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4/21/2015
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
CCRN/PCCN Review – Hematology
Anemia Etiology
Defects in production
Increased destruction
Increased less of erythrocytes
CCRN/PCCN Review – Hematology
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Anemia Microcytic
MCV < 80; MCHC < 32
Iron deficiency anemia, Thalassemia, chronic lead poisoning
CCRN/PCCN Review – Hematology
Anemia Normocytic
MCV 80 – 100; MCHC 32 – 36
Acute blood loss; chronic disease
CCRN/PCCN Review – Hematology
Anemia Macrocytic MCV > 130; MCHC > 36
Vitamin B12 or folate deficiency MCV > 101 – 120; MCHC > 36
Liver disease
CCRN/PCCN Review – Hematology
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Thrombocytopenia Definition
platelet count < 100,000
most common cause of bleeding disorders
CCRN/PCCN Review – Hematology
Thrombocytopenia platelet production
bone marrow abnormalities leukemia aplastic anemia radiation therapy inherited (Fanconi’s anemia)
CCRN/PCCN Review – Hematology
Thrombocytopenia platelet destruction
infection
drug – induced
ITP
DIC
CCRN/PCCN Review – Hematology
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Thrombocytopenia Etiology
abnormal distribution or sequestration in spleen
dilutional after hemorrhage, RBC transfusions
CCRN/PCCN Review – Hematology
Thrombocytopenia Clinical Presentation
usually asymptomatic
platelets < 20,000 petechiae
ecchymosis
GI/GU bleed
CNS bleed
CCRN/PCCN Review – Hematology
Thrombocytopenia Diagnosis
hemoglobin,hematocrit, platelets
Prolonged bleeding time, PT, PTT
CCRN/PCCN Review – Hematology
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Thrombocytopenia Treatment
treat underlying cause
administer platelets
CCRN/PCCN Review – Hematology
Thrombocytopenia Complications
life – threatening hemorrhage
CCRN/PCCN Review – Hematology
ITP Definition
autoimmune disorder
low platelet count & mucocutaneous bleeding
CCRN/PCCN Review – Hematology
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ITP Etiology
platelet destruction
autoantibodies to platelet – membrane antigens
CCRN/PCCN Review – Hematology
Clinical Presentation Severe
petechiae
purpura
epistaxis
heme – positive stool
CCRN/PCCN Review – Hematology
ITP
Diagnosis – Lab
platelets decreased but normal in size
normal RBCs and WBCs
CCRN/PCCN Review – Hematology
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ITP
Management
minimize activity
avoid medications that increase risk of bleeding (ASA, NSAIDs)
CCRN/PCCN Review – Hematology
ITP
Management
monitor platelets closely
administer platelets if < 50,000
steroids
high – dose IgG
CCRN/PCCN Review – Hematology
ITP
Complications
Intracranial hemorrhage
CCRN/PCCN Review – Hematology
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CCRN/PCCN Review – Hematology
HITT
Complication of heparin therapy
Types
Type 1
Type 2
CCRN/PCCN Review – Hematology
HITT
Should be suspected if:
Drop in platelet count
Fall is greater than 50% of baseline
Skin lesions at injection site
Acute systemic effects
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CCRN/PCCN Review – Hematology
HITT
Complications
Venous thromboembolism most common complication
Arterial thrombosis, less often
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CCRN/PCCN Review – Hematology
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
CCRN/PCCN Review – Hematology
HITT
Management
discontinue and avoid all heparin products
warfarin
platelet transfusion
Direct Thrombin Inhibitors
Definition
serious bleeding disorder
thrombosis; then hemorrhage
CCRN/PCCN Review – Hematology
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Pathophysiology
Vascular
vasoconstriction
collagen for hemostasis
CCRN/PCCN Review – Hematology
Pathophysiology
Intrinsic Clotting Cascade
endothelial injury
assessed by PTT
CCRN/PCCN Review – Hematology
Pathophysiology
Extrinsic Clotting Cascade
tissue thromboplastin
assessed by PT
CCRN/PCCN Review – Hematology
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Etiology of DIC Obstetric abruptio placentae amniotic fluid embolus
eclampsia retained dead fetus
CCRN/PCCN Review – Hematology
Etiology of DIC
Hemolytic/Immunologic
anaphylaxis
sickle cell crisis
hemolytic blood reaction
massive blood transfusion
CCRN/PCCN Review – Hematology
Etiology of DIC
Neoplastic
adenocarcinoma
leukemia
pheochromocytoma
CCRN/PCCN Review – Hematology
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Etiology of DIC
Infectious
bacterial
fungal
viral
rickettsial
CCRN/PCCN Review – Hematology
Etiology of DIC
Vascular
shock
dissecting aneurysm
CCRN/PCCN Review – Hematology
Etiology of DIC
Miscellaneous
emboli
ARDS
snake bites
ASA poisoning
GI disturbances
CCRN/PCCN Review – Hematology
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Laboratory Findings platelets fibrinogen PT &/or PTT d - dimer or FSP ATIII TEG waveform
CCRN/PCCN Review – Hematology
Management
Treat underlying cause
surgery
antimicrobials
antineoplastics
CCRN/PCCN Review – Hematology
Management
Stop Thrombosis
IV heparin
AT III
plasmapheresis
CCRN/PCCN Review – Hematology