments, renal ailments, low hemoglobin, lemon yellow skin, hepatomegaly and splenomegaly

63

What would the hemoglobin of a patient with Pernicious Anemia be?

7-8 g/dL

64

Test for determining the amount of vitamin B12 excreted in the urine through a 24 hour sample

Shilling test of B12 absorption

65

How is Pernicious Anemia treated?

Life-long B12 injections

66

What would the lab findings of a patients with Pernicious Anemia be?

Decreased B12 levels and reticulocyte count; Increased MCV, methylmalonic acid, and homocysteine levels

67

How are B12 Deficiency and Folic Acid Deficiency Anemias differentiated?

In Folic Acid Deficiency Anemia, the nervous system functions normally but the RBCs have a shorter life span

68

What are the causes of Folic Acid Deficiency Anemia?

Poor nutrition, anti-seizure medications, birth control pills, and malabsorption due to ETOH

69

What are the signs and symptoms of Folic Acid Deficiency Anemia?

Cheilosis, stomatitis, watery diarrhea, painful ulcers on mucous membranes, difficulty swallowing, and flatulence

70

A disorder of the lips marked by scaling and fissures at the corners of the mouth

Cheilosis

71

What is the prevention for Folic Acid Deficiency Anemia?

Diets high in folic acid and B12

72

What is the treatment for Folic Acid Deficiency Anemia?

Folic acid replacement therapy

73

What is an example of a Folic Acid Deficiency Anemia?

Megaloblastic Anemia

74

What would the lab values of a patients with Folic Acid Deficiency Anemia be?

Decreased folate levels and increased MCV

75

Deficiency of circulating RBCs due to the failure of the bone marrow in producing them

Aplastic Anemia

76

Which stem cell is injured in patients with Aplastic Anemia?

Pluripotent stem cell

77

What should patients with Aplastic Anemia be assessed for?

Pallor, Petechiae, and Ecchymosis indicated bone marrow failure

78

What diseases does Aplastic Anemia generally occur with?

Leukopenia, thrombocytopenia, or pancytopenia

79

What can cause Aplastic Anemia?

Long time exposure to toxic agents, ionizing radiation, pesticides, or infection

80

What would the lab values of someone with Aplastic Anemia be?

Decreased reticulocyte found, WBC, Hgb, Hct, and platelets

81

What is the immune response of Aplastic Anemia regulated by?

Cytotoxic T Cells

82

What are the treatments for Aplastic Anemia?

Immunosuppressive Therapy, Splenectomy, or Bone Marrow Transplantation

83

What is the treatment of choice for Aplastic Anemia?

Bone Marrow Transplant

84

What do patients post splenectomy need to be supported with?

Platelets, FFP, RBCs and WBCs

85

Stimulates the bone marrow to come back in patients with Aplastic Anemia

Immunosuppressive Therapy

86

Anemia caused by renal disease

Decreased Erythropoietin Production

87

Anemia marked by three defects: decreased erythrocyte life span, ineffective bone marrow response to erythropoietin, and altered iron metabolism

Anemia of Chronic Disease

88

Anemia caused by hemolysis within blood vessels or lymphoid tissues

Autoimmune Hemolytic Anemia

89

Anemias caused by cellular abnormalities of the hemoglobin structure, marked by an imbalance between the beta chain and the alpha chain of hemoglobin, resulting in RBC membrane damage, ineffective RBC production, and hemolysis

Thalassemias

90

A chronic myleoproliferative disorder arising from ma chromosomal mutation in a single Pluripotent cell characterized by an abnormal proliferation of bone marrow stem cells with self destructive expansion of RBCs

Polycythemia Vera

91

What are the erythropoietin levels in a patient with Polycythemia Vera?

Normal

92

What would the CBC reveal in a patient with Polycythemia Vera?

Increased hemoglobin, RBCs, WBCs, and platelets

93

How is Polycythemia Vera Treated?

Draining the bad blood and throwing it away, increasing hydration, and anticoagulants

94

Why is Polycythemia Vera very bad?

The increase in all of the cells is so severe that blood circulation is impaired as a result of the increased blood viscosity and volume

95

What would the hemoglobin of a person with Polycythemia Vera be?

18 g/dL

96

What would the RBC of a person with Polycythemia Vera be?

6 million

97

What would the hematocrit of someone with Polycythemia Vera be?

55% or higher

98

What are the major hallmarks of Polycythemia Vera?

Massive RBC production, Excessive leukocyte production, and excessive platelet production

99

What are the signs and symptoms of Polycythemia Vera?

