PCCN Review Hematology

Transcription

1 PCCN Review Hematology Leanna R. Miller, RN, MN, CCRN-CMC, PCCN-CSC CEN, CNRN, CMSRN, NP Education Specialist LRM Consulting Nashville, TN Anemia Definition reduction in RBC concentration Causes iron deficiency Thalassemia anemia of chronic disease Anemia Etiology Defects in production Increased destruction Increased less of erythrocytes 1

2 Anemia Microcytic MCV < 80; MCHC < 32 Iron deficiency anemia, Thalassemia, chronic lead poisoning Anemia Normocytic MCV ; MCHC Acute blood loss; chronic disease Anemia Macrocytic MCV > 130; MCHC > 36 Vitamin B 12 or folate deficiency MCV > ; MCHC > 36 Liver disease 2

3 Definition platelet count < 100,000 most common cause of bleeding disorders platelet production bone marrow abnormalities leukemia aplastic anemia radiation therapy inherited (Fanconi s anemia) platelet destruction infection drug induced ITP DIC 3

4 Etiology abnormal distribution or sequestration in spleen dilutional after hemorrhage, RBC transfusions Clinical Presentation usually asymptomatic platelets < 20,000 petechiae ecchymosis GI/GU bleed CNS bleed Diagnosis hemoglobin,hematocrit, platelets Prolonged bleeding time, PT, PTT 4

5 Treatment treat underlying cause administer platelets Complications life threatening hemorrhage ITP Definition autoimmune disorder low platelet count & mucocutaneous bleeding 5

6 ITP Etiology platelet destruction autoantibodies to platelet membrane antigens Clinical Presentation Severe petechiae purpura epistaxis heme positive stool ITP Diagnosis Lab platelets decreased but normal in size normal RBCs and WBCs 6

7 ITP Management minimize activity avoid medications that increase risk of bleeding (ASA, NSAIDs) ITP Management monitor platelets closely administer platelets if < 50,000 steroids high dose IgG ITP Complications Intracranial hemorrhage 7

8 HITT Complication of heparin therapy Types Type 1 Type 2 HITT Should be suspected if: Drop in platelet count Fall is greater than 50% of baseline Skin lesions at injection site Acute systemic effects 8

9 HITT Complications Venous thromboembolism most common complication Arterial thrombosis, less often 9

10 HITT Diagnosis drop in platelet count immunoassays (antibodies against heparin/platelet factor 4 (PF4) functional assays (measure the platelet-activating capacity of PF4/heparin-antibody complexes HITT Management discontinue and avoid all heparin products warfarin platelet transfusion Direct Thrombin Inhibitors Definition serious bleeding disorder thrombosis; then hemorrhage 10

11 Pathophysiology Vascular vasoconstriction collagen for hemostasis Pathophysiology Intrinsic Clotting Cascade endothelial injury assessed by PTT Pathophysiology Extrinsic Clotting Cascade tissue thromboplastin assessed by PT 11

12 Etiology of DIC Obstetric abruptio placentae amniotic fluid embolus eclampsia retained dead fetus Etiology of DIC Hemolytic/Immunologic anaphylaxis sickle cell crisis hemolytic blood reaction massive blood transfusion Etiology of DIC Neoplastic adenocarcinoma leukemia pheochromocytoma 12

13 Etiology of DIC Infectious bacterial fungal viral rickettsial Etiology of DIC Vascular shock dissecting aneurysm Etiology of DIC Miscellaneous emboli ARDS snake bites ASA poisoning GI disturbances 13

14 Laboratory Findings platelets fibrinogen PT &/or PTT d - dimer or FSP ATIII TEG waveform Management Treat underlying cause surgery antimicrobials antineoplastics Management Stop Thrombosis IV heparin AT III plasmapheresis 14

15 Management Administer blood products prbcs platelets FFP cryoprecipitate Complications hypovolemic shock acute renal failure infection ARDS 15