5Th Quarter Hematology Part 2

Front 1

These types of cells have a role in phagocytosis of foreign microbes

Back 1

White blood cells

Front 2

What is a normal neutrophil count

Back 2

4000 to 11,000

Front 3

When neutrophils Reach This level it is considered neutropenia

Back 3

Below 2000

Front 4

Two reasons for low neutrophil levels

Back 4

Marrow unable to replace as fast as being used

They are being destroyed too quickly

Front 5

How long after chemotherapy do patients neutrophil counts often drop too low

Back 5

10 to 12 days

Front 6

Neutropenia leads to this

Back 6

Higher risk for infection

Front 7

Signs and symptoms of infection are often masked

Back 7

Neutropenia, due to lack of available neutrophils

Front 8

Signs and symptoms of inflammation may not occur

Back 8

Neutropenia, due to lack of neutrophils

Front 9

In neutropenia even with infection pus formation is absent. This is because white blood cells are absent.

Back 9

True

Front 10

What is the most important thing to Monitor and recognized in patients with neutropenia

Back 10

Changes in temperature, even low-grade fever demands immediate attention

Front 11

With this condition signs and symptoms of infection often occur in the mouth, throat, perianal area, pulmonary system. All are entry points to the body

Back 11

Neutropenia

Front 12

This is not considered a disease but instead A syndrome or a side effect

Back 12

Neutropenia

Front 13

This condition can be a intentional or unintentional side effect

Back 13

Neutropenia

Front 14

In this condition the patient is more prone to infections even just from their own normal flora

Back 14

Neutropenia

Front 15

These patients are unable to fight even minor things on their own. We must recognize infection early and get on antibiotics within an hour if possible

Back 15

neutropenia

Front 16

CBC with differential as well as bone marrow aspiration may be utilized in this condition

Back 16

Neutropenia

Front 17

Tuberculosis can cause neutropenia

Back 17

True

Front 18

Blood cultures are one way to identify the organism that may cause problems with this condition. Blood cultures are preferably taken when there is a temperature and are always taken from two different sites

Back 18

True

Front 19

It is important to always get the culture before beginning antibiotic therapy

Back 19

True

Front 20

With complications occurring from this condition broad-spectrum coverage is used until cultures come back. May use multiple antibiotics in combination

Back 20

Neutropenia

Front 21

Two types of medication used in neutropenia

Back 21

Antibiotics and hematopoietic growth factors such as neupogen and neulasta

Front 22

What is GCSF

Back 22

Granulocyte colony-stimulating Factor, used in neutropenia. Neupogen and neulasta

Front 23

What are the side effects of medications like neupogen and neulasta

Back 23

Bone pain

Front 24

These stimulate bone marrow production helping to build more neutrophils. They are available by Sub-Q injection, IV, and you may give an analgesic before to help decrease bone pain

Back 24

Neupogen and neulasta

Front 25

In this condition the patient's own common Flora is the most common cause of infection in these patients. They can get very sick very fast

Back 25

neutropenia

Front 26

What is a normal platelet count

Back 26

150,000 to 450,000

Front 27

What is thrombocytopenia

Back 27

Platelet count less than 150,000

Front 28

Prolonged bleeding with minor injury

Back 28

Thrombocytopenia

Front 29

Spontaneous bleeding without injury

Back 29

Thrombocytopenia

Front 30

Four main reasons for acquired thrombocytopenia

Back 30

Decreased platelet production

Increased platelet destruction

Increased consumption of platelets

Abnormal platelet function

Front 31

Thrombocytopenia can be either acquired or genetic

Back 31

True

Front 32

An example of genetic thrombocytopenia

Back 32

Fanconi syndrome, these patients have pancytopenia which is low in all blood levels including red blood cells, white blood cells and platelets

Front 33

Average lifespan of platelets

Back 33

7 to 10 days

Front 34

Myelosuppression, viral infection and chronic alcoholism can lead to this

Back 34

Decreased platelet production

Front 35

May occur during pregnancy, from severe burns, HIV, spleen problems

Back 35

Increased platelet destruction, associated with thrombocytopenia

Front 36

May be caused by DIC

Back 36

Increased consumption of platelets

Front 37

May be caused by medications such as diuretics, estrogen, aspirin, heparin, ginger, garlic, cloves

Back 37

Abnormal platelet function

Front 38

Autoimmune disease in which platelets are produced normally and function normally but are coated with antibodies so the spleen sees them as foreign and they are destroyed by phagocytosis.

