Hematology and Oncology Quiz 2023 with verified questions and answers

RBC count 4.2-5.4 million female 4.7-6.1 million male WBC count 5,000-10,000/mm3 MCV (mean corpuscular volume) 80-95 fL MCH (mean corpuscular hemoglobin) 27 -31 pg/cell TIBC (total iron binding capacity) 250-460 mcg/dL Iron • Females 60-160 mcg/dL • Males 80-180 mcg/dL Platelets 150,000-400,000/mm3 HGB Females: 12-16g/dl Males: 14-18g/dl elderly: levels slightly decreased HCT • Females 37-47% • Males 42-52% elderly: levels slightly decreased aPTT (activated partial thromboplastin time) 30-40 seconds (1.5 to 2.5 times control value if receiving heparin therapy) PT 11-12.5 seconds, 85%-100% INR 0.8 to 1.1 (desired goal of 2 to 3 on warfarin therapy) D-dimer Less than 0.4 mcg/mL Fibrinogen levels 200-400 mg/dL Fibrin Degradation Products (FDPs) 10 mcg/mL blood components plasma, red blood cells, white blood cells, platelets Plasma fluid portion of blood erythrocytes consist primarily of hemoglobin Erythropoietin stimulates the differentiation of the primitive myeloid stem cell into an erythroblast -produced in the kidney HCT (Hematocrit) the number of RBCs as a percentage of whole blood HGB (Hemoglobin) main intracellular protein of RBCs Blood type is determined by antigens (A,B,O; Rh + or -) Blood transfusion key points -Assess VS and temp prior to administration (baseline vitals) -establish large bore IV access (greater than 18g) -Initiate transfusion within 30 minutes of receiving blood from bank -inspect blood for bubbles (gas) or cloudiness (hemolysis) -ensure ABO group and Rh type agree with medical record -use blood administration to transfuse blood with 0.9% normal saline only -Infuse slowly for first 15 minutes and remain with client for 30 minutes -Change tubing after 2 units of transfusion Pre-procedure for Transfuse packed RBC's -take vitals -s/s of reaction to the blood: itching, hives, swelling, SOB, fever, chills, N/V, back pain, flushing, hematuria (STOP immediately) -Use special tubing with filter for fibrin clots Procedure for transfusion of packed RBCs -obtain the packed RBCs after starting IV line -do NOT infuse longer than 4 hours -check for reactions: sepsis, circulatory overload, fever, allergic, acute hemolytic reactions Post procedure for transfusion of packed RBCs -obtain vitals and breath sounds -monitor patient for 6 hours for circulatory overload -monitor for delayed hemolytic reaction intra-procedure for transfusion of platelets/frozen plasma -obtain plasma/platelets after starting IV line -infuse each unit of FFP over 30-60 minutes as tolerated Post-procedure for transfusion of platelets/frozen plasma -another round of platelets can be ordered 1 hour after -monitor closely for 6 hours for circulatory overload Febrile Non-Hemolytic Transfusion Reaction (FNHTR) concerning cause initial presentation is similar to more adverse reactions -examples: fever, chills, increase or decrease mild dyspnea Management of Febrile non-hemolytic transfusion reaction -Stop transfusion, rule out hemolysis i.e. check labels, repeat type and cross, coombs test (test that can be done after initial reaction, especially in perinatal women, to check for any antibodies present that can react with blood) -Antipyretics +/- meperidine for chills and rigors Acute hemolytic transfusion reaction (AHTR) occurs due to rapid transfused RBC destruction (hemolysis) -can occur within minutes, hours post-transfusion usually in 24 hours -IgM mediated complement fixation leading to rapid intra vascular hemolysis- hypovolemic shock, renal failure, disseminated intravascular collapse Clinical presentation of AHTR TRIAD of fever, flank pain (kidneys), and reddish brown urine from hemoglobinuria -DIC (disseminating intravascular coagulation) Management of AHTR -STOP transfusion alert blood bank -rule out transfusion reaction -supportive care: ABCs, intubation, +/- pressors -patient will be in shock (low BP, high HR) -cardiac monitoring because of risk of hyperkalemia -infuse NS to maintain BP and promote diuresis transfusion anaphylactic reaction -occurs within a few seconds to minutes following transfusion -SOB, hives, low BP, high HR, swelling treatment of anaphylactic reaction -stop transfusion -call RRT/code -consider IV epinephrine drip -monitor ABCs and give +/- vasopressor support Urticarial reaction (transfusion) -allergenic products