Hematology

RBC Disorders

WBC Disorders

Clotting Disorders

Iron Deficiency AnemiaAplastic AnemiaVitamin B12/Pernicious AnemiaSickle Cell Anemia

Inadequate amount of iron impairs formation of hemoglobin and RBCs and results in decreased ability of the blood to transport oxygen to the tissues.Results from blood loss, increased metabolism demands, syndromes of GI malabsorption, and dietary inadequacy.

Risks FactorsInadequate Diet Gastrointestinal BleedingMenstruationPregnancyAssessmentPicaIrritabilityWidened Pulse PressureBrittle nails, Spoon shapedPearly white scleraCracked painful corners of mouth (cracks in the corners of mouth, due to poor nutrition or vitamin deficit)Weakness and fatigueRestless Leg Syndrome

Nursing ImplementationsIdentify the causeSmall easily digestible meals.Oral iron therapy (ferrous sulfate) IM therapy (Iron dextram) give via Z-track method.Give iron rich foodsExercise with planned rest periodsMonitor for signs and symptoms of Iron OverdoseSide Effects:Black stoolConstipationFoul aftertaste

Iron-Rich FoodsBreads and cereals and whole grainsDark green, leafy vegetables and legumes and potatoesDried fruit, raisins, and prune juiceEgg yolkKidney beansLiver, meatsMolassesNuts and seedsShellfishTofu

The nurse selects which of the following as the most appropriate dietary menu items for a client with iron-deficiency anemia?Salad with lettuce, fruit, and nutsRoast beef and broccoliLasagna with tomato sauce and steamed carrotsMixed green salads topped with tuna fish

An adult female client has been treated for iron deficiency anemia. To evaluate the effectiveness of the treatment, the nurse would assess for resolution of which of the following symptoms?DermatitisPale conjunctivaBleeding gumsHair pigment changes

A client has been diagnosed with iron deficiency anemia (IDA), and wants to know what foods would help to maintain adequate iron levels in the body. Which of the following items regarding diet information would be beneficial for the nurse to include in a teaching plan for achieving the goal of increased iron levels?Maintain a strict vegetarian diet.Eat ice cubes that are present in beverages.Increase tea and cereal in the diet.Use adequate sources of vitamin C in the diet

Which of the following statements made by a client with iron-deficiency anemia indicates the need for further teaching?"I should stop taking the medicine if my stools turn black.""I should dilute the liquid iron preparation and use a straw when taking it.""I can prevent the constipation by increasing the intake of fluids and fiber.""I should return to the clinic if my stomach upset worsens with this medication."

A client with iron-deficiency anemia is scheduled for a complete blood count. The nurse anticipates that the report will show which characteristics of the red blood cells (RBCs)?Normocytic, normochromicMacrocytic, normochromicMicrocytic, hypochromicNormocytic, hyperchromic

A client has an order for an iron preparation to be given by the parenteral route. The nurse plans to give the medication by which of the following routes?Intermittent infusionDeep gluteal intramuscular (IM) injection, using the Z-track methodIntramuscular in the deltoid to promote medication dissipation through muscle contractionSubcutaneous injection with weekly site rotation

The nurse is preparing an IM injection of Iron Dextram (Dexferrum) that is especially irritating to subcutaneous tissue. To prevent "tracking" of the medication and irritation to the tissues, it is best to take which of the following actions?Use a small-gauge needleAdminister at a 45-degree angleApply ice to the injection siteUse the z-track technique

Aplastic anemia happens when there has been an injury to stem cells, causing a decrease in all blood elements (pancytopenia); erythrocytes, leukocytes, and thrombocytes may all be depressed.

Sometimes called bone marrow failure

Can come on slowly or all of a sudden or at any age.

DiagnosisBone Marrow BiopsyRisk FactorsHigh doses of Radiation or Chemotherapy.Exposure to toxic chemicals (BENZENE, Chloramphenicol)Autoimmune disorder (Lupus)Assessment:Deficiency in erythrocytes, leukocytes and thrombocytesPetechiae, purpura, bleeding, pallor, weakness, tachycardia and fatigue

Intervention:Stem Cell transplantImmunosuppressive medicationCorticosteroidsBlood transfusionWear medical alert bracelet

A nurse is admitting a client with a diagnosis of aplastic anemia. Which of the following is the best room for the nurse to assign this client?A semi-private room with a client whose diagnosis is urosepsis.A regular private room at the end of the hall.A private isolation room equipped with a negative airflow.A semi-private room with a client whose diagnosis is thrombophlebitis.

The nurse is obtaining a health history on a client who is admitted with a diagnosis of rule out aplastic anemia. Considering the diagnosis, which of the following data is most important for the nurse to elicit during the interview?Recent travel outside the countryExposure to chemicals and drugsHistory of blood transfusionMedication allergies

A nurse caring for a client who has experienced a bone marrow biopsy and aspiration should assess for which of the following as the most serious complication?HemorrhageInfectionShockSplintering of bone marrow fragments

Lack of B12 results in defective maturation of RBCs

When vitamin B12 deficiency anemia is caused by a lack of intrinsic factor, a substance normally secreted by the gastric mucosa, it is called pernicious anemia.

Pernicious anemia is caused by a lack of intrinsic factor. Intrinsic factor is a protein produced by the stomach that binds to vitamin B12.

DiagnosisTheSchillings testis a medical investigation used for patients withvitamin b12 deficiency. The patient is given two doses of vitamin B-12 (cobalamin). The first dose is radioactive and taken by mouth. The second dose is not radioactive and is given as a shot 2-6 hours later. Urine is then collected over the next 24 hours to measure whether vitamin B-12 is normally absorbed.Excreting 8-40% of the radioactive vitamin B-12 within 24 hours is normal.

Vitamin B12/Pernicious AnemiaRisk Factors:Partial or complete gastric resectionVeganismHeredityAssessment:Tingling and numbness on hands and feet.Difficulties in memory and balance.Sore tongueIrritability, mild depression.

Assessment Cont:Red swollen tongueDecrease sense of vibration in lower extremities.Babinski+ Romberg testDecreased reflexes.Nursing Implementations:Vitamin B12 therapy for life (may be monthly injections)Rotate injection sitesSix small feedings, soft pureed foods.

