Unit 3 Hematologic Screen

Question 1

What are s/s of Hematologic Disorders?

Answer 1

Problems associated with Physical Effort (Often Minimal Exertion)
- Dyspnea
- Chest pain
- Palpitations
- Severe weakness
- Fatigue

Can also affect the CNS
- Headaches, drowsiness, dizziness, syncope

Changes in the Integumentary System
- pallor of the face, hands, nail beds, and lips
- Cyanosis or clubbing of the fingernail beds

Question 2

What are some Erythrocyte Disorders?

Answer 2

• Anemia: Too few erythrocytes; a reduction in the O2 carrying capacity of the blood as a result in abnormality.
• Polycythemia: Too many erythrocytes
• Poikilocytosis: Abnormally shaped erythrocytes
• Anisocytosis: Abnormal variations in size of erythrocytes
• Hypochromia: Erythrocytes deficient in hemoglobin

Question 3

What are the common causes of Anemia found in PT practice?

Answer 3

• Iron Deficiency: associated with chronic GI blood loss secondary to NSAIDs use
• Chronic Disease (cancer, kidney disease, liver disease) or inflammatory disease
• Infectious Disease: Such as tuberculosis or acquired immunodeficiency syndrome (AIDS) and neoplastic disease or cancer (bone marrow failure)
• Vitamin B-12 Deficiency: Pernicious Anemia

Question 4

What is the difference between slow developing Anemia and Rapid Onset of anemia?

Answer 4

• Slowly developing anemia is tolerated and there may be no symptoms until hemoglobin concentration and hematocrit fall below one half of normal.
• Rapid onset of anemia will result in an abrupt lack of oxygen transport to the lungs and muscles

Question 5

What are Clinical Signs and Symptoms of Anemia?

Answer 5

• Skin Pallor (palms, nailbeds) or yellow-tinged skin (Mucosa, conjunctiva)
• Fatigue and listlessness
• Dyspnea on exertion accompanied by heart palpations and rapid pulse (more severe anemia)
• Chest pain with minimal exertion
• Decreased diastolic blood pressure

Question 6

What are the Nervous System Manifestations for Pernicious Anemia?

Answer 6

• Headache
• Drowsiness
• Dizziness, syncope
• Slow thought process
• Apathy, depression
• Polyneuropathy

Question 7

Why would patients with anemia need caution in PT clinics?

Answer 7

• Patients have diminished exercise tolerance
• PTs must be cautious during exercise testing and when prescribing, dosing, and progressing exercises
• Consider tolerance and/or perceived exertion levels (Borg Scale)
• Exercise for any client with anemia should first be approved by their physician

Question 8

What is Polycythemia?

Answer 8

This is characterized by increases in both the number of RBCs and the concentration of hemoglobin. This condition increases whole blood viscosity and volume
- Can also be associated with living in elevations about 3500 ft

Question 9

What is the difference between Primary and Secondary Polycythemia?

Answer 9

Primary: Is a relatively uncommon neoplastic disease of the bone marrow of unknown etiology (Polycythemia vera) <- {This can cause headache, dizziness, toe joint swelling (gout), itchiness after shower

Secondary: Is a physiologic condition resulting from a decreased oxygen supply to the tissues (Smoking, tumors, lung disorders, living or exercising in high altitudes)

Question 10

What are the Clinical Signs and Symptoms of Polycythemia?

Answer 10

Directly related to the increase in blood viscosity
- General malaise and fatigue
- Shortness of breath
- Headache
- Dizziness
- Fainting
- Hypertension (Therapist should watch for this)

These were the one highlighted in the PP, there are more s/s

Question 11

What is Sickle Cell Anemia?

Answer 11

It is a generic term for a group of inherited, autosomal recessive disorders characterized by the presence of an abnormal form of hemoglobin, the oxygen-carrying constituent of erythrocytes

Question 12

What are the Causes of Sickle Cell? What demographic is sickle cell common in? How is it diagnosed?

Answer 12

Causes:
- Genetic mutations in the hemoglobin beta gene
- In has a inherited pattern

Common in:
- African Americans
- Hispanic Americans

Diagnosis:
- A blood test to check for hemoglobin S (Abnormal shape)

Question 13

What are the Clinical Signs and Symptoms of Sickle Cell?

Answer 13

• Recurrent episodes of Vaso-occlusion and inflammation results in progressive damage to most organs, including the brain, kidneys, lungs, bones, and cardiovascular system. CVA and cognitive impairments are a frequent and severe manifestation
• Pain: caused by the blockage of sickled RBCs forming sickle cell clots. The clots may be in an organ, bone, or joint of the body. Painful episodes of ischemic tissue damage may last 5 or 6 days and manifest in many different ways, depending on the location of the clot.

Question 14

What are the 2 Leukocyte Disorders (WBC)?

Answer 14

• Leukocytosis
• Leukopenia

Question 15

What is Leukocytosis?

Answer 15

An Infectious Disease
- It can be associated with an increase in circulating neutrophils, which are recruited in large numbers early in the course of most bacterial infections

Question 16

What is Leukopenia?

Answer 16

This occurs in many forms of bone marrow failure such as that following antineoplastic chemotherapy, or radiating therapy, in overwhelming infections, in dietary deficiencies, some medications, or in autoimmune diseases. Unlike leukocytosis, leukopenia is NEVER beneficial

Question 17

What are signs and symptoms for leukocytosis?

