Hematology

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tiffanydawnn
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129563
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Hematology
Updated:
2012-01-22 23:56:06
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Hematology
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Hematology
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  1. blood
    • major transport system
    • defense
    • body temp
    • clotting factors - liver
    • blood buffers - bicarb, H+ ions
    • adults - 5L
    • 55% plasma - PROTEINS, glucose, salts, vitamins, hormones, antibodies
    • 45% formed elements - RBC/WBC/platelets
  2. erythropoiesis
    • erythropoietin: hormone from kidneys that stimulates red bone marrow to produce RBC
    • stimulated by hypoxia
    • with increased RBC production - reticulocyte count will exceed RBC count
  3. thrombopoietin
    hormone from liver/kidney that stimulates platelet production
  4. RBC
    • biconcave
    • no nucleus
    • contains Hgb
    • transports O2 and CO2
    • lives 120 days
  5. RBC lab values
    • RBC: 4-6 million
    • Hgb: 14-18 (male) 12-16 (female)
    • Hct: 40-50 (male) 35-45 (female)
    • **Hgb 8 or less - transfusion
  6. MCV
    • mean corpuscular volume
    • SIZE
    • microcytic or macrocytic
  7. MCH
    • mean corpuscular hemoglobin
    • COLOR
    • hypochromic (pale - less HgB)
    • hyperchromic (dark - more Hgb)
  8. RDW
    • red cell distribution width
    • variation of RBC width
    • should be narrow gap (normal 11-15%)
    • wide gap could mean recovery from anemia
  9. RBC breakdown
    • lives 120 days
    • phagocytosis in liver/spleen
    • heme releases Fe which returns to bone marrow for reuse
    • heme->indirect bilirubin->enters plasma->binds to albumin->to liver->breaksdown to direct bilirubin->excreted in bile
    • jaundice - liver not breaking down bile - could be spleen or liver issue
  10. anemia
    • reduction in the O2-carrying capacity of blood r/t deficiency of RBC or hemoglobin
    • leads to tissue hypoxia
    • less energy production
    • reduced cell metabolism/reproduction
    • compensation: tachypnea, peripheral vasoconstriction
  11. types of anemia
    • blood loss - acute or chronic
    • nutritional
    • --iron - lack of intake OR due to blood loss - MOST COMMON
    • --B12 (pernicious) - stomach not making intrinsic factor (elderly)
    • --folic acid - alcoholic
    • hemolytic - sickle cell
    • aplastic - bone marrow
  12. s/s of anemia
    • pallor: skin, mucous membranes, **conjunctiva**, nail beds
    • tachycardia: compensation - heart beats faster to increase blood supply/get more O2
    • tachypnea: compensation - attempt to get more O2
    • fatigue: less O2 available
    • dyspnea on exertion: less O2 available
    • bone pain: increased erythropoiesis
    • decreased LOC: cerebral hypoxia
  13. complications of anemia
    • angina: myocardial hypoxia
    • CHF: increased demand on heart
    • GI ulcers
    • stomatitis: inflammation of mouth/tongue
    • hair/skin changes
    • cheilosis: cracks on side of mouth
  14. acute blood loss anemia
    • rapid decrease in blood volume
    • normal MCV/MCH
    • decreased H&H
  15. chronic blood loss anemia
    • depleted iron stores
    • r/t iron deficiency anemia
    • **tiny, pale RBCs**
    • decreased MCV/MCH (microcytic/hypochromic)
  16. B12 deficiency anemia
    • pernicious anemia
    • malabsorption of B12 r/t lack of intrinsic factor
    • increased MCV (macrocytic)
    • nucleated (immature RBCs)
    • dx: Shilling test - test for intrinsic factor
    • s/s: **beefy red tongue**, paresthesias (B12 important for myelination of neurons)
    • tx: B12 injections(1x month)/SL tabs(daily)
  17. folic acid deficieny anemia
    • r/t malnutrition
    • alcohol suppresses folate metabolism
