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Med Screening > Screening for Hematologic Conditions > Flashcards

Screening for Hematologic Conditions Flashcards

1
Q

primary vs secondary hematologic dz

A

primary - bc of hematologic system

secondary - primary dz has caused sx relating to hematologic sx
- ex: pt w CA undergoing chemo that is impacting ability to produce blood cells

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2
Q

what % is plasma of the total blood volume

A

55-65%

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3
Q

what is contained in the plasma

A

clotting factors
albumin/proteins
humeral immunity
electrolytes

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4
Q

what pt sx should make you consider the plasma levels

A

cramping - hydration status?

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5
Q

what % is the cellular components of the total blood volume

A

35-45%

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6
Q

what is contained in the cellular components of the blood

A

erythrocytes - RBCs
leukocytes - WBCs
thrombocytes - platelets

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7
Q

what cells are included in a CBC

A

WBC
Hgb
Hct
Plt

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8
Q

norms for WBC

A

5k-10k

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9
Q

norms for Hgb

A

female: 12-16
male: 14-17

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10
Q

norms for Hct

A

female: 36-48%
male: 42-52%

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11
Q

norms for plts

A

150k-450k

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12
Q

what does a CBC panel chicken foot layout look like

A

\ Hgb /
WBC ——- Plt
/ Hct \

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13
Q

what is Hct

A

hematocrit
% of RBCs in total volume of blood

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14
Q

who should be screened via a CBC

A

chronic NSAIDs
chemo
recent surgery

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15
Q

why do you want a CBC w chronic NSAID usage

A

chronic NSAID use can lead to GI bleeding
- aspirin is a blood thinner and can be linked to microscopic bleeding
- can lead to inc blood loss

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16
Q

why do you want a CBC w someone undergoing chemo

A

impacts total cell volume

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17
Q

what pt reports would indicate a need for a CBC screen (5)

A
  1. spontaneous bleeding (nosebleed, urine, stool, gums)
  2. transfusions
  3. rapid onset dyspnea, chest pain, weakness, fatigue w palpitations
  4. changes in nails, changes in skin tone
  5. more easily bruising/bleeding
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18
Q

what are hematology specific sx (6)

A
  1. problems w exertion
    - dyspnea
    - chest pain
    - palpitations
    - severe weakness
    - fatigue
  2. neurologic sx
    - HA
    - drowsiness
    - dizziness
    - syncope
    - polyneuropathy
  3. skin/fingernail bed changes
  4. GI/GU changes
  5. severe pain and swelling joints or ms
  6. wounds or easy bruising/bleeding of skin, gums, mucous membranes, esp without trauma
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19
Q

what in a family hx are you looking for when doing a hematologic screening

A

CV or pulm dz
sickle cell anemia

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20
Q

what are screening Qs for a hematologic screen

A

problems w exertion
- any hx of CV/P system dysfunction or dz
- changes in activity to accommodate?
recent change in altitude?
hx of recurrent infections?

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21
Q

what is the function of erythrocytes

A

key role in transport of O2 and CO2

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22
Q

what is the total amt of erythrocytes affected by

A

male>female
inc w higher altitude over time
athletes > sedentary (higher demand)

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23
Q

what are erythrocyte pathology

A

anemia - too few
polycythemia - too many
sickle cell anemia - wrong shape / dec effectiveness

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24
Q

what is anemia

A

dec O2 carrying capacity
- dec quantity
- dec quality

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25
Q

what is a considerations of anemia’s pathology

A

sx not necessarily a dz

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26
Q

what patients will you frequently see anemia in (5)

A
  1. iron deficiency related to chronic GI blood loss (NSAID use, postop status)
  2. chronic or inflammatory dz
  3. neurologic conditions (pernicious anemia)
  4. infectious dz (TB or AIDS)
  5. neoplastic dz or cancer (bone marrow failure)
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27
Q

when does anemia typically present

A

when 1/2 of normal values
- slower changes may go unnoticed

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28
Q

what are clinical s/sx of rapid onset anemia (3)

A

dyspnea
weakness and fatigue
palpitations

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29
Q

what are observable signs of anemia (3)

A

pale palms w normal colored creases
pale/yellow mouth/eyes/mucus membranes
brittle or concave nails

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30
Q

what are objective measures of anemia

A

dec diastolic BP
inc HR
DEC EXERCISE TOLERANCE

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31
Q

what flag is anemia

A

emergent red - unknown, severe sx
yellow - known dx, change in status, discuss w provider

