Hematology Overview and Normal Ranges
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Questions and Answers

What is the primary purpose of high-dose chemotherapy in bone marrow transplant preparation?

  • To stimulate bone marrow production
  • To enhance the patient's immune response
  • To eradicate diseased bone marrow (correct)
  • To treat existing infections

What is the first sign of graft versus host disease (GVHD) that a patient may exhibit?

  • Nausea
  • Weight loss
  • Fever
  • Rash (correct)

What is a critical nursing priority during the care of a patient post-bone marrow transplant?

  • Monitoring for dizziness
  • Evaluating pain levels
  • Checking respiratory rate
  • Assessing for signs of infection (correct)

In a scenario of bone marrow harvesting, from which parts of the body is bone marrow typically collected?

<p>From the iliac crests (D)</p> Signup and view all the answers

What condition was H.J diagnosed with before presenting with new symptoms?

<p>Non-Hodgkin lymphoma (D)</p> Signup and view all the answers

What is a major characteristic of Myelodysplastic Syndrome?

<p>It may be pre-cancerous. (C)</p> Signup and view all the answers

What is the primary cause of death in individuals with leukemia?

<p>Infection (C)</p> Signup and view all the answers

Which type of lymphoma is characterized by the presence of Reed Sternberg cells?

<p>Hodgkin’s Lymphoma (D)</p> Signup and view all the answers

What is the significance of the Philadelphia Chromosome in leukemia?

<p>It is a common finding in CML. (B)</p> Signup and view all the answers

What type of cells are overproduced in Multiple Myeloma?

<p>Dysfunctional plasma cells (C)</p> Signup and view all the answers

A key urinary marker for Multiple Myeloma is the presence of which protein?

<p>Bence Jones Protein (D)</p> Signup and view all the answers

Which of the following findings would most likely indicate acute myeloblastic leukemia (AML)?

<p>High blasts percentage with low neutrophils (B)</p> Signup and view all the answers

What is a common characteristic symptom of lymphoma?

<p>Painless lymph node enlargement (C)</p> Signup and view all the answers

Which type of anemia is characterized by an overproduction of bone marrow?

<p>Polycythemia Vera (D)</p> Signup and view all the answers

What is the most common type of anemia associated with small cell size?

<p>Microcytic anemia (C)</p> Signup and view all the answers

Which immune cell is responsible for selectively attacking and destroying non-self cells?

<p>Cytotoxic T-cell (C)</p> Signup and view all the answers

Tumor Lysis Syndrome is characterized by the release of what into the bloodstream?

<p>Cellular contents from rapid tumor cell breakdown (B)</p> Signup and view all the answers

What is a common treatment approach for Polycythemia Vera?

<p>Hydration and anti-coagulants (D)</p> Signup and view all the answers

Which cell type is primarily involved in allergic reactions?

<p>Eosinophil (B)</p> Signup and view all the answers

What does a Bone Marrow Biopsy typically require in terms of procedure?

<p>Informed consent, sterile technique, and a local anesthetic (A)</p> Signup and view all the answers

Which type of cell is involved in the non-specific attack of mutated and malignant cells?

<p>Natural killer cell (C)</p> Signup and view all the answers

What is the primary concern for the nurse when the patient returns after the central venous catheter insertion?

<p>Risk of infection at the insertion site (A)</p> Signup and view all the answers

Which of the following is an expected adverse effect of idarubicin?

<p>Myocardial toxicity (A)</p> Signup and view all the answers

What laboratory values should the nurse monitor closely for during chemotherapy treatment?

<p>Complete blood count and electrolytes (A)</p> Signup and view all the answers

Given the provided vital signs, what nursing action should be taken first?

<p>Notify the physician about the elevated temperature (A)</p> Signup and view all the answers

Based on the blood work provided, what blood product is most likely to be ordered?

<p>Platelet transfusion (A)</p> Signup and view all the answers

Which nursing intervention is most appropriate to monitor the patient's status during chemotherapy?

<p>Monitor and assess volume status regularly (D)</p> Signup and view all the answers

What is the safest approach regarding the administration of cytarabine?

<p>Ensuring hydration to prevent renal toxicity (D)</p> Signup and view all the answers

What is the major purpose of the induction phase in chemotherapy?

<p>Achieving remission (A)</p> Signup and view all the answers

What common oncologic emergency is H.J. experiencing based on his lab values?

