Hematology: Iron-Deficiency Anemia, Sickle Cell Anemia, Vitamin D Deficiency, Folic Acid Deficiency, Leukocytosis, Leukopenia, Leukemia, Multiple Myeloma, Thrombocytopenia, Aplastic Anemia, and Polycythemia Vera

What is iron-deficiency anemia?

it is when the red blood cells are too small, too few, or do not have enough hemoglobin within the blood

What can cause iron-deficiency anemia?

• low iron diet

• mal-absorption of iron

What are the labs and diagnostic tests for iron-deficiency anemia?

• serum blood draw

• stool for occult blood

• colonoscopy

• gastroscopy

What are some nursing actions and interventions for iron-deficiency anemia?

• give supplemental O2 if needed

• give high iron diet

• give supplemental iron

What are some teachings for patients with iron-deficiency anemia?

• tell pt. to take supplemental iron

• tell pt. iron can cause dark stools

• tell pt. iron supplements can cause constipation so have a high fiber diet, stay hydrated, and use stool softeners  

• tell pt. to take iron supplements 30 minutes before meals

• tell pt. to take with vitamin C (orange juice)

What is sickle cell anemia?

it is the abnormal formation of hemoglobin causing it to be stiff and elongated

What are the signs and symptoms of sickle cell anemia?

• low O2 levels

• pain

• chronically low red blood cells and hemoglobin

What are some complications of sickle cell anemia?

• Sickle Cell Crisis 

  - splenomegaly

  - kidney failure

  - acute chest syndrome (pneumonia, chest pain, pulmonary infiltrates, dyspnea)

What are the signs and symptoms of sickle cell crisis?

•  pain (especially in joints)

• fever

• swelling and tenderness throughout body

• tachypnea

• hypertension

• nausea & vomiting

• possible deep vein thrombosis

What are some nursing actions and interventions for sickle cell anemia?

• give pt. supplemental O2

• let pt. rest

• give oral and IV fluid replacement to dilute blood

• administer antibiotics as ordered

• give blood transfusion when ordered

• give morphine for pain

What are some teachings for patients with sickle cell anemia?

• tell pt. to limit physical activity

• tell pt. to stay hydrated

What causes vitamin D deficiency?

• the gastric membranes are not secreting intrinsic factor which is needed for the absorption of B12

  • also known as pernicious anemia

What causes folic acid deficiency?

• low folic acid diet

• decrease absorption due to medications

• alcohol abuse

• hemodialysis pt.

What is leukocytosis?

 it is a high white blood cell count in blood due to increase neutrophil in response to acute infection or inflammation

What is a lab for leukocytosis?

CBC (high WBC, band neut, metamyelocyte) 

What are some nursing actions and interventions for leukocytosis?

• give antipyretics for fever

• collect cultures as needed to determine cause of increase white blood cells

• administer antibiotics when ordered

• review CBC

What is leukopenia?

it is a low white blood cell count due to decrease in neutrophils mainly caused by chemotherapy

What are some signs and symptoms of leukopenia?

• low grade fever

• chills

• weakness

• sepsis/septic shock

What are some nursing actions and interventions for leukopenia?

• give antibiotics when ordered

• have strict handwashing

• monitor pt.’s temperatur every 4 hours

• give WBC stimulating medications when ordered

• do reverse isolations to keep pathogens from pt.

• monitor CBC

What is leukemia?

it is a group of cancers affecting the blood and blood-forming tissues of the bone marrow, lymph system, and spleen with overproduction of white blood cells, overcrowding all other normal cells

What white blood cell disorder can be fatal if left untreated?

leukemia can be fatal if untreated

What are some signs and symptoms of leukemia?

• extreme leukocytosis with WBC as high as >100,000

• severe shift to the left with many blasts

• bone marrow failure results in overcrowding by abnormal cells and inadequate production of normal bone marrow elements

What are some complications of leukemia?

• anemia with fatigue

• thrombocytopenia

• decrease in number of functioning neutrophils

What are some treatments for leukemia?

• chemotherapy

• radiation

• donor bone marrow transplants

What are some labs and diagnostic tests for leukemia?

• blood marrow aspiration 

• CBC (high WBC, Blasts, Metamyelocytes, Myelocytes, Promyelocytes, Basophils)

What are some nursing actions and interventions for leukemia?

• monitor for infection

• let pt. rest

• do bleeding precautions

• do reverse isolation when indicated

What is multiple myeloma?

 it is bone marrow cancer in which plasma cells proliferate and overcrowd the bone marrow

What are some signs and symptoms of multiple myeloma?

