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Hematologic ProblemsMedical Surgical Nursing

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What is the clinical manifestation of Thalassemia minor?
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Mild to moderate anemia with microcytosis (small cells) and hypochromia (pale cells)
How is Thalassemia major treated?
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Symptoms are managed with transfusions and IV infusions of a chelating agent that binds to iron (deferoxamine/Desferal), possibly a splenectomy.
____________ are a group of disorders caused by impaired DNA synthesis and is characterized by the presence of large RBCs.
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Megaloblastic anemias
What are the two most common forms of megaloblastic anemia?
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Vitamin B12 (Cobalamin) deficiency and folic acid deficiency.
What is erythroleukemia?
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A malignant blood disorder characterized by a proliferation of erythropoietic cells in bone marrow. It causes megaloblastic anemia.
What is intrinsic factor (IF) and where is it secreted?
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It is a substance needed for the absorption of vitamin B12 (Cobalamin). It is secreted in the gastric mucosa by the parietal cells (distal ileum = duodenum and jejunum)
What is the most common cause of cobalamin deficiency?
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Pernicious anemia
When does pernicious anemia typically develop?
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Between the ages of 40-60, it is usually diagnosed at age 60.
What ethinicities are most likely to develop pernicious anemia?
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People of Scandinavian descent or Africa Americans. The condition is more severe in African Americans, begins earlier, and most often in women.
What types of medications can cause a B12/cobalamin deficiency?
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Long term use of H2-histamine receptor blockers.
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What are the symptoms of a B12/cobalamin deficiency?
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Sore tongue, anorexia, n/v, abdominal pain, weakness, paresthesias, reduced vibratory and position senses, ataxia, impaired thought processes ranging from confusion to dementia.
What tests are used to diagnose pernicious anemia?
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Schillings test-radioactive cobalamin or IV admin of IF
How is cobalamin deficiency treated?
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Cyanocobalamin or hydroxycobalamin (IV), or Nascobal
What are the common causes of folic acid deficiency (which leads to megaloblastic anemia)?
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Poor diet, malabsorption disorders (especially small bowel), medications, alcohol abuse, anorexia, and from hemdialysis.
How is a cobalamin deficiency differentiated from a folic acid deficiency since the symptoms are very similar?
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Cobalamin deficiency presents with neuro systems, whereas folic acid deficiency does not
What medications can cause a folic acid deficiency?
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Methotrexate, phenobarbital, Dilantin
How is anemia of chronic disease differentiated from other anemias?
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Serum levels of ferritin are elevated and iron stores are increased, the RBC are normocytic, normochromic, and hypoproliferative
What medications are given to patients with renal disease to treat the associated anemia?
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Epogen, Procrit, Darbepoeitin (Aranesp)
__________ anemia is a disease in which the patient has peripheral blood pancytopenia and hypocellular bone marrow.
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Aplastic anemia
What type of anemia are antithymocyte globulin (ATG), hematopoeitic stem cell transplant (HSCT)and cyclophosphamide (Cytoxan) used to treat?
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Aplastic anemia Note: HSCT is generally used for people under 45 & ATG or Cytoxan is generally for people over 45
_________ anemia occurs when the destruction of RBCs occurs at a rate that outpaces the production of RBCs.
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Hemolytic anemia
  
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