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. What would you like to do?
- prothrombin to thrombin
- fibrinogen to fibrin
what usually causes?
What kind of meds?
what would be low?
- -baso, eosin, neutr
- supp of bone marrow/chemo, radiation, bact, -
- -viral inf, genetics (possibility)
- -deadly infection
- - inflammatory stuff, ulcers in mucous membranes, later- pneumonia, UTI
- find/x cause of marrow suppression
- treat/prevent infections
- xfusion of PRBC
- figrastim (Neupogen) SC
- lots of WBCs, no infection,
- splenomegaly, lymphadenopathy, mepatomegaly, bone pain, meningeal irritation, oral lesions, bleeding, petechiae
AML in kids
- 5 year remission- only 25%
- can survive longer
What is normal value of WBCs?
What meds elevate?
- 4.500-10,500 cells/mm3
- epinephrine, aspirin, allopurinol, steroids, heparin
- bacterial infections, bone marrow dep, pernicious anemia
- antibiotics, anithyroid, antiepiletic, ntihistamines, chemo, diuretics
renal failure leads to anemia how?
what mimics the missing thing?
- erythropoietin rel by kidneys
Platelet count- normal value?
What drugs affect platelet count?
- 150-400 X10^3
- aspirin, heparin
(thrombocythemia, thrombocytosis) renal failure, malignancies, chronic pancreatitis
(thrombocytopenia) include disseminated intravascular goag, hemolytic anemia, bone marrow malignancies.
Less than 20,000 cells/mm3 associated with a tendency for spontaneous bleeding and prolonged bleeding time.
malignant neoplastic immunodeficiency disease of bone marrow.
neoplastic cells infiltrate bone marrow- bone probs like pain, fractures, deformities, back pain
- older 40, peak at 65, gradual, insidious, , suscpt to infection follows disturbances of antibody form by abnormal plasma cells.
- bone destruction w dissemination into lymph nodes, liver, spleen, kidneys, patho fractures.
- Prod of all blood cells crowded out, so infection, anemia, inc pot for bleeding. Ca and Ph drain from bones, leading to hyper calc and renal problems, cell dest contrib to dev of hyperuicemia, wcan cause renal failure alon w myeloma protein.
dx- radiographic sk studies, bone marr biopsy, lab exam bl and urine, monoclonal ab may be present, aeb serum or urine electrophoresis. no cure. radiation, chemo for tumor size. intineoplastic drugs. Analgesic and ortho supports. Fluid, corticosteroids
Platelets/ What's HIT?
What's antidote to Heparin?
- Heparin induced thrombocytopenia
- platelets coated in antibodies
What's antidote to Warfarin?
What is it needed for?
adequate nerve func, protein and carb metab, normal growth, RBC dev, cell repro
Flushing diarrhea, itching, rash, hypoK
GI functions, K levs at beg of treatment. Need to return for shot 1X/mo if pernicious anemia
Erythropoieses, inc RBC, WBC, plt fomr in megaloblastic anemias,
rash, pruritis, gen malaise, bronchospas, slight flushing
IM, SC, IV
Rep iron stores needed for RBC development
- NVD const epigastric pain, black and red tarry stools, discolored urine, staining of teeth
- between meals, OJ, straw to avoid staining teeth
Given for Mild Von Willebrand's, not for Hemophilia
Prom reabsorp of water by kidneys and inc plasma factor 8 lev, inc platelet agg, resulting in vasopressor effect, nasal irr, cong, drowsiness, h ache, flushing, nausea, ab cramps, heartburn, vulval pain, HTN, avoid overhydration
Can cause hyper or hyponatremia, cures D insipidous
Stim prolif and diff of neutrophils
fever, alopecia, sk pain , NVD, mucositis, anorexia
Adverse affects- thrombocytopenia
(arryth, chest pain mi- very rare)
clot and bleed, clot and bleed, clot and bleed
Heparin, easier to get a head of, even tho can be a cause
Elevated D-dimer (clotting)
- Elevated coag (bleeding)
Subcut Heparin doesn't affect aPTT, but can cause...
IV Heparin Monitor...how often...until...
IV therapeutic range?
- aPTT q 6 h until therapeutic
- 1.5-2 X normal PTT
How many RNs have to sign off?
What is antidote?
What is Heparin for?
- DVT and prev, usually SC
- Maintain patency of indwelling IV cath- IV in catheter only, during/post MI, thrombotic stroke-IV, A fib
stop __-__ min before procedure
- Ibuprophen, ASA, Warfarin, other anticoags
- bleeding, excessive bruising,
- monitor stools,
- heparin stopped 30-60 prior to procedures
- aPTT, platelets (same, just aPTT more sensitive) for thrombocytopenia, liver enzymes- if liver damaged, making clotting factors longer, caution w heparin, HCT only if bleeding
White clot syndrome
- formation of clots dt heparin (related to DIC)
given for potential bleeding dt heparin overdose, dilute and give IV slowly over 30 minutes, severe hypotension, circ collapse, brady, pulm edema
causes severe hypotension and bradycardia
If allergic to Heparin or have HIT, give
- angiomax or bivalirudin
- DON"T MONITOR aPTT
- may increase
- 1.2 life 25 min
- Given in PCI procedures instead of Heparin
Low molecular weight heparin
- DVT prophy
- dec dose in renal stop 12-24 h prior to procedures
- platelets, hgb, HCT, ALT, AST, don't monitor coag.. CNS,-fever, confusion, edema, anemia, thrombocytopenia, bleeding, angioedema, anaphylaxis
What would you like to do?
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