Hematology Med Surg
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What is the definition of Anemia?
- Reduction of either Hemoglobin or Hematocrit
- Anemia is more like a syndrome than a specific disease and may have many different causes
What are the normal values for Hemoglobin and Hematocrit?
- Male-13.5-17.5 g/dL
- Female- 12-16 g/dL
- Male: 41-53%
- Female: 36-46%
What is the normal value for RBCs, platelets and WBCs?
- RBCs:4-5 million/mm3
- WBCs: 5,000-10,000
What are some different types of anemia?
- Sickle Cell Disease
- G6PD Deficient Anemia
- Iron Deficient Anemia
- Vitamin B12 Deficiency Anemia
- Aplastic Anemia
What is sickle cell disease?
- A problem with the formation of hemoglobin chain.
- It is genetic, autosomal recessive
- Most common in African Americans
- 40% of total hemoglobin is HbS
- When exposed to decreased oxygen, these cells sickle and clump together, leading to a VOE (vaso-occlusive event)
- THIS CAN CAUSE ORGAN DAMAGE
What are some things that cause sickling of the RBCs?
- venous stasis
- high altitudes
- extreme temp changes
- strenuous exercise
- emotional stress
How are Sickled RBCs different from normal RBCs?
- Sickled RBCs will go back to normal when oxygenated, but they are fragile and break easily
- Average lifespan of a Sickled RBC is 12-15 days where a normal RBC is 120 days
- -hemolytic anemia
Name organ tissues often involved in sickle cell damage
How is sickle cell disease diagnosed?
- Electrophoresis of blood sample:
- -Sickle cell trait (AS) will show <40% HbS
- Sickle cell disease (SCD) will show 80-100% HbS
- -It will also show the number of sickled cells
- -Other tests deal with the complications of the disease
What are the S/S of a Sickle Cell Crisis?
- Risk for high output HF due to increased blood viscosity (JVD, S3 heart sound)
- Skin changes- may show pallor, jaundice or ulcers
- Distended abdoment
- Kidney failure
- Behavioral changes
- Pronator Drift
- Priaprism- excessive vascular engorgement of the penic
What is the nursing care for SCD?
- Pain medication- around the clock, not PRN
- PO/IV intake (increase fluids)
- Keep extremities straight and HOB not greater than 30 degrees-promotes circulation
- Keep room warm-vasodilation
- Avoid manual BP if possible
- No tight clothing
- Circ checks q1hr
- Patient education
How is SCD pharmacologically managed?
- Pain medications
- Hydroxyurea (Droxia):
- -Stimulates fetal Hb (HbF)
- -Long term use has high risk of leukemia
- -suppresses bone marrow function
What is Iron deficiency anemia?
- Serum ferritin < 10ng/mL (Normal: 12-300 ng/dL)
- *Most common anemia, more common in women, elderly and poor nutrition
- May Result from blood loss, poor Gi absorption of iron and inadequate diet
What are the s/s of Iron deficient Anemia?
- Exercise Intolerance
- Fissures at the corner of mouth
- Brittle, spoon nails
Where is iron normally stored in the body?
- 2/3 of the iron is stored in the hemoglobin
- 1/3 stored in bone marrow, spleen, liver and muscles (these are usually depleted first)
What is the treatment for iron deficient anemia?
- Mild: Oral iron supplements (ferrous sulfate(Feosol))
- -Take between meals
- -Drink with straw as not to stain teeth
- Severe: IV or IM iron
- -Z track method to prevent skin staining
What is the importance of B12?
- Vitamin B12 activates the enzyme that moves folic acid into the ell so that DNA synthesis can occur
- Usually absorbed in GI tract with instrinsic factor
What is Vitamin B12 Deficiency Anemia?
- Vitamin B12 deficiency leads to anemia by inhibiting folic acid transport and reducing DNA synthesis in precursor cells
- -this improper DNA leads to increased size of RBCs and macrolytic RBCs
What is pernicious anemia?
- Failure to absorb B12 caused by deficiency of intrinsic factor which is needed for GI absorption.
- Causes: Small bowel obstruction, chronic diarrhea and diverticulitis, low intake of B12 (such as vegetarianism)
What are the S/S of B12 Deficiency Anemia?
- Pallor, Jaundice, fatigue, weight loss
- Glossitis- beefy, smooth tongue
How is B12 Deficiency diagnosed?
- Shilling test: multilevel test for instrinsic factor
- Radioactive B12 PO and IM to saturate liver
- Assess in 24 hours
- If B12 is not absorbed, it will spill into the urine
What is the treatment for B12 Deficient Anemia?
- B12 injections for pernicious anemia
- May use CaloMist nasal spray
- *lifelong therapy
What is Aplastic Anema?
- Deficiency of circulating RBCs due to decreased RBC production in the bone marrow
- S/S of poor oxygenation
- Treated with a bone marrow transplant
What is G6PD Deficient Anemia?
- This is a genetic condition
- Hemolysis of the RBCs due to a lack of glucose 6 phosphate dehydrogenase (G6PD)
What is Polycythemia Vera?
- Hypervicious blood due to increase in RBC production
- Polycythemia Vera may be a cancer of the RBCs
What is Primary Thrombasthenia?
- Glanzman' Thrombasthenia
- Autosomal recessive gene where clotting factors do not exist
- May be treated with platelet precautions
What is the distinct characteristic for Hemophilia?
- They do not bleed more, they simply bleed longer due to lack of clotting factors
- Genetic Cause
What is Idiopathic thrombocytopenia Purpura?
- Autoimmune response coats platelets so macrophages destroy them
- There is a low number of circulating platelets even though production is normal
- These mangles platelets block up the spleen and a spleenectomy may be necessary
What is DIC?
- Disseminating Intervascular Coagulation: clotting at the beginning uses up all of the clotting factors, putting the person into a hemophilic state (thrombocytopenia)
- This person is first at risk of embolism, then at risk for hemorrage
- This person is also at risk for sepsis and septic shock
What is the normal PT/INR for coumadin?
- PT: Normal- 11-12.5 sec
- Anticoag therapy- 1.5-2.5x normal
- INR: Normal-0.7-1.8
- Anticoag therapy-2-3
What is a normal PTT and aPTT for heparin therapy?
- PTT: normal-60-70 sec
- aPTT:normal-30-45 sec
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