Hypertension, hyperkalemia, dark, flushed appearance, distended veins, weight loss, fatigue, itching, hemorrhoids, swollen, painful joins, enlarged spleen, MI, strokes, and bleeding tendencies

100

What causes the hyperkalemia seen in patients with Polycythemia Vera?

The breaking of RBCs

101

Type of cancer with uncontrolled production of immature white blood cells in the bone marrow

Leukemia

102

What kind of cells are seen in the peripheral blood smear of a patient with leukemia?

Blastic

103

What are the risk factors for leukemia?

Ionizing radiation, exposure to certain chemicals and drugs, bone marrow hypoplasia, genetic factors, immunologic factors, stress, and environmental factors

104

What happens to the RBCs and platelets of patients with leukemia?

The uncontrolled production of WBCs decreased their numbers

105

What is the childhood leukemia?

Acute Lymphocytic Leukemia

106

What is the adult leukemia?

Acute Myelogenous Leukemia

107

Why are the chronic leukemias not as bad as the acute leukemias?

They don't really affect the patient's life span and are acquired most frequent after the 7th decade

108

What are the clinical manifestations of leukemia?

Increased heart rate, decreased blood pressure, increased respiratory rate, pale and cool skin, weight loss, nausea, anorexia, and headache

109

What would a lab assessment of a patient with leukemia reveal about their hemoglobin and hematocrit levels?

They would be decreased

110

Which leukemia patients have the poorest prognosis?

Those with high white blood cells counts at diagnosis

111

Which acute leukemia is worse?

Acute Myelogenous Leukemia

112

What test confirms the diagnosis of leukemia?

Bone marrow biopsy

113

Where is the bone marrow biopsy taken from to confirm the diagnosis of leukemia?

The posterior iliac crest

114

What is the major cause of death for patients with leukemia?

Infection

115

Normal flora become causative agent of infection

Auto contamination

116

What are the priority nursing diagnoses for patients with leukemia?

Risk for infection, then risk for injury

117

What are the drug therapies for acute leukemia?

Induction therapy, consolidation therapy, maintenance therapy and drugs for infections

118

What is the goal of induction therapy?

It is given when patients are rebounding from nadir in the hopes that the new marrow will essentially cure itself

119

What is the goal of consolidation therapy?

Remission of leukemia stays in remission

120

What drugs are given to prevent infections in patients with acute leukemia?

Nystatin and bowel cleansers

121

What infection precautions need to be in place for patients with acute leukemia?

Hand washing, private room, HEPA filtration, masks, minimal bacteria diet, not uncooked foods, meticulous skin care

122

Standard treatment for leukemia, this procedure purges the present marrow of the leukemic cells and gives new, health marrow

Bone Marrow Transplant

123

Why does a bone marrow transplant work in curing leukemia?

Because bone marrow is the source of stem cells, and new stem cells won't be leukemic

124

When are patients with leukemia given bone marrow transplants?

When they are in remission

125

What happens to the bone marrow doner?

If they go on iron supplements they will be back to normal in three months

126

What is the first sign of bone marrow rejection?

A rash on the palmar surface of the hands

127

Cancer that starts in a single lymph node or single chain of lymph nodes with the Reed-Sternberg cell

Hodgkin's Lymphoma

128

What are the signs and symptoms of Hodgkin's Lymphoma?

Large, painless lymph node, fever, malaise, and night sweats

129

What is the treatment for Hodgkin's Lymphoma?

External radiation alone or in combination with chemotherapy

130

Cancer that starts in a single lymph node or single chain of lymph nodes without the Reed-Sternberg cell

Non-Hodgkin's Lymphoma

131

What is the treatment for Non-Hodgkin's Lymphoma?

Radiation therapy and chemotherapy

132

Which is worse, Hodgkin's or Non-Hodgkin's Lymphoma?

Non-Hodgkin's Lymphoma

133

Uncommon white blood cell cancer that involves a more mature lymphocyte

Multiple Myeloma

134

What are the signs and symptoms of Multiple Myeloma?

Fatigue, easy bruising, bone pain, fractures, hypertension, increased infection, hypercalcemia, and fluid imbalance

135

What is the treatment for Multiple Myeloma?

Chemotherapy

136

Why do patients with Multiple Myeloma experience hypercalcemia?

Because calcium is being leeched from their bones

137

What do the bone of patients with Multiple Myeloma look like?

Swiss Cheese

138

Autoimmune disorder characterized by large ecchymosis or petechial rash on arms, legs, upper chest and neck

Autoimmune Thrombocytopenic Purpura

139

What would the lab findings of a patients with Autoimmune Thrombocytopenic Purpura show??