in blood products activate IgE in recipient leading to histamine release from mast cells and basophils -only reaction in which transfusion can be resumed -give benadryl 25-50 mg IV/PO if urticaria is extensive and restart infusion Transfusion Associated Circulatory Overload (TACO) volume overload associated with transfusion signs and symptoms of TACO -shortness of breath -increased left atrial pressure -jugular venous distention -elevated systolic blood pressure Treatment of TACO -oxygen -possible intubation and mechanical ventilation -diuresis to reduce volume Bacterial complications of transfusions -platelets are at greatest risk of bacterial infection because stored at room temp -packed RBCs can not hang longer than 4 hours bone marrow aspiration biopsy -usually drawn from iliac crest -often very painful -ensure proper positioning based on where it occurs -administer anti-anxiety/sedatives for pain, needles long/large -post procedure its important to ensure pain control (AVOID aspirin) anemias Lower than normal hemoglobin and fewer than normal circulating erythrocytes; a sign of an underlying disorder normal Hgb females: 12-16.5 males: 14-17 hemolytic anemia excess destruction or shortened lifespan of RBCs -sickle cell disease general manifestations of anemia -fatigue -weakness -dizziness -syncope -pallor -dyspnea -nail changes -tachycardia -jaundice -depression diagnostics of anemia Draw a CBC which includes rbc, wbc, hgb, hct, platelets important to examine in anemia -hemoglobin and hematocrit levels -iron studies -vitamin B12 levels -folate levels Complication of anemia can lead to heart failure due to increased demand on heart to supply O2 to tissues iron deficiency anemia due to inadequate dietary iron intake and blood loss manifestations of iron deficiency anemia smooth red tongue, brittle nails, angular chelosis (red around mouth), pallor treatment of iron deficiency anemia oral ferrous sulfate: can change stool color and cause GI upset especially in pregnant women nursing management of iron deficiency anemia -intake food sources high in iron (meats, beans, leafy greens) -encourage iron administration with vitamin c and take between meals on empty stomach Anemia in renal disease decreased erythropoietin -erythropoietin triggers bone marrow to make RBCs then carry O2 throughout body aplastic anemia -damage to marrow stem cells (t lymphocytes attack own bone marrow resulting in marrow aplasia) -idiopathic but sometimes environmental exposure megaloblastic anemia folic acid or vitamin B12 deficiency anemia -produces abnormally large (megaloblastic) RBCs Folic acid deficiency anemia -deficiency of folic acid which is found in green veggies and liver -occurs in alcoholics and certain malabsorption bowel diseases Vitamin B12 Deficiency Anemia faulty absorption from GI tract (following GI surgery) -found in strict vegans manifestations of vitamin B12 deficiency anemia smooth red tongue, diarrhea, pallor, paresthesias, confusion, balance issues, proprioception issues Treatment of Vitamin B12 Deficiency Anemia -vitamin b12 supplementation -oral supplements if vegan -patients with malabsorptive issues must get IM monthly sickle cell anemia altered sickle hemoglobin gene, causing hemoglobin molecule to be defective -will be rigid and sickle ("s") shaped clinical manifestations of sickle cell anemia anemia, bony enlargement, tachycardia, enlarged heart sickle cell crisis (vasoocclusive crisis) entrapment of erythrocytes in microcirculation causing tissue hypoxia, inflammation, necrosis, pain -acute chest syndrome, pulmonary hypertension, stroke Management of sickle cell anemia -pharmacologic therapy, transfusion therapy, supportive care, stem cell transplant nursing priorities for sickle cell anemia -maintain tissue perfusion -pain management (elevate/support extremity, avoid cold compresses) -fluid intake (hydration is key) Thrombocytopenia low platelet level (less than 150,000) in an adult -severe 5,000 can see spontaneous bleeding -.20,000 can see petechiae, nasal bleeding, gingival bleeding Immune Thrombocytopenic Purpura (ITP) autoimmune; most common in females -causes destruction of normal platelets medical management of ITP administer immunosuppressive agents (corticosteroids) nursing care of ITP -implement interventions to reduce bleeding risk -avoid aspirin -avoid rectal temps/meds