<p>Tumor lysis syndrome (A)</p> Signup and view all the answers

Which laboratory result confirms the diagnosis of tumor lysis syndrome?

<p>Uric acid of 23.7 mg/dL (C)</p> Signup and view all the answers

What is a possible neuromuscular clinical manifestation of H.J.'s condition?

<p>Tingling of the extremities (D)</p> Signup and view all the answers

What renal clinical manifestation is expected in H.J. given his lab findings?

<p>Renal failure symptoms (D)</p> Signup and view all the answers

What treatment is ordered to manage H.J.'s condition effectively?

<p>IV fluids with sodium bicarbonate (D)</p> Signup and view all the answers

Which lab finding indicates the need for emergency intervention concerning potassium levels?

<p>Potassium of 6.1 mmol/L (D)</p> Signup and view all the answers

What sign may present in H.J. due to hypocalcemia?

<p>Trousseau's sign (D)</p> Signup and view all the answers

Which medication is specifically administered to help lower uric acid levels?

<p>Allopurinol (D)</p> Signup and view all the answers

Flashcards

Anemia Classification

Anemia is categorized by red blood cell size: microcytic (small), normocytic (normal), and macrocytic (large).

Microcytic Anemia Cause

Iron deficiency is the most common cause of microcytic anemia.

Polycythemia Vera Cause

Overproduction of bone marrow cells (different from secondary polycythemia).

Polycythemia Vera Effect

Increased blood viscosity leads to a higher risk of blood clots.

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Polycythemia Vera Monitoring

Monitor potassium (K+) and uric acid levels during treatment.

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Polycythemia Vera Treatment

Treatment includes hydration, anticoagulants, and phlebotomy with apheresis.

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WBC Differential - Neutrophil

Phagocytic cells that ingest and destroy pathogens (like bacteria).

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WBC Differential - Monocyte

Mature into macrophages and phagocytize pathogens, migrating to tissue.

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Bone marrow transplant complications

Bone marrow transplant patients are at high risk of infection, bleeding, and graft-versus-host disease (GVHD).

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What is myeloablative therapy?

Myeloablative therapy is a high-dose chemotherapy regimen used to wipe out existing bone marrow before a bone marrow transplant.

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Graft-versus-host disease (GVHD)

GVHD occurs when the transplanted bone marrow cells attack the patient's own tissues.

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What are the common GVHD symptoms?

The first sign of GVHD is often a rash, but it can affect other organs as well.

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What medications are used for GVHD?

Common immunosuppressant medications like cyclosporine, corticosteroids, and methotrexate are used to prevent and treat GVHD.

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Myelodyslastic Syndrome

A condition where the bone marrow doesn't make enough healthy blood cells. It may progress to leukemia but is not cancer itself.

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Pancytopenia

A blood disorder characterized by a decrease in all blood cell types, including red blood cells (RBCs), white blood cells (WBCs), and platelets.

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What are common nursing interventions for thrombocytopenia?

Nursing interventions for thrombocytopenia include monitoring for bleeding, preventing injury, and managing bleeding if it occurs. This may involve using soft toothbrushes, avoiding contact sports, and administering platelet transfusions.

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What are common nursing interventions for leukopenia?

Nursing interventions for leukopenia include protecting the patient from infection through hand hygiene, isolation precautions, and vigilant monitoring of their temperature.

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What's the difference between acute and chronic leukemia?

Acute leukemia is characterized by a sudden onset of symptoms and rapid progression. Chronic leukemia has a slower onset and progresses over time.

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What are blasts?

Blasts are immature white blood cells (WBCs) that are found in large numbers in acute leukemia.

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What is the Philadelphia Chromosome?

A specific chromosomal abnormality associated with certain types of leukemia, particularly chronic myeloid leukemia (CML) and acute lymphoblastic leukemia (ALL).

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What are the major features of lymphoma?

Lymphoma is a cancer of the lymphatic system characterized by painless lymph node enlargement, night sweats, and often fatigue.

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Central Venous Catheter Insertion: Risk

After a central venous catheter placement, the nurse must be vigilant for signs of pneumothorax (collapsed lung), which can occur due to inadvertent puncture of the lung during catheter insertion.

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Cytarabine (Ara-C) Side Effects

Cytarabine is a chemotherapy drug that can cause several adverse effects including peripheral neuropathy (numbness and tingling in extremities), pulmonary edema (fluid buildup in the lungs), hepatotoxicity (liver damage), renal failure (kidney dysfunction), and conjunctivitis (inflammation of the conjunctiva).

