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Hematology
365
12
Nursing
Graduate
03/08/2014
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Term
Anemia
 Definition
  • deficiency of RBCs and/or Hgb caused by:
    • nutritional deficiencies
    • blood loss
    • destruction of RBC
    • Vitamin B12 deficiency
    • Bone marrow failure
    • Genetic abnormalities
Term
Iron Deficiency Anemia
 Definition
  • Inadequate supply of dietary iron
  • Generally preventable
  • At risk: adolescents, premature infants, infants that drink cow's milk (shouldn't be introduced into diet until 1yr-18 months)
  • S/S: fatigue, low body weight, pale mucous membranes, anorexia, orthostatic HTN, dizziness
  • Treatment: Increase intake of Iron (red meat, eggs, beans), oral or parental supplementation (Z track in buttocks to prevent leaking, injection hurts), transfusion of packed RBCs
  • Oral iron: ferrous sulfate in acidic environment (give with OJ, 1 hr before meals. Liquid Iron should be diluted- stains teeth, use straw
  • Nursing: teach food high in iron, how to take supplement, nutritional diary
Term
Pernicious Anemia
 Definition
  • Vitamin B12 deficiency 
  • Intrinsic factor not available-needed for absorption (Gastric bypass)
  • S/S paresthesias of feet & hands, weakness, sore tongue, pallor, n/v
  • Diagnostics: RBC large w/ abnormal shape, CBC, check B12 & Folic acid level
  • Schilling test: radioactive B12 given- if not absorbed- very little excreted in urine
  • Treatment: monthly IM injections of B12 for life
Term
Sickle Cell Disease
 Definition
  • Production of abnormal Hgb that causes RBC sickle shape
  • Causes increased blood viscosity & circulation time, cell becomes more hypoxic
  • Usually African Americans, Mediterranean & Eastern decent
  • Recessive gene
  • Incurable, often fatal from infections
  • Sickle cell crisis: Hgb plug capillary beds->no oxygenation->tissue ischemia->pain
    • Triggered by stressors: high altitude, emotional stress, cold weather, alcohol
  • s/s: bone & abdomen pain, acute chest syndrome, CVA, pallor of mucous membranes, fatigue
  • Treatment: No cure, prevent sickling episodes, pneumonia, splenectomy, phrophylactic antibiotics, blood transfusions (can lead to iron in tissues)
  • Nursing: Prevent infection, maintain hydration, IV therapy w/ NS, bedrest, O2, pain management (no demoral), folic acid, hydroxyurea (decreased production of abnormal cells), bone marrow transplant
Term
Thalassemia
 Definition
  • autosomal recessive genetic disorder
  • Inadequate production of normal Hgb
  • Mediterranean & Equatorial regions of Asia & Africa
Term
Thalassemia Minor
 Definition
  • One thalassemic gene
  • Asymptomatic frequently
  • Moderate anemia: splenomegaly, mild jaundice
  • Body adapts to decreased Hgb
Term
Thalassemia Major
 Definition
  • Life-threatening
  • Physical & mental growth retardation, delayed secondary sex characteristics
  • Pale, splenomegaly, hepatomegaly, jaundice, hypoxemia->ha, pain, bone marrow hyperplasia
  • No specific treatment: blood transfusions w/ IV deferoxamine (hemosiderosis) after 3-4 yrs of age
Term
Hemophilia
 Definition
  • bleeding disorder due to a deficiency of blood clotting factor
  • Genetic- almost always males (unless mom is carrier and dad is active hemophiliac)
  • Diagnosis: low levels of factor VIII or IX, prolonged PTT, normal: platelet count, PT & fibrinogen
  • S/S: slow, persistent bleeding, epistaxis, bleeding after dental work, hematomas, hemoarthrosis. S/S may not occur until 6 months: mobility->falls
  • Treatment:Amicar: antifibrolytic agent helps prevent bleeding, Replace clotting factors, transfusions.
  • Mild cases: DDAVP causes increase in factor VIII
  • Nursing: no narcotics for pain, prevent bleeding, monitor for hemorrhage, avoid injections, med alert bracelets, avoid ASA, wear helmets, gloves, swimming is good sport, never do PROM, avoid ice in liquids to prevent GI bleeding
Term
Hemophilia A
 Definition
  • Factor VIII deficiency
  • 80% of hemophilia
Term
Hemophilia B
 Definition
  • Factor IX deficiency
  • "Christmas disease"
Term
Hemoarthrosis
 Definition
  • bleeding into joints
  • S/S: like arthritis, joint pain, stiffness, tingling, decreased mobility, joints hot to touch, swelling, 
  • Elevate & immobolize the joint during bleeding episodes, analgesics, avoid obesity, AROM, PT
Term
von Willebrand Disease
 Definition
  • hereditary bleeding disorder. Many never know they have the disease.
  • Diagnosis: decreased vonWillebrand factor levels & platelet agglutination. Prolonged bleeding time
  • S/S: easy bruising, epistaxis, gingival bleeding, excessive bleeding w/ lacerations or surgeries, menorrhagia.
  • Treatment: von Willebrand protein infusion, DDAVP, avoid ASA & NSAIDs, Amicar
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