FNP Hematologic Disorders PowerPoint PDF

Part 21 Evaluation and Management of Hematologic Disorders  Anemia (Chapter 218, Slide 1 of 3) Anemia is not a disease, but rather a sign or symptom of an underlying disorder Anemia is defined as a reduction in the number of red blood cells (RBCs), hemoglobin concentration, or...

Part 21 Evaluation and Management of Hematologic Disorders  Anemia (Chapter 218, Slide 1 of 3) Anemia is not a disease, but rather a sign or symptom of an underlying disorder Anemia is defined as a reduction in the number of red blood cells (RBCs), hemoglobin concentration, or hematocrit Categories of anemia based on etiology: Hypo-proliferative (RBC production disorders) Iron-deficiency anemia, B12 deficiency, renal failure, marrow failure Non-hypo-proliferative (RBC destruction disorders) Hgb-related: Sickle cell anemia and thalassemia Anemia from blood loss Acute or chronic  Anemia (Chapter 218, Slide 2 of 3) Clinical presentation For gradual onset, symptoms do not usually appear until hemoglobin is less than 7.5 g/dL May initially experience fatigue, malaise, headache, dyspnea, irritability, and a mild decrease in exercise tolerance Severe symptoms: Reduced exercise capacity, resting tachycardia, and dyspnea requiring supplemental oxygen Physical exam findings Wide pulse pressure, midsystolic or pansystolic murmur Brittle or spoon-shaped nails, glossitis, angular cheilitis Palmar creases are as pale as the surrounding skin Diagnostics CBC with differential (MCV is an important diagnostic value), RBC morphology Reticulocyte count, peripheral blood smear, hemoglobin electrophoresis Serum ferritin, serum iron, total iron-binding capacity (TIBC), transferrin saturation percentage, and vitamin B12/folate levels  Anemia (Chapter 218, Slide 3 of 3) Management Pharmacotherapy Iron-deficiency anemia: Ferrous sulfate Megaloblastic anemia: B12 and folate Anemia of chronic disease: Monitoring, usually no symptoms Sickle cell anemia: Hydroxyurea, analgesics Aplastic anemia: Managed by hematology Hemolytic anemias: G6PD, transfusions B thalassemia: RBC transfusions to maintain adequate hemoglobin levels and iron chelation; genetic counseling Referral is recommended for hemoglobin values of less than 10 g/dL  Blood Coagulation Disorders (Chapter 219, Slide 1 of 3) Coagulation is the process by which blood changes from the fluid phase needed for tissue perfusion to a cohesive gel that prevents blood loss A quantitative deficiency or a qualitative abnormality in counterbalancing coagulant or anticoagulant participants may tip the balance toward either bleeding (coagulopathy) or clotting (thrombosis) Disorders may be inherited or acquired Inherited Von Willebrand disease, hemophilia A, and hemophilia B Acquired Medications (e.g., aspirin, nonsteroidal anti-inflammatory drugs [NSAIDs], or anticoagulants) or related to organ dysfunction or medical injury (liver disease, cancers)  Blood Coagulation Disorders (Chapter 219, Slide 2 of 3) Clinical presentation Hereditary (congenital) bleeding disorders usually have a lifelong history of symptoms, such as easy bruising and prolonged bleeding with cuts, surgery, or other trauma Acquired disorders may become evident later in life in the absence of a history of abnormal bleeding Clinical presentation of acquired bleeding disorders may include a recent onset of increased bruising, bleeding with trauma, nosebleeds, or a recent change in platelet count or clotting test results Physical exam may reveal Bruises, petechiae, gingival bleeding, epistaxis, and hematomas Blood clots—Lower extremity edema, dyspnea, and hypoxia  Blood Coagulation Disorders (Chapter 219, Slide 3 of 3) Diagnostics Platelet count Platelet function analysis Peripheral blood smear PT or aPTT clotting time D dimer Venous ultrasound Contrasted CT chest (preferred) or ventilation/perfusion scans (for patients unable to have CT contrast due to allergy or renal contraindication) Management Case-dependent based on the underlying etiology Hematologist consult/management