NP Certification

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Author:
northlover
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47619
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NP Certification
Updated:
2010-11-05 23:20:42
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Hemathology
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Hemathology for ACNP certification
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  1. Non-Hodgkins Lymphoma
    • - Cause is unknown, may have viral etiology
    • - Often presents with lymphadenopathy
    • -Most common neoplasm between ages 20 and 40
    • -Classified as low, intermediate or high-grade based on histologic type
    • - less predictable pattern of spread than Hodgkin's disease
    • - Advanced stage disease is usually apparent
  2. Hodgkin's Disease
    • - Cause is unknown
    • - More common in males, avarage age is 32
    • - Usually presents with cervical adenopathby and spreads in a predicatable fashion amond lymph node groups
    • -Characteristic Reed-STernberg cells differentiate from non-Hodgkin's disease
  3. Lymphomas diagnostic and management
    • 1. CT, x-rays, ultrasonography, MRI used to locate and stage the disease
    • 1. Biopsy, histopathologic examination confirms diagnosis
    • Management:
    • 1. Radiation
    • 2. Chemotherapy
    • 3. Bone marrow transplantation
  4. Leukemias: neoplasms arising from hematopoietic cells in the bone marrow
    • Signs/smyptoms: may be asymptomatic
    • - Fatigue
    • - Weakness
    • -anorexia
    • -generalized lymphadeopathy
    • - weight loss
    • Laboratory/diagnostics:
    • 1. CBC with subnormal RBCs and neutrophils
    • 2. Elevated sedimentation rate
    • 3. Peripheral blood smear usually distinguishes acute and chronic leukemia, but a bone marrow aspiration is required to confirm the diagnosis
  5. Acute Nonlymphocytic Leukemia (ANL)/Acute Nyelogenous Leukemia (AML)
    • - constitues 80% of acute leukemias in adults
    • -Remission rates from 50 to 85%
    • - Long term survival 40%
  6. Acute Lymphocytic Leukemia (ALL)
    • - More difficult to cure in adults taht children (90% remission rate in children)
    • - Pancytopenia with circulating blasts (hallmark of disease)
  7. Chronic Lymphocytic Leukemia (CLL)
    • - Most common leukemia in adults
    • - Occurs in both middle and old age
    • -Median survival is 10 years
    • - Lymphcytosis (hallmark of disease)
  8. Chronic Myelogenous Leukemia(CML)
    • - Occurs most often in persons aged 40 and older
    • - Median survival is 3 to 4 years
    • - Phidadelphia chromosome seen in leukemic cells (hallmark of disease)
  9. Hgb
    • Normal: 14-18 in males
    • 12-16 in females
  10. Hct
    • Measures of % of a given volume of whole blood that is occupied by erythrocytes; the amount of plasma to total RBC
    • Normal: 40-54 in males
    • 37-47 in females
  11. TIBC - total iron binding capacity
    250-450 ug/dl
  12. Serum Iron
    50-150
  13. Mean Corpuscular Volume (MCV)
    • Expression of the average volume and size of individual erythrocytes
    • Normal 80-100
    • (Microcytic <80, normocytic 80-100, macrocytic >100)
  14. Mean corpuscular hemoglobin (MCH)
    • expression of the average amount and weight of Hgb contaned in a single erythrocyte
    • Normal 26-34
  15. Mean corpuscular Hemoglobin Concentration (MCHC)
    • Expression of the average Hgb concentration or proportion of each RBC occupied by Hgb as a percentage. More accurate measure than MCH
    • Normal 32-36
  16. Low MCV
    • Iron Deficiency anemia
    • Thalassemia
  17. High MCV
    B12 deficiency, folate deficiency, alcoholism, liver failurea nd drug effects
  18. Normocytic
    Anemia of chronic disease, sickle cell disease, renal failure, blood loss and hemolysis
  19. Idopathic Thrombocytopenia Purpura (ITP)
    • - In adults, is usually chronic, causing mild to severe thrombocytopenia
    • - Only occasionally patients develop bleeding that requires hospitalization
    • _ Women outnumber men in incidence by a ration of 3:1
    • Laboratory:
    • - bone marrow analysis
    • - Low Platelet count with other causes of thrombocytopenia ruled out. Hystory of easy bruising or bleeding
  20. ITP
    • Management
    • - May not be necessary until the platelet count is <20,000
    • - High dose corticosteroids may help to elevate the platelet count within 2-3 days
    • - IV gamma globulin usually produces a responce within 2-3 sYA
    • - gamma globulin is preferred to steroids in HIV -related ITP
    • -Platelet transfusion may occasionally benefit
    • - Thrombocytopenic precautions:
    • - avoid constipation (increase fiber, laxatives)
    • - no flossing, no shaving
    • - hold pressure for 5 minutes or more for cuts, line incertion, ets.
    • - Heparin - induced thrombocytopenia purpura (HIT)
    • - Argartoban
    • Lepirudin
  21. Disseminated Intravascular coagulation
    DIC results from the intravascular activation of both the coagulation and fibrinolytic systems (thrombin and plasmin are acitvated), causing simultaneous thrombosis and hemorrhage. Mortality rate is 50-85%
  22. DIC associated conditions
    • - Malignant neoplasms
    • - infection/sepsis
    • -liver disease
    • -massive trauma
    • - extensive burns
    • - Shocks
    • - Obstetrical complications
    • - Acute Leukemia
  23. DIC pathophysiology
    • - Thrombin causes conversion of fibrinogen to fibrin, producing fibrin clots int the microcoagulatio
    • - coagulation factors (fibrinogen, prothrombin, platelets, factors V and VIII) are thus reduced
    • _Circulating thrombin activates the fibrinolytic system which lyses fibrin clotes into fibrin degradation products (FDPs)
    • - Hemorrhage results from the anticoagulatn activity of FDPs and the depletion of coagulation factors)
  24. DIC s/s
    • - varies greatly in clinical severity (bleeding vs thrombosis)
    • - Profound dissturbances in hemostasis with ecchymosis, oozing from venipunctures sites, petechiae to mucous membranes
  25. DIC laboratory/diagnostics
    • 1. Thrombocytopenia (platelets <150,000)
    • 2. Hypofibrinogemia (fibrinogen <170)
    • 3. Decreased RBCs
    • 4. Increased fibrin degradation products (FDPs) (>45 mcg/ml or present at .1:100 dilution)
    • 5. Prolonged PT(>19 sec)
    • 6. Prolonged PTT (>42 seconds)
    • D-Dimer reflects simultaneous activation of thrombin and plasmin
    • With increased FKPs, gives a predictive accuracy of 96% for diagnosing DIC
  26. DIC management
    • 1. Goal: treat the underlying condition and control bleeding
    • 2. Platelet transfusion for thrombocytopenia, FFP to replace clotting factors, and cryoprecipitate to naintain fibrongen levels are given if bleeding is severe
    • 3. The use of heparin to decrease thrombin generation remains controversial.
    • 4. consider: antithrombin
    • Drotrecogin alfa-activated (Xigris) 24 mcg/kb/hr IV continous
    • After all therapeutic agents fail, antifibrinolytics such as amicar or tranexamic acid
    • 5. Therapy is aimed at cessation fo bleeding, increasing plasma fibriogen and the platelet count, and decreasing FDPs

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