A client diagnosed with anemia who is being treated with iron replacement therapy is not responding to clinical treatment and reports tingling and paresthesias of the extremities. The nurse questions the client to determine if the client:Is compliant with iron replacement therapyHas an underlying medical condition of diabetes that is complicating the course of treatment.May also have a vitamin B12 deficiency that may account for presentation of neuropathy symptoms.May be taking vitamin C supplements that may account for presentation of neuropathy symptoms.

When conducting discharge teaching for a client who is at risk for pernicious anemia because of gastrectomy, the nurse reinforces that the client will require which of the following for preventive treatment?Niacin supplementation for lifetimeVitamin B12 injections for lifetimeA single dose injection of ferrous sulfate to correct the conditionRiboflavin injections monthly for at least a year

The nurse would assess a client who has undergone a small bowel resection of the ileum for development of which type of anemia?Iron-deficiency anemiaPernicious Anemia Anemia of chronic diseaseAplastic anemia

The client is given radioactive Vitamin B 12 in water for a Schilling test. The nurse instructs the client that the primary purpose of this test is to measure his body's ability to do which of the following?Store Vitamin B12Digest Vitamin B12Absorb Vitamin B12Produce Vitamin B12

Inherited hemoglobinopathies that cause abnormal sickle shaped hemoglobin to partially or totally replace normally shaped RBC.The Vaso-occlusive crisis, or sickle cell crisis, is a common painful complication of sickle cell disease in adolescents and adults.Conditions such as anxiety, dehydration, infection or trauma may trigger a sickling crisis. Difficulty breathing and excruciating pain are symptoms of a crisis. Common in people with African or Mediterranean descent.

Sickle Cell Anemia

Assessment:Increased susceptibility to infection. AnemiaSickle cell CrisisJaundice Irritability, lethargy, anorexia and malaise

When caring for a client with sickle cell crisis, which dietary measures should the nurse emphasize?

High-protein supplementsLimited intake of sodium-rich foodsSix small meals eaten throughout the dayHigh fluid intake

Which of the following nursing observations indicate that a positive outcome for a client with sickle cell crisis has been met?

The client has an intake of 3,000 mL per day.The urinary output is 20 cc per hour.Client complains of persistent joint pain.The client has a temperature of 100 degrees F.

Which of the following nursing diagnoses should receive the highest priority in a client with sickle cell crisis?PainSelf-care deficitActivity intoleranceAltered health maintenance

The nurse is preparing a teaching plan for a client with sickle cell disease about ways to prevent crisis episodes. Which of the following should be emphasized to prevent sickle cell crisis?

Eat nutritious foods that are high in iron.Seek treatment for infections as soon as possible.Take adequate amounts of supplemental vitamins and minerals.Avoid any type of physical activity.

A couple seeks genetic counseling for sickle cell. Both have sickle cell traits. The nurse understands that the chances of the couple's offspring developing sickle cell disease with each pregnancy is:None of the offspring will develop sickle cell disease.Twenty-five percent of their offspring will develop sickle cell disease.Fifty percent of their offspring will develop sickle cell disease.All their children will have sickle cell traits, but none will have the disease.

A 14-year-old boy with sickle cell anemia is admitted with severe pain in his abdomen and legs. He asks why the doctor ordered oxygen when he is not having any problems breathing. The nurse will be most accurate in stating that the main therapeutic benefit of oxygen is to:Prevent further sickling.Prevent respiratory complications.Increase the oxygen-carrying capacity of red blood cells (RBCs).Decrease the potential for infection during the crisis.

A 2-year-old has just been diagnosed with sickle cell anemia. The nurse has explained the diagnosis to the family as well as provided information about the treatment plan. The nurse will anticipate the need for additional teaching when the mother makes which statement?"My husband loves to fly his small plane. I guess we'll have to take a commercial plane for our trips from now on.""If my child gets the flu bug, she might develop a sickling crisis.""My child will need extra iron tablets because of her anemia." "During a sickling crisis, my child will probably be hospitalized for pain control and hydration therapy."

InterventionPrevent Sickling CrisisAvoid anything that triggers hypoxiaIncrease FluidsInfection preventionEncourage diet of high calorie, high protein, with folic acid supplement Supportive therapy during crisisAvoid stress and fatigueOxygen therapy and blood transfusion (as prescribed) to increase tissue oxygenation

Bone marrow disorder characterized by an abnormal increase in RBC's (erythrocytosis) often accompanied by leukocytosis.

Untreated survival time is 12 years; with treatment, 715 years.

Assessment:Ringing in the ears.Feeling of abdominal fullness.Pruritus after bathingPain Ruddy complexionGum bleedingEnlarged spleen

Nursing Implementation Observe signs of bleeding, thrombosis, stools, urine, gums, skin, ecchymosis.Avoid prolonged sitting, knee gatch and pillow under the knees.Cool water baths to decrease pruritusForce fluids to reduce blood viscosityAvoid foods high in ironAvoid falls and bumps

The nurse is preparing a teaching plan for a client with polycythemia vera on ways to maintain nutrition. The nurse should include in the plan which of the following?Increase intake of foods high in iron. Encourage small, frequent meals rather than three big meals.Increase the amount of red meats and organ meats in the diet.Encourage the use of hot spices in foods to stimulate appetite

Autosomal recessive disorder characterized by the reduced production of one of the globin chains in the synthesis of hemoglobin.

Most common in descents such as Italians, Greeks, Syrians or their offsprings.

Assessment:Frontal bossingMaxillary prominenceWide-set eyes with a flattened noseGreenish-yellow skin toneHepatosplenomegalySever AnemiaMicrocytic; hypochronic red blood cells

Treatment/Nursing ImplementationTreatment is supportive; the goal of therapy is to maintain normal hemoglobin levels by the administration of blood transfusions.Bone marrow transplantation may be offered as an alternative therapy.Monitor for Iron overload (iron-chelating agent Desferal)SplenectomyGenetic counseling

The nurse has completed some child and family education for a child diagnosed with thalassemia. The medical plan of treatment includes blood transfusions when the anemia reaches a severe point. Which statement by the parents indicates a need for further education?Because of the anemia, my child will need extra rest periods.My child inherited this disorder from both of us.We should be alert to periods when our child seems paler than usual.My child needs an iron supplement.