Decreased platelet count and large numbers of megakaryocytic in the bone marrow

140

How is Autoimmune Thrombocytopenic Purpura treated?

Therapy to prevent bleeding, drugs to suppress immune function, blood replacement therapy, and splenectomy

141

Rare disorder in which platelets clump together abnormally in the capillaries and too few remain in circulation, causing inappropriate clotting

Thrombotic Thrombocytopenic Purpura

142

What is the treatment for Thrombotic Thrombocytopenic Purpura?

Plasma pheresis, FFP, aspirin, alprostadil, plicamycin, and immunosuppressive therapy

143

What is plasma pheresis?

Blood letting by the unit

144

Deficiency of factor VIII in the blood causing the inability of the blood to clot

Hemophilia A

145

Deficiency of factor VIIII in the blood causing the inability of the blood to clot

Hemophilia B

146

Which is more common, Hemophilia A or B?

A

147

What is the treatment for Hemophilia A?

Blood transfusion and factor VIII therapy

148

What do patients with Hemophilia need to be assessed for?

Excessive hemorrhage and joint and muscle hemorrhage

149

What lab tests do patients with Hemophilia A need to take?

PTT

150

What is the most common problem for hemophiliacs?

The degeneration of joint function related to chronic bleeding into the joints

151

In which of the hemophiliac's joints does excessive bleeding take place?

Hip and knee

152

Why are B12 injections given IM?

Because they will tattoo the skin

153

Which test measure how long blood takes to clot?

PT/INR

154

Which test assesses the intrinsic clotting cascade and the action of specific clotting factors?

PTT

155

What is the nursing priority after a bone marrow or aspiration?

Prevent excessive bleeding

156

What does multiple myeloma result in?

The overproduction of antibodies or gamma globulins

157

What is the pathophysiology of Autoimmune Thrombocytopenic Purpura?

The body creates an antibody which is placed upon the surface of platelets, making them more likely to be destroyed by macrophages

158

A client is scheduled for a bone marrow aspiration. What does the client's nurse do before taking the client to the treatment room for the biopsy?

Verify that the client has given informed consent

159

When assessing an adult client endurance in performing ADLs what question should the nurse ask?

How is your energy level compared with last year?

160

Why is an accurate family history important when assessing a patient for a hematological disorder?

Because many disorders that affect blood and blood clotting are inherited

161

What decreased lab value is concerning for a nurse because it is not age related?

Platelet count

162

A client with a low platelet count asks why platelets are important. How does the nurse answer?

The clotting process begins with your platelets

163

In which anemia would the patient have an elevated reticuloctye count?

Hemolytic Anemia

164

What is the best way to assess the nutritional status of a client?

Ask the client to write down everything he or she has eaten for the past weak

165

A clinic nurse is discharging a 20-year-old client who had a bone marrow aspiration performed. What does the nurse advise the client to do?

Place an ice pack over the site to reduce bruising

166

A client has a bone marrow biopsy done. Which nursing intervention is the priority post procedure?

Applying pressure to the biopsy site

167

How does aspiring interfere with blood clotting?

It inhibits the activation of platelets

168

Which nursing action is most effective in reducing the potential for sepsis in clients?

Frequent and thorough hand washing

169

What intervention most effectively protects a client with thrombocytopenia?

Encouraging the use of an electric shaver

170

A patient with thrombocytopenia is being discharged. What information does the nurse incorporate into the teaching plan for this client?

Use a soft-bristled toothbrush

171

A client with multiple myeloma reports bone pain that is unrelieved by analgesics. How does the nurse respond to this client's problem?

"Would you like to try some relaxation techniques?"

172

A nurse is caring for a client with neutropenia. Which clinical manifestation indicates that an infection is present or should be ruled out?

Wheezes or crackles

173

A nurse is caring for a client with neutropenia who has a suspected infection. Which intervention does the nurse implement first?

Obtains requested cultures

174

A nurse is assessing a newly admitted client with thrombocytopenia. What factor needs immediate intervention?

A nosebleed

175

A nurse is infusing platelets to a client who is scheduled for a hematopoietic stem cell transplant. What procedure does the nurse follow?

Infuses the transfusion over a 15-10 minute period

176

Why are patients with leukemia at extreme risk for infection even though their WBC is so high?

Their WBCs are too immature to fight infection

177

Which predation is most important for the nurse to teach a client with leukemia to prevent an infection by autocontamination?

Perform mouth care three times daily

178

Which precaution is most important for the nurse to teach a client with autoimmune thrombocytopenic purport who is receiving corticosteroid therapy to control the disease?

Avoid contact sports and any activity that could cause injury

179

What is the most important environmental risk for developing leukemia?

Smoking cigarettes