PCCN Review - FOCUS CONFERENCES · 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,

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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


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Anemia Microcytic

MCV < 80; MCHC < 32

Iron deficiency anemia, Thalassemia, chronic lead poisoning


Anemia Normocytic

MCV 80 – 100; MCHC 32 – 36

Acute blood loss; chronic disease


Anemia Macrocytic MCV > 130; MCHC > 36

Vitamin B12 or folate deficiency MCV > 101 – 120; MCHC > 36

Liver disease


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Thrombocytopenia Definition

platelet count < 100,000

most common cause of bleeding disorders


Thrombocytopenia platelet production

bone marrow abnormalities leukemia aplastic anemia radiation therapy inherited (Fanconi’s anemia)


Thrombocytopenia platelet destruction

infection

drug – induced

ITP

DIC


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Thrombocytopenia Etiology

abnormal distribution or sequestration in spleen

dilutional after hemorrhage, RBC transfusions


Thrombocytopenia Clinical Presentation

usually asymptomatic

platelets < 20,000 petechiae

ecchymosis

GI/GU bleed

CNS bleed


Thrombocytopenia Diagnosis

hemoglobin,hematocrit, platelets

Prolonged bleeding time, PT, PTT


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Thrombocytopenia Treatment

treat underlying cause

administer platelets


Thrombocytopenia Complications

life – threatening hemorrhage


ITP Definition

autoimmune disorder

low platelet count & mucocutaneous bleeding


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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


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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


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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

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HITT

Complications

Venous thromboembolism most common complication

Arterial thrombosis, less often

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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


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Pathophysiology

Vascular

vasoconstriction

collagen for hemostasis


Pathophysiology

Intrinsic Clotting Cascade

endothelial injury

assessed by PTT


Pathophysiology

Extrinsic Clotting Cascade

tissue thromboplastin

assessed by PT


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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


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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


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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


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Management Administer blood products pRBCs platelets FFP cryoprecipitate


Complications

hypovolemic shock

acute renal failure

infection

ARDS


PCCN Review - FOCUS CONFERENCES · 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,

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