Back 38

Idiopathic thrombocytopenic purpura, ITP

Front 39

Life of platelets drops from 7 to 10 days down to only 1 to 3 days

Back 39

Idiopathic thrombocytopenic purpura

Front 40

Thrombocytopenia in which abnormal destruction of circulating platelets occurs

Back 40

Idiopathic thrombocytopenic purpura

Front 41

What is the most common type of thrombocytopenia

Back 41

Idiopathic thrombocytopenic purpura

Front 42

This type of thrombocytopenia occurs usually in women 20 to 40 years of age and children

Back 42

Idiopathic thrombocytopenic purpura

Front 43

This type of thrombocytopenia has a gradual onset with recurrent episodes

Back 43

Idiopathic thrombocytopenic purpura

Front 44

There is a possible correlation between this type of thrombocytopenia and H pylori but it has not been proven why yet

Back 44

Idiopathic thrombocytopenic purpura

Front 45

It is unknown why we get this type of thrombocytopenia however there is enhanced agglutination, meaning sticking together, of platelets which leads to microthrombi

Back 45

Thrombotic thrombocytopenic purpura, TTP

Front 46

In this thrombocytopenia microthrombi can deposit in arterioles and capillaries

Back 46

Thrombotic thrombocytopenic purpura

Front 47

This is a type of thrombocytopenia that occurs over time due to immune responses to heparin

Back 47

Heparin induced thrombocytopenia and thrombosis, HITTS

Front 48

Many with this condition are asymptomatic

Back 48

Thrombocytopenia

Front 49

Four signs and symptoms that may be seen for internal bleeding with thrombocytopenia

Back 49

Hypotension, tachycardia, pain and dizziness

Front 50

What is the major complication of thrombocytopenia

Back 50

Hemorrhage

Front 51

When platelets get below 20,000 we may see these three external signs and symptoms of thrombocytopenia

Back 51

Mucosal bleeding, cutaneous such as bruising and petechiae, prolonged bleeding

Front 52

These two things are usually seen when platelet counts get below 50,000

Back 52

Petechiae and ecchymosis

Front 53

Small flat pinpoint microhemorrhages

Back 53

Petechiae

Front 54

Bruising

Back 54

ecchymosis

Front 55

When platelets reach below this level we start to see spontaneous bleeding which may be internal and fatal

Back 55

Below 5000

Front 56

Platelet count, PT, PTT, H&H, bone marrow biopsy

Back 56

Diagnostics used in thrombocytopenia

Front 57

In this condition PT and PTT will be normal because they assess coagulation factors and not platelets

Back 57

Thrombocytopenia

Front 58

Avoid aspirin, no IM injections, avoid suctioning, soft-bristled toothbrush, stool softeners

Back 58

Thrombocytopenia nursing care

Front 59

No rectal temperature or enemas, electric razor only, prevent Falls

Back 59

Nursing care thrombocytopenia

Front 60

Use the smallest needle possible if IV is required

Back 60

Thrombocytopenia

Front 61

When platelet levels reach around the 20,000 range this is often given

Back 61

Platelets

Front 62

Given as close to blood type as possible but we don't worry quite as much about compatibility unless they have had many transfusions overtime and may have developed antibodies

Back 62

Platelets

Front 63

One unit of donor blood is about this many milliliters

This is spun down to create one unit of platelets which is about this many milliliters

Back 63

450 to 500 ml

30 to 50 Ml

Front 64

Platelets often come in six pack and eight packs. This means platelets from six different to eight different patients and units of blood

Back 64

True

Front 65

Phoresis

Back 65

A unit of platelets that has all come from the same donor

Front 66

Many premedicate with this medication before administering platelets

Back 66

Antihistamine such as Benadryl

Front 67

Four types of medical care for thrombocytopenia

Back 67

Corticosteroids, prednisone or Solu-Medrol

Immunosuppressive meds

Splenectomy

Platelet transfusion

Front 68

Used in thrombocytopenia because they suppress the phagocytic response of the spleen

