hematology

Myeloma [plasma & B cell & antibodies]

"CRAB": - Ca2+ elevate in blood - Renal Failure - Anemia - Bone lesion & pain

A patient has been receiving intramuscular injections of hydroxocobalamin as treatment for pernicious anemia. Which statement by the patient indicates that he understands the therapy? - "I will get the injection for a week and then stop." - "Once my levels are up, I won't need the drug anymore." - "I will need these injections monthly for the rest of my life." - "I need the injections now, but then I can switch to a pill."

"I will need these injections monthly for the rest of my life."

reticulocyte of erythrocytes development

- 1% of circulating RBC - Nucleus lost - remain in bone marrow for 1 day & then released into the circulation - 24 to 48 hrs: matures into erythrocyte [good indication of erythropoietic activity]

Treatment of Major Thalassemia [Microcytic Hypochromic]

- Bone Marrow Transplant - Frequent transfusion - Chelation therapy

Chronic Health Problems of LOW WBC?

- auto immune - lupus/leukemia - aplastic anemia - chemotherapy

Mean Corpuscular Volume (MCV)

- average SIZE of RBC - determines Micro- /Normo-/Macro- cytic - Normal: 84 - 96 fL

Mean Corpuscular Hemoglobin (MCH)

- average amount of HEMOGLOBIN in RBC [COLOR] - determines Hypo-/Normo- chromic - Normal: 28 - 34 pg/cell

Treatment of aplastic anemia

- bone marrow transplant

Anemia caused by chronic disease

- cancer, chronic renal failure, & liver failure [kidney releases erythropoietin = alerts bone marrow to produce more RBCs]

Clinical manifestation: Folate (folic acid) anemia

- classic signs of anemia - painful ulcer of tongue & cheeks - Fissure of lips & mouth - no neuro manifestations

Leukemia symptoms

- easy bleed & bruise - PURPLISH patches or spots

Thalassemia [Microcytic Hypochromic]

- genetics - decreased hemoglobin in RBCs

Why might someone become anemic suddenly?

- hemorrhage - Cancer [suppressed bone marrow, radiation therapy] - Renal Disease - Gastrointestinal Issue [Issues w/ absorption of nutrients]

Minor Thalassemia [Microcytic Hypochromic]

- heterozygous [ from 1 parent only] - Mild anemia, asymptomatic - No treatment needed, maybe genetic counseling - Increased survival w/ Malaria

Major Thalassemia [Microcytic Hypochromic]

- homozygous [from both parents] - infant death/stillbirth - severe anemia, potential bone deformity, iron overload

erythroblast of erythrocytes development

- huge nucleus - hemoglobin synthesis

prevention of sickle cell anemia

- hydration - avoid intense exercise, high altitude

Folic acid [Folate] deficiency anemia [MACROcytic anemia]

- impairs DNA synthesis & impedes maturation of RBC

sickle cell anemia

- increase malaria survival - Hgb & Hct = decreased - PLT = increased - vasoocclusion, hypoxia, ischemia

Etiologies: iron deficiency anemia [MICROcytic Hypochromaic]

- insufficient dietary intake - males: 12 mg/day - females: 15 mg/day - child: 10 mg/day - Pregnant: 30 mg/day - Increase loss through bleeding [menorrhagia, gastric ulcers, ASA, NSAIDs] - Decrease iron due to parasitic infection [hookworms]

Clinical Manifestations [iron deficiency]

- koilonuchia [spoon shaped nails] - blue sclera [ sclera is blue instead of white]

aplastic anemia

- lack RBC, WBC, & PLTs production [pancytopenia] - ^ = DECREASED HGB & PLTs - neutrophil <500 mL [Infection] - Methotrexate caused [Chemotherapy/radiation therapy]

normoblasts of erythrocytes development

- nucleus shrinks - increase hemoglobin activity

Pernicious anemia [macrocytic anemia]

- parietal cells destroyed = B12 def & Iron def anemia

Which groups is folic acid deficiency anemia common in?

- pregnant & lactation - Fad diets - Alcohol Use disorders - chronically malnourished/anorexia - celiac disease

treatment of sickle cell anemia

- stem cell transfusion - hydroxyurea (chemo drug helps produce FETAL Hgb) - blood transfusions - symptom management: hydration, oxygen [SP < 92%], pain meds

The nurse is teaching a patient who is to receive epoetin alfa about possible adverse effects. Which would the nurse include? -Diarrhea -Asthenia -Vomiting - Dizziness - Fatigue

-Diarrhea -Asthenia -Vomiting

pica (iron deficiency)

-craving for non food items - pagophagia [crave for ice]

Post hemmorhagic anemia

-loss of RBC's due to trauma/ruptured aneurysm

Approximately what percentage of the body's red blood cells (RBCs) is destroyed and replaced each day?