The nurse is caring for a child diagnosed with thalassemia major who is receiving her first chelation therapy. The nurse reinforces teaching about chelation therapy with the parents by stating that it is done to:Decrease the risk of hypoxia.Decrease the risk of bleeding.Eliminate excess iron.Prevent further sickling of red blood cells (RBCs).

The elementary school nurse is called to the gym when a child with a history of thalassemia complains of dizziness during physical education class. The priority action of the nurse should be to:Assist the child to the nurse's office to lie down until the dizziness passes.Assist the child to sit in the gym until the dizziness passes.Utilize an ammonia ampoule to prevent loss of consciousness.Assess the child's blood pressure and pulse.

The nurse is caring for a child with beta-thalassemia who has received many blood transfusions. The nurse assesses for which of the following as a priority at this time?NeutropeniaPetechiaeHemosiderosisHemoglobin S formation

In Hodgkin's lymphoma, cells in the lymphatic system grow abnormally and may spread beyond the lymphatic system. As Hodgkin's lymphoma progresses, it compromises your body's ability to fight infection.

When B cells develop into large abnormal cells, these abnormal, cancerous cells are called Reed-Sternberg cells. Instead of undergoing the normal cell cycle of life and death, Reed-Sternberg cells don't die, and they continue to produce abnormal B cells in a malignant process.

Signs and SymptomsPainless swelling of lymph nodes in your neck, armpits or groin.Persistent fatigueFever and chillsNight sweatsUnexplained weight loss as much as 10 percent or more of your body weightCoughing, trouble breathing or chest painLoss of appetiteItching

Nursing InterventionFor stages I and II without mediastinal node involvement, the treatment of choice is extensive external radiation of the involved lymph node regions.With more extensive disease, radiation and multidrug chemotherapy are used.Monitor for drug-induced pancytopenia, an abnormal depression of all the cellular components of the blood, which increases the risk for infection, bleeding, and anemia.Monitor for signs of infection and bleeding.Protect the child from infection.Monitor for side effects related to chemotherapy or radiation; the most common side effect of extensive irradiation is malaise, which can be difficult for older children and adolescents to tolerate both physically and psychologically.

A client is scheduled for biopsy to rule out lymphoma. The nurse understands that a biopsy finding suggestive of a lymphoma is the presence of:Reed-Sternberg cells.Philadelphia chromosome.Epstein Barr virus.Herpes simplex virus.

A client has just been diagnosed with Hodgkin's disease. Several hours after she returns to the room after having a lymphangiogram, she tells the nurse her urine is blue. The nurse's best response is:"That's OK. It will go away on its own.""I'll call the doctor, and he can explain the cause of the urine discoloration.""This is a predictable response to the test and shows you are adequately excreting the dye.""This is an expected side effect of the test. It will go away by itself in a few hours."

The nurse monitors a client with Hodgkin's disease for which of the following complications that could be fatal?Spinal cord compressionSuperior vena cava obstructionKidney and/or liver failureInfection and/or hemorrhage

A client with suspected Hodgkin's disease wants to know why a lymph node biopsy is necessary. The best response by the nurse is that the biopsy is:The easiest test to confirm the diagnosis.The most definitive test to confirm the diagnosisLess likely to cause major complications.The quickest way to find the correct answer.

Cancer of blood forming organs causing an uncontrolled production of white blood cells (leukocytes, myelocytes, and their precursors) by the bone marrow.Four primary categories of leukemia according to the type of WBC involved and the rate of cell growth.Acute Lymphoblastic Leukemia (ALL)Acute Myelogenous Leukemia (AML)Chronic Lymphoblastic Leukemia (CLL)Chronic Myelogenous Leukemia (CML)

Acute Lymphoblastic Leukemia (ALL)Most common type of leukemia in young childrenThis disease also affects adults, especially those age 65 and older Standard treatments involve chemotherapy and radiation The survival rates vary by age: 85% in children and 50% in adultsAcute Myelogenous Leukemia (AML)Occurs more commonly in adults than in childrenMore commonly in men than womenAML is treated with chemotherapyThe five-year survival rate is 40%

Chronic Lymphocytic Leukemia (CLL) Most often affects adults over the age of 55. It sometimes occurs in younger adults, but it almost never affects children. Two-thirds of affected people are men. The five-year survival rate is 75%. It is incurable, but there are many effective treatments.Chronic Myelogenous Leukemia (CML) Occurs mainly in adults. A very small number of children also develop this disease. Treatment is with imatinib (Gleevec) or other drugs. The five-year survival rate is 90%

Risk Factors:Exposure to chemicalsRadiationTreatment of other types of cancerDiagnosisBone Marrow BiopsyAssessment:FatigueWeaknessPain (joints)Night Sweats

Assessment Cont:Petichiae, EchymosisSpleenomegaly HepatomegalyEnlarged lymph nodes.Low WBC/Extremely HighLow RBCLow Platelets

Nursing Implementations:Observe for early signs of infectionMouth Care q2Assess and control Bleeding, anemiaProvide Rest, Comfort, NutritionNausea, antiemetics, usually Reduce side effects from therapeutic regimenProvide emotional/spiritual supportLet the patient participate in treatmentMaintain strong support system

The nurse would teach a client with sickle cell trait that he or she:Should avoid fluid loss and dehydration.Can expect to experience hemolytic jaundice.Can expect to experience chronic anemia.Is protected from sickle cell crises under normal circumstances

A client has an order for a test to determine if pernicious anemia is present. For which of the following tests should the nurse schedule the client?Serum folate levelSchilling testSerum iron and total iron-binding capacity (TIBC)Bone marrow aspiration

An adolescent receiving cyclophosphamide (Cytoxan) for acute lymphocytic leukemia (ALL) asks the nurse to come quickly to evaluate blood in my urine. The most important action by the nurse would be to:Explain this is normal for these drugs. Measure intake and output. Force fluids to improve the hematuria.Recognize that this is untoward and report the event

A child with leukemia has developed pancytopenia. The nurse would institute which measures designed to reduce stomatitis in this child during the course of chemotherapy? (Select all that apply.)Using alcohol-based mouthwash to reduce oral organismsAdministering pain medications as orderedIncreasing intake of citrus juices, such as orange juice, that contain Vitamin CRinsing the mouth several times a day with plain waterBrushing the teeth twice a day with a firm-bristled toothbrush

A client with leukemia is receiving chemotherapy. The client is immunosuppressed, with a low absolute neutrophil count. The nurse anticipates that which of the following medications would be used in the treatment of the client?Zidovudine (AZT)G-CSF (Neupogen)Raloxifene (Evista)Toremifene (Fareston)

A 3-month-old infant is diagnosed with leukemia. Which of the following does the nurse anticipate will be part of the plan of care for this infant?The baby will be placed in isolation.Leukemia is familial, and other children should be assessed.All immunizations will be withheld during exacerbations. The baby will be NPO during chemotherapy.

