NUR 305 Exam 3 Hematology & Oncology

Hema-/Hemato

blood

Erythro-

red

Neutro-

neutrophil, neutral

Leuko-

white

Thrombo

clot

A-

absent, none, no

Lymph-

lymph

Myel-

bone marrow

-emia

in blood

-cyte

cell

-cytosis

increase in cell numbers

-penia

deficiency

-oma

tumor

-lytic

destruction

-poeisis

creation, formation

Hematopoesis

formation of blood

Erythropoietin

formation of red

Erythrocyte

red blood cell

Leykocyte

white blood cell

Thrombocyte

platelet (“clot” cell)

Anemia

no blood

Leukocytosis

increase in white blood cells

Leukopenia

deficiency of white blood cells

Neutropenia

deficiency of neutrophils

Thrombocytopenia

deficiency of platelets

Lymphoma

tumor of lymph

Myeloma

bone marrow tumor

Hemolytic

blood destruction

Thrombolytic

clot destruction

Bone Marrow

produces all the different cells

Kidney

• excretes erythropoietin when hypoxia detected

• erythropoietin (hormone) that stimulates red blood cell production 

Liver + Spleen

“clean-up” crew

Hematologic Organs

bone marrow, kidney, liver, spleen

Reticulocytes

immature RBCs

The number of Reticulocytes…

is a good indicator of bone marrow activity (represent recent production of RBCs) 

Liver

• produces prothrombin and other clotting factors

• stores extra iron in ferritin

• Vitamin K

Spleen

• cannot live without

• destroys RBCs that are old or abnormal

• breaks down hemoglobin

• stores platelets

• filters antigens

Complete Blood Count (CBC)

• blood is examined in a smear 

• then the different types of cells are counted

• RBC, WBC, platelet count, hematocrit, hemoglobin

RBCs CBC Normal Range

• women: 3.6-5.0 million

• men: 4.2-5.4 million

WBCs CBC Normal Range

5,000-10,000 mm³

Platelet Count CBC Normal Range

90,000-450,000 per microliter of blood

Hematocrit CBC Normal Range

• women: 37-47% 

• men: 40-50% 

Hemoglobin CBC Normal Range

• women: 12-15 g/dL 

• men: 14-16.5 g/dL

Anemia from Decreased Production of RBCs

• iron deficiency anemia

• vitamin B12 deficiency anemia

• aplastic anemia

Anemia from Increased Destruction of RBCs

sickle cell disease

Iron Deficiency Anemia

a condition where the body lack enough iron to make hemoglobin, which leads to reduced oxygen-carrying capacity of the blood; iron is necessary for hemoglobin production → macrocytic (small) and hypochromic (pale) red blood cells

Iron Deficiency Anemia Causes

1. decreased iron consumption

2. decreased iron absorption

3. increased bleeding

Iron Deficiency Anemia Manifestations

cyanosis to sclera, brittle nails, decreased appetite, headache, irritability, stomatitis (redness & irritation of tongue), pica, fatigue

Iron Deficiency Anemia Treatment

• identify and treat the cause (stop bleeding source)

• diet

• supplementation (oral or IV iron if dietary changes aren’t enough

Vitamin B12 Deficiency Anemia

• pernicious anemia

• causes macrocytic RBCs (large, immature cells)

• occurs when the body fails to activate the enzyme that moves folic acid into precursor RBCs → cell division and growth cannot occur properly

Vitamin B12 Deficiency Anemia Causes

• vitamin B12 deficiency due to lack of intrinsic factor (needed for B12 absorption in the stomach)

• decreased vitamin B12 intake (e.g. strict vegan diet or malnutrition)

Vitamin B12 Deficiency Anemia Manifestations

pallor, jaundice, smooth, beefy red tongue (glossitis), paresthesia (numbness/tingling  of hands and feet, unsteady gait), loss of deep tendon reflexes, anorexia (loss of appetite) 

Vitamin B12 Deficiency Anemia Tx

dietary sources of B12 and vitamin supplementation

Aplastic Anemia

bone marrow depression leading to ↓ production of all blood cells (pancytopenia) → low RBCs, WBCs, and platelets

Aplastic Anemia Causes

autoimmune reponse (body attacks bone marrow), medications, medical treatments (radiation), viral infections (hepatitis, Epstein-Barr), genetic factors

Aplastic Anemia Manifestations

anemia, leukoytopenia, thrombocytopenia

Aplastic Anemia Tx

blood transfusions and bone marrow transplant

Sickle Cell Disease (SCD)

• caused by abnormal hemoglobin (HbS) that “sickles” under stress

• sickled cells become rigid and sticky, blocking blood flow

• cells return to normal shape once stressor is removed

Sickle Cell Trait

• less than half of RBCs are sickled

• usually asymptomatic unless under extreme stress (dehydration, high altitude)

Sickle Cell Disease

• almost all RBSs are sickled

• chronic symptoms and complications

Sickle Cell Disease Genetic Risk

• autosomal recessive disorder 

• 1 in 500 african american affected 

• more common individuals of african and mediterranean descent 

Sickle Cell Crisis

hypoxia, dehydration, infection, pregnancy, high altitudes, extreme hot or cold temperatures, strenuous exercise, emotional stress, anesthesia

Sickle Cell Disease Manifestations

sever pain, dyspnea, tachycarida/angina, fatigue, jaundice (from RBC breakdown), palloe, priapism (prolonged painful erection)