Back 68

Corticosteroids

Front 69

This may lead to a partial or complete remission of thrombocytopenia

Back 69

Splenectomy

Front 70

Prolonged clotting time and abnormal bleeding time

Back 70

Hemophilia

Front 71

Sex-linked hereditary disorder caused by defective or deficient coagulation factors. Transmitted by women but most often displayed by men

Back 71

Hemophilia

Front 72

The classic form of hemophilia, it is the most common type with 80% of patients having it

Back 72

Hemophilia a

Front 73

Also known as Christmas disease named after Stephen Christmas

Back 73

Hemophilia B

Front 74

Deficiency of factor 8 in the coagulation Cascade

Back 74

Hemophilia a

Front 75

Deficiency of factor 9 in the coagulation Cascade

Back 75

Hemophilia B

Front 76

Condition that may be mild to severe

Back 76

Hemophilia

Front 77

This Is A congenital bleeding disorder characterized by a deficiency in Von Willebrand's coagulation protein which should circulate with coagulation factor 8

Back 77

Von Willebrand's disease

Front 78

This is the most common congenital bleeding disorder occurring more than even hemophilia

Back 78

Von Willebrand's disease

Front 79

Characterized by abnormal bleeding time it is seen equally in both sexes

Back 79

Von Willebrand's disease

Front 80

Children are usually diagnosed around six to eight months when they become more mobile and have teeth coming in. It may not be diagnosed until adulthood in some cases

Back 80

Von Willebrand's disease

Front 81

Any bleeding can lead to life-threatening Hemorrhage in these patients

Back 81

Hemophilia and Von Willebrand's disease

Front 82

Slow persistent bleeding

Delayed bleeding

uncontrollable hemorrhage

Epistaxis

GI bleed

Hematuria

Ecchymosis

Back 82

Hemophilia and Von Willebrand's disease

Front 83

Bleeding into the joints. It is important to completely rest the joint!

Back 83

Hemarthrosis, associated with hemophilia and von Willebrand's disease

Front 84

Replaces coagulation factor 8 and fibrinogen it is made from whole blood

Back 84

Cryoprecipitate

Front 85

A treatment for hemophilia B

Back 85

Transfusion of factor-9

Front 86

The main treatment for these conditions is replacing clotting factors

Back 86

Hemophilia and Von Willebrand's disease

Front 87

Eventually patients may be taught to administer their own clotting factors at some point as this is a chronic condition

Back 87

Hemophilia and Von Willebrand's disease

Front 88

Avoid medications that interfere with platelet aggregation such as alcohol, some herbs and aspirin

Back 88

Hemophilia and Von Willebrand's disease

Front 89

Disorder and acceleration of the clotting Cascade. This is a very serious coagulation disorder!

Back 89

Disseminated intravascular coagulation

Front 90

Depletion of clotting factors and platelets leaving patients at risk of severe hemorrhage. All of them are used up in a big thrombosis throughout the body

Back 90

Disseminated intravascular coagulation

Front 91

This is usually a side effect of some other disease process. Often seen in very sick ICU patients who may be septic, had significant trauma, shock and advanced cancer

Back 91

Disseminated intravascular coagulation

Front 92

Initial phase of disseminated intravascular coagulation

Back 92

Abnormal clotting occurs throughout the body not localized.

Enhanced platelet aggregation happens forming thrombi

Front 93

Secondary phase of disseminated intravascular coagulation

Back 93

Thrombi formation activates the fibrinolytic system which then goes through breaking clots down. This produces anticoagulant effects causing blood to lose ability to clot

Front 94

Bleeding is the first symptom

Back 94

Disseminated intravascular coagulation

Front 95

Cyanosis, tissue necrosis from clots blocking areas, pulmonary emboli, ards, EKG changes, oliguria from blocking of urine outflow

Back 95

Thrombosis related to disseminated intravascular coagulation

Front 96

Prolonged PT and PTT, platelet counts decreased, D-dimer elevated

Back 96

Disseminated intravascular coagulation

Front 97

Specific to fibrin breakdown, blood should not normally have detectable levels of this it shows fibrinolysis occurring

