Hematology Flashcards
(179 cards)
1
Q
Reduction in either the number of red blood cells, the amount of hemoglobin or the hematocrit
A
Anemia
2
Q
Measure of the immature RBCs; reflection of bone marrow activity in producing RBCs
A
Reticulocyte count
3
Q
What is the normal reticulocyte count?
A
0.5 - 2.0% of the total RBCs
4
Q
What are the normal iron levels?
A
60-160 mcg/dL (F) and 80-180 mcg/dL (M)
5
Q
What are the normal serum ferritin levels?
A
10-50 ng/mL (F) and 12-300 ng/mL (M)
6
Q
What is the normal total iron binding capacity level?
A
250-460 mcg/dL
7
Q
Measure of the gas-carrying capacity of the RBCs
A
Hemoglobin
8
Q
Measure of the packed cell volume of RBCs, expressed as a percent of the total blood volume
A
Hematocrit
9
Q
Amount of iron combined with proteins in serum; accurate indicator of status of iron storage and use
A
Iron
10
Q
Major iron storage protein; normally present in blood in concentrations directly related to iron storage
A
Serum Ferritin
11
Q
What should the bone marrow of an anemic patient be doing?
A
Producing lots and lots of RBCs
12
Q
Measurement of all proteins available for binding iron; evaluation of the amount of extra iron that can be carried
A
Total Iron Binding Capacity
13
Q
The ITBC is an indirect measurement of what?
A
Trasnferrin
14
Q
What are the causes of anemia?
A
Blood loss, an impaired production of erythrocytes, and an impaired destruction of erythrocytes
15
Q
What are many of the symptoms of anemia caused by?
A
The hypoxia created by the decreased oxygen being carried to tissues
16
Q
What is the function of the RBC?
A
Transport oxygen from the lungs to systemic tissue and carry CO2 from the tissue to the lungs
17
Q
How is anemia diagnosed?
A
CBC, Reticulocyte count, and peripheral blood smear
18
Q
Which types of trauma can cause RBC destruction?
A
Ecmo, bypass, or left ventricular assist device
19
Q
What is the physiological manifestation of anemia?
A
Reduced O2 carrying capacity
20
Q
What are the classic signs of anemia?
A
Fatigue, weakness, dyspnea, pallor, and tachycardia
21
Q
Why do anemic patients experience tachycardia?
A
Because their bodies are trying to increase cardiac output to compensate for the decreased oxygen levels
22
Q
What determines the severity of the anemia?
A
Hemoglobin
23
Q
Which severity of anemia leaves patients with few symptoms, including possible palpitations, dyspnea, and diaphoresis?
A
Mild (Hemoglobin 10-14)
24
Q
Which severity of anemia causes increased cardiopulmonary symptoms at rest and activity with a roaring in the ears?
A
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
