Hematology Review

• Exam 1 covers course content from Module 1 (DIC, Hematologic Drugs), Module 2 (Sickle Cell, Hemophilia, and Blood Products), Module 3 (Asthma across the Lifespan, Cystic Fibrosis, Respiratory Drugs), and Module 4 (Cancers, Chemotherapy/Radiation).
• Questions include multiple choice, select all that apply, and two Next Gen case studies.

Terms to Know

• Fibrinolysis is a physiological process that involves the breakdown of fibrin, a protein that forms blood clots.
• Petechiae are tiny, pinpoint-sized red or purple spots that appear on the skin due to bleeding under the surface.
• Dactylitis is a medical condition that causes inflammation of the fingers or toes, resulting in swelling, pain, and redness.
• A vesicant is a chemical agent that causes blistering of the skin and mucous membranes.
• Epistaxis is a condition where blood flows from the nose.
• Proliferation is a rapid increase in something or numbers.
• Orthopnea is shortness of breath or difficulty breathing when lying down.
• Priapism is a prolonged erection that lasts for more than four hours and is not associated with sexual stimulation.
• Steatorrhea is characterized by the presence of excessive fat in the stool.
• Azotorrhea is characterized by the excessive excretion of nitrogenous substances.
• Myelosuppression is a condition where the bone marrow does not produce enough blood cells.
• Hemarthrosis is a condition where blood accumulates in the joint cavity, causing pain, swelling, and limited mobility.
• Dysplasia is abnormal growth and development of cells in a tissue or organ.
• Azotemia is a condition where there are elevated levels of nitrogenous waste products in the blood.

Significance of Lab Values

• Therapeutic ranges pertain to PT/INR, aPTT, and PTT.
• PT/INR:
  • Increased PT/INR means blood is clotting more slowly than normal.
  • Decreased PT/INR means blood is clotting too quickly, indicating a risk of blood clots.
• aPTT/PTT:
  • Increased aPTT/PTT indicates blood is taking longer than normal to clot, signifying a bleeding disorder, liver disease, or deficiency in certain clotting factors.
  • Decreased aPTT/PTT indicates blood is clotting faster than normal, increasing the risk of blood clots, leading to MI or stroke.
• Fibrinogen:
  • Increased fibrinogen indicates a higher risk of blood clots due to infection, inflammation, cancer, RA, NS, MI, stroke, pregnancy, stress, increased cortisol levels, or tobacco use.
  • Decreased fibrinogen (hypofibrinogenemia) means blood has a reduced ability to clot.
• Clotting factors:
  • Increased clotting factors: a disorder that causes excessive blood clotting (hypercoagulation).
  • Decreased clotting factors: blood doesn't clot as effectively, leading to excessive bleeding.
• D-dimer:
  • Increased D-dimer suggests potential clotting disorder, pregnancy, recent surgery, trauma, or inflammation due to the breakdown of blood clots.
  • Decreased D-dimer indicates there is no clotting disorder, as this substance is only released when a blood clot breaks down.
• Platelet count:
  • Increased platelet count indicates risk of forming blood clots due to excessive presence (thrombocytosis), which can be caused by infections, recent surgery, certain meds, bone marrow disorders, or cancer.
  • Decreased platelet count (thrombocytopenia) means individual will bruise or bleed more easily than usual due to decreased ability to stop bleeding from cuts or injuries, leading to bruising, nosebleeds, and bleeding gums.
• RBCs:
  • Increased RBCs occur due to health conditions like polycythemia vera, heart disease, lung disease, kidney disease, sleep apnea, blood cancers, dehydration, cigarette smoking, or living at high altitudes.
  • Decreased RBCs (anemia) mean the body does not have enough RBCs to carry oxygen to the organs and tissues, causing fatigue and weakness, which can be caused by meds, cancer, vit deficiency, malnutrition, kidney disease, internal bleeding, bone marrow failure, or thalassemia.
• Hemoglobin:
  • Increased Hemoglobin indicates an increased concentration of oxygen carrying proteins in the blood, which can be caused by dehydration, high altitudes, smoking, intense exercise, COPD, heart disease, sleep apnea, or kidney disease.
  • Decreased Hemoglobin (anemia) mean RBCs are not healthy enough or hemoglobin too, causing fatigue, weakness, SOB, or pale skin.
• Hematocrit:
• WBCs:
  • Decreased WBCs- anemia- body doesn't have enough RBCs to carry O2 effectively causing fatigue, SOB, weakness.
• ANC (Absolute Neutrophil Count):
  • Increased ANC (“neutrophilia”)- body is producing too many neutrophils.
  • Decreased ANC “neutropenia”- body has a harder time fighting off infections bc neutrophils are the primary immune cells that attack bacteria.

