hematology

Hematology: 

Drug therapy for anemia 

  • Ferrous sulfate 

    • Treats iron deficiency anemia 

    • GI side effects are common, so take with food 

    • Other side effects are constipation and black, tarry stools 

    • IV may leave a metallic taste in the mouth, or may dye teeth w the liquid form 

    • No antacids, they can reduce the absorption 

    • Vit C can increase absorption

    • Iron toxicity (GI issues, shock, liver and HF) - give deferoxamine 

  • Cyanocobalamin 

    • Treat pernicious/vit B12 deficiency anemia caused by lack of intrinsic factor 

    • Often IM injection 

    • Schilling test to see gastric absorption rate 

    • Hypokalemia is a common adverse reaction

    • Encourage intake of B12 rich foods - dairy, enriched cereal, egg yolk 

    • No alcohol it affects the level of B12 absorption 

  • Common adverse reaction of folic acid is that it can turn pee an intense yellow color 

  • Folic acid absorption can be impaired by chronic alcohol use 


Drug therapy for bleeding disorders 

  • Hemophilia - inherited bleeding disorder d/t defect of coagulation factor VIII or IX

    • Plasma derived VIII, recombinant factor VIII

    • Plasma derived IV, recombinant factor IX 

    • Replace the factors in clients with hemophilia

    • Factors are obtained from plasma of human donors 

    • IV bolus admin 

    • Adverse reactions: itching, rash, difficulty breathing 

  • Desmopressin (DDAVP) 

    • ADH hormone that stimulates release of stored factor VIII in the body 

    • IV or intranasal 

    • Adverse reactions: fluid retention, hyponatremia (neuro symptoms seizures, HA, nausea, dizzy), CHF and HTN 

    • Monitor I+O and monitor Na+ 

    • Retain fluid in the legs or lungs 

    • Pt education - daily weights, report weight gain/edema, instruct on techniques, HTN and HF precautions 



Drug therapy to prevent and dissolve (thromboembolic drugs- stop blood from coagulating) 

  • Some interfere with factors, some inhibit vitamin K 

  • S+S of clots or under anticoagulation - DVT, pulmonary embolism (difficult breathing, chest pain, coughing up blood) 

  • S+S of bleeding or over anticoagulation - blood in urine/stool, GI ulcers, bruising easily, petechiae 

  • Heparin, enoxaparin (lovenox) 

    • Thrombin inhibitor - inhibits factors and clotting 

    • Monitor VS, lab values (CBC), signs of bleeding, assess for bruising at the injection site, avoid NSAIDS and ASA 

    • Protamine is the antidote 

  • Warfarin 

    • Vit K antagonist 

    • Impacts the INR, important to monitor the range, high INR=blood to thin 

    • Vitamin K is the antidote 

    • Monitor VS and signs of bleeding 

    • Advise clients to watch vit. K rich food intake 

  • Aspirin 

    • Small daily dose for prevention of cardiovascular/cerebrovascular events 

    • Antiplatelet drug, suppresses platelet aggregation 

  • Clopidogrel 

    • ADP receptor inhibitor 

    • Given to patients who have had a heart attack 

    • Adverse reaction: GI upset/bleeding, thrombocytopenic purpura-rare but serious reaction 

  • Alteplase 

    • Thrombolytic drug - breaks up clots 

    • Given to pts with an embolic stroke (tPA) 

    • Watch for bleeding 

    • Do not give to pt w a history of intracranial hemorrhage

    • Do not give w additional thromboembolic drugs 

    • tPA considerations: interventions related to bleeding 

    • Contraindicated if you are already bleeding  

Drug therapy to support hematopoiesis

  • Epoetin alpha 

    • Stimulates formation of RBCs 

    • Used for anemia, after dialysis, chemo pts 

    • Increases risk for clots 

    • IV or SQ 

    • Monitor lab values 

  • Filgrastim 

    • Stimulates formation of WBCs 

    • Reduce risk of infection 

    • ADR: bone pain and fever 

    • Splenomegaly w prolonged use 

    • IV or SQ 

    • Monitor CBC weekly 

  • Oprelvekin 

    • Stimulate formation of platelets 

    • In the plasma 

    • Treat thrombocytopenia 

    • Fluid retention is common ADR - monitor I+O and weights 

    • Admin SQ after chemo treatment 

Blood products 

  • RBCs 

  • FFP - fresh frozen plasma 

    • can be used for warfarin overdose 

    • Give to pt w elevated PTT bc it replaces coagulation factor and bleeding 

  • Platelets  

    • Cement truck, has to be infused quickly

    • Active bleeding 

  • Reaction symptoms: chills, fever, lower back pain, headache, HTN, tachycardia, tachypnea 

  • Need a type and screen lab within 72 hrs 

  • Watch for circulatory overload