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Hematologic
Week 10
| Term | Definition |
|---|---|
| Polycythemia patho | Primary: Polycythemia vera due to gene mutation causing proliferation of RBCs (may also have increased growth of WBC and platelets). Secondary: tissue hypoxia - increased production of erythropoietin (overproduction of RBC with normal WBC/platelets) |
| Polycythemia complications | Hyperviscosity, increased blood volume, congestion, tissue hypoxia. MI, STROKE, DVT, PE. Hemorrhage (nose/GI bleed). HF, myelofibrosis due to bone marrow scarring. |
| Polycythemia symptoms | slow, progressive disease causing hypoxia/hyperviscosity (SOB, headache, fatigue, dizzy), platelet issues (nosebleeds/bleeding gums), cap engorgement (blurred vision, pruritus, facial flushing), splenomegaly, hepatomegaly, weight loss, HTN |
| Polycythemia diagnosis / treatment | Imaging (US, xray, MRI), splenomegaly, renal sources (tumor/cyst). Bone marrow biopsy, erythropoietin levels, blood smear, genetic testing, CBC. Phlebotomy (weekly 500mL draw), fluid intake, aspirin, radiation, no smoking, ALLOPURINOL (gout) |
| Thrombocytopenia patho | reduced platelets (normal 150,000-450,000). Decreased production, increased platelet utilization (TTP/DIC) /destruction. |
| Immune mediated thrombocytopenia | Heparin-induced thrombocytopenia (HIT), receiving heparin for an existing thrombus or clot and develops immune responses 5-14 days after admin. Risk factors: female, heparin therapy longer than a week |
| Idiopathic thrombocytopenia purpura (ITP) | most common. destroyed in hrs by antiplatelet antibodies. Risk factors: african descent, obese, female (15-40), viral infection, meds, lupus. Immune dysfunction with antiplatelet antibodies formed. |
| Thrombocytopenia symptoms / diagnosis | bruising and petechiae (first signs), spontaneous nose bleeds, gum bleeding, hematuria. Dx with hx, CBC, coag, Hgb, blood smear, type and cross match |
| Treatment for ITP | Corticosteroids first, IVIG next, Rituximab next, splenectomy in extreme cases. |
| Treatment for HIT | stop heparin, admin direct thrombin inhibitor (ARGATROBAN), no warfarin (causes skin gangrene), no platelets |
| Treatment for DIC | resolve underlying issues, abx therapy, fluid resus, supportive care to maintain hemostasis, platelet transfusion (under 20,000), cryoprecipitate (plasma with factor VIII), whole blood, prophylactic transfusions. VS q15min |
| Complications of thrombocytopenia | massive hemorrhage, multisystem organ failure, spontaneous bleed, intracranial hemorrhage, TTP (DVT, PE, stroke) |
| Bleeding precautions | Soft bristle toothbrush, electric razor, shoes/slipper use, maintain clutter free area, avoid rectal insertion, do not blow nose, avoid sex when platelet count low, apply direct pressure to cut, IM injections/blood draws at a minimum |
| Pancytopenia patho | Decrease in all three major blood cell types (anemia, leukopenia, thrombocytopenia). Caused by chemo/radiation, aplastic anemia, autoimmune, HIV/hep, toxins/meds |
| Pancytopenia symptoms / treatment | anemia (fatigue, pallor, dyspnea), leukopenia (fever, recurrent infections), thrombocytopenia (petechiae, bruising, bleeding gums). Treat with transfusions, growth factor stimulants (FILGRASTIM/NEUPOGEN/EPOGEN) |
| Neutropenia | WBC less than 1500/mm3. Caused by chemo/radiation, aplastic anemia, leukemia, myelodysplastic syndromes, autoimmune, viral, meds. |
| Neutropenia precautions | hand hygiene, avoid crowds/children/sickness, wash raw fruits/veggies well, monitor temp daily, seek immediate med attention for fever/rigors/illness, no live plants, avoid standing water, complete meds, private room in hospital, avoid rectal insertion |
| Lymphoma | single progenitor cell in lymph system develops into solid tumor. Hodgkins (EBV infection, family hx), NonHodgkins (chemical/carcinogenic exposure, immune, infectious agents, previous cancer treatment) |
| Lymphoma symptoms | painless swelling of lymph nodes, drenching night sweats, unintentional weight loss, fatigue, persistent cough (worse when lying flat due to mediastinal mass), SOB, abd fullness. Hodgkins: itching, excoriation from scratching |
| Lymphoma diagnosis / treatment | CBC, elevated uric acid/lactate dehydrogenase, biopsy, imaging. Provide chemo, radiation, immunotherapy, bone marrow transplant (allogenic from donor or autologous from their own stem cells) |
| Complications of lymphoma | superior vena cava syndrome, spinal cord compression, spinal cord compression, hypercalcemia (need immediate treatment). Also includes myelodysplasia, hepatic/renal dysfunction, hyper viscosity or venous thrombotic events |
| Multiple myeloma | Cancer of plasma cells leading to excess abnormal antibodies. Results in hypercalcemia, bone/back pain, SOB, anemia, paresthesia, pallor, fatigue, bone breakdown, AKI, weight loss, increased HR/RR |
| Multiple myeloma treatment | chemo/bisphosphonate, pain meds, fluid intake (protect kidneys) |
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