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Questions and Answers
What is the primary function of red blood cells?
What is the primary function of red blood cells?
Which of the following is NOT a component of blood?
Which of the following is NOT a component of blood?
What is the approximate lifespan of a red blood cell?
What is the approximate lifespan of a red blood cell?
What is the role of the reticuloendothelial system (RES) in the hematologic system?
What is the role of the reticuloendothelial system (RES) in the hematologic system?
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Which type of white blood cell is involved in fighting infection through phagocytosis?
Which type of white blood cell is involved in fighting infection through phagocytosis?
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What is the primary function of platelets?
What is the primary function of platelets?
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Where are red blood cells produced?
Where are red blood cells produced?
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What percentage of blood volume is composed of plasma?
What percentage of blood volume is composed of plasma?
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What complication can arise from excessive PRBC transfusions in thalassemia major?
What complication can arise from excessive PRBC transfusions in thalassemia major?
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Which of the following is a primary treatment to manage thalassemia major symptoms?
Which of the following is a primary treatment to manage thalassemia major symptoms?
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Which of the following is a potential consequence of long-term survival in beta thalassemia patients?
Which of the following is a potential consequence of long-term survival in beta thalassemia patients?
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What should be included in patient education during the reproductive years for those with thalassemia?
What should be included in patient education during the reproductive years for those with thalassemia?
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Which of the following is a common cause of death in patients with thalassemia major?
Which of the following is a common cause of death in patients with thalassemia major?
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What is the primary reason for administering a small test dose of iron dextran parenterally?
What is the primary reason for administering a small test dose of iron dextran parenterally?
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Which dietary choice can help improve iron absorption?
Which dietary choice can help improve iron absorption?
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What are the typical hemoglobin values for a patient with sickle cell disease?
What are the typical hemoglobin values for a patient with sickle cell disease?
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What is a potential complication of sickle cell disease that manifests as fever and respiratory distress?
What is a potential complication of sickle cell disease that manifests as fever and respiratory distress?
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What type of sickle cell crisis is caused by an infection with the human parvovirus?
What type of sickle cell crisis is caused by an infection with the human parvovirus?
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What are some risk factors that can precipitate a sickle cell crisis?
What are some risk factors that can precipitate a sickle cell crisis?
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What symptom indicates that pulmonary hypertension has progressed in a sickle cell disease patient?
What symptom indicates that pulmonary hypertension has progressed in a sickle cell disease patient?
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Which of the following is TRUE regarding the administration of IM iron injections?
Which of the following is TRUE regarding the administration of IM iron injections?
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Which complication of sickle cell disease is the leading cause of death in young adults?
Which complication of sickle cell disease is the leading cause of death in young adults?
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How should a nurse explain the need for continued iron therapy to a patient?
How should a nurse explain the need for continued iron therapy to a patient?
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What is the most common hematologic condition?
What is the most common hematologic condition?
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What is the primary role of platelets in the body?
What is the primary role of platelets in the body?
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Which of the following is NOT a potential complication of a bone marrow aspiration?
Which of the following is NOT a potential complication of a bone marrow aspiration?
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Which type of anemia is characterized by a deficiency in iron needed for hemoglobin synthesis?
Which type of anemia is characterized by a deficiency in iron needed for hemoglobin synthesis?
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What is the name given to the craving for ice, starch, or dirt, often seen in individuals with iron deficiency anemia?
What is the name given to the craving for ice, starch, or dirt, often seen in individuals with iron deficiency anemia?
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Which of the following is a common clinical manifestation of iron deficiency anemia?
Which of the following is a common clinical manifestation of iron deficiency anemia?
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Which laboratory test is NOT typically used to diagnose and monitor iron deficiency anemia?
Which laboratory test is NOT typically used to diagnose and monitor iron deficiency anemia?
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What is the role of erythropoietin in the body?
What is the role of erythropoietin in the body?
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Which of the following medical interventions is NOT a common treatment for iron deficiency anemia?
Which of the following medical interventions is NOT a common treatment for iron deficiency anemia?
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Which of these options describes the role of bile in the digestion of fats?
Which of these options describes the role of bile in the digestion of fats?
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What is the main goal of chronic pain management for patients with sickle cell disease?
What is the main goal of chronic pain management for patients with sickle cell disease?
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Study Notes
Hematologic Disorders: Assessment and Management
- The hematologic system includes blood and its production sites (bone marrow, reticuloendothelial system).
- Blood comprises plasma (55%), and blood cells (RBCs, WBCs, platelets) (45%).
Hematopoiesis
- Red blood cells (RBCs) are produced in bone marrow as reticulocytes, carrying oxygen via hemoglobin; lifespan ~120 days
- White blood cells (WBCs), divided into granulocytes and lymphocytes, fight infection, and engage in phagocytosis and immune responses
- Platelets (thrombocytes) are cell fragments essential for coagulation and hemostasis; lifespan ~10 days
Assessment and Diagnostic Evaluation
- History & physical exam are initial assessments
- Complete blood count (CBC) is a common initial test assessing RBCs, WBCs, platelets, hemoglobin, and hematocrit.
- Erythrocyte sedimentation rate (ESR) and coagulation tests (PT, PTT, INR) evaluate specific aspects of blood function.
- Bone marrow aspiration/biopsy assess blood cell production and potential infection/tumour.