    • risk for neural tube defects (spina bifida) in pregnancy
    • increased MCV (macrocytic)
    • nucleated (immature RBCs)
  18. iron deficiency anemia
    • decreased intake, chronic bleed, malabsorption, liver disease
    • microcytic/hypochromic
    • **tiny, pale RBCs**
    • s/s: pica, nail pitting, cold intolerance, menstrual
    • tx: treat underlying cause, iron supplements (take with OJ unless in renal failure - do not take with coffee/tea/dairy/antacids)
  19. dietary iron
    • high in iron
    • --red meat, seafood
    • --leafy green veggies
    • --nuts, beans, whole grains
    • low in iron
    • --cow's milk
    • --egg whites
    • --soy protein
  20. hemolytic anemia
    • intrinsic factors (RBC production disorders)
    • --RBC cell membrane
    • --Hgb structure
    • --G6PD (enzyme abnormality)
    • extrinisic factors (RBC destruction disorders)
    • --drugs/chemicals
    • --toxins
    • --infections
    • --trauma/burns
    • --mechanical damage
  21. sickle cell anemia
    • hereditary, chronic hemolytic anemia
    • defect in hemoglobin synthesis (hemoglobin S) where RBCs become crescent shaped
    • life span - 40 years
    • recessive (need trait from both parents)
    • RBC life span - 35-40 days - spleen working hard
    • --splenomegaly , hyperbilirbinemia, jaundice
    • hypoxia causes sickling->microvascular occlusions->ischemia and pain
    • triggers: cold, high altitudes, dehydration, strenuous activity, fever, smoking, infections, stress
    • tx: O2, fluids, pain meds
  22. sickle cell s/s
    • pain - vasoocclusive/thrombotic crisis
    • fever
    • pallor
    • fatigue
    • jaundice
    • irritibility
    • poor wound healing
    • splenomegaly
    • anemia
    • risk for stroke - occlusions
  23. aplastic anemia
    • rare disorder where red bone marrow is replaced by fat
    • autoimmune - immune system attacks bone marrow
    • unable to produce new RBCs (as well as WBCs/platelets) - pancytopenia
    • causes: idiopathic, radiation, chemicals, chemotherapy, antibiotics, viral illnesses (HIV, mono, Hep C)
    • tx: treat underlying cause, transfusions, BMT, antibiotics
    • dx: risk for bleeding, risk for infection
  24. anemia diagnostic tests
    • CBC: decreased RBC, Hgb, Hct
    • Fe: decreased
    • TIBC (total iron binding capacity): increased
    • ferritin: decreased
    • bone marrow aspiration: aplastic anemia
  25. anemia meds
    • iron
    • B12
    • folic acid
    • hydroxyurea: decreases production of RBCs (for sickle cell - suppresses RBC production and stimulates fetal Hgb that does not sickle)
    • immunosuppressive therapy: aplastic anemia
  26. polycythemia
    • excess RBCs - Hct > 55
    • primary/secondary/relative
    • dx: bone marrow studies, **serum erythropoietin level (PV=low, secondary=high)**
    • tx: treat underlying cause, quit smoking, periodic phlebotomy (300-500ml), hydroxyurea (PV), antihistamines, ASA (thrombosis)
  27. primary polycythemia
    • polycythemia vera
    • uncommon
    • myeloproliferative disorder - myeloid line
    • erythroid stem cell in bone marrow producing too many RBCs
    • LOW erythropoietin level
  28. secondary polycythemia
    • most common form
    • HIGH erythropoietin levels r/t chronic hypoxia
    • high altitude, smoking, lung disease
  29. relative polycythemia
    • caused by dehydration
    • hemoconcentration - elevated Hct because of increased concentration
    • RBC normal
  30. polycythemia s/s
    • plethora: red, ruddy appearance
    • puritis
    • hepatomegaly/splenomegaly
    • elevated BP
    • bounding pulse
    • CHF
    • headaches/visual disturbances
    • thromboses/infarctions of organs and extremities
  31. thrombocytes
    • originate in bone marrow
    • blood clotting
    • platelet plug
    • life span - 7-10 days (stop ASA 7-10 days before surgery)
    • stored in spleen