1%

Erythropoiesis: RBC production

1. Reduced O2 levels in blood 2. KIDNEY senses & releases ERYTHROPOIETIN 3. Erythropoietin stimulates red bone marrow 4. Enhanced erythropoietin INCREASES RBC count 5. Increases O2 carrying of the RBC

RBC distribution width (RDW)

11.5-14.5% - variation of RBC size ie. iron deficiency

Hemoglobin count (Hgb)

12 - 17g/dL

After teaching a group of students about anemias, the instructor determines that the teaching was effective when the students identify what as the critical issue? - Altered red blood cell production or deficient functioning of red blood cells - Decreased levels of platelets - A defect in white blood cell function - A deficiency of vitamin B12

Altered red blood cell production or deficient functioning of red blood cells

A patient with chronic renal failure receiving epoetin alfa will be having a total left hip arthroplasty. What supplementation should the patient receive prior to surgery? - A protein supplement - A blood transfusion - An iron supplement - A folic acid supplement

An iron supplement

Decrease hemocrit

Anemia

Treatment of anemia of chronic disease

Epoietin alfa

Hemocrit (Hct/RBC) (HCT)

F: 37-47 % M: 42-52%

T/F: The mature red blood cell contains a nucleus.

False

secondary polycythemia [ increase RBC production as adaptive response]

Hypoxia due to: - Lung disease, COPD [pulmonary disease] - High Altitude

Organs where iron is reused?

Liver spleen bone marrow

Acute High Infections of HIGH WBC

Neutrophils (bacterial) [60-80%] Lymphocytes (viral) [20 - 30%] Monocytes (chronic infection: TB) [3-8%] Eosinophils (eating parasites) [1-6%] Basophils (Bee stings allergic) [0-2%]

After teaching a group of students about the types of anemia, the instructor determines that the teaching was successful when the students identify which anemia results from an inability to produce the intrinsic factor? - Pernicious anemia - Sickle cell anemia - Iron deficiency anemia - Folic acid deficiency anemia

Pernicious anemia

elevated hemocrit

Polycythemia

Lab values minor thalassemia

Reduced: - MCV - MCH Increase - hgb

Lab values for anemia

Reduced: - hemoglobin - RBC count - hematocrit

The nurse is administering epoetin alfa (Epogen). Which administration technique would not be considered appropriate for the patient identified? - The nurse administers the epoetin alfa (Epogen) into the patient's peripheral IV line. - The nurse administers epoetin alfa (Epogen) into the patient's central IV line. - The nurse administers epoetin alfa (Epogen) via IM injection. - The nurse administers epoetin alfa (Epogen) as a bolus injection as the patient completes dialysis.

The nurse administers epoetin alfa (Epogen) via IM injection.

Which symptom, if assessed after the administration of epoetin alfa (Epogen), would be cause for alarm? The patient displays weakness on one side of the body. The patient states the injection "hurts." The patient reports "bone pain." The patient is tired.

The patient displays weakness on one side of the body.

A client taking epoetin alfa requests changing the medication from the subcutaneous route to the PO route. How should the nurse respond? - This medication is destroyed in the stomach and can only be given by injection. - The drug dose must be increased if being given via the oral route. - This medication causes severe diarrhea if given orally. - The oral route is not as effective.

This medication is destroyed in the stomach and can only be given by injection.

T/F: Cyanocobalamin is a vitamin B12 in a nasal formulation for patients with pernicious anemia

True

The patient is being prescribed epoetin alfa for the treatment of anemia related to the renal failure. The patient also has a history of diabetes mellitus, uncontrolled hypertension, osteoarthritis, and hypothyroidism. Which of these conditions should the nurse bring to the physician's attention prior to administering the medication? - Diabetes mellitus - Osteoarthritis - Uncontrolled hypertension - Hypothyroidism

Uncontrolled hypertension

A male client is prescribed interferon. What is his probable diagnosis? Sepsis Viral hepatitis Bacteremia Hypertension

Viral hepatitis

The physiology instructor is talking with the students about the development of blood cells. What would the instructor tell the students causes a hemocytoblast to change into an immature RBC? Vitamin B12 Vitamin C Vitamin A Vitamin D

Vitamin B12

When administering iron injections, which method would the nurse use? - Z-track intramuscular - Intradermal - Subcutaneous - This medication is not to be given as an injection.