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32
Q

what is polycythemia

A

inc number of RBCs and concentration of Hgb
- inc total blood volume & inc viscosity
- inc clotting tendency, can limit flow to brain/vital tissues

can be primary or secondary

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33
Q

what are clinical s/sx of polycythemia (6)

A
  1. SOB, fatigue, HA, pruritis (rash)
  2. inc BP
  3. peripheral vascular neuropathy
    - small vessel occlusion
  4. gout (w primary)
  5. sx inc after dehydration or w altitude training
  6. dx after stroke or thrombosis
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34
Q

what flag is polycythemia

A

yellow - more urgent referral than anemia

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35
Q

what is sickle cell anemia

A

inherited autosomal recessive condition
abnormal form of Hgb

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36
Q

what is the impact of the abnormal form of Hgb seen in sickle cell anemia

A

curved shape limits O2 carrying capacity and flexibility of cell
- vasoocclusion and chronic hemolytic anemia

chronic hemolytic anemia = RBCs are destroyed much faster bc dec ability of cells to function

37
Q

clinical s/sx of sickle cell anemia (4)

A
  1. occurs w series of “crises”
  2. anemia
  3. pain from clotting (any organ)
  4. over time, progressive damage to organs from vasoocclusion and inflammation
38
Q

what organs do you see progressive damage to d/t sickle cell anemia

A

kidneys
lungs
**bones/joints (HIPS, SHOULDER)
heart/lungs
brain (CVAs, cog impairment)

39
Q

what flag is sickle cell anemia

A

yellow flag - pt likely aware of dx
- just have to determine if currently emergent

40
Q

what is the function of leukocytes (WBCs)

A

key role in inflammatory and immune response

41
Q

what are types of leukocytes

A

lymphocytes - viral infections
granulocytes
- neutrophils (bacterial)
- eosinophils (parasitic)
monocytes

42
Q

what dictates the # of leukocytes at any given time

A

changes in reaction to dz process or chronic conditions

43
Q

what pathology is associated w leukocytes

A

leukopenia - dec WBCs
leukocytosis - inc WBCs
leukemia - immature/don’t work correctly

44
Q

what is leukopenia dx at

A

dec WBCs <5k

45
Q

leukopenia occurs d/t (4)

A

bone marrow failure
overwhelming infection
dietary deficiency
autoimmune dz

46
Q

what are clinical s/sx of leukopenia (5)

A

sore throat/cough
high fever, chills, sweating
ulceration of mucous membranes
dysuria
persistent infections

47
Q

what are PT clinical implications of leukopenia

A

WBC count typically lowest 1-2wks post chemo/radiation tx
- consider when booking sessions

any constitutional sx in immunocompromised pts warrants immediate medical referral

48
Q

what flag is leukopenia

A

yellow - be aware of WBC count
- referral pattern depends on pt specifically

49
Q

what is leukocytosis dx at

A

inc WBCs >10k

50
Q

leukocytosis is a common finding related to what (8)

A

bacterial infection
inflammation
tissue necrosis
cancer
splenectomy
acute appendicitis
pneumonia
hemorrhage

51
Q

how would a hemorrhage lead to leukocytosis

A

lot of blood loss
- body is recreating blood bringing cell number up

52
Q

what are clinical s/sx of leukocytosis (5)

A

fever
chills
local inflammation
local tissue trauma
aware of risk of infection post-op

53
Q

what flag is leukocytosis

A

yellow - varying levels
- need to monitor
- make MD aware

54
Q

what is leukemia

A

malignant dz of blood forming organs
develops in bone marrow -> replication and release of immature WBCs

production of immature WBCs can result in poor production of normal blood cells (RBCs, Plts)
- see inc risk of bleeding

55
Q

what types of leukemia are there

A

ALL (acute lymphoblastic)
AML (acute myelogenous)
CLL (chronic lymphocytic)
CML (chronic myelogenous)

56
Q

what population do you see ALL in? prognosis?

A

3-7yo and >65yo
- children good px w active tx

57
Q

what population do you see AML in? prognosis?

A

inc incidence in 40+yo
- poor px w tx

58
Q

what population do you see CLL in? prognosis?

A

50+yo
2-10yr survival

59
Q

what population do you see CML in? prognosis?