    • normal level: 150-400
  32. thrombocytopenia
    • platelet count < 100
    • causes: reduced production, increased storage in spleen, accelerated destruction
    • **< 20: risk for spontaneous bleed
    • **< 10: risk for fatal bleed
    • dx: CBC, ANA (antinuclear antibody - body attacking itself - autoimmune), serological tests (Hep C, CMV, EBV, toxoplasmosis, HIV), bone marrow aspiration (aplastic anemia)
  33. blood clotting disorders
    • vitamin C deficiency
    • ITP/TTP
    • Heparin-induced thrombocytopenia
    • ESRD - thrombopoietin from kidney
    • vitamin K deficiency - liver disease
    • Hemophilia/VW
    • anticoagulants
  34. ITP
    • immune/idopathic thrombocytopenia purpura
    • autoimmine disease - immune system destroys platelets
    • acute - any age follows a viral illness, lasts 1-2 months
    • chronic - young adults 20-50, females > males, may require splenectomy
    • s/s: petechiae, purpura, brusing, epistaxis, hematuria, heavy menses, spontaneous intracranial bleed (HA)
  35. TTP
    • thrombotic thrombocytopenia purpura
    • rare disorder
    • small clots in microcirculation
    • affects heart, kidney, brain
    • same s/s as ITP
  36. thrombocytopenia tx
    • steroids - autoimmune
    • immunosupressives
    • platelet transfusions (< 20,000)
    • --increased risk with platelet transfusions
    • --count only raised 10,000
    • --platelets only effective 3 days
    • --risk for bacterial infection (stored at room temp)
    • plasma
    • surgery - splenectomy
  37. DIC
    • disseminated intravascular coagulation
    • systemic inflammatory response
    • intravascular clotting and bleeding
    • sepsis, surgery/trauma, cancer, pregnancy/childbirth
  38. hemophilia A
    • ***deficient factor VIII***
    • X-linked recessive trait
    • carried by females, manifested in males
    • mild, moderate, severe
  39. hemophilia B
    • **deficient factor IX**
    • identical to A
  40. hemophilia C
    • **deficient factor XI**
    • Ashkenazi Jews
    • mild disorder
  41. Von Willebrand's disease
    • **deficient of vW factor**
    • most common hereditary bleeding disorder
    • autosomal dominant - only need one gene
    • men and women
    • mild
    • prolong bleeding post-op/dental extraction
  42. hemarthrosis
    • bleeding in joint
    • RICE (minor)
    • transfuse (major)
  43. hemophilia s/s
    • hemarthrosis
    • brusing/hematoma
    • bleeding gums, GI
    • gastric pain/GI bleed
    • hematuria
    • occult blood in stool
    • epistaxis
    • pain (hematoma pressure on nerves)
  44. hemophilia dx
    • normal platelets
    • **elevated PTT**
    • factor assays (decreased VII, IX, XI)
    • amniocentesis/CVS in pregnancy
    • PT - normal
    • BT - prolonged in vW, normal in hemophilia
  45. hemophilia meds
    • replace deficient clotting factors
    • FFP: all clotting factors
    • DDAVP: vasoconstrictor
    • avoid ASA
  46. hemophilia teaching
    • recognize internal bleeding
    • RICE
    • safe home
    • safe grooming
    • oral hygiene
    • preparing/administering IV meds
  47. platelets vs FFP
    • platelets
    • --raises platelet count 10,000
    • --functions for 3 days
    • FFP
    • --contains no platelets
    • --contains clotting factors, electrolytes, proteins
  48. leukocytes
    • myeloid - RBCs, platelets, WBCs
    • lymphoid - B cells, T cells
  49. leukemia
    • cancer cells in bone marrow causes unregulated proliferation of immature white blood cells
    • acute vs chronic / lymphocytic vs myelocytic
    • AML - adults - poor prognosis
    • CML
    • ALL - children - best prognosis
    • CLL
    • etio: radiation, chemicals, viruses, chromosomal abnormalities (Philadelphia chromosome)
  50. acute leukemia
    • rapid increase in the numbers of immature blood cells
    • ALL - more common in children, best prognosis
    • AML - adults, poor prognosis
