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?

From the iliac crests Signup and view all the answers

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

Non-Hodgkin lymphoma Signup and view all the answers

What is a major characteristic of Myelodysplastic Syndrome?

It may be pre-cancerous. Signup and view all the answers

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

Infection Signup and view all the answers

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

Hodgkin’s Lymphoma Signup and view all the answers

What is the significance of the Philadelphia Chromosome in leukemia?

It is a common finding in CML. Signup and view all the answers

What type of cells are overproduced in Multiple Myeloma?

Dysfunctional plasma cells Signup and view all the answers

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

Bence Jones Protein Signup and view all the answers

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

High blasts percentage with low neutrophils Signup and view all the answers

What is a common characteristic symptom of lymphoma?

Painless lymph node enlargement Signup and view all the answers

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

Polycythemia Vera Signup and view all the answers

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

Microcytic anemia Signup and view all the answers

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

Cytotoxic T-cell Signup and view all the answers

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

Cellular contents from rapid tumor cell breakdown Signup and view all the answers

What is a common treatment approach for Polycythemia Vera?

Hydration and anti-coagulants Signup and view all the answers

Which cell type is primarily involved in allergic reactions?

Eosinophil Signup and view all the answers

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

Informed consent, sterile technique, and a local anesthetic Signup and view all the answers

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

Natural killer cell Signup and view all the answers

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

Risk of infection at the insertion site Signup and view all the answers

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

Myocardial toxicity Signup and view all the answers

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

Complete blood count and electrolytes Signup and view all the answers

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

Notify the physician about the elevated temperature Signup and view all the answers

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

Platelet transfusion Signup and view all the answers

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

Monitor and assess volume status regularly Signup and view all the answers

What is the safest approach regarding the administration of cytarabine?

Ensuring hydration to prevent renal toxicity Signup and view all the answers

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

Achieving remission Signup and view all the answers

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

Tumor lysis syndrome Signup and view all the answers

Which laboratory result confirms the diagnosis of tumor lysis syndrome?

Uric acid of 23.7 mg/dL Signup and view all the answers

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

Tingling of the extremities Signup and view all the answers

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

Renal failure symptoms Signup and view all the answers

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

IV fluids with sodium bicarbonate Signup and view all the answers

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

Potassium of 6.1 mmol/L Signup and view all the answers

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

Trousseau's sign Signup and view all the answers

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

Allopurinol Signup and view all the answers

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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Description

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.