A

rarest type
25-60yrs
poor px

60
Q

what are risk factors for leukemia (5)

A

exposure to ionizing radiation
- occupationally, from tx
prior chemo
hereditary disorders
some viruses
some immunodeficiency disorders

61
Q

what are clinical s/sx of leukemia (6)

A

think of cells lost
- infection (dec WBCs)
- bruising/bleeding (dec plts)
- fatigue (dec RBCs)
anorexia
enlarged lymph nodes
wt loss or loss of appetite
- 10% of BW in 10-14days unintentionally
enlarged spleen
arthritic joint sx in child

62
Q

why would you see anorexia and enlarged lymph nodes in pts w leukemia

A

body trying to fight an infection

63
Q

what flag is leukemia

A

yellow - monitor and make PCP aware of findings

64
Q

what is the function of thrombocytes (plts)

A

function in hemostasis and maintain capillary integrity

65
Q

what pathologies are associated w thrombocytes

A

thrombocytosis - too high
thrombocytopenia - too low
hemophilia - unable to function properly

66
Q

when is thrombocytopenia dx

A

dec plts <150k

67
Q

what are potential causes for thrombocytopenia

A

bone marrow failure
- d/t radiation, leukemia, cancer
meds
- NSAIDs, chemo, coumadin, warfarin

68
Q

what is the danger of thrombocytopenia

A

bleeding in GI or CNS can become life threatening

69
Q

when do clinical s/sx of thrombocytopenia start to present

A

plts <100k

70
Q

what are clinical s/sx of thrombocytopenia (5)

A
  1. spontaneous bleeding
    - petechiae (purple pin point <2mm)
    - purpura (larger 2mm-1cm)
    - ecchymoses (bruising >1cm; acute dark purple/blue&raquo_space; yellow - time frame tell you severity of plt ct)
    - epistaxis (nose bleed)
  2. joint swelling (blood in joint)
  3. menorrhagia (GI bleed into stool)
  4. gum bleeding
  5. melena
71
Q

what are PT clinical implications of thrombocytopenia (3)

A
  1. avoid strenuous exercise w valsalva/bearing down
  2. careful w BP cuff use
  3. avoid visceral manip, mechanical compression, soft tissue mobilization prior to discussion w MD
72
Q

why do you avoid strenuous exercise w someone w thrombocytopenia

A

can break a blood vessel
- esp in eye or brain

73
Q

what flag is thrombocytopenia

A

red - undiagnosed is immediate referral to MD

74
Q

what is thrombocytosis

A

inc platelets, usually temporary

75
Q

primary vs secondary thrombocytosis

A

primary - unregulated plt production
secondary
- compensation for hemorrhage
- post surgery/splenectomy
- iron deficiency or polycythemia
- cancer

76
Q

what are clinical s/sx of thrombocytosis (4)

A

pain, clotting
DVT
bruising
splenomegaly

77
Q

why might there be pain associated w thrombocytosis

A

related to clotting around organs and other tissues

78
Q

why might you see splenomegaly w thrombocytosis

A

spleen trying to break down excessive plt count

79
Q

what is the flag for thrombocytosis

A

yellow - need to monitor

80
Q

what is hemophilia

A

hereditary clotting disorder
- abnormal function of plasma clotting proteins (factors VIII and IX)

bleeding longer, not faster

81
Q

clinical s/sx of hemophilia (3)

A

hemarthrosis
- sx may last 1-3 days to wks
- hemophilic arthropathy
ms hemorrhage
GI bleed

82
Q

how can hemarthrosis present in hemophilia

A

bleeding into joint
- present as hot, sore joint
dec ROM
spontaneous or w trauma/stress

seen in knees, ankles, hips, shoulders, and elbows most commonly

83
Q

what is the danger w hemarthrosis in hemophilia

A

can have recurrent exacerbations that damage the joint
- progressive loss of motion
- ms atrophy
- contractures

84
Q

where is ms hemorrhage most commonly seen in hemophilia

A

in flexor groups&raquo_space; flexion contractures
- ex: iliopsoas, gastroc, forearm

85
Q

what is the flag for hemophilia

A

yellow - severity of bleed will determine referral requirements

86
Q

what are immediate medical referrals

A

thrombocytopenia - excessive bleeding, not having enough plts

rebound tenderness in aabdomen

87
Q

what are soon medical referrals

A

known anemia - chang in status or exercise progressions

new joint sx w known hemophilia

88
Q

what are next regular visit

A

non-life threatening sx
when PT not able to address issues

Med Screening (17 decks)

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