Final review-1.doc - Hematology Anemia Thrombocytopenia...

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Hematology: Anemia, Thrombocytopenia Hypoproliferative anemias o Iron deficiency anemia Most common cause is blood loss Malabsorption of iron (celiac disease) Prolonged – smooth, sore tongue, brittle nails, angular cheilosis , PICA, Irons stores depleted, reflected by low ferritin levels and low Hgb leve. GI surgery CRF – loss of iron and folic acid during dyalisys Management: Oral iron prep: 6-12 months, on empty stomach if oral, IV, IM available (check for allergy, have EPI on hand), liquid – use straw, rinse mouth, oral hygiene. No antacids, Vit. C enhances absorption, Z-track for IM, no rubbing injection site. Iron rich food: liver, beans, raisins, molasses Anemias in renal disease o Shortened lifespan of erythrocytes o Deficient erythropoietin o Dialysis o Epogen: keep Hgb level 11-12 mg/dl Megaloblastic anemias o Folic acid deficiency anemia – 1mg PO daily or IM for people with malabsorption o Vitamin B12 deficiency anemia (cyanocobalamin) Poor nutrition, malabsorption (Crohn’s), GI surgery , no intristic factor (pernicious) Neuro manifestations Management: B12 for life all routes Teach pt they may end up using walker later in time Vitamin B12 for life! If tongue feels better, less red after several days, therapeutic treatment is working Schilling test : o oral dose of radioactive B12, with large parenteral nonradioactive B12. If oral dose is absorbed, 8% is excreted in urine = cyanobalamin anemia o If no radioactivity in urine, same test, but added IF. If positive radioactivity in urine after adding IF = malabsorption = Pernicious anemia Hemolytic anemia o Low O2 causing increased reticulocyte count o RBC broken down, heme convertes to bilirubin, excreted in bile o Immune hemolytic anemia RBC coated with antibodies (alloantibodies) Hemolytic transfusion reaction Fatigue, dizziness, splenomagaly, jaundice, lymphadenopathy Management: Corticosteroids, blood transfusions in severe anemia, splenectomy (watch for infection) Monoclonal antibodies (Rituximab) Immune thrombocytopenia Purpura (ITP) o Platelets covered to antibodies, destroyed by macrophages o Liver disease, coagulation disorder o Management: FFP, PRBC, platelets (if count is 5-10k) Immunosuppressants IVIG – side effects Win-Rho – coats RBC’s (side effect is anemia) HIT, HITTS, White coat syndrome o Heparin induced thrombocytopenia o STOP HEPARIN! o Can cause DVT, MI, CVA Hematology: Polycythemia Vera Polycythemia Vera o Abnormal increase in RBC, WBC and platelets
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o Bone marrow hyperactive o Increase viscocity of blood, risk for CVA, MI, PE, DVT. o Erythromyalgia relieved by cooling o Management: Phlebotomy – once or twice a week. Goal is <45% Hct Chemotherapy, s/e leukemia No smoking Anticoagulants Exercise o Secondary polycythemia vera is overproduction of RBC in respsonse to hypoxia, may be due to living in high altitudes. Same treatment, or move to lower altitude.
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  • Spring '17
  • Acevedo
  • General Nursing Management,  Prolonged

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