  51. chronic
    • excessive build up of relatively mature but abnormal white blood cells
    • gradual onset, prolonged course
    • mature cells
    • CLL - B cells do not mature into plasma cells
    • CML - polycythemia and thrombocytosis
  52. WBC diff
    • segs/polys - fully grown neutrophil
    • bands - young neutrophils (can still fight infection)
    • blasts - baby neutrophils
    • --belong in bone marrow
    • --ONE blast in peripheral smear is LEUKEMIA (one blast = one million cancer cells)
  53. leukemia complications
    • anemia/thrombocytopenia - suppression of RBC and platelet production
    • hyperuricemia - rapid turnover of cells (give allopurinol)
    • bone pain - crowding of bone marrow
    • lymphadenopathy, spenomegaly, hepatomegaly
    • viscous blood
    • greatest risks: infection/bleeding
  54. leukemia s/s
    • fever
    • bleeding
    • bone pain
    • WL
    • fatigue
    • CNS
  55. leukemia tx
    • chemo/radiation
    • colony stimulating factors after chemo
    • BMT (acute leukemia)
    • stem cell transplant
    • interferon, interleukins
  56. chemotherapy
    • interrupts cell metabolism and replication at different stages
    • phase-specific and non-phase specific forms
    • usually combination therapy
    • **reduction chemo: wipes out bone marrow (ALL)**
    • **consolidation chemo: suppresses bone marrow (CML/CLL)**
    • ALL into CNS - chemo does not cross BBB (may give chemo directly into brain ventricles/lumbar puncture)
  57. BMT
    • best match (HLA)
    • amount harvested based on recipient
    • aspirate from sternum or iliac cresr
  58. Graft vs Host
    • graft attacks host
    • acute or chronic (> 100 days)
    • can be lethal
  59. peripheral stem cell transplant
    • quicker than BMT
    • done via blood bank
    • several times needed
    • donor may require platelet transfusion
  60. lymphatic system
    • vessels, nodes, spleen, tonsils, thymus
    • filters lymph
    • maintains fluid volume
    • essential to immune response
  61. lymphoma
    • malignant lymphocytes
    • related to lymphocytic leukemia
    • tumors in the node - enlarged, nonmobile, nontender
    • over 43 types (Hodgkins vs non-Hodgkins)
    • can metastisize
    • tx: chemo, radiation, stem cell transplant
  62. Hosgkin's lymphoma
    • malignant **Reed-Sternberg cells** lymph nodes
    • central nodes - cervical/subclavical
    • very curable
  63. non-Hodgkin's lymphoma
    • **no Reed-Sternberg cells**
    • peripheral nodes
    • spreads early
    • prognosis varies
  64. lymphoma dx
    • CBC
    • ESR - erythrocyte sedementation rate - how long it takes for RBCs to settle - elevation = inflammation
    • chem panel
    • CXR
    • CT
    • PET
    • biospy nodes
    • Ann Arbor system used for staging
  65. multiple myeloma
    • malignant plasma cells (B cells) that produce large amount of M protein
    • incurable
    • causes hypercalcemia (kidney failure), pathological fractures
    • M proteins turn into Bence Jones proteins in urine
  66. multiple myeloma s/s
    • bone pain
    • stress fractures
  67. hypercalcemia tx
    • IV fluids
    • loop diuretics (lasix)
    • Zometa - pushes calcium into bones
    • calcitonin
    • corticosteroids
    • weight bearing exercise
  68. multiple myeloma dx
    • CBC
    • bone marrow study
    • UA - Bence Jones
  69. multiple myeloma tx
    • induction chemo - wipe out bone marrow
    • BMT
    • maintenance chemo/prednisone
    • radiation
    • support bones
    • fluids (kidneys)
  70. corrected calcium math
    • normal albumin - 3.5 - 5
    • normal calcium - 8 - 10.2
    • **for every 1 gram albumin is low, add 0.8 to calcium**
  71. ANC math
    • absolute neutrophil count
    • WBC x % neutrophils
    • s/b > 500
    • < 500 = neutropenic precautions

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