Which of the following characteristics is associated with chronic leukemia?Immature lymphocytes proliferate the marrowGradual onset of the disease Rapid disease progressionPrimarily affects younger adults

The common feature of leukemia is which of the following?A compensatory polycythemia stimulated by thrombocytopenia.An unregulated accumulation of white blood cells in the bone marrow.Increased blood viscosity resulting from an overproduction of white cells.Reduced plasma volume in response to a reduced production of cellular components.

A 40-year-old client is referred to a hematologist with a tentative diagnosis of acute myelogenous leukemia (AML). The client's only complaint is fatigue. Which of the following diagnostic tests would the nurse expect to be ordered first?Liver function studies Uric acid Lumbar puncture Bone marrow biopsy

A 3-month-old infant is diagnosed with leukemia. Which of the following does the nurse anticipate will be part of the plan of care for this infant?The baby will be placed in isolation.Leukemia is familial and other children should be assessed.All immunizations will be withheld during exacerbations.The baby will be NPO during chemotherapy.

Refers to a group of bleeding disorders resulting from a deficiency of specific coagulation proteins. Inherited as a (sex-linked) recessive trait. Occurs in men but is transmitted by women carriers who are symptom free.There are two main types of hemophilia.Hemophilia A, you have little to no clotting factor VIII (8). About 9 out of 10 people with hemophilia have type A. Hemophilia B, youre missing or have low levels of clotting factor IX (9).

Assessment:Abnormal bleeding from Umbilical cordProlonged bleeding from cutsEpistaxisJoint pain, tenderness, swelling and limited ROMTendency to bruise easilyNormal platelet count but clotting time may be abnormal.

Nursing InterventionsPrevent injury and Bleeding as Much as possibleProvide an environment as safe as possibleControl bleeding episodes when they occurAvoid IM/IV administration of drugNo aspirin and NSAID'sGive Antihemophillic factor via IVAdvice child to wear medic alert bracelet

Which of the following blood products does the nurse anticipate the physician will order for a client diagnosed with hemophilia?

Whole bloodPacked red blood cells (PRBCs)Fresh frozen plasma (FFP)Albumin

The nurse would explain to a client newly diagnosed with hemophilia that it is a hereditary bleeding disorder that:Has a higher incidence in females.Is associated with joint bleeding, swelling, and damage.Is related to genetic deficiency of the von Willebrand factorCan be caused by lack of Vitamin B12

The nurse is administering factor VIII to a child with hemophilia. The nurse should observe for which potential complication during the infusion?

Fluid overloadTransfusion reactionEmboli formationContracting AIDS

At a hemophilia camp, several children with injuries arrive at the clinic at the same time. When prioritizing care for the children, the child who requires the most immediate care from the nurse is the child with:A swollen knee.Abrasions on both arms.A slight head injuryA puncture wound in the foot.

A 2-year-old with hemophilia is being discharged, and the nurse is completing discharge teaching with his parents. Which of the following statements by the parents indicates they require further teaching regarding hemophilia?It is good to know that his sister will not get hemophilia also.If our son has a temperature, we will not give aspirin or ibuprofen, only acetaminophen.We will get a Medic-Alert bracelet for our son as soon as we get home.We will be sure to watch our son very closely to make sure he does not have another episode of bleeding.

Idiopathic Thrombocytopenic Purpura (ITP)Is a bleeding condition in which the blood doesnt clot as it should. This is due to a low platelets count.Acute ITP: self limiting with a duration of less than 6 months; typically follows a viral disease.Chronic ITP: Autoimmune disease of young adulthood

Secondary Thrombocytopenia: (thiazides, aspirin, nonsteroidals, sulfonamides, Tagamet, Lanoxin, Lasix, heparin, morphine, Tegretol)

Idiopathic Thrombocytopenic Purpura (ITP)Nursing Considerations:Bleeding PrecautionsAvoid aspirin containing products and any other medications or herbs with an anticoagulant effectPut firm, consistent pressure on any bleeding area for 510 minutes.Do not use dental floss.Shave with an electric razor to decrease the risk of accidental cuts.

Idiopathic Thrombocytopenic Purpura (ITP)

The nurse instructs the client receiving chemotherapy that which of the following should be avoided to reduce the risks associated with thrombocytopenia?Being near individuals with upper respiratory infectionKeeping fresh flowers and plants in the homeShaving with an electric razorTrimming nails with a nail clipper

A child diagnosed with Sarcoma is being treated with chemotherapy. The results of a complete blood count (CBC) indicate severe thrombocytopenia. Nursing interventions related to this finding would include: (Select all that apply)Encouraging foods high in iron.Limiting physical contact with the child.Removing fresh flowers from the childs room.Clearing the floor of the childs room to prevent falls and bruises.Minimizing needle sticks and intrusive procedures.