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Idarubicin (Idamycin) Side Effect

Idarubicin is a chemotherapy drug that can cause myocardial toxicity (damage to the heart) leading to congestive heart failure (CHF).

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Chemotherapy Side Effects: Nursing Actions

Nurses monitor labs to detect early signs of drug toxicity, assess patients for symptoms related to side effects, and monitor fluid status to prevent complications like dehydration or edema.

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Fever in Chemotherapy Patient

Fever in a chemotherapy patient is a serious concern due to their immunosuppressed state. It could indicate infection, requiring prompt evaluation and intervention.

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Blood Cultures: When to Order

When a patient on chemotherapy develops a fever, blood cultures are ordered to identify the potential causative organism and guide antibiotic therapy.

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Chemotherapy-Induced Neutropenia

Chemotherapy can significantly reduce white blood cell count (especially neutrophils) leading to neutropenia. This increases the risk of infections.

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Blood Products for Neutropenia

Patients with neutropenia from chemotherapy typically receive blood products like granulocyte colony-stimulating factor (G-CSF) to stimulate white blood cell production and boost their immune system.

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What is Tumor Lysis Syndrome?

Tumor Lysis Syndrome (TLS) is a life-threatening oncologic emergency caused by the rapid breakdown of cancer cells, releasing large amounts of waste products into the bloodstream, leading to electrolyte imbalances, kidney damage and other complications.

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What lab values confirm TLS?

Elevated levels of uric acid, potassium (K+), phosphate, and decreased calcium (Ca) are characteristic of TLS.

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What clinical manifestations indicate TLS?

TLS can manifest as cardiac arrhythmias, renal failure, muscle weakness, seizures, and signs of hypocalcemia like muscle cramps and tetany.

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What is the role of IV fluids in TLS treatment?

Aggressive IV hydration with 0.9% saline helps dilute and flush out the waste products, reducing their concentration in the bloodstream.

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How does furosemide (Lasix) help with TLS?

Furosemide, a loop diuretic, enhances the excretion of uric acid and potassium, further reducing their levels in the blood.

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Why administer sodium bicarbonate in TLS?

Sodium bicarbonate is given intravenously to help neutralize the high acid load caused by the waste products, protecting the kidneys from damage.

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What is the purpose of allopurinol in TLS?

Allopurinol inhibits the production of uric acid, slowing down the buildup of this waste product in the body.

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Why is Kayexalate given in TLS?

Sodium polystyrene sulfonate (Kayexalate) binds to potassium in the gut, helping to lower the high levels of potassium in the blood.

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Study Notes

Altered Hematologic Function

  • Conditions: Anemia, Polycythemia Vera, Myelodysplastic Syndrome, Leukemia, Multiple Myeloma, Lymphoma, Tumor Lysis Syndrome, Idiopathic Thrombocytopenic Purpura

Normal Ranges (Hematology)

  • WBC Count: 4,000-10,000 /mm3
  • RBC Count: 4.5-6.0 mil/mm3
  • Hemoglobin: 14-18 g/dL
  • Hematocrit: 40-50 %
  • MCV: 82-98 fL
  • MCH: 27-31 pg
  • MCHC: 32-36 g/dL
  • RDW-CV: 11-16 %
  • Platelets: 140,000-450,000 /mm3
  • Differential Count (values vary): Neutrophils (40-75%), Lymphocytes (15-45%), Monocytes (2-12%), Eosinophils (1-6%), Basophils (0-1%), Bands (0-3%)

White Blood Cell (WBC) Differential

  • Neutrophil: Nonspecific ingestion and phagocytosis
  • Monocyte: Maturing into a macrophage, migrating to tissues
  • Macrophage: On-site ingestion and phagocytosis of microorganisms
  • Eosinophil: Weak phagocytic action, releasing vasoactive substances for allergic reactions
  • Basophil: Releases histamine and heparin

Immunity

  • B-lymphocyte: Responds to foreign cells and proteins. Enhances immune activity through cytokine secretion.
  • T-lymphocyte: Enhances immune activity through cytokine secretion.
  • Plasma cell: Secretes immunoglobulins (antibodies) in response to antigens
  • Cytotoxic T-cell: Selectively attacks and destroys non-self cells, including grafts, and transplanted organs
  • Natural killer cell: Non-selectively attacks mutated and malignant cells; also attacks grafts and transplanted organs

Bone Marrow Biopsy

  • Procedure: Informed consent; sterile technique; local anesthetic necessary, Iliac Crest; pressure and pain during biopsy
  • Purpose: Diagnosing blood-disorders and cancers (cancer spreading to a specific site).

