Hematologic Emergencies

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Information about Hematologic Emergencies

Published on October 15, 2008

Author: aSGuest1068

Source: authorstream.com

Hematologic Emergencies : Hematologic Emergencies Sickle Cell Anemia : Sickle Cell Anemia Pathophysiology Genetic abnormality causes red cells to contain hemoglobin S rather than hemoblobin A At low oxygen tensions hemoglobin S forms long, rigid rods RBCs become distorted, sickle-shaped Sickle Cell Anemia : Sickle Cell Anemia Pathophysiology Sickled RBCs cannot pass through small vessels Thrombosis Infarction Sickled RBCs are fragile Hemolysis Sickle Cell Anemia : Sickle Cell Anemia Incidence Gene present in 10% of black population (sickle cell trait) One in every 400 to 600 blacks has sickle cell anemia Sickle Cell Anemia : Sickle Cell Anemia Incidence Also occurs in populations from Puerto Rico Turkey India Middle East Southern Europe North Africa Sickle Cell Anemia : Sickle Cell Anemia Incidence Sickle cell gene survives by providing resistance to malaria Two normal genes = malaria = death Two sickle-cell genes = sickle cell anemia = death One normal gene/one sickle-cell gene = survival Persons with sickle cell trait survive, pass gene to offspring Sickle Cell Anemia : Sickle Cell Anemia Thrombotic crisis (vasoocclusive-infarctive) Precipitated by: Cold exposure High altitude Dehydration Infections Gnawing pain in bones (tibias, back), joints, muscles, and abdomen Sickle Cell Anemia : Sickle Cell Anemia Hemolytic Crisis Rupture of sickled cells Fall in hematocrit with jaundice Sickle Cell Anemia : Sickle Cell Anemia Aplastic Crisis Suppression of RBC production Life threatening decrease in hematocrit Sickle Cell Anemia : Sickle Cell Anemia Complications Acute Respiratory Insufficiency Thrombus formation Pneumonia CNS Involvement Vascular occlusion TIA, CVA Sickle Cell Anemia : Sickle Cell Anemia Complications Arthropathy Aseptic necrosis Hemarthosis Septic arthritis Priapism Sickle Cell Anemia : Sickle Cell Anemia Complications Renal infarction Flank pain Hematuria Narcotic drug addiction Sickle Cell Anemia : Sickle Cell Anemia Management Oxygen IV fluids Analgesia Hemophilia : Hemophilia Cause Inherited, sex linked recessive gene Produces clotting factor deficiencies Hemophilia A (Factor VIII) Hemophilia B (Factor IX) Hemophilia : Hemophilia Signs Swollen, painful joints Local bleeding out of proportion to injury Subcutaneous bleeding Bleeding from mucous membranes Abdominal pain, distension Hematemesis, melena Hemophilia : Hemophilia Management Standard techniques for hemorrhage/ hypovolemia Apply ice packs to hemarthoses/ bleeding sites In hospital, administration of clotting factor cryoprecipitate, or fresh frozen plasma Disseminated Intravascular Coagulation (DIC) : Disseminated Intravascular Coagulation (DIC) Pathophysiology Damage tissue, blood vessels, blood cells Clotting mechanism activation Excess clotting Diffuse microthrombi Consumption of clotting factors DIC : DIC Pathophysiology Split fibrin products from clots inhibit clotting Clotting factor consumption, split fibrin products lead to: Hemorrhage Shock DIC : DIC Causes Gram negative sepsis Abruptio placentae/missed abortions Burns Heat Stroke Shock Transfusion reaction with hemolysis DIC : DIC Signs/Symptoms Petechiae and ecchymosis Bleeding from mucus membranes, orifices, venipuncture sites Blood in urine, stool, vomitus, sputum Signs/Symptoms of hypovolemia DIC : DIC All patients with predisposing conditions or who are critically ill should be monitored for signs of prolonged clotting or of bleeding DIC : DIC Management Control bleeding Treat hypovolemia Fresh frozen plasma or cryoprecipitate to inhibit bleeding, activate normal clotting Identify and treat cause DIC : DIC Management Heparin to inhibit additional clotting (controversial) Antifibrinolytic Agents (Amicar) to inhibit fibrinolysis and formation of split fibrin products (controversial) Anticoagulant Use with Hemorrhage : Anticoagulant Use with Hemorrhage Control bleeding/treat hypovolemia with standard techniques Use ice packs to supplement pressure dressings Antidotes Coumadin Vitamin K, fresh frozen plasma Heparin Protamine sulfate Leukemia : Leukemia Definition Neoplastic disorder of blood cell forming tissues Causes uncontrolled production of white cells Leukemia : Leukemia Clinical manifestations Decreased RBCs Bleeding (decreased platelets) Infection WBC immaturity Chemotherapy Leukemia : Leukemia Clinical manifestations Bone pain Liver, spleen, lymph node enlargement Anorexia Leukemia : Leukemia Management Oxygen IV Analgesia Infection control procedures

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