The nurse assesses for petechiae and ecchymosis as the most common signs in a client diagnosed with which of the following disorders?Iron-deficiency anemiaPernicious anemiaVitamin K deficiencyThrombocytopenia

The nursing care plan for a client diagnosed with idiopathic thrombocytopenia purpura (ITP) takes into account which of the following therapies for this disorder?Alkylating chemotherapyPlatelet transfusionsCorticosteroid therapyBone marrow transplant

A hereditary bleeding disorder characterized by a deficiency of or a defect in a protein term Von Willebrand factor (vWF)

Disorder causes platelets to adhere to damage endothelium

Tendency to bleed from mucous membranes

Von Willebrand Disease (vWF)Assessment:EpistaxisGum BleedingEasy bruisingExcessive menstrual bleedingIntervention:The administration of clotting factorsProvide emotional support

A client with von Willebrand's disease presents to the hospital with prolonged bleeding following a dental procedure. The nurse is aware that the client might need to be transfused with which of the following products?CryoprecipitatePRBCsGranulocytesPlatelets

Questions?

Iron Deficiency Anemia is a condition that develops as a result of inadequate level of iron in the Blood.Without enough iron, your body can't produce enough hemoglobin, a substance in red blood cells that enables them to carry oxygen.It can be caused with Different Factors Blood Loss (menstruation, trauma or Chronic Bleeding)Lack of iron in DietPregnancy Inability to absorb iron (Malabsorption syndromes)

*Assessment:Lab Assessment:Decrease RBC LevelIncrease in Bilirubin because of destruction of RBC that releases bilirubin in the blood.Dark urine Caused by BilirubinDecrease in Hematocrit and HemoglobinMicrocytic and Hypochromic cells.Pica (a medical disorder characterized by an appetite for substances largely non-nutritive ) it is a condition where the body senses that there is something lacking in your body.Irritability Decrease oxygen in the brainBrittle nails, Spoon shaped nails Because of poor capillary circulation to distal parts of the body.Cracked painful corners of the Lip - Poor nutritionWeakness and Fatigue Decrease oxygen in the body.Tachycardia - (heart rate increased to pump what few red blood cells to compensate with the oxygen demand)Restless Leg Syndrome - RLS causes a sensation in the legs or arms that can most closely be compared to a burning, itching, or tickling sensation in the muscles in IDA it is usually caused by decrease circulation to the distal part of the body.

*Identify the cause Bleeding, malabsoption or low dietary intake of ironSmall easily digestible meals to easily absorb iron and to decrease discomfort of cheilosis.Oral Iron therapyMonitor for Side Effect of oral iron therapy (black stool, constipation and Foul aftertaste)For pediatric clients use a straw to avoid staining of teeth.Usually taken with foods rich in Vit. C to increase absorption or Iron.For severe IDA use IM therapy of iron dextram give through Z-track method. (See video for Complete details)Exercise with planned rest periods

*Correct 2 With iron-deficiency anemia, it is important to select dietary items that are high in iron to counteract the deficit. Red meat tends to be high in iron, as do some green, leafy vegetables. Although options 1 and 4 contain salad greens (and therefore are green, leafy vegetables), the other components of these meals are not as high in iron. Lasagna and carrots (option 3) are not as high in iron as the other choices*2 A sign of anemia is pale conjunctiva. If resolved, the conjunctiva should be pinker. The other symptoms are not specific to iron deficiency and are usually associated with other vitamin or mineral deficiencies

*4 Vitamin C helps to enhance the absorption of iron in the diet, and is an easy step in diet management towards improving iron levels in the body. A strict vegetarian diet focuses on non-heme sources of iron that are not as readily absorbable as heme sources (option 1). Eating ice cubes is an example of pica, which is ingestion of a non-food substance (option 2). Nonfood items will not help to maintain iron, or prevent iron deficiency, and in certain cases can actually lead to deficiency states. Tea contains tannic acid, and cereals contain phytates and fibers, all of which lead to decreased iron absorption in the diet (option 3).

*correct>1 The client on an oral iron preparation should be taught to expect stools to turn black because of the excessive iron that is eliminated. All the other choices should be included in the teaching plan. The health care practitioner may change the iron preparation prescribed to the client if gastrointestinal symptoms become intolerable.

*The morphologic characteristics of RBCs in iron-deficiency anemia is microcytic and hypochromic. Vitamin B12 anemia produces a macrocytic and normochromic morphology. Aplastic anemia, hemolysis, and acute blood loss will reveal RBCs with normocytic and normochromic characteristics*correct>2 IM administration is recommended over intravenous infusion because of the potential for anaphylaxis. The gluteal muscle is the best route for administration since the muscle is large and highly vascular. The Z-track method is preferable to prevent tattooing of the skin and tissue necrosis caused by infiltration into the subcutaneous tissue.

*Z-track technique prevents "tracking" and is used for administering medications that are especially irritating to subcutaneous tissue. With z-track, the skin is pulled approximately 1 inch laterally away from the injection site, the medication is injected, the needle withdrawn and the tissue released. The other answers are incorrect.*Aplastic Anemia - There has been an injury to stem cells, causing a decrease in all blood elements (pancytopenia); erythrocytes, leukocytes, and thrombocytes may all be depressed.Can cause death if not treated.

*Diagnosis - Bone Marrow Biopsy (see video)Suppression of bone marrow caused by radiation therapy, chemotherapy Drugs or chemicals, e.g., benzene, chloramphenicol (Chloromycetin); can occur one week after a drug is startedInfectious processes such as with viruses (e.g., hepatitis)Cancerous infiltration of bone marrow May be born with it Often the cause is unknown

NCLEX FOCUSFocus on the chemicals that can cause Aplastic anemia e.g. benzene that is found in GASOLINE.If you have aplastic anemia it doesnt mean that you only have decrease in RBC you also have decrease WBC that can put you at risk for INFECTION and decrease in platelets that can also put you at risk for BLEEDING.If due to a drug reaction, can be fatal as many times it is irreversible

*Stem cell transplant to have healthy, functioning stem cells.Immunosuppressive medication if it is caused by an Autoimmune disorder (SLE) to decrease immune response.Corticosteroids - to decrease the InflammationBlood transfusion for minor casesAlways wear medic alert bracelet

NCLEX FOCUSStem cell transplant needs a compatible donor . (identical twin, sibling or parent)*correct>2 Clients with aplastic anemia usually experience pancytopenia (decreased erythrocytes, leukocytes, and platelets). The client with this type of hypoplastic anemia should therefore have a room where reverse isolation can be instituted. The client with aplastic anemia is susceptible to infection as well as hemorrhage. Respiratory isolation requiring negative airflow (option 2) is not necessary in the care of clients with aplastic anemia