Medications

• Key information for the following medications include indications, side effects, and nursing considerations when administering: Factor 8, Hydroxyurea and Desmopressin.
• The following medications may be tested on this exam: Acetaminophen, Aspirin, Celecoxib, Diphenhydramine and Dornase Alfa

Pharmacokinetics and Pharmacodynamics of Hematologic Drugs

• Anticoagulants: Slows down the body's process of making clots, blocking liver proteins to help blood clot, and can either break down existing clots or prevent them from growing larger.
• Antiplatelets (ADP inhibitors): Decreases the ability for platelets to clump together and form clots in the body, makes blood less sticky to prevent clots from forming/growing in arteries, or relax smooth muscle to dilate blood vessels.
• Desmopressin (ADH): Maintains more water through increased reabsorption in the kidneys, leading to decreased urine output, while signaling the kidney to retain more water, decreasing urine reproduced, and maintaining the body's fluid balance.
• Factor VIII (8) and IX (11): Replaces a missing protein to help blood clot, reducing excessive bleeding- factor 8 is a made in the liver but circulates in the bloodstream while factor II is a part of the coagulation cascade.
• Folic acid: Helps the body make new cells for bodily functions like cell growth, prevents anemia, and lowers risk of heart disease/stroke, while aiding cell growth and development, DNA synthesis, and RBC production.
• Iron preparations: increases hemoglobin and reticulocytes to treat iron deficiency, while helping your body produce RBCs and hemoglobin for muscle strength, energy, and mental function.
• Pernicious anemias: rapidly increases RBC production to alleviate fatigue and weakness, providing a nutrient for many bodily functions.
• Thrombolytics: activates fibrinolysis where the drug breaks down blood clots, while dissolving blood clots to restore blood flow and prevent tissue damage via IV.

Disseminated Intravascular Coagulation (DIC)

• Pathophysiology involves a serious bleeding and thrombotic disorder resulting from abnormally initiated and accelerated clotting, which leads to decreased platelets and uncontrollable hemorrhage.
  • Risk and causes of DIC include shock, septicemia, hemolytic processes, obstetric conditions, tissue damage, malignancies, chronic conditions and transplant rejection or post-op complications.

Priority Collaborative Interventions for DIC

• Nursing Care: Early recognition of bleeding through skin color, circulation, and cap refill, inspecting signs of external and internal bleeding, recognizing signs of microthrombi, placing pt in semi-fowlers for chest expansion, monitoring labs and fluid status
• Collaborative care involves assessing s/sx of hemorrhage and shock, stabilize with oxygen, treatment depends on underlying cause, and bleeding or thrombosis, dictated by severity.
• Blood products to treat include FFP, Cryoprecipitate, Platelets and RBCs.

Drugs for Thrombosis

• Anticoagulants- Warfarin: PE, VTE, A-fob, prosthetic heart valves, TIA, MIA prevention
• Anticoagulants- Heparin**: Used for AMI, CVA, PE, DVT, DIC- adjunct for open heart, hemodialysis, blood transfusion, prophylaxis, VTE/PE
• Enoxaparin (Lovenox): anticoagulant, is also used AMI, CVA, PE, DVT- adjunct for open heart, hemodialysis, blood transfusion, prophylaxis, VTE/PE
• Antiplatelets (ADP Inhibitors)- Clopidogrel: MI, ischemia CVA, stents is often given with ASA for ACS

Module 2: Sickle Cell Anemia

• Pathophysiology: Hgbs reacts to deoxygenation and dehydration by solidifying and stretching the RBC into a sickle shape.
  • Causes : significant blood loss (trauma, surgery), illness, the spleen is already affected due to the short life span of the RBC with HgB S, climbing to high altitudes, keeping continued stress, low fluid intake and elevated temperature as from fever or strenuous exercise.
  • Acute symptoms: include vaso-occlusive crisis, acute chest syndrome, sequestration and hyperhemolytic or aplastic crisis Interventions:
    • focus on preventative measures such as infection prevention, hydration as well as, managing the symptoms and crisis such as high Hgb maintenance

Module 3: Asthma

• Pathophysiology: Exposure to allergens or irritants triggers inflammatory response.
  • Results in: Inflammation, bronchoconstriction, hyperresponsiveness, and edema of airways limiting air flow
• Interventions: assess airway, oxygenate as well as administer medication (consider oral or IV steroids and SABAs)

Module 4: Cancers

• Cellular regulation: all functions carried out within a cell to MAINTAIN
• Radiation Management:
  • Administer and monitor for adverse effects but the goal is to eliminate localized cancer cells with the use of ionizing radiation.