An abnormally low number of circulating RBCs, low Hemoglobin or both is known as:

Anemia

Loss of a leg

Surgical Trauma

Bad diet

and

Bone Marrow failure

What physical condition stimulates RBC production:

An RBC lives about how long?

From stemcell to RBC, how long does it take? 

And what precipitates this process?

3-5 days

hypoxia stimulates RBC production

Destoyed RBCs are converted into what substance?

1. RBC production is slower

2. Iron deficiency is common

3. Lower Plasma levels

4. Less Effective immune system

5. Automimmune disorders become more common

(LOW:RBCprod-Iron-Plasma-Immune-

& more auto immune disorders)

What determines and tells the kidneys to produces Erythropoeitin to stimulate RBC production?

Hypoxia in the Brain, causes the brain to send the message to the kidneys

The following lab test Hb/Hct shows HIGH or LOW values when anemia is present?

Anemia Signs & Symptoms: SPOON SHAPED NAILS

What type of anemia is this associated with?

Sickle Cell is associated with what population?

Whats the normal lab value range for:

RBC

Whats the normal lab value range for:

HGB

Whats the normal lab value range for:

HCT

38 - 49

(38 Special sings for the San Francisco 49-ers)

Whats the normal lab value range for:

RDW

11.6 - 14.8

Whats the normal lab value range for:

PLT

150 - 450

Whats the normal lab value range for:

WBC

Red Blood Cell Distribution Width.  

(a wide width indicates an immature RBC/reticulocyte,

and a smaller width means its mature!)

Indicates the amount of 02 carrying capacity of a heme unit

A higher than normal ESR signifies what?

clumping of RBCs, meaning faster sinking....

this means infection and disease state b/c protiens bind to the RBCs and they clump and sink fast.

Normal person:  1

Person on coagulants:   2 to 3

Person with atrial problems:   3 to 4

(an INR is always ordered with a PT test)

It confirms presence of FSP (Fibrin Split Products)

Normal D-dimer = <250 ug/L

If its higher, you got pulmonary embolism, intravascular diseas, thrombosis, neoplastic disease or Pregnancy. 

Anemia

Hemodilution

Massive Blood Loss

POLYCYTOTHEMIA

HEMOCONCENTRATION

(can be from dehydration or blood loss)

THROMOBOCYTOSIS

(can result from hemorrhage, cancer, anemia or inflammation)

If Low, anemia, hemorrhage or fluid retention

(caused by hemodilution)

What does LOW RBC mean below 4.2 to 5.14?

 i.e. Causes of 

What does HIGH RBC mean OVER 4.2 to 5.14?

 i.e. Causes of 

Red Cell indices (aka erythrocyte indices) provied important informatino about Hb concentration, weight and size of an average RBC.  

Name the 3 indice and descriptions:

MCV - ratio of HCT to RBC indicating RBC avg size

MCH - ratio Hb weight to RBC count, indicates avg RBC weight

MCHC - conc of hb in 100ml packed RBCs

MCV range is 82 - 98

MCH range is 26 - 46

MCHC range is 31 - 37

If LOW  MCV or MCHC, means microcytic, hypochromic anemias caused by low iron, thalassemia, or b6 anemia

If HIGH, macrocytic anemia caused by FOLIC or B12 deficiency. 

can indicate cirrhosis, hepatitis, Vit K deficiency, anticoagulation problems, or massive blood transfusion

PROTHROMBIN time that is slower than

the 10-14 second  range may indicate what?

Of the anemias, which is the most common form of anemia?

3 anemias caused by DECREASED erythrocyte production:

Iron deficient,

Thalassemia

and

Sideroblastic

Vit B12

and

Folic Acid

T/F:    30% of the world, and 5-10% of the

"over-45" US population have Iron-deficiency anemia

1 mg of Iron is lost daily thru feces, sweat & urine...   TRUE/FALSE

Pregnant women lose 2mg per day.

Menstrating women lose 1.5 per day.

Of what?

Cobalamin and Folic acid's role in Erythropoiesis is?

Aids in Iron Absorption

In IRON-deficient anemia, the most common findings is/are:

PALLOR

&
GLOSSITIS

(also chelitis- inflamed lips)

The best time to take iron supplements is when?

heartburn, constipation, diarrhea

(give patients stool softeners ALONG with iron)

2ml max per injection

19-20 guage needle

2-3" length

give in upper outer quadrant of buttocks

Z-TRACK it!

