Hematologic disease

common indicators of hematologic disorders

• dyspnea

• chest pain

• palpations

• severe weakness

• fatigue

When are hematologic symptoms typically arise

with physical effort/movement

What is often a cause of hematologic s/s seen in PT

Medications

What causes an erythrocyte disorder

problem with hemoglobin, leading to difficulty transporting O2 and CO2

types of erythrocyte disorders

• anemia

• polycythemia

• poikilocytosis

• hypochromia

describe anemia

too few erythrocytes

describe polycythemia

too many erythrocytes

describe poikilocytosis

abnormally shaped erythrocytes

describe anisocytosis

abnormal variations in size of erythrocytes

describe hypochromia

erythrocytes deficient in hemoglobin

What percentage of blood is made up by erythrocytes

40%

What factors can affect erythrocytes count

testosterone (gender)

skeletal muscle

physical activity level

O2 demands

s/s of erythrocytosis

• weakness

• fatigue

• headache

• lightheadedness

• dyspnea

how does erythrocytosis affect PT session

monitor for fatigue and vitals

s/s of anemia

• orthostatic hypotension

• dizziness

• chest pain

• leg cramps with exercise

how does anemia affect PT session

monitor vital signs, cardiac rhythm, fatigue, leg cramps, cognitive impairments

s/s of hemoglobin trending up

• fatigue

• headache

• dizziness

• TIA dysrhythmias

• bleeding

how does upward trending hemoglobin affect PT session

monitor vitals and cardiac rhythms

fall prevention

activity pacing

critical values for hemoglobin

<5 or >20

s/s of downward trending hemoglobin

• pallor

• tachycardia

• orthostatic hypotension

• dysrhythmias

how does downward trending hemoglobin affect PT session

talk w/ nursing

monitor vitals, especially SpO2

orthostatic hypotension

What is sickle cell

inherited, autosomal recessive disorder that causes an abnormality with the form of hemoglobin

2 key features of sickle cell

chronic hemolytic anemia

vasoocclusion

What can cause a sickle cell crisis

stress from viral/bacterial infection

hypoxia

dehydration

emotional disturbance

extreme temp

fever

strenuous physical exertion

fatigue

how long does a sickle cell crisis last

5-6 days

what is a sickle cell crisis

painful episodes of ischemic tissue damage

types of leukocyte disorders

lymphocytes

monocytes

granulocytes

role of lymphocytes

produce antibodies and react with antigens

role of monocytes

immature cell that leave blood and travel to tissues to form macrophages

role of granulocytes

lysing agents (digest foreign materials)

What level is considered leukocytosis

>10,000/mm³

s/s of leukocytosis

fever

fatigue

bleeding

how does leukocytosis affect PT session

timing of therapy (in mornings)

what level is considered leukopenia

<500/mm³

s/s of leukopenia

inflammation in/around mouth

headache

night sweats

how does leukopenia affect PT session

monitor s/s of infection and fatigue

fall prevention

When does WBC drop the most after chemotherapy

7-14 days

role of platelets

hemostasis and capillary integrity

What affects platelet function

anticoagulant drugs

foods

exercise

diseases of the liver

normal range for platelets

150,000 - 400,000

s/s of thrombocythemia

• headache

• dizziness

• chest pain

• tingling in hands/feet

how does thrombocythemia affect PT session

screen for DVT

causes for thrombocythemia

cancer

splenectomy

inflammation

causes for thrombocytopenia

hemorrhage

oncologic diseases

chemotherapy

radiation

s/s of thrombocytopenia

petechiae

ecchymosis

oral bleeding

how does thrombocytopenia affect PT session

fall prevention

monitor for fatigue

types of coagulation disorders

hemophilia

hemiarthrosis

describe hemophilia

hereditary blood clotting disorder due to an abnormality on plasma clotting proteins factor VII and IX

hemophilia A affects which protien

VII

hemophilia B affects which protein

IX

what are the most common clinical manifestations of coagulation disorders

1. hemiarthrosis

2. muscle hemorrhages

What presentation indicates iliopsoas bleed

severe pain with active trunk flexion, but absent with rotation

What presentation indicates hip bleed

mild pain with trunk flexion, but severe pain with rotation

When should a physician referral be done when suspecting hemophilia

severe bruising, hematomas, and multiple petechia

or pain in joint with known dx

clues to screen for hematologic disease

• previous hx or current administration of chemo/radiation

• chronic use of aspirin/NSAIDs

• spontaneous bleeding

• recent surgery or transplant

• rapid onset of dyspnea, CP, weakness, fatigue with palpitations