Z-track intramuscular

A client is taking aldesleukin. The nurse knows that this medication is used to treat what condition? Select all that apply. - Metastatic kidney cancer - Hodgkin's disease - Metastatic melanoma skin cancer - Liver cancer - Metastatic bone cancer

a. Metastatic kidney cancer B. Metastatic melanoma skin cancer Aldesleukin activates cellular immunity; produces tumor necrosis factor, interleukin-1, and interferon gamma; and inhibits tumor growth. It is used to treat metastatic kidney cancer and metastatic melanoma skin cancer. The drug is highly toxic and is contraindicated in clients with preexisting serious cardiovascular or pulmonary impairment. It is given only to hospitalized clients and should be prescribed and administered by health professionals (e.g., oncology nurses) who are experienced in its use.

treatment of polycythemia vera

blood draws & chemo/radiation

myeloma

bone marrow tumor

leukemia

cancer of the blood

lymphoma

cancer of the lymph nodes

< 5K WBC meaning?

chronic health problem

While reviewing a client's the record, the nurse sees that the client received a dose of interferon alpha-2b? For what disorder does the nurse suspect the client was being treated? - bacterial pneumonia - ankylosing spondylosis - asthma - chronic hepatitis C

chronic hepatitis C Explanation: Interferon alfa-2b is a biologic response modifier that binds to cell surfaces and alters intracellular activities in viral infections. As a result, viruses are less able to enter uninfected cells and reproduce. Interferon alfa-2b is used to treat chronic hepatitis C and other diseases caused by viruses. Interferon alfa-2b is not used to treat asthma, bacterial pneumonia, or ankylosing spondylosis.

anemia meaning

decrease oxygen carrying capacity of blood

T/F: Folic acid is necessary for cell growth and maintenance of the myelin sheath.

false

Where is B12 absorbed?

ileum

A patient has been diagnosed with hairy cell leukemia. The patient is to begin taking Interferon alfa-2b. What will the nurse include in instructions to the patient concerning this drug? - Increase fluid intake while taking the drug. - Treat constipation with over-the-counter laxatives. - Continue to maintain maximal physical activity. - Avoid drinking alcohol white taking the drug.

increase fluid intake while taking the drug.

A male client is self-administering epoetin in the home. The nurse encourages him to include what supplements as part of his daily medication regimen? Iron Vitamin A Folic acid Vitamin C

iron

A client is receiving ferrous sulfate as treatment for iron deficiency anemia. After teaching the client, which statement indicates the need for additional teaching? - "I need to make sure that I eat enough foods containing iron." - "I need to take an antacid with the pill to prevent an upset stomach."

"I need to take an antacid with the pill to prevent an upset stomach."

A client diagnosed with iron deficiency anemia is learning about her prescribed iron supplement. Which additional information would the nurse include in the client's teaching plan? - "If you have an increased appetite, call your primary provider." - "If darkening of the stools appears, call your primary care provider." - "If you get a little thirsty, call your primary care provider." - "If constipation or diarrhea become severe, call your primary care provider."

"If constipation or diarrhea become severe, call your primary care provider."

After teaching a patient about the adverse effects of iron therapy, the patient demonstrates understanding of the information when the patient identifies what adverse effects? (Select all that apply.) Anorexia Dark stools Constipation Dizziness Fatigue

- Anorexia - Dark stools - Constipation

Polycythemia vera [increase RBCs]

- Bone Marrow disorder [ excessive production of RBCs] - Elevated hematocrit & hemoglobin - risk of thrombus

hemolytic anemia

- Damage of RBCs - ex: sickle cell or thalassemia anemia

A client is experiencing iron toxicity. Which agent would the nurse expect to be given? - Dimercaprol - Succimer - Edetate calcium disodium - Deferoxamine

Deferoxamine

An adult client has developed renal failure secondary to an overdose of a nephrotoxic drug. Which assessment finding would the nurse recognize as being most suggestive of impaired erythropoiesis? - Fatigue and increased heart rate - Frequent infections and low neutrophil levels - Agitation and changes in cognition - Increased blood pressure and peripheral edema

Fatigue and increased heart rate

A 69-year-old client has been diagnosed with malignant melanoma. The care team has collaborated with the client and her family and agreed on a plan of care that includes administration of interferon alfa-2b. After administering interferon alfa-2b, the oncology nurse should anticipate that the client may develop which adverse effect? - Flulike symptoms - Decreased level of consciousness - Profound diaphoresis - Cyanosis and pallor

Flulike symptoms

HIGH folic acid foods

Glandular meats, yeast, dark green leafy vegetables, legumes, whole grains

> 10K WBC meaning?