Speed of injection:  1 ml/min

(if IV, saline flush the line after)

Which anemias are considered

NORMOCYTIC and NORMOCHROMIC?

(hint: means normal size and normal color)

Mainly, what are the causes of loss of NORMO RBCs?

Blood loss

Hemolysis

Kidney disease

Cancers

Refractory Anemia

Aplastic Anemia

Sickle Cell

Pregnancy

You have anemia and your RBCs are MACROCYTIC and NORMOCHROMIC.... what causes this?

Low B12, Low FOLIC, liver disease,

and post splenectomy

You have anemia and your RBCs are MICROCYTIC and HYPOCHROMIC.... what causes this?

Iron Overloading

(comes from too many transfusions and is corrected with Desferal, a chelating agent thta binds to iron)

Thalassemia patients should take Zinc & Vit C... why?

In Sickle Cell, if both parents have the trait, what % in the child is the chance of having that trait?   

Also how about the % for disease?

25% of disease....   25% of no disease or trait

50% of carrying the trait!

Unused Blood should be returned to the lab in 30 minutes or less. 

What increments of time to check blood transfusions?

Has to be checked by 2 nurses

1. check ID of client

2. correct ABO and RH factor

3. Not expired blood

2-3 hours   

Anything after 4, the blood can spoil.

Fever

Rash

Hemolytic Reaction

Anaphylactic Reaction (life threatening)

Circulatory Overload

If you detect a fever, chills or chest pain,

or low BP during blood administration,

what should you do?

During a transfusion, what do you do if you get a hemolytic reaction? 

(hint: manifested by back & chest pain, fever, SOB, and IMPENDING DOOM)

This is a fatal reaction due to imcompatible blood.  RBCs are going to war!

STOP INFUSION an Call MD

Keep vien open with NS

During a transfusion, what do you do if you get a Anaphylactic reaction? 

(hint:  allergic reaction)

Its an allergic reaction to immunoglobulins, which happens IMMEDIATLY upon infusion. 

You'll see GI cramping, vomiting and diarrhea

MAIN ISSUE:  Cardiopulmonary Arrest.

 BEGIN CPR

During a blood transfusion, what do you do if you have circulatory overload?  And what causes it?

Its caused by too much too fast!

STOP INFUSION, Call MD

Prepare to give diuretics to quell chest pains, cough, FROTHY sputum, crackles and wheezes and increased HR

RESUME infusion later and MUCH SLOWER

Its an autosomal recessive disease causing over-absorption of IRON, too much in the tissues.

Common in northern Europeans.

You take out 500ml of blood weekly for 2-3 years. 

Excess RBCs (or an HCT over 55)

REALLY THICK BLOOD that causes CLOTS

Types: 

Primary - 40-70yo Jewish men (Vera)

Secondary - elevated erythropoeitin levels 

Hypoxia signals brain to tell kidneys to produce more erythropoeitin

Usually high altitudes, smoking, or lung disease is the environmental cause

Whats D-Dimer?

High Uric Acid

D-dimer (to find clots)

Hyperuricemia (high uric acid d/t RBC lysis)

High HGB and HCT in proportion to the RBCs

Headaches, blurred vision, weakness, vertigo,pruritis, pain, Plethora,

wieghtloss, thrombotic episodes

and Splenomegaly (vera type)

Give small meals,

Monitor bleeding

Low Sodium, Low Iron, HIGH CALORIE diet

Fluids (3 litres per day)

PLATELET DISORDERS:

What are unique to cell fragments?

PLATELET DISORDERS:

What is the normal amount of platelets?

250,000 to 400,000 per ML

(think a $250-$400 plate dinner)

PLATELET DISORDERS:

Life of a platelet?

PLATELET DISORDERS:

What are the 5 stages of HEMOSTASIS?

1. Vessel Spasm

2. Platelet Plug Formation

3. Coagulation

4. Clot retraction

5. Clot dissolution

(think VP CCC -vice pres of craven community college)

PLATELET DISORDERS:

Thrombocytopenia is what?  And what is the # lab range indicating this?

