HEMATOLOGIC SYSTEM

office ambience (wpltp)

ferrous sulfate(oral)/iron dextran (IM/IV)

forms of iron given to treat iron deficiency anemia or to prevent its occurrence in at risk clients (blood loss, heavy menstruation, occult blood loss). enables hemoglobin to carry oxygen. ADRs include GI disturbances (nausea, constipation, diarrhea), metallic taste and seizures/anaphylaxis with parenteral form, stained teeth in liquid form, green/black stool, and iron toxicity in OD (common in children). antidote is deferoxamine. should be given on a test dose and on an empty stomach (food reduces absorption). monitor client’s bowel habits, teeth, hemoglobin/hematocrit, reticulocytes, and RBCs.

microcytic anemia

iron deficiency anemia; small RBCs

macrocytic anemia

lack of B12 or folic acid either via malabsorption or deficiency; large RBCs

cyancobalamin (B12)

used in pernicious (lack of IF) and B12 deficiency anemia. works to restore B12 levels by bypassing stomach so IF is not needed (parenteral forms). is given orally if a lack of intrinsic factor is not an issue. can also be given intranasally. ADRs include HTN, erythema, and hypokalemia as K is depleted in restoration of the production of RBCs. monitor K levels, B12, hgb/hct, RBCs, and reticulocytes. if given IN, avoid hot food 1 hour before and after administration. schilling test (evaluation of B12 absorption) should be performed before PO administration.

folic acid

treats folate deficiency (needed for DNA and RNA synthesis; required for erythropoiesis) and prevents neural tube defects (used for women of childbearing age). usually PO. ADRs include abnormally bright yellow urine, cancer in long-term use (colorectal/prostate), hypersensitivity, masking of B12 deficiency in high doses (limit is 1000mcg), and rash. check b12 before admin to confirm absence of deficiency, as presence of B12 deficiency during treatment can lead to permanent neuronal damage.

factors VIII and IX

treats hemophilia A (F8) and B (F9) by replacing clotting factors 8 and 9 to reduce bleeding episodes and injuries. can be plasma derived (from donated human plasma) or recombinant derived (genetically engineered from hamsters or human cells). risk of developing HIV or hepatitis is low via recent advancements, but there is a risk of prions disease/serious brain tissue damage (creutzfeldt-jakob disease) in plasma derived forms. other ADRs include allergic reactions and rashes or itching. reconstitute when giving IV and administer slowly. given PRN or as prophylaxis (preventative care). monitor factor 8 and 9 levels and be cautious using with anticoagulant drugs.

desmopressin (DDAVP)

a form of ADH that helps with hemophilia A as it stimulates release of stored factor 8. has no effect on factor 9; is used for active bleeding episodes or during surgery. only works if patient can make factor 8 themselves. given IV or IN as oral form does not treat hemophilia. ADRs include fluid retention and hyponatremia (causing seizures via low Na), CNS effects, and GI issues. monitor patient’s Is and Os, Na levels, factor 8, and weight. also restrict fluid and sodium intake. caution is required for patients with preexisting HTN or HF taking this med.

heparin

prevents the formation of thrombi effectively treating things such as ischemic stroke and pulmonary embolisms via DVT. binds to antithrombin and makes it inactive, preventing activation of factor 10, thrombin, and fibrin. a high alert med only given SUBQ or IV.

enoxaparin

prevents the formation of thrombi effectively treating things such as ischemic stroke and pulmonary embolisms via DVT. specifically a factor 10 inhibitor; has no effect on thrombin directly.

heparin/enoxaparin ADRs

hemorrhage/bleeding in any part of the body, heparin induced thrombocytopenia, hypersensitivity, and neurological injury. monitor patients for signs of bleeding (low BP, high HR); pTT (how quickly blood clots) should not be 2x patients baseline. also monitor CBC, Hct, and platelets (hold if <100k). educate patient on bleeding risks and behavioral changes necessary (soft toothbrush, electric razor only). antidote is protamine sulfate.

warfarin (coumadin)

inhibits vitamin K to prevent thrombosis for things such as strokes, TIAs, MIs, and pulmonary embolisms. blocking of vitamin K leads to inhibition of factors 7,9, and 10, subsequently blocking prothrombin. a high alert med. ADRs include bleeding/hemorrhage (especially if prothrombin time is high; indicates toxicity). monitor for s/s of bleeding (low BP, high HR), CBC, Hct, PT/INR. educate patient on bleeding risk and to not consume high vitamin K (leafy green veggies) as it can block effects (antidote).

aspirin

an antiplatelet that inhibits platelet aggregation, reducing risk of MI, stroke, and angina along with the reocclusion of stents. irreversibly binds to COX-1 enzyme, inhibiting its action of enhancing platelet aggregation. is permanent until death of platelet. 81 mg is sufficient for therapeutic effect. ADRs include bleeding tendency due to blood thinning, GI ulceration, renal dysfunction, reye’s syndrome for children under 18, and salicysm (toxicity). monitor patients for ADRs and educate them to stop 1 week before surgery. teratogenic.

COX-1

stimulation causes increased production of mucus in gastric mucosa and decreased production of stomach acid, enhanced platelet aggregation, and promoted kidney perfusion.

clopidogrel (Plavix)

inhibits platelet aggregation by blocking ADP receptor on platelets, blocking the signal for aggregation. irreversible and lasts for the life of the platelet. ADRs include GI dysfunction, thrombotic thrombocytopenia purpura (plts clump together and impair blood flow to organs. sheer number of clots manifests as low plts, leading to bleeding). patients should stop taking at least 1 week before surgery and avoid anticoagulants, NSAIDs, glucocorticoids, and herbs. monitor patients platelets and PT.

alteplase (tPA)

breaks down already developed clots by converting plasminogen into plasmin to break down fibrin meshwork of existing clot. a high alert med that is time sensitive. ADR is severe bleeding. monitor patients for bleeding, loss of consciousness, CBC, Hct/Hgb, plts, aPTT, and PT/INR. also limit invasive procedures. max dose is 100mg. patient needs to lie flat and be on bed rest during infusion; monitor their neurological status. antidote is aminocaproic acid. should be given 2-4.5 hours after onset of s/s.

epoetin alfa (Epogen)

erythropoietic GF that stimulates growth and development of RBCs. useful in anemia, chemo, and HIV. can avoid the need for blood transfusions. ADRs include high Hct levels that can cause hypertension, CVAs/seizures, MIs and heart failure, and cardiac arrest. monitor patients Hgb and BP (check both before admin). is ineffective if the patient has low iron. SUBQ/injection only.

filgrastim (Neupogen)

leukopoietic GF that stimulates growth and development of WBCs (mature neutrophils) to help prevent infection. given SUBQ or IM only. ADRs include leukocytosis (high level not indicative of infection), bone pain, fever, splenomegaly, ARDS, and allergic reaction. monitor CBC w/ differential and notify provider of WBC count is greater than 10k.

oprelvekin (IL-11)

thrombopoietic GF that stimulates growth and development of megakaryocytes, assisting with clotting/thrombocytopenia and avoiding a platelet transfusion. ADRs include fluid retention due to increased plasma volume causing dilution anemia, cardiac dysrhythmias, allergic reactions, conjunctivitis, blurred vision, and papilledema (ocular pressure). monitor patients HR, EKG, Is and Os, weight, CBC, electrolytes, and eyes and lungs for pulmonary edema. hold if platelets get above 50k.

prothrombin time (PT)

a measure of how long it takes the blood to clot

INR

standardizes PT for validity; high =clot risk, low=bleed risk