Answer 17

• Fever
• Symptoms of localized or systemic infection
• Symptoms of inflammation or trauma to tissue

Question 18

What are signs and symptoms for Leukopenia?

Answer 18

• Sore throat, cough
• High fever, chills, sweating
• Ulcerations of mucous membranes (mouth, rectum, vagina)
• Frequent or painful urination
• Persistent infection

Question 19

What are the functions of Platelets?

Answer 19

• Platelets (Thrombocytes) function primarily in hemostasis (to stop bleeding) and in the maintenance of capillary integrity
• They function in the coagulation (blood clotting) mechanism by forming hemostatic plugs in small ruptured blood vessels or by adhering to any injured lining or larger blood vessels

Question 20

What is normal Platelet count for adults and children?
What is critically low and high platelet count?

Answer 20

150,000-350,000 /uL (Microliters)
Critically Low <20,000 /uL
Critically High >1,000,000 /uL

Question 21

What are 2 platelet Disorders?

Answer 21

• Thrombocytosis
• Thrombocytopenia

Question 22

What is Thrombocytosis?

Answer 22

An Increase in platelet count (exceeds 1 million/mm3) that is usually temporary. Tendency to clot because blood viscosity is increased, high platelet count, resulting in intravascular thrombosis of the
sludged platelets
- Peripheral BV, particularly in the fingers and toes, are affected

Question 23

What is Thrombocytopenia?

Answer 23

A Decrease in the number of platelets (less than 150,00/mm3) in circulating blood, can result from decreased or defective platelet production or from accelerated platelet destruction. Spontaneous Bleeding

Question 24

What are the Clinical Signs and Symptoms of Thrombocytosis?

Answer 24

• Thrombosis
• Splenomegaly (enlarged spleen)
• Easy bruising

Question 25

What are the Clinical Signs and Symptoms of Thrombocytopenia?

Answer 25

- Bleeding after minor trauma - Spontaneous bleeding - Menorrhagia (excessive menstruation) - Gingival bleeding - Melena (black, tarry stools)

Question 26

What are the most common causes of Thrombocytopenia in the PT clinic?

Answer 26

- Bone marrow Failure - Radiation - Aplastic anemia - Leukemia - Metastatic carcinoma Cytotoxic Agents (Chemotherapy) - Medications - NSAIDs, including aspirin - Methotrexate - Gold - Coumadin/Warfarin

Question 27

What is hemophilia?

Answer 27

*Coagulation Disorder* - A hereditary blood-clotting disorder caused by an abnormality of functional plasma-clotting proteins known as factors VIII and IX - People with hemophilia **bleed longer than those with normal levels** of functioning factors VIII or IX, but **the bleeding is not any faster than would occur in a normal person with the same injury**

Question 28

What is Acute Hemarthrosis? What are some symptoms from this?

Answer 28

Bleeding in the joint spaces is the most common clinical manifestation of the hemophilia S/S: - Tingling or prickling sensation - Stiffening into the position of comfort - Decreased ROM - Pain - Swelling - Tenderness -Heat

Question 29

With Bleeding of other systems, what is common with a Muscle Hemorrhage?

Answer 29

*2nd most common type* - Gradual intensification of pain - Protective spasm of the muscle - **Iliopsoas is the most affected muscle** - Loss of sensation

Question 30

With Bleeding of other systems, what is common with bleeding involving the CNS?

Answer 30

- Intraspinal Hemorrhage (rare) - Intracranial Hemorrhage, can cause: --Irritability, lethargy --Seizure --Death --Apnea --Unequal pupils

Question 31

With Bleeding of other systems, what is common with bleeding involving the GI system?

Answer 31

- Abdominal pain and distention - Melena (blood in stool) - Hematemesis (Vomiting blood) - Fever - Lower abdominal/groin pain due to bleeding into wall or large intestine or Iliopsoas muscle - Flexion contracture of the hip due to spasm of the iliopsoas muscle secondary to retroperitoneal hemorrhage

Question 32

When screening for Hematologic Diseases, what are some Special Questions to ask?

Answer 32

- Have you recently been told you are anemic? - Have you recently had any serious blood loss (possibly requiring transfusion)? *Also consider Anemia; jaundice/hepatitis post-transfusion* - Have you ever been told you have a congenital heart defect (also chronic lung/heart disorders)? *Polycythemia; also possible with a history of heavy tobacco use* - Do you have a history of bruising easily, nosebleeds, or excessive blood loss? (Can be polycythemia, hemophilia, thrombocytopenia) - Have you been exposed to occupational or industrial gases, such as chlorine or mustard gas?

Question 33

When should there be a Medical Referral or Consultation?

Answer 33

- Any patient with suspicion of anemia (weakness and fatigue, SOB) not previously diagnoses - Use of certain drugs, exposure to radiation, or recent cytotoxic cancer chemotherapy can affect the bone marrow - Keep an eye on any history of excessive menses, folate-poor diet, alcohol abuse, drug ingestion, family history of anemia, and family roots in geographic areas where RBC enzyme or hemoglobin abnormalities are - Presence of severe bruising, hematomas, and multiple petechiae usually indicates a platelet count well below normal - Clients who have been diagnosed with hemophilia, medical referral should be made when any painful episode develops in the muscle(s) are joint(s)

Question 34

When should the patient require Immediate Medical Attention?

Answer 34

When they present with signs and symptoms of thrombocytopenia (decreased platelets, excessive bleeding, petechiae, severe bruising) previously unseen or unreported to the physician