Infection

A client is receiving epoetin alfa for anemia. Which adjunctive therapy is imperative with epoetin alfa? - Iron supplementation - Renal dialysis - Potassium supplements - Sodium restriction

Iron supplementation

The nurse is teaching a nursing student about anemia and knows that it is important to start by explaining the causes of anemia. Which statement is true about the cause of anemia? - "Anemia is a condition caused by reduced amounts of protein, causing less oxygen to be delivered to the tissues." - "Anemia is a condition caused by reduced amounts of platelets, causing less oxygen to be delivered to the tissues." - "Anemia is a condition caused by reduced amounts of hematocrit, causing less oxygen to be delivered to the tissues." - "Anemia is a condition caused by reduced amounts of hemoglobin, causing less oxygen to be delivered to the tissues."

Lack of hematocrit causing less O2

The client is a woman, 79 years of age, prescribed an iron preparation for anemia. The client's daughter becomes alarmed and calls the provider before giving the iron after she reads the label, because she knows that her mother is also taking which medication? - Vitamin A every week - Levothyroxine every day - One NSAID as needed A statin drug every day

Levothyroxine every day

Lab Values major thalassemia

Reduced: - hgb - mcv - mc hemoglobin

A patient has been prescribed epoetin alfa. The nurse recognizes that this medication is indicated for treatment of anemia associated with which disease process? Renal failure Heart failure Lung failure Liver failure

Renal failure

The nurse is caring for a patient with chronic kidney disease who is receiving epoetin alfa. Which assessment finding would be of greatest concern for the nurse? - Dry, nonproductive cough - A rash under the breast - Reports of calf pain on dorsiflexion of the foot - 1 pound weight gain in 1 week

Reports of calf pain on dorsiflexion of the foot

A client with iron deficiency anemia has begun taking daily supplements of oral ferrous sulfate. The nurse should add what nursing diagnosis to the nursing care plan? - Risk for peripheral neurovascular dysfunction related to use of iron supplements - Risk for unstable blood glucose related to use of iron supplements - Risk for excess fluid volume related to use of iron supplements - Risk for constipation related to use of iron supplements

Risk for constipation related to use of iron supplements

After reviewing the major types of anemia, students demonstrate understanding of the information when they identify what as an example of a hemolytic anemia? - Sickle cell anemia - Iron deficiency anemia - Folic acid deficiency anemia - Pernicious anemia

Sickle cell anemia

A student nurse is caring for a client who is receiving a hematopoietic agent. To test the student's understanding, the nursing instructor states that the drug could be administered by what route?

Subcutaneous or Intravenous

A client has chronic renal failure. As the disease progresses, the client is experiencing increasing shortness of breath. The nurse suspects that the client is experiencing symptoms associated with: hypertension. hypoglycemia. anemia. thrombocytopenia.

anemia

If a person has chronic renal disease, what are they at a risk for?

anemia [not enough healthy RBC in body]

A patient with chronic heart failure has begun treatment with epoetin alfa, which she will receive in her own home from a home health nurse. The nurse should teach the patient to supplement this treatment with a diet that is high in - iron-rich foods such as beans and leafy green vegetables. - protein and low in carbohydrates. - complex carbohydrates and vegetable-source proteins. - calcium, such as dairy products, fish and vegetables.

iron-rich foods such as beans and leafy green vegetables.

Where is folic acid absorbed ?

jejunum & duodenum

Why is folate important during pregnancy?

prevents neural tube defects: - spina bifida [ exposed spinal nerve] - anencephaly [lack of development of the brain]

The anemia that occurs with chronic renal failure is caused by the kidneys themselves. What inability of the kidneys causes anemia in chronic renal failure? - Produce erythropoietin - Produce rennin - Produce angiotensin - Inactivate vitamin D

produce erythropoietin

All hematopoietic and immune blood cells are derived from which cells in the bone marrow? Stem cells Alfa cells Beta cells Theta cells

stem cells

Treatment for Vit B12/Pernicious Anemia

- Cyanocobalamin - injection [if intrinsic factor deficiency IS problem] - oral [If intrinsic factor deficiency NOT problem] - Dietary adjustments - Monitor CBC & B12 levels for response to therapy

Erythropoiesis Nutrition

- Proteins Vitamin B12 - Folic Acid [Folate] - Iron

RBC distribution width (RDW)

- Shows variation in size of RBCs - Normal: 11.5-14.5%

what vitamin is is good with iron? what vitamin inhibits?

