Screening for Hematologic Disease

Question 1

what does blood consist of?

Answer 1

1. Plasma
2. Erythrocytes
3. Leukocytes
4. Platelets

Question 2

what does plasma do?

Answer 2

carries antibodies and nutrients to tissues and removes wastes from tissues

Question 3

what is the role of erythrocytes?

Answer 3

carry oxygen to tissues and remove CO2 from them

Question 4

what is the role of leukocytes?

Answer 4

act in inflammatory/immune responses

Question 5

what is the role platelets (thrombocytes)?

Answer 5

together with coagulation factors in plasma, control the clotting of the blood

Question 6

S/S of hematologic disorders with minimal exertion

Answer 6

1. dyspnea
2. chest pain
3. palpations
4. severe weakness
5. fatigue

Question 7

Neurological symptoms of hematologic disorders

Answer 7

1. HA
2. Drowsiness
3. Dizziness
4. Syncope
5. Polyneuropathy

Question 8

S/S of hematologic disorders

Answer 8

1. neurological symptoms
2. skin fingernail changes
   
   • pallor of the face, hands, nail beds, and lips
   • cyanosis of clubbing of nail beds
3. presence of blood in stool
4. easy bruising

Question 9

what is included in the hematologic review of systems?

Answer 9

1. skin color or nail bed changes
2. bleeding: nose, gums, easy bruising, melena
3. fatigue, dyspnea, weakness
4. rapid pulse, palpitations
5. confusion, irritability
6. HA

Question 10

List Hematologic Disorders

Answer 10

1. Anemia
2. Polycythemia
3. Sickle Cell Anemia
4. Leukocytosis
5. Leukopenia
6. Thrombocytosis
7. Thrombocytopenia
8. Hemophilia

Question 11

what is anemia?

Answer 11

a reduction in oxygen-carrying capacity of blood

results of abnormality in quality or quantity or RBCs

Question 12

what are the most common causes of anemia?

Answer 12

1. excessive blood loss
2. increased destruction of erythrocytes
3. decreased production of erythrocytes

Question 13

PT considerations for anemia

Answer 13

• diminished exercise tolerance is expected in pts with anemia and exercise should be approved by MD

Question 14

what is polycythemia?

Answer 14

increase in number of RBCs and concentration of hemoglobin

increased whole blood viscosity and increased blood volume

Question 15

PT considerations for polycythemia

Answer 15

results in thickening of blood and increased risk for clotting

Question 16

what is sickle cell anemia

Answer 16

an inherited, autosomal recessive disorder characterized by presence of abnormal form of hemoglobin (altered shape of cell to sickled or curved shape)

Question 17

populations that sickle cell anemia is more prominent in

Answer 17

1. more common in African Americans
2. also in individuals from:
   
   1. India
   2. Mediterranean countries
   3. Saudi Arabia
   4. Caribbean islands
   5. South and Central America

Question 18

sickle cell anemia is characterized by what?

Answer 18

a series of “crises” or acute manifestations of symptoms

Question 19

Clinical S/S of sickle cell anemia

Answer 19

1. Pain caused by blockage of sickled RBCs
2. May be in organ, bone, or joint of the body
   
   1. joint pain most often occurs in shoulder or hip
   2. painful episodes may last hours or up to 5-6 days
   3. may cause Hand-foot syndrome

Question 20

what is hand-foot syndrome?

Answer 20

painful swelling in dorsum of hands and feet

Question 21

list factors that may cause a crisis

Answer 21

1. viral or bacterial infection
2. hypoxia
3. dehydration
4. emotional disturbances
5. extreme temperatures
6. fever
7. strenuous physical exertion
8. fatigue

Question 22

what is leukocytosis

Answer 22

a sign of an inflammatory response

WBC count of 10,000k

Question 23

Leukocytosis is helpful in aiding the body’s response to:

Answer 23

1. Bacterial infection
2. Inflammation or tissue necrosis
3. Metabolic intoxications
4. neoplasms
5. acute hemorrhage
6. splenectomy
7. acute appendicitis
8. pneumonia
9. intoxication by chemicals
10. acute rheumatic fever

Question 24

what is leukopenia

Answer 24

a reduction in number of leukocytes in blood

below 5000

Question 25

what can cause leukopenia?