*2 Aplastic anemia may be congenital or acquired, but most cases do not have an identifiable etiology. It is known that aplastic anemia may follow exposure to chemicals (e.g., Benzene, DDT) or drugs (chloramphenicol, sulfonamides). It is therefore important that the nurse obtain exposure history on this client.*1 The risk for hemorrhage is of greatest risk since a large-bore needle is used to perform the biopsy and aspiration. Many of these clients often have an altered clotting capability. While the risk of infection is also a consideration, the procedure is performed under sterile conditions and is less of a concern than hemorrhage

*Vitamin B12 helps with the regulation of RBC it is also called the Food for the Nerves as it also maintains the conduction of the nervous system.Vitamin B12 vs. Pernicious anemiaVitamin B12 deficiency results from an inadequate intake of vitamin B12 or a lack of absorption of ingested vitamin B12 from the intestinal tract.Pernicious anemia results from a deficiency of intrinsic factor, necessary for intestinal absorption of vitamin B12; gastric disease or surgery can result in a lack of intrinsic factor.

**Risk factors.Veganism or being vegetarian the good sources of vit b 12 is usually found in lean meats. And dairy products.Partial or Complete gastric resection - Intrinsic factor is secreted by the parietal cells of the intestines/stomach. Removing parts of the ileum will decrease the production of intrinsic factor thac can affect vit b12 absorption.Heredity parents of a child who are both vegetarian can cause inborn pernicious anemia to the child.

NCLEX FOCUSTo support the diagnosis of vit b12 or pernicious anemia from other types of anemia are the presence of neurological signs and symptoms as vitamin b12 also helps maintain the nervous system of the client.Tingling and numbness of handsDifficulties in memory and balance+babinski reflex+rombergs test Decrease reflexes

*Nursing Implementations and ManagementVitamin b12 deficiency treatment: increase vit b12 intake usually found in lean meats and dairy products.Pernicious anemia treatment is Vitamin b 12 injections every month for life (rotate injection sites) for patient who cannot take injections give vitamin b12 nasal spray every week for life. (keep refrigerated) red tinge of fluid is expected from the nose.*3 Anemic clients who do not respond to iron replacement therapy and present with symptoms associated with neuropathy are likely to be suffering from an underlying vitamin B12 deficiency. Option 1 is incorrect because, even if the client were not being compliant, these types of symptoms would be due to an associated clinical deficiency. Option 2 is unrelated to any information presented in the question. Option 4 is incorrect because the use of vitamin C supplements would cause symptoms of iron overload since it enhances the absorption of iron*correct>2 Pernicious anemia is due to a clinical deficiency of intrinsic factor that prevents the absorption of vitamin B12 in the body. This commonly occurs following gastrectomy. Thus, for treatment to be effective, vitamin B12 must be administered via injection for the rest of the clients life. Options 1 and 3 are incorrect because niacin is unrelated to pernicious anemia, and iron will not correct pernicious anemia. Option 4 is incorrect because riboflavin is not related to the issue of pernicious anemia and riboflavin is administered orally.*Resection of the distal ileum results in the impaired absorption of Vitamin B12. The other cause of Vitamin B12 deficiency is the loss of intrinsic factor-secreting surfaces that are normally secreted by parietal cells.*correct>3 Pernicious anemia is caused by the body's inability to absorb Vitamin B12. This is caused by a lack of intrinsic factor in the gastric juices. The Schilling test helps diagnose pernicious anemia by determining the client's ability to absorb Vitamin B12

*Normal RBC vs. Sickle Cell RBC LifespanNormal RBC = 80- 120 daysSickle cell= 10- 20 daysOxygen TransportNormal RBC = Healthy hemoglobin that can transport oxygen.Sickle Cell = does not carry hemoglobin well.Shape Normal RBC = Round and SoftSickle Cell = Crescent Shape, Stiff and Sticky

*Sickle cell crisisVaso-occlusive Crisis- most common and the most painful crisis as sickle-shaped red blood cells that obstruct capillaries and restrict blood flow to an organ, resulting in ischemia, pain and necrosis and often organ damage.Splenic sequestration Crisis Acute, painful enlargement of spleen because of pooling of blood inside the spleen that can cause sudden circulatory problems e.g. Hypovolemia.Aplastic Crisis - Worsening of Anemia in sickle cell disease.

*TransmissionSickle cell disease is congenitally acquired. For the disease to be active, the patient must have 2 sickle cell genes. A client with one gene is considered a carrier. If both parents carry the sickle cell trait, offspring will have a 25% chance of inheriting the disease.Sickledex test To check for presence of sickle cell trait.Hemoglobin Electrophoresis - To check if the client has Sickle cell disease.One of every ten afro-americans carry the trait. If only one parent carry the defective gene there is 50% chance of producing a child with sickle cell trait.

AssessmentIncreased susceptibility to infection.- spleen is one of the most affected organs in sickle cell disease the spleen act as the graveyard of dead Sickle cell that will make the spleen enlarged because of the short life span of sickle cells at the same time the spleen will get overworked and cannot function to help the immune response.Anemia because of incompetent oxygen transport.Sickle cell CrisisJaundice because of involvement of spleen and increase in bilirubin in the skin from dead Sickle cells

NCLEX FOCUSInjury prevention for patients with sickle cell disease to prevent Splenic Rupture (Spleen Rupture). E.g. avoiding contact sports, avoiding constipation to prevent increase pressure inside the abdomen and avoid gas forming foods.Cool water baths for management of jaundice.

*The sickled shape of the red blood cell (RBC) can lead to occluded circulation and impaired RBC production. Adequate hydration is essential to improve blood flow, reduce pain, and prevent renal damage. There are no specific restrictions or recommendations in regards to protein, sodium, or frequency of meals*An observation for the client in sickle cell crisis that indicates a positive outcome includes stable vital signs, an oral intake of 3,000 mL/day, and verbalization of pain control. Maintaining an adequate intake is essential to maintain blood flow, decrease pain, and prevent renal damage.*1 The client in sickle-cell crisis will have pain related to ischemic tissue injury resulting from obstruction of blood flow. The other diagnoses, although important, are of lesser priority than the nursing diagnosis of pain

*2 Clients with sickle cell disease have scarred spleen resulting in decreased ability to fight off infection. The individual with sickle cell disease must seek early treatment of infections. Pneumonia is one of the most common infections affecting individuals with sickle cell disease. Option 4 is inaccurate in that vigorous physical activity should be avoided.

