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Hematology NP

Info & Q: NP EXAM

QuestionAnswer
To Dx pt with anemia either one or both of these need to be out of range? Hemoglobin (Hgb) Hematocrit (Hct)
A good rule to follow is that the Hgb times 3 should equal or be very close to the Hct, if not suspect? Bad lab procedure or something not right
Which is more accurate, Hgb or Hct? Hgb because it is a measure of weight as opposed to a calculated percentage
cytic means, micro means, normo means, macro means cell, small (microcytic), normal (normocytic), big (macrocytic)
On CBC we look at ________ to determine the size of the RBC. MCV (mean corpuscular volume)
The amount of ______ in a RBC determines its color. Hemoglobin
chromic means hypo means normo means hyper means color not enough (hypochromic) normal (normochromic) too much (hyperchromic)
On the CBC we look at ______ to determine the color of the RBC. MCH (mean corpuscular hemoglobin)
Two basic groups of anemic pts are: 1. the elderly (low H&H) 2. Smokers, COPD, Hi Alt (hi H&H - polycythemia)
If you divide the Hct by RBC that will give you the ______. MCV
On CBC we look at the ______ to tell us how the RBCs vary in size from one to another. RDW (Red Blood Cell Distribution Width)
RDW value should be ______. less than 15% is normal
On CBC we look at the ______ to tell us how much iron is circulating in the patient's blood right now. serum iron
On CBC we look at the ______ to tell us how much iron is in storage in the bone marrow as a result of low serum iron. serum ferritin
On CBC we look at the ______ to tell us the bone marrow's ability to produce new RBC. reticulocyte count
When the lab takes a drop of blood and looks at it under microscope they look, measure and describe the RBCs. Peripheral Smear
If a pt with anemia takes an iron supplement on the morning of testing, what will happen to his serum iron level? The serum iron level will be elevated.
On CBC what do the size and color of the RBC look like in pt with Iron deficiency anemia? (MCV)Microcytic (MCH)Hypochromic
A 64 yr old male anemic probabley has blood loss through _______. GI tract
A 38 yr old female anemic probably has blood loss through _______. Heavy menses
Iron Deficiency Anemic patients usually don't present symtomatic until H&H are about 10 & 30; at that time they c/o? I am so tired
On CBC of Iron Deficiency Anemia pt we look at the ______ to determine how much area on RBC is available for iron to attach. Total Iron Binding Capacity (TIBC)
What foods are high in iron? red meat, organ meat, dried beans and peas, green leafy vegetables, whole grain
How should we instruct our Iron Deficiency Anemic patients to take ferrous sulfate? Take ferrous sulfate with food high in vitamin C
What will happen to the absorption of ferrous sulfate if the patient takes it with food, maybe because of "it upsets" his stomach? Ferrous sulfate absorption is decreased when taken with food.
How long does it take for an Iron Deficient Anemia patient to return to normal iron levels when taking supplementation? It takes about 4-6 months for anemic patient to return to normal iron levels when taking ferrous sulfate.
What labs do we get when checking to see if our Iron Deficient Anemia patient has returned to normal levels? CBC and Serum ferritin
When looking at CBC of pt wtih Anemia of Chronic Disease what size and what color are the RBC? (MCV)normocytic (MCH)normochromic
What is the basic problem with RBCs in Anemia of Chronic Disease? They don't live to 120 days; the chronic disease is "beating up" the RBCs thus we don't have enough of them and the body is in chronic state of trying to make more.
What is the best way to manage Anemia of Chronic Disease? Manage the Chronic Disease so that it will quit beating up the RBCs
On CBC what do the size and color of the RBCs look like when pt has Thalassemia? (MCV)microcytic (MCH)hypochromic
Where is iron stored when it is taken as a supplement? The liver
On CBC what is the difference between Iron Deficiency Anemia and Thalassemia? RDW (IDA increase; Thal normal) Serum Iron (IDA decrease; Thal normal) TIBC (IDA increase; Thal normal) Serum Ferritin (IDA decrease; Thal normal)
What is treatment for pt with Thalassemia? No therapy; many pt require low Iron diet
What is the main NO NO when treating Thalassemia? Do not load up on Iron
What lymph nodes would you expect to pop up with a sore throat? Anterior cervicle or tonsilar
A posterior, non-tender and fixed lymph node is a red flag for what dx diff? leukemia
A pt with leukemia or lymphoma is going to be susceptible to bugs (ie: strep throat) but the KEY is picking up the something else; So Don't Jump to ________!!!!! Conclusions
On CBC a pt with B12 deficiency anemia will have what size RBCs? MCV - macrocytic
Basically speaking, a B12 deficiency anemia is what type of problem with B12? Absorption
What anemia is associated with B12 deficiency anemia? Pernicious Anemia
What effect does B12 have on RBCs that are in the bone marrow? B12 causes RBCs in the bone marrow to mature; if there is not enough B12 available then the bone marrow holds on to the RBCs waiting for B12 all the while the RBCs are continuing to grow larger.
What pts are susceptible to getting pernious anemia? Elderly, alcoholics, gastric bypass
What supplement should all pts that have had gastric bypass be on? B12 because of absorption problems
Pernicious anemia is tough to DX; MCV & MCH should be big clue but to really be slick get this? B12 level
When getting a B12 level what should we ask the patient? Did you take a vitamin today?
On CBC of pt with pernious anemia, what will the color of the RBCs be? MCH - nomocytic
The best place to assess for anemia when examining a pt is the what? conjuntiva
What is the best way to manage pt with pernicious anemia? B12 IM; (avoid oral - they have an absorption problem)
A pt getting B12 supplement for pernicious anemia will take it for how long? Typically Life
A pt with Pernicious Anemia will have what type of reflexes? Hyporeflex
Anytime we see a pt with a rash one of the first things to do and document is, does the rash do this? Blanches (if not then it means that blood is "extravasated" from vessels to under the skin)thus always prompting bloodwork
How will a pt present if he has Idiopathic Thrombocytopenia Purpura (ITP)? Bruising (esp low extremities), bleeding from nose or gums
Basically what is ITP? Low platelets (technically <150,000 but may see less than 50,000 or 20,000 or 2,000 and the lab will be calling)
How do we manage ITP? PUNT; typically give prednisone for 1 month
What is the name for WBC? Leukocytes
When lookig at CBC what "type" of WBC should be present in the largest amount? Neutrophils 60-70%(another name is Segs or Polys)
When looking at CBC what "type" of WBC should be present in the second largest amount? Lymphocytes 20-25%
When looking at CBC - WBC differential and we see Polys and Lymphs close together (low polys and high lymphs - 43/46) we should thinks what type of infection? Viral
Within first hour of getting sick, which of the WBC are the first to move (up/down) (viral/bacterial)? Polys and Lymphs
Whaich of the WBC take at least 24 hours to respond to sickness? Monocytes (if monos are elevated then pt has been sick for more than 24 hrs)
When Eosinophils get elevated what should we think? Parasitic infections or allergic rxns
FYI: CBC no or low mono (sick less 24 hr?)maybe but don't forget could be immunocompromised pt that will NEVER mount a huge WBC, WHY? recent cortisone shot - immunosuppresant/ or pt taking prednisone
On CBC what are Bands? immature WBC released because the bone marrow identifies a big infection thus early release
If pt c/o of burning tongue (or any tongue complaint) we should get this lab? B12 (pernicious anemia)
Created by: dprest
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