Anemia: Cell Size

  • Microcytic: Iron deficiency (most common).
  • Normocytic: Aplastic anemia (bone marrow failure), Hemolytic anemia (auto-immune).
  • Macrocytic: Folate deficiency, B12 deficiency, Pernicious anemia

Polycythemia Vera

  • Problem: Overproduction of bone marrow. Different than secondary polycythemia.
  • Effects: Increased viscosity > clotting
  • Monitoring: Potassium (K+), uric acid levels
  • Treatment: Hydration, anti-coagulants, phlebotomy with or without apheresis. JAK2 Mutation.

Myelodysplastic Syndrome

  • Description: Not cancer, may be precancerous.
  • Effects: Pancytopenia (Know nursing interventions for thrombocytopenia, leukopenia, anemia)

Leukemia

  • Types: Acute or chronic; sudden onset vs. slow onset
  • ALL: Most commonly seen in children.
  • AML: Acute Myeloid Leukemia
  • CLL: Chronic Lymphocytic Leukemia
  • CML: Chronic Myeloid Leukemia
  • Blasts are baby cells: Overproduction of dysfunctional, immature WBCs (blasts) overwhelming production of RBCs and platelets. Infection is a frequent cause of death.
  • Philadelphia Chromosome: Marker in certain leukemias (ALL and CML)

Lymphoma

  • Description: Cancer of the lymphatic system.
  • Hodgkin's Lymphoma: Characterized by Reed-Sternberg cells.
  • Non-Hodgkin's Lymphoma: Sub-categorized as.B-cell or T-cell

Multiple Myeloma

  • Problem: Overproduction of dysfunctional cancerous plasma cells
  • Effects: Interferes with normal RBC, WBC and platelet production
  • Plasma cells in anatomy: Important for antibody production
  • Bence Jones Protein: Presence in urine, consistent with Multiple Myeloma

Tumor Lysis Syndrome (TLS)

  • Association: Associated with Chemotherapy
  • Consequences: Hyperuricemia, Hyperphosphatemia, Hyperkalemia, Acute renal failure, arrhythmias, death

Bone Marrow Transplant

  • Description: Harvesting bone marrow from a donor (patient's brother here). Stem cells are retrieved (removed) for transplant.
  • Procedure: High-dose chemotherapy / myeloablative therapy to wipe out affected bone marrow. New marrow will be induced via central venous catheter
  • Time: 14-21 days to engraft and produce new marrow

Nursing Priorities

  • Infection
  • Bleeding
  • Organ rejection: Immunosuppressant therapy may be needed to prevent graft vs host disease (GVDH); cyclosporine, corticosteroids, methotrexate

Case Studies

  • Case Study 1: A 43-year-old female, diagnosed with Acute Myeloblastic Leukemia (AML) from a rash, joint pain, epistaxis, bleeding gums, and fatigue. CBC reports 39,000 WBCs, 64% neutrophils, 4% monocytes, 17% blasts (indication for AML).
  • Case Study 2: A 46-year-old male, diagnosed with non-Hodgkin lymphoma months prior experiencing malaise, muscle weakness, night sweats, and palpitations, and is presenting with new symptoms of metastatic disease in liver and spleen (potentially representing a complication). CBC reports 1,500 WBCs, 66% neutrophils, 16% lymphocytes, 15% monocytes, and 5% eosinophils.

Labs: CBC Results

  • Multiple laboratory values are listed for a complete blood count (CBC) for both patients. Some are abnormal and critical, in Case Study 1 and Case Study 2

Labs: Metabolic Panel Results

  • Specific lab results for various metabolites in blood. Specific results are noted including abnormal levels of various metabolites

Clinical Markers

  • Reed Sternberg Chromosome: Specific to Hodgkin's lymphoma.
  • Philadelphia Chromosome: Linked to specific leukemias.
  • Bence Jones Protein (urine): Specific to Multiple Myeloma.

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This quiz covers various altered hematologic functions including conditions such as anemia and leukemia, as well as essential normal ranges for blood components. Test your knowledge on white blood cell differentials and the roles of various blood cells in the immune response.

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