*2 Sickle cell disease is an autosomal recessive genetic disorder where the individual is homozygous for the abnormal hemoglobin. If both parents have sickle cell traits, there is a 25 percent chance that each pregnancy will produce a child with the disease.

*1 RBCs sickle under conditions where low oxygen concentrations exist; therefore, administering oxygen will prevent additional sickling. The oxygen has no effect on the oxygen-carrying capacity of RBCs. It will not have an effect on development of respiratory complications. It will not decrease the potential for infection

*correct>3 The child with sickle cell anemia does not need more iron supplements than the regular child. The cause of the child's anemia is fragile red blood cells, which are broken down more rapidly than the normal cell. Children with sickle cell anemia must guard against low oxygen tension in the air. For that reason, they should not fly in unpressurized planes. Because infections increase the basal metabolic rate (BMR) and oxygen requirements, infections often precipitate a crisis. During a sickling crisis, the child will need hydration therapy and pain management to break the sickling cycle

*Supportive therapy for patient on Vaso Occlusive crisisFor mild pain patient is given mild analgesicsFor moderate to severe pain best analgesics would be morphine Do not use demerol as it causes normeperedine seizures especially with pediatric clients.NCLEX FOCUS Prevention of Sickling Crisis is the most commonly asked Questions in NCLEX. Prevent DISH to happenDehydration Increase fluid intake greater than 2000cc/day avoid hot places e.g. the beach.Infection Update vaccination schedules to prevent infection. Stress Avoiding physical and emotional stressHypoxia/heat - Avoid activities that can cause hypoxia e.g. rigorous exercise, increase in altitude and unpressurized airplane cabins. Intervention HOPHydrationOxygenPain management

*Disease in which there is an increase in production of red blood cells.Increased hemoglobin levels are present. Plasma volume levels can be low or normal.Platelets are outnumbered by RBC = Bleeding precaution.Increased production by stem cells in the bone marrow.Causes highly viscous blood, decreased microcirculatory blood flow, and thrombotic episodes.*Feeling of abdominal fullness because of enlarged spleen from too much dead RBC. Pruritus after bathing because of increased bilirubin in the skin from dead RBC.Ruddy complexion - because of increased RBC that gives red complexion of the face of the patient.Gum bleeding result of decrease platelets causing bleeding

*NCLEX FOCUSMonitor and prevent bleeding episodes Avoid constipation, use soft tooth brush to decrease gum bleeding and injury prevention.Monitor the patient for signs of thrombosis and prevent thrombosis formation e.g. avoiding the use of knee gatch and do not sleep with pillows under the knees.Cool water baths rather than warm water baths to decrease pruritus.Monitor signs of dislodged thrombus.Avoid Green leafy vegetables, lean meats and Eggs as they are high in iron. Injury prevention for the clientAssist the client for phlebotomy 300-500 cc of blood per week.*2 Clients with polycythemia experience satiety and fullness resulting from hepatomegaly and splenomegaly. Frequent small meal servings will help maintain adequate nutrition. Foods rich in iron are not appropriate since there is an increase in erythrocytes in this condition. Spicy foods will increase the gastrointestinal symptoms, which also include dyspepsia and increased gastric secretions.

*Autosomal recessive trait- both parent should carry the defective gene (b thalassemia minor)A.K.A. cooleys anemia, or Mediterranean anemia.

*Bone deformities mostly facial bone deformities caused by increased activity of bone marrow mostly flat bones e.g. face, skull and pelvisSpleen enlargement because of death frequent blood transfusion.

*NCLEX FocusNCLEX questions regarding Beta thalassemia is focused on the treatment and its effect on the patient.The long term treatment of choice for this patient is focused on supplying the patient healthy hemoglobin to supply the client oxygen. Blood transfusion that usually reach up to 8 times a year.Iron overload is monitored for the client who is receiving too much blood transfusions.Removal of the spleen is advised for the client to prevent splenic rupture. Post Splenectomy patients aer at risk of having an infection because of decrease immune response.Genetic counseling for beta thalassemia minor (carriers) In case of Iron overload Desferal (deferoxamine) is given to the client.*correct>4 A child diagnosed with thalassemia who will receive multiple transfusions throughout life will need chelation therapy for excessive iron stores. An iron supplement would be inappropriate in this child

*correct>3 Chelation therapy works to rid the body of excess iron storage that results from the frequent transfusions required to maintain adequate hemoglobin. Chelation will have no effect upon hypoxia or bleeding. Sickling of RBCs does not occur with thalassemia

*correct>2 As the child's safety is the first concern, walking to the office would not be safe at this time. Sitting immediately will decrease the chance of falling. The urgent safety requirements take precedence over physical assessment. The information given does not indicate the need for ammonia at this time to prevent fainting

*Hodgkin's Lymphoma Cancer of the lymphatic systemCells in the lymphatic system grow abnormally and may spread beyond the lymphatic system. As Hodgkin's lymphoma progresses, it compromises your body's ability to fight infection. *DiagnosisBiopsy to check the presence of Reed sterberg cellsBone marrow aspirationPainless Swelling of lymph nodes because of over growth and over production of Reed sternberg cells.Fatigue, fever and chills because of progression of diseaseAnorexia malnutrition and as an effect of immunosuppressionChest pain indication of spread of the diseaseIncreased sensitivity to the effects of alcohol or pain in your lymph nodes after drinking alcohol.

*The most important part for treating Hodgkins lymphoma is early detection and the number of affected cervical lymph nodes.The first most commonly affected lymph nodes are the cervical lymph nodes if it progresses to the midiastinal part of the body the prognosis is poor.