Answer 25

can occur due to chemo/radiation, in overwhelming infections, in dietary deficiencies and in autoimmune disease

Question 26

PT considerations for leukopenia

Answer 26

1. good hand washing practices so important in this population 2. pt with known leukopenia presenting with constitutional symptoms (fever, chills, sweats) requires immediate medical referral

Question 27

what is thrombocytosis?

Answer 27

increase in platelet count usually temporary

Question 28

PT implications for thrombocytosis

Answer 28

increased clotting risk (secondary to high platelet count and increased blood viscosity)

Question 29

what is thrombocytopenia

Answer 29

decrease in number of platelets results form of decreased or defective platelet production or form accelerated platelet destruction

Question 30

PT considerations for thrombcytopenia

Answer 30

1. PT needs to be alert for: 1. severe bruising 2. external hematomas 3. joint swelling 4. multiple petechiae 2. strenuous exercise or exercise that involves straining/bearing down could cause hemorrhage 1. particularly of eyes and brain 2. avoid Valsalva

Question 31

Causes of thrombocytopenia

Answer 31

1. bone marrow failure 2. radiation 3. aplastic anemia 4. leukemia 5. metastatic carcinoma 6. chemotherapy 7. medications

Question 32

what meds can cause thrombocytopenia

Answer 32

1. NSAIDs 2. Methotrexate 3. Coumadin/Warfarin

Question 33

Clinical S/S of thrombocytopenia

Answer 33

1. bleeding after minor trauma 2. Spontaneous bleeding 1. petechiae 2. bruises 3. pupura spots (bleeding under the skin) 4. epistaxis (nosebleeds) 3. excessive menstruation 4. gingival bleeding 5. melena

Question 34

what is Hemophilia?

Answer 34

1. a hereditary blood-clotting disorder 2. caused by abnormality of functional plasma-clotting proteins 3. bleed longer but not faster than those without the condition

Question 35

what is most common clinical manifestation of hemophilia?

Answer 35

acute hemarthrosis

Question 36

what is the second most common clinical manifestation hemophilia?

Answer 36

muscle hemorrhage

Question 37

Clinical S/S of acute hemarthrosis

Answer 37

1. bleeding into the joint is one of the most common clinical manifestations of hemophilia 1. may be result of trauma or may be spontaneous 2. most often affects knee, elbow, ankle, hip and shoulder 1. stiffening into position of comfort 2. decreased ROM 3. pain 4. swelling 5. tenderness 6. heat

Question 38

Clinical S/S of muscle hemorrhage

Answer 38

1. gradually intensifying pain 2. protective spasm of the muscle 3. limitation of movement at the surrounding joints 4. muscle assumes the position of comfort (usually shortened) 5. loss of sensation 6. common in flexor muscle groups

Question 39

T/F: bleeding into muscles can be more insidious and massive than joint hemorrhages

Answer 39

TRUE

Question 40

List clues to screening for hematologic disease

Answer 40

1. previous history of chemotherapy or radiation therapy 2. chronic or long-term use of aspirin or other NSAIDs 3. spontaneous bleeding of any kind 1. especially w/history of hemophilia 4. Recent major surgery or previous transplantation

Question 41

guidelines for immediate medical attention

Answer 41

S/S of thrombocytopenia

Question 42

guidelines for medical referral

Answer 42

new episodes of muscle or joint pain in pts with hemophilia

Question 43

what hematologic disorders are associated with increased clotting risk?

Answer 43

1. polycythemia 2. sickle cell anemia 3. thrombocytosis

Question 44

what hematologic disorders are associated with patients receiving chemo/radiation?

Answer 44

1. leukopenia 2. thrombocytopenia

Question 45

complications of overuse of NSAIDs can result in what hematologic disoders?

Answer 45

thrombocytopenia