• bone pain

• possible bone fractures

• hypercalcemia

• confusion

• anorexia

• renal problems

• arrhythmias

• low platelets, anemia, leukopenia

What is a complication of multiple myeloma?

kidney damage is a complication

What are some treatments for multiple myeloma?

• stem cell therapy 

• chemotherapy

• bone marrow transplant

What are some nursing actions and interventions for multiple myeloma?

• monitor for infections

• monitor for bleeding

• fracture precautions

• monitor calcium levels

What is thrombocytopenia?

it is a reduction in platelets below 150,000

What can cause thrombocytopenia?

• NSAIDs

• Immune Thrombopenia (ITP)

• Thrombotic thrombocytopenic purpura 

• Wiscott-Aldrech syndrome (inherited)

• Autoimmune disease (platelet antibodies destroy platelets)

What are some signs and symptoms of thrombocytopenia?

• bleeding gums

• epistaxis (nose bleeds)

• petechiae/purpura

• weakness

• fatigue 

• anemia

What are some nursing actions and interventions for thrombocytopenia?

• monitor for intracranial hemorrhage & intra-abdominal bleeding

• platelet infusions as ordered

• do not do IM injections, NG tubes, urinary catheters

• do not give antiplatelet medications or NSAIDs

What is aplastic anemia?

it is a decrease in all blood cells (white blood cells, red blood cells, & platelets)

What can cause aplastic anemia?

• chemicals 

• drugs

• radiation

• viruses

• parasites

What are some signs and symptoms of aplastic anemia?

• fatigue

• shortness of breath (low red blood cells)

• abnormal bleeding (low platelet)

• infection, fever (low white blood cells)

What is the lab for aplastic anemia?

CBC (low red blood cells, hemoglobin, hematocrit, white blood cells, neutrophils, platelets)

What are the nursing actions and interventions for aplastic anemia?

• monitor for infections

• put pt. on bleeding precautions

• administer O2 for shortness of breath

• let pt. rest

• do blood transfusions as needed

• administer steroids and neupogen when ordered

What is polycythemia vera?

it is an increase in all blood cell types, especially red blood cells causing blood to become too thick, organs become congested, and hypercoagulation

What can cause polycythemia vera?

chromosomal mutation

What are some signs and symptoms of polycythemia vera?

• hypertension

• headache

• dizziness

• tinnitus

• visual disturbances

• heart failure

• thrombophlebitis

• shortness of breath

What are some complications of polycythemia vera?

• splenomegaly

• hepatomegaly

What are some nursing actions and interventions for polycythemia vera?

• do therapeutic phlebotomy (taking blood from pt.)

• monitor I&Os

• administer medications to reduce platelet count

• put pt. on deep vein thrombosis precautions

• do active and passive range of motion exercises with pt. 

• schedule phlebotomy every 2-3 months

What are some teachings for patients with polycythemia vera?

• tell pt. to increase fluid intake 

• tell pt. they will need to get a phlebotomy every 2-3 months to get rid of extra blood

What percent of blood is plasma?

55% of blood

What percent of blood is blood cells?

45% of blood

What is anemia?

it is the deficiency of number of red blood cells, quantity of hemoglobin, or low volume of hematocrit

What is the hemoglobin and hematocrit in mild anemia?

• Hgb: 10-14 g/dl

• Hct:30-42%

What are the signs and symptoms of mild anemia?

• probably no symptoms

• shortness of breath

• mild weakness

What is the hemoglobin and hematocrit in moderate anemia?

• Hgb: 6-10 g/dl

• Hct:18-29%

What are the signs and symptoms of moderate anemia?

• increased heart rate

• fatigue

• pallor

• shortness of breath at rest

• shortness of breath during activity

What is the hemoglobin and hematocrit in severe anemia?

• Hgb: <6 g/dl

• Hct: <18%

What are the signs and symptoms of severe anemia?

• pale

• diaphoresis

• blurred vision

• jaundice

• tachycardia

• angina

• increased respiratory rate

• shortness of breath at rest

• depression

• dizzy

• irritability

• confused

What can trigger sickle cell anemia?

• infection

• stress (emotional or physical)

• surgery

• blood loss

• high altitude

What are immature neutrophils called?

they are called bands

Increase in amount of bands means what?

it means the bone marrow is releasing a lot of immature white blood cells into blood circulation

What are the requirements for bone marrow aspiration?

• pt. needs to sign consent form for procedure

• administer pain meds before procedure

• hold pressure on site after aspiration, especially if client is low in plts or on anticoagulants

• pt. need to lay supine for 30 minutes after procedure

• monitor for infection

What picture depicts multiple myeloma?