Exam 1

HEMATOLOGY Laboratory Norms RBC 4-6 Hgb 14-18 Hct 37-54 PT 12-15 INR 0.8-1.8 aPTT 20-40 *Important Facts* The liver plays an important role in the breakdown of RBC and houses many clotting factors. The spleen plays an important role in fighting infections. Bone Marrow Biopsy Aspiration can be done via sternum or posterior ileac crest. Biopsy can only be done via posterior ileac crest. Pain with aspiration is normal. s/p APPLY PRESSURE!! NO NSAID or ASA. risk for bleeding and infection. Anemia Mild (Hgb 10-14) No Sx May experience Sx upon exertion s/a palpitations, diaphoresis, dyspnea. Moderate (Hgb 6-10) Cardiopulmonary Sx at rest HR, RR Severe (Hgb <6) Affecting multiple body systems d/t tissue ischemia Sx include pallor, jaundice, pruritis, irritability, agitation, NV, weakness, fatigue, wt, sensitivity to cold. *Important Facts* Iron is absorbed in the duodenum and upper jejunem. It is stored in the BM, spleen and liver as Ferritin. Iron Deficiency Anemia D/t dietary deficiency, absorption, blood loss, hemolysis, dialysis Sx include Pallor, Glossitis, Spoon shaped nails w/ longitudinal ridges, Chelitis, headaches, Pica, parastesias. Treat underlying cause! Diet, Supplements, PRBC. Ferrous Sulfate- PO. Take on empty stomach 1 hour ac meals w/ OJ. Liquid form should be drank with a straw bc it will stain teeth. IV form has high possibility for anaphylactic reaction. Give test dose first. IM inj can stain skin. Make sure to change needle after drawing up. Z track. Foods in iron include Red meats, Liver, turkey, whole wheat bread/cereal, green leafy veggies, beans, legumes, dried fruit, eggs. Cobalmin Deficiency (B12) d/t absorption issues (IF) as with Pernicious anemia, IBD, GI surgery. Long term Histamine users, alcohol abuse, vegetarians. Sx include beefy red tongue, NM degeneration of spinal cord (weakness, ataxia, parastesias of hands and feet, confusion, etc) Treat underlying cause if possible. IM inj for life, diet. * risk for gastric CA!!* Foods in B12 include liver, dairy (milk, eggs, cheese) and tuna. Folic Acid Deficiency d/t malnutrition, pregnancy, HD, BCP, methotrexate Sx similar to B12 deficiency without NM degeneration. Treat underlying cause. Folic Acid supplements, diet. Foods in Folic Acid include liver, pork, citrus, green leafy veggies, shellfish, beans. Aplastic Anemia A PLASTIC PAN!! d/t underproduction of RBC, WBC and Plt. Causing PANCYTOPENIA. BM biopsy will produce dry tap. risk for bleeding, infection and oxygenation issues!!!! Treat by removing causative agant. Stem cell tx, steroids, Cytoxan. Hemolytic Anemia d/t destruction of RBC at a rate exceeding production Sx include JAUNDICE, enlarged spleen and liver, tubular necrosis. Sickle Cell Anemia Hemolytic anemia causing sickling of RBC. Acute Chest Syndrome is Common!! Treat with folic acid supplements, hydroxurea, EPO, Blood transfusions, BM/stemm cell tx. Teach to avoid high altitudes, fluid intake, treat infections promptly, In crisis, give O2, pain medications, rest, fluids. Thrombocytopenia Plts <150,000 Plt=BLEEDING

Sx Bleeding, petichiae, purpura. Bleeding occurs when Plt < 50,000

Transfuse when Plt < 10,000 Treat cause, steroids, plasmapheresis, splenectomy. MEDICAL EMERGENCY!! HIT (WHITE CLOT SYNDROME) High alert to increased heparin gtt needed to maintain therepuetic aPTT or Plt count drop by 50%. Treat; STOP HEPARIN!!! Give Protamine, plasmapheresis, lifetime allergy to low molecular weight heparin. Instead use bival, or lepirudin. Hemophilia/Von Wildebrand d/t deficiency of clotting factors Sx include pathological fx, ostelytic lesions, Hypercalcemia, pain is not relieved by conventional methods and supine position makes it worse. Treat with Fluids3-4 l/day!!! Flush the Ca out!!!!! Chemo, plasmapheresis, radiation, stem cell tx, pain management.

ITP (BLEEDING) Autoimmune in Plts Treat w/ spenectomy, steroids, chemo, plts. TTP (BLEEDING AND CLOTTING) Characterized by hemolytic anemia, thrombocytopenia, neuro abn, fever, renal abn. (HUS) Heparin gtt Bolus before gtt. Gtt usually starts at 14u/kg. Follow nomogram. Weight based. aPTT q6 hours. Sx include slow persistent, prolonged bleeding from injuries, delayed bleeding, ecchymosis, GI/GU bleeding, hemoarthrosis. Treat bleeding with ice, pressure, packing, or topical thrombin. ROM after bleeding stops. Replace clotting factors, DDAVP. Avoid contact sports, No ASA or NSAIDS, No IM or SQ injections, medic bracelet. DIC (BLEEDIND AND CLOTTING) The worry is the clots!!! Sx include bleeding, petichiae, oozing IV sites and/or skin, etc. Dx made be elevated Fibrin Split and elevated D Dimer. Treat the cause and support the pt!! Leukemia in WBC production but they do not function properly. Lymphoma Hodgkins- localized, painless, Reed Steinbergs cells, infection common. (Sx anemia, enlarged spleen) Non Hodgkins-desseminated, (Head to toe sxCNS, dyspnea, NV, abd pain, cough) Treat leukemia and lymphomas with radiation, chemo, BM or stemm cell Tx. High alert to pancytopenia r/t chemo! Neutropenia Neutrophil count < 1500. Normal is 2000-4000 Severe is <500. FEVER ALWAYS REQUIRES IMMEDIATE ATTENTION!!! Treat with neutropenic precautions, handwashing, no fresh veggies or fruits, no red meats, daily showers, avoid crowds. Multiple Myeloma CA of the Bone.