Back 97

D-dimer

Front 98

This is essential to reversal of disseminated intravascular coagulation

Back 98

Treat the underlying cause

Front 99

Blood products used for treatment of disseminated intravascular coagulation

Back 99

Platelets for thrombocytopenia

Cryoprecipitate

fresh frozen plasma for clotting factors

Front 100

What medications may be used in treatment of disseminated intravascular coagulation

Back 100

Anticoagulants such as Heparin and Lovenox to prevent new clots from forming

Front 101

Three pharmacologic therapies for disorders of hemostasis

Back 101

Anticoagulants

Anti platelets

Hematopoietic growth factors

Front 102

Disrupt the clotting Cascade and in doing so supresses the production of fibrin. Enhances activity of antithrombin which then inactivates thrombin and factor 10

Back 102

Heparin

Front 103

Not given PO due to molecules being too large to pass through membranes

Back 103

Heparin and Lovenox

Front 104

Rapid acting and available in subcutaneous or IV methods

Back 104

Heparin

Front 105

Uses include pulmonary emboli, dialysis, after a stroke, prophylactic from surgery , DVT

Back 105

Heparin

Front 106

What must be monitored with Heparin therapy

Back 106

PTT

Front 107

What is a normal PTT

Back 107

30 to 40

Front 108

With Heparin therapy how do we want PTT

Back 108

1 1/2 to 2 1/2 times normal

Front 109

What is the antidote for heparin

Back 109

Protamine sulfate

Front 110

Loading dose calculation for heparin

Back 110

80u/kg IV push

Front 111

Rate for maintenance dose of Heparin

Back 111

18u / kg / HR

Front 112

How is heparin dosed

Back 112

In units per kilogram per hour

Front 113

In calculating Heparin drip dosing the pharmacist uses what

Back 113

adjusted body weight

Front 114

Made of shorter molecules but just as effective as heparin

Back 114

Lovenox

Front 115

Half-Life is longer so it can be given on a fixed dose schedule

Back 115

Lovenox

Front 116

You do not have to monitor PTT with this medication

Back 116

Lovenox

Front 117

Can be given at home

Back 117

Lovenox

Front 118

Given subcutaneously dosed per patient wait

Back 118

Lovenox

Front 119

Prevention and treatment of DVT is frequently used post-op. It is now the first line therapy in prevention of DVT

Back 119

Lovenox

Front 120

What is the antidote for Lovenox

Back 120

Protamine sulfate

Front 121

Only given po, take several days to develop Peak effects

Back 121

Warfarin

Front 122

Good for long-term prophylaxis of clot formation

Back 122

Warfarin

Front 123

This medication antagonizes vitamin K there by suppressing coagulation

Back 123

Warfarin

Front 124

What must be monitored with Warfarin treatment

Back 124

PT and INR, monthly if stable

Front 125

What is the antidote for Warfarin

Back 125

Vitamin-k

Front 126

International normalization ratio

Back 126

INR

Front 127

An order for Coumadin is usually only good for 24 hours in the hospital

Back 127

True

Front 128

Usually given around 5 p.m. in the hospital to give time for labs, orders and pharmacy

Back 128

Coumadin

Front 129

It is important to know that some foods such as leafy dark greens interact with this medication

Back 129

Warfarin

Front 130

What is a normal PT

Back 130

11 to 12.5

Front 131

Therapeutic range for PT with Warfarin use

Back 131

One and a half to two times normal

Front 132

What is a normal INR

Back 132

1.3 to 2.0

Front 133

Therapeutic range for Warfarin therapy of an INR

Back 133

2 to 3

Front 134

List two newer anticoagulants on the market

Back 134

Pradaxa and Xarelto

Front 135

As effective as Coumadin without the need to monitor INR or adjust the dose

Back 135

Pradaxa

Front 136

Very expensive medication, must remain in original package until use!

Back 136

Pradaxa

Front 137

No antidote available

Back 137

Pradaxa

Front 138

No INR monitoring required with these two newer anticoagulant

Back 138

Pradaxa and Xarelto

Front 139

Both these medications inhibit platelet aggregation and are used for Peripheral arterial disease

Back 139

Plavix, pletal

Front 140

Take 30 minutes before or two hours after meals

Back 140

Pletal

Front 141

Avoid grapefruit juice

Back 141

Pletal