Its LOW PLATELET COUNT

Anything less than 150,000 per ml

PLATELET DISORDERS:

Thrombocytopenia is due to what 3 causes?

1. Decreased production

2. Increased amount in spleen

3. Accelerated destruction

(aint makin 'em fast enough, spleens hoggin 'em, and they be getting blown up faster)

PLATELET DISORDERS:

3 Types of Thrombocytopenia

1. Immune T. Purpura

2. Thrombotic T. Purpura

3. Heparin-induced T. and Thrombosis

PLATELET DISORDERS:

Thrombocytopenia S&S?

Bleedin'

Petichiae

Purpura

Ecchymoses

After injection, they keep bleedin'

Internal Bleeding

PLATELET DISORDERS:

Thrombocytopenia Diagnostic tests:

PT, PTT and INR

and takin a peek at the platelet count under a microscope

Low H&H, Low RBC too... cause if they're Bleedin' a lot 'cause of no platelets, then this will follow.

PLATELET DISORDERS:

Thrombocytopenia medical treatment includes:

Chemo, Steroids, IV Immunoglobulins

and a Splenectomy

And Transfusions of Blood, PLatelets and Vitamin K

PLATELET DISORDERS:

Thrombocytopenia nursing interventions... name a couple.....

Bleeding precautions

 Teach S&S of bruising

Avoid trauma and ASA drugs

Limit activities during episodes

PLATELET DISORDERS:

With Thrombocytopenia, S&S of bleeding are:

BLACK tarry stools

BLOOD in urine

Petechiae

Bruise easily

Bleeding nose and gums

PAINFUL JOINTS

PLATELET DISORDERS:

HEMOPHILIA is a rare inherited disorder of low levels of one missing clotting factor. 

Name the 3 different Hemophilia types?

Type A

Type B

VonWillebrand's disease

(A Big Willebrand)

PLATELET DISORDERS:

In Hemophilia TYPE A, what is the missing factor?

Factor VIII

(think Factor Aight)

PLATELET DISORDERS:

In Hemophilia TYPE B, what is the missing factor?

Factor IX

(think Factor Bix)

makes no sense but you'll remember it!

PLATELET DISORDERS:

In Hemophilia TYPE VonWillebrand, what is the missing factor?

Factor vW

(think:  Mr. VonnWillebrand drives a VW)

PLATELET DISORDERS:

In Hemophilia, what are the manefestations?

Hemathrosis (blood in the joints)

Bruising

Bleeding

Pain or paralysis

PLATELET DISORDERS:

With Hemophilia, what diagnostic tests are used?

PT

Thrombin time

Platelet count

PTT

Bleeding time

Factor assays

(so...  PT&PTT, clot&bleed time, Factor tests)

PLATELET DISORDERS:

How is Hemophilia treated?

You marry outside of the British Royal family.

OR

Give Clotting Factor

&

Desmopressin Acetate too raise levels during surgeries

Major Trauma, Cancer, or pretty much any overwhelming infection, even snakebite. 

When you have something major, it releases thrombin and "unrestricted clotting".

When you used all the clot factors up... YOU DEAD!

Petechiae & Purpura

Ecchymosis

Joint Pain

Bleeding from puncture sites, mucosa, & GI tract

N/V

SOB

Oliguria (low urine output)

Muscle & Back Pain

Shock, Convulsions, Coma

Bright light at the end of a tunnel lined

with dead relatives

When assessing a patients nutritional-metabolic pattern related to hematologic health, the nurse should check for

Skin texture & color...   i.e. petichiae

2ml/minute

In the emergency room with a sickle cell patient, which  of the following is priority to control the sickling process?

02

IV fluids

Morphine

Acetamenophen

IV fluids!   

Because once in crisis, 02 cant control it.  Its better for pending crisis.

A patient asks what they can take to decrease or cure Sickle Cell Disease.... Which of the following can do this?

a) Hemodialysis

b) Hydroyurea (Hydrea)

c) Hemopoetic Stem Cell Transplantation (HSCT)

d) Frequent Blood Transfusion

b) Hydroyurea (Hydrea)

c) Hemopoetic Stem Cell Transplantation (HSCT)

The others dont cure, they just treat the complications of sickle cell episodes.