- Bone marrow is usually obtained from the iliac crest or sternum
Bone Marrow Aspiration/Biopsy Procedure
- Patient preparation involves explanation, potential anxiety management (medication), informed consent.
- Procedure involves deep breaths or relaxation techniques.
- Potential complications include bleeding and infection; pressure & sterile dressing are applied post-procedure.
- Mild discomfort (ache) at biopsy site for 1-2 days is common; aspirin-containing analgesics should be avoided postprocedure.
Anemia
- Anemia is a condition where hemoglobin levels are lower than normal, reducing oxygen delivery to tissues.
- It's a symptom, not a disease, and various underlying causes exist.
- It's the most common hematologic disorder.
Classification of Anemia
- Hypo-proliferative: Inadequate RBC production due to marrow damage (medications, chemicals) or lack of essential factors (iron, vitamin B12, folic acid, erythropoietin).
- Bleeding: Results from loss of RBCs due to various causes.
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Hemolytic: RBC destruction, releasing hemoglobin into plasma. Increased bilirubin, erythropoietin production (increased reticulocyte count).
- Intracellular (e.g., sickle cell disease, G-6-PD deficiency)
- Plasma-related (e.g., immune hemolytic anemias)
- Direct injury (e.g., mechanical heart valve)
Iron Deficiency Anemia
- Caused by insufficient dietary iron, inadequate iron stores, or blood loss.
- Causes include ulcers, gastritis, inflammatory bowel disease, menorrhagia, pregnancy (without supplementation), chronic alcoholism, iron malabsorption (post-surgery, celiac/IBD).
- Clinical Manifestations: Fatigue, weakness, pallor, tachycardia, palpitations, dyspnea, nausea, vomiting, melena (dark stools), diarrhea, anorexia, glossitis, pica (craving non-food items) and potential symptoms of a smooth, red tongue, brittle/ridged nails, and angular cheilosis.
- Assessment: Bone marrow aspiration, low hematocrit, RBC, hemoglobin, and ferritin values.
- Medical Management: Identify and address the cause, oral iron supplements (ferrous sulfate, ferrous gluconate), potentially IV/IM iron dextran (if oral ineffective/poorly tolerated) with a small test dose and monitoring, long-term iron therapy (~6-12 months).
Sickle Cell Anemia
- Hereditary, often from consanguineous marriage
- Defective hemoglobin (HbS) causes rigid, sickle-shaped RBCs, impairing blood flow.
- Clinical Manifestations: Jaundice (especially sclera), low hemoglobin (5-11 g/dL), potential bone marrow expansion, tachycardia, cardiomegaly, dysrhythmias, heart failure. Complications include infections, stroke, kidney injury, impotence, heart failure, pulmonary hypertension.
-
Sickle Cell Crisis: Three types:
- Acute vaso-occlusive crisis: Microcirculation blockage, tissue hypoxia, inflammation, necrosis.
- Aplastic crisis: Parvovirus infection, rapid hemoglobin drop, lack of reticulocytes.
- Sequestration crisis: Sickled cells pooled in spleen (children), liver/lung (adults).
- Risk factors include dehydration, cold exposure, stress, strenuous activity, infection, low oxygen tension.
- Acute Chest Syndrome: Respiratory distress, fever, new chest x-ray infiltrates (leading cause of death in young adults). Often associated with infection, fat embolism, infarction, thromboembolism, or bone marrow embolism. Requires aggressive RBC transfusion and antibiotic therapy; mechanical ventilation may be necessary.
- Pulmonary Hypertension: Frequent complication, often a cause of death. Patients may present with fatigue, exertional dyspnea, dizziness, chest pain, or syncope, but pulse oximetry & breath sounds may be normal initially. Doppler echocardiography screening may identify elevated pulmonary artery pressure.
- Stroke: Common in younger patients; decreased cerebral blood flow due to anemia, hemolysis, and hypoxic stress. Tx includes RBC transfusions to reduce HbS below 30% and prevent cerebral edema.
Thalassemia
- Hereditary anemias causing hypochromia, microcytosis, hemolysis, and variable anemia.
- Defective hemoglobin synthesis with reduced globulin chain production.
- Reduced hemoglobin causes premature RBC destruction.
- Classification: Alpha (milder) and Beta (variant severity, including Thalassemia major/Cooley's anemia, often fatal in early childhood if untreated).
- Management: Possible PBSCT, RBC transfusions, iron chelation therapy.
- Thalassemia Major: Severe anemia, hemolysis, ineffective erythropoiesis; transfusion therapy improves growth/development; iron overload complications necessitate chelation therapy. Late complications include neurologic complications (cognitive dysfunction, peripheral neuropathy, cerebrovascular disease).
Overall Management and Nursing Care
- Nursing Interventions: Managing pain and fatigue, infection prevention, coping skill promotion, and knowledge deficit. Pain management may involve aspirin, NSAIDs, or parenteral opioids, alongside nonpharmacological approaches like physical therapy, cognitive behavioral therapy, and support groups (for chronic pain).
- Fluid and Preventative Measures: Adequate hydration during sickle cell crises.
- Education for Prevention: Maintaining adequate hydration, avoiding cold, stress, strenuous activity, or infection is critical for reducing crisis frequency.
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Description
Test your knowledge on the fundamentals of hematology, including the functions and components of blood. This quiz covers various aspects such as red blood cells, white blood cells, platelets, and conditions like thalassemia. Ideal for students in medical and health science courses.
