med surge exam one continued...

hematology

study of blood-forming tissues

hematopoiesis

blood cell production

where are blood cells produced

within the bone marrow

what blood cells does bone marrow produce

rbcs, wbcs, and platelets

what do blood cells develop from

nondifferentiated immature blood cells

what creates non differentiated immature blood cells

stem cells

yellow bone marrow

adipose

red bone marrow

hematopoetic

what is serum

plasma minus the clotting factor

another name for rbcs

erythrocytes

what do rbcs transport

O2 and CO2

what is hemoglobin made up of

iron and protein

what is oxyhemoglobin made up of

O2 and iron

what is erythropoiesis

rbc production

what is hemolysis

the breakdown of rbcs

what do rbcs produce when they are broken down

bilirubin

where does bilirubin go once its produced

to the liver and is then excreted

when do you get low hemoglobin

with blood loss and anemia

what is hemoglobin

heme and globin, carries O2 and CO2 in rbcs

what does heme mean

iron

what does globin mean

protein

what is a hematocrit

a % of rbcs in relationship to total blood volume

what does a hematocrit best show

total blood volume loss

what is Mean Corpuscular Volume (MCV)

average volume or size of a single rbc

what is Mean Corpuscular Hemoglobin (MCH)

average weight/amount of hemoglobin within a RBC

what is Mean Corpuscular Hemoglobin Concentration (MCHC)

average concentration of hemoglobin within a single rbc

whats another name for leukocytes

wbcs

what is the normal wbc count

5,000-10,000

what are neutrophils

phagocytosis, most plentiful and 1st responders to an infection

what is an eosinophil

phagocytosis, main allergic reaction, parasitic infection

what is a basophil

inflammatory response, allergic reaction

what is a lymphocyte

cellular, humoral immune response

what is a monocyte

phagocytosis, cellular immune response

what is a shift to the left

lacking maturity

what is a shift to the right

Ripe (over matured/aged)

characteristics of shift to the left wbcs

immature, acute infection, early, bacterial infections

characteristics of shift to the right wbcs

mature, chronic, aging, over mature

what do the shift left and right describe

wbcs

when is wbc low

< 4000

when wbc is low what is the pt placed on

neutropenic precautions

neutropenic precautions are common in what

cancer pts

some characteristics of neutropenic precautions

wash hands, limit visitors, no flowers, fresh fruit, or raw meat, fever or subtle infection signs are considered an emergency

whats the temp thats considered a warning sign for potential fever/infection

a temp over 100.4

why aren’y we very concerned about a low platelet count until it is very low

bc life of a platelet is quick, turnover happens fast

another name for thrombocytes

platelets

what do thrombocytes do

clot!

critical thrombocyte levels

< 10,000 and > 1 million

what organ stores a lot of blood and 1/3 of our platelets

the spleen

what happens to a pt if the have a splenectomy?

these pts will be at a higher risk for infection and bleeding for the rest of their life :(

sad fact about old people

old people have a diminished ability to recover from acute illness and/or compensate for chronic diseases

characteristics of old peoples diminished functions

changes in bone marrow, hemoglobin levels, vascular integrity, blood cell responsiveness and reserves

what are vegetarians at a high risk for

anemia

what is the Erythrocyte Sedimentation Rate (ESR)

rate at which rbcs settle in saline over 1 hour

What does a ESR measure

non-specific measure of inflammatory conditions (don’t know why or where, just know inflammation exists)

during a ESR women are slightly _ than men

higher

what is serum iron

the amount of iron that you have

what is total iron binding capacity

all the proteins that act to bind or transport iron

what is ferritin

major iron storage protein

what is transferrin

largest of proteins that bind to iron

When serum iron is up, what also goes up

ferritin

when total iron binding capacity is down, what also goes down

transferrin

serum iron and ferritin have what kind of a relationship with total iron binding capacity and transferrin

inverse (exp: if serum iron goes up, total binding capacity goes down)

what is prothrombin time (PT)

assessment of clotting factors (warfarin)

drugs/diagnosis’s associated with PT

heparin drip, vitamin K deficiency, or therapeutic Coumadin dose

what is Activated Partial Thromboplastin Time (PTT)

assessment of clotting times (herapin)

drugs associated with PTT

Coumadin, therapeutic (60-70 seconds)

what is the international normalized ratio (INR)

standardized method of reporting PT (normal 0.8-1.1 seconds)

Drugs associated with INR

Coumadin, and therapeutic (2-3.5)

what causes anemia

poor nutrients, chronic kidney disease, and trauma/blood loss

anemia is a deficiency in what

a deficiency in rbcs, hgb, and hct

most common type of anemia

iron deficiency anemia

common cases of blood loss causing iron deficient anemia

heavy menstrual bleeding, dialysis, and chronic kidney disease

causes of iron deficiency anemia

inadequate diet intake, malabsorption, and blood loss

foods to eat when iron deficient

leafy green veggies, red meat, and sardines

what diseases put you at risk to absorb iron

surgeries, crohns, and celiac (anything that effects the duodenum)

why is the duodenum important

the duodenum is where iron absorption occurs

if blood diagnostics come back abnormal what does the provider typically do

add on iron tests

clinical manifestations for iron deficiency anemia

pallor, glossitis, cheilitis, headache, and paresthesias

what is cheilitis

inflammation of lips

where is iron best absorbed

in an acidic environment (have pt drink orange juice or take vitamin C)

if you give iron IM what do you have to be careful to do

Z track

why do you have to z track iron given IM

bc otherwise it may leak into the sub q skin and give them a tattoo they didn’t ask for

when should you take iron supplements

1 hour before meals

how should you take undiluted liquid iron

drink with a straw and aim for the throat , otherwise it may stain teeth

tx of iron deficient anemia

treat underlying problem, nutrition therapy, oral iron supplements

what is thalassemia

a group of diseases involving inadequate production of normal Hgb

what happens to a pt if they have 1 thalassemic gene

thalassemia minor, minor problem, usually they’re good

what happens to a pt if they have 2 thalassemic genes

thalassemic major, a major problem, a lot more symptoms and a shorter lifespan :(

clinical manifestations of thalassemia minor

often asymptomatic, mild to moderate anemia, mild splenomegaly, bronzed skin color, bone marrow hyperplasia

clinical manifestation of thalassemia major

growth & development defiects, jaundice, splenomegaly, hepatomegaly, cardiomyopathy, thickening of cranium and maxillary cavity, iron overload

what number hgb do we do a transfer for in a pt with thalassemia major

when hgb drops below 7

why do we hold out for a hgb transfer in thalassemia major

we want their bone marrow to work, if we keep giving them transfusions their bone marrow will stop making blood

what do we give to pts with thalassemia major

chelating agents

why do we give pts with thalassemia major chelating agents

to reduce iron overloading

what other med could we give someone with thalassemia major

reblozyl subq q 21 days

what are megaloblastic anemias

abnormally large rbcs

how are megaloblasts caused

impaired dna synthesis, resulting in defective rbc maturation

main causes of megaloblasts

cobalamin and folic acid deficiencies

what is cobalamin

vitamin B12

what is a cobalamin deficiency

low levels of vitamin B12