- Vit C [good absorption] - Vit D [inhibits]

macrocytic anemia [Vita B12 anemia]

- Vitamin B12 deficiency [impairs DNA synthesis & maturation of RBC] - MCV > 96 fL

parietal cells produces?

- acid [iron absorption] - intrinsic factor [stomach/ B12 absorption]

Blood cancers

- excess RBC production that LACK NORMAL FUNCTION [does NOT carry O2, fight infections, or form clots] - leukemia, lymphoma, myeloma

Acute Myelocytic Leukemia (AML)

- excess immature myeloid blast cells & reduced production of normal cells - adult PT's - RAPID progression

Chronic Myeloid Leukemia [CML]

- excess production of PLTs, RBC, & granulocytes - ELDERLY Pts - SLOWLY progresses

Chronic Lymphocytic Leukemia (CLL)

- excessive MATURE B & T cells - ELDERLY - SLOW progression

Clinical Manifestations of anemia

- fatigue - Pallor - SOB - DIzziness - Tachycardia [ increase HR]

treatment of iron deficiency anemia

- ferrous sulfate - adverse effects: GI side effects, staining of teeth, dark stool

clinical manifestations: macrocytic anemia [Vita B12/Pernicious anemia]

- glossitis [ tongue inflamed] - paresthesias [numbness/tingling]

Mean Cell Hemoglobin Concentration (MCHC)

28 - 34 g/dL

RBC normal value

4.5-5.5 Million (4-5 females)

white blood cells count

5K - 10K

Mean Platelet Volume (MPV)

7.4-10.4 fL - PLT size

The average lifespan of a red blood cell (RBC) is approximately:

80 - 120 days

Which patient will be at the greatest risk for anemia and be the most likely candidate for epoetin alfa therapy? A 62-year-old male with cancer A 20-year-old female A 30-year-old pregnant woman A 40-year-old male with a high white blood cell count

A 62-year-old male with cancer

A patient develops anemia secondary to chronic hemodialysis. The health care provider prescribes iron sucrose. The nurse expects this drug to be administered by which route? Oral Intravenous Intramuscular Subcutaneous

IV

Nurse Considerations for BLOOD CANCER PTs

Immunocompromised Precautions: 1. no fresh flower 2. neutropenic diet 3. good hand hygiene 4. wear PPE 5. limited visitors

Sideroblastic Anemia {Microcytic Hypochromic]

- dysfunctional hemoglobin synthesis - iron accumulates in mitochondria of immure RBC [ring sideroblasts]

Acute Lymphocytic Leukemia (ALL)

- excess IMMATURE B & T cells - children - RAPID progress

The client is a woman 65 years of age being treated for anemia secondary to chronic kidney disease. The nurse explains to the client that she will be getting a prescription for Epogen. Which of the following additional information would the nurse provide? - Chronic kidney disease slows the production of red blood cells causing anemia. Epogen stimulates the production of red blood cells to treat anemia. - Chronic kidney disease has an affect on the production of red blood cells causing anemia. Epogen minimizes the effect on the production of red blood cells to cause anemia. - Chronic kidney disease has no affect on the production of red blood cells causing anemia. Epogen stimulates the production of red blood cells to treat anemia. - Chronic kidney disease stimulates the production of red blood cells causing anemia. Epogen slows the production of red blood cells to cause anemia.

Chronic kidney disease slows the production of red blood cells causing anemia. Epogen stimulates the production of red blood cells to treat anemia

A client has chronic renal failure. As the disease progresses, the client is experiencing increasing shortness of breath, due to anemia. The nurse would anticipate which medication order? Interferon gamma Filgrastim Epoetin alfa Penicillin

Epoetin alfa

A patient is to be administered an erythropoiesis-stimulating agent. Which of the following drugs would the nurse administer? Ferrous sulfate Epoetin alfa Hydroxyurea Folic acid

Epoetin alfa