Sickle Cell Disease Tx

manage pain, remove or treat the stressor (hydration, oxygen, infection control), prevent future crisis (rest, fluids, avoiding triggers, and possible medications)

Polycythemia Vera

• a cancer or RBCs causing overproduction of erythrocytes

• rare but can be life-threatening due to thickened blood and clotting risk

Polycythemia Vera Manifestations

flushed, dark-purple facial skin (plethora), intense itching (especially after warm baths), hypertension and tachycardia, thrombosis (blood clots), hyperkalemia (from excess RBC breakdown), headaches and visual changes

Polycythemia Vera Tx

• phlebotomy with apheresis (removes blood → separates RBCs → returns plasma to patient)

• increase hydration (prevents clot formation)

• anticoagulants (reduce risk of thrombosis)

• chemotherapy or radiation (suppresses bone marrow activity in severe cases)

Leukocytopenia

↓ total WBC count below 5,000/µL

Neutropenia

↓ neutrophils (type of WBC that fights infection)

Leukocytopenia/Neutropenia Causes

drug suppression, radiation therapy, congenital congenital conditions, bone marrow cancers, spleen destruction, vitamin deficiency 

Leukocytopenia/Neutropenia Manifestations

• depends on severity and cause

• frequent infections and ulcerations 

• typical signs of infection may be minimal or absent due to low WBC count

Neutropenic Precautions

• protect patient from infection

Infectious Mononucleosis (Mono)

• caused by the EBV - part of the herpes virus family

• spread through saliva

• self-limiting illness

• common in adolescents and young adults

Leukemia

• cancer of the leukocytes (WBCs)

  • abnormal WBCs overproduce, crowding out normal blood cells in bone marrow

Leukemia leads to,,,

pancytopenia (↓ RBCs, WBCs, platelets)

Leukemia Types

ALL, AML, CLL, CML

ALL Leukemia 

• acute lymphocytic 

• affects children, responds well to chemo with a good prognosis

AML Leukemia

• acute myelogenous

• affects adults, responds farely well to chemo, with prognosis worse than ALL

CLL Leukemia 

• chronic lymphocytic

• affects adults, responds poorly to chemo, most live for many years

CML Leukemia

• chronic myelogenous

• affects adults, responds poorly to chemo, with poor prognosis

Leukemia Clinical Manifestations

pancytopenia, frequent infections, fatigue, weight loss, fever, SOB, easy bleeding, easy bruising, night sweats, swollen lymph nodes, bone or joint pain

Leukemia Diagnosis

bone marrow biopsy confirms abnormal leukocyte growth

Leukemia Treatment

chemotherapy and hematopoietic stem cell transplant (replaces diseased marrow with healthy stem cells)

2 Major Types of Lymphoma

Hodgkin’s (HL) and Non-Hodgink’s (NHL)

Hodgkin’s Lymphoma (HL)

• cancer of the lymphatic system 

• least common of the two lymphomas 

• presence of Reed-Sternberg cells (diagnostic maker) 

• usually starts in lymph nodes of the upper body 

• predictable spread from one lymph to another

• seen in teens/young adults and men aged 50-60s 

HL Clinical Manifestations

• fever, heavy night sweats, unplanned weight loss (B symptoms)

• large, painless lymph nodes

• pain in lymph nodes after alcohol consumption

HL Stage I

one site

HL Stage II

two sites

HL Stage III 

above and below diaphragm

HL Stage IV

multiple organs/tissues

HL Recurrent

returns after treatment

Non-Hodgkin’s Lymphoma (NHL)

• all lymphoid cancers that lack Reed-Sternberg cells

• more common than Hodgkin’s but with poorer prognosis 

• spreads less orderly than HL 

• common in men and older adults

NHL Causes

• H. pylori infection

• epstein-barr virus (EBV)

• immunosuppression

NHL Clinical Manifestations & Treatment

• similar to HL: swollen, painless lymph nodes, fever, night sweats, weight loss

• Treatment: chemotherapy, radiation, stem cell transplant (depends of stage and spread)

Multiple Myeloma

• cancer of plasma cells

• involves excessive numbers of abnormal plasma cells in the bone marrow

• leads to overproduction of Bence Jones proteins, which are excreted in the urine

Multiple Myeloma

• often asymptomatic early on

• elevated serum total protein 

• pancytopenia m

• bone pain 

• decreased bone density → pathologic fractures 

• hypercalcemia 

• recurrent bacterial infections 

• kidney dysfunctions

Hemostasis

• the process that stops bleeding 

• normal: seals injured blood vessels to prevent blood loss 

• abnormal: can cause excessive bleeding or inappropriate clotting 

Stages of Hemostasis 

• vessel spasm: vasoconstriction to reduce blood flow 

• platelet plug formation: platelets adhere to collagen and each other 

• blood coagulation: fibrin forms a stable clot 

• clot retraction: edges of wound pull together 

• clot dissolution (fibrinolysis): clot breaks down after healing

Idiopathic (Autoimmune) Thrombocytopenic Purpura (ITP)

• autoimmune destruction of platelets, through bone marrow production is normal

• may follow viral infection

• most common in women ages 2-0-50 with other autoimmune disorders

ITP Clinical Manifestations

• large ecchymoses, petechiae, purpura

• mucosal bleeding (nose, gums)

• anemia

• hemorrhage (severe cases)