NCLEX FOCUSCommon NCLEX question regarding Hodgkins lymphoma is the nursing responsibilities of the patient to the client. Initiation of Neutropenic Precaution according to protocol.No fresh fruits and vegetables are allowed to the clients food plan except peeled.No potted plants, fresh flowers and pets inside the patients room.Pepper seasoning is also contraindicated as it is considered fresh.Thoroughly cook meat and foods up to the boiling point. Avoid foods prepared Half cookedBottled water is preferred to the patient under neutropenic precaution or give a glass of water to the client but if not consumed within 15 mins. Discard the water. Consult your doctor before vaccines or immunization.Avoid rectal exams, procedures and medication route as it can irritate the rectal mucosa and can lead to infection.Visitors with colds, cough and fever are not allowed inside the patients room.Avoid crowded placesFrequent hand washing to prevent the spread of infection.Teaching the client about the side effects of the Chemotherapy and Radiation therapyInstitute bleeding and neutropenic precaution.Knowing the difference of non-hodgkins and hodgkins lymphoma.Hodgkins presence of Reed Sternberg cellsNon- Hodgkins No reed sternberg cells

*1 Histological isolation of Reed-Sternberg cells in lymph node biopsy examination is a diagnostic feature of Hodgkin's lymphoma. Philadelphia chromosome is attributed to chronic myelogenous leukemia

*Correct 3After a lymphangiogram, veins of the lower extremities, dorsal skin of the feet, and urine may have a blue-green discoloration from dye excretion for 2 to 5 days. The best response to the client's question is one that provides accurate information as well as reassuring the client.4 Relentless proliferation of lymphocytes invade and compromise the function of various organs, especially the bone marrow. Most clients with Hodgkin's disease exhibit signs of immune deficiency early in the disease. Immunosuppressive therapy makes the client even more susceptible to infection and hemorrhage because of a compromised bone marrow function.

*2 A lymph node biopsy is the only definitive means of establishing the diagnosis of Hodgkin's disease. The presence of the Reed-Sternberg cell is ascertained through this biopsy. Options 1, 3, and 4 are not necessarily true

*Leukemia is cancer of the body's blood-forming tissues, including the bone marrow and the lymphatic system. More common in boys than girls.

NCLEX FocusDifference of Chronic vs. AcuteHow to identify each type of leukemia.

*Difference of Acute leukemia to Chronic leukemiaLeukemia Affects WBC it can be the Lymphoid or the Myeloid cell.Stem cells are young cells that can grow into an adult cell e.g. WBC, RBC and platelets. Before stem cells become adult WBC they enter a precursor stage called the blast stage, the blast stage is the immature stage of WBC. The acute type of leukemia happens during the blast stage where the patient experience acute progression of the disease because of over production of Blast cells where they cannot function as a healthy WBC that can fight infection and outnumbering other healthy mature cells e.g. RBC and platelets causing petichae and anemia. The Chronic Type of anemia is very common in adults where the cancer progresses slowly and signs and symptoms appear late or minimal. Chronic type of leukemia happens in a relatively mature, but still abnormal white blood cells. That is why the symptoms of the disease appear very slow.*correct>4 Sickle cell trait is generally a mild condition that produces few if any manifestations. These clients are considered carriers of the disease and require genetic counseling to determine presence of the hemoglobin S. Certain stressors result in a sickle cell crisis.

*2 Schilling test involves the administration of radioactive Vitamin B12. Increased absorption of Vitamin B12 when intrinsic factor is given parenterally is indicative of pernicious anemia.

*4 Hematuria is an adverse effect of the commonly used cancer medication cyclophosphamide (Cytoxan) and should be reported. Fluids are usually encouraged prior to administration, and the bladder is emptied frequently to prevent hematuria. Measuring intake and output should be done routinely on all clients and is not specific to managing this complication.

*correct>2, 4 Studies have shown that simply rinsing the mouth with water decreases the onset of stomatitis in chemotherapy patients. Alcohol-based mouthwash would be avoided as it is drying to the oral mucous membranes. A stiff toothbrush may cause the gums to bleed. Should oral lesions be present, acidic foods and liquids will increase discomfort. Drinking through a straw and pain management will provide comfort for the child, as will using swabs for mouth care.*correct>2 Recall that neutrophils are granulocytes. The medication that would increase the neutrophil count is G-CSF (granulocyte colony-stimulating factor). Zidovudine is an antiviral medication and would be useful if the client had a viral infection. Raloxifene is a selective estrogen receptor modulator that is used to reduce bone resorption in post-menopausal women with or at risk for osteoporosis. Toremifene is an antiestrogen similar to tamoxifen (Nolvadex) that is used to treat metastatic breast cancer in post-menopausal women.

*correct>3Immunizations should be withheld during leukemia exacerbations, because the immune system is compromised, and the client cannot manage an appropriate response to the immunization. There is no need to place the client in isolation without added evidence of immunosuppression (option 1). Options 2 and 4 are irrelevant to the issue of the question

*2 Chronic leukemia progresses over a period of years rather than weeks. It occurs primarily between ages of 50 and 70*2 Leukemia is a result of erratic production of white blood cells by the bone marrow, which replace normal marrow components. It can arise from both a lymphatic and a myelocytic etiology. White blood cells are often immature and incapable of performing their expected function(s).**3 Immunizations should be withheld during leukemia exacerbations because the immune system is compromised and the client cannot manage an appropriate response to the immunization. There is no need to place the client in isolation without added evidence of immunosuppression (option 1). Options 2 and 4 are irrelevant to the issue of the question.*3 FFP is derived from one unit of whole blood and contains the clotting factors that the client needs plus fibrinogen. Option 1 is incorrect because even though whole blood contains some clotting factors, it is deficient in others and is indicated for significant acute blood loss (which is not the client's problem). Option 2 is incorrect because improved oxygen-carrying capacity (rendered by the infusion of PRBCs) is something the client does not need. Hemophilia is a clotting disorder that requires clotting factor replacement. Option 4 is incorrect, because albumin contains no clotting factors.

*Hemophilia is a group of hereditary clotting factor disorders characterized by prolonged coagulation time that results in prolonged and sometimes excessive bleeding. It is an X-linked recessive characteristic transmitted by female carriers, displayed almost exclusively in males often resulting in spontaneous bleeding into the joints resulting in hemoarthrosis with joint deformity and potential disability. Option 3 is a specific form of hemophilia, von Willebrand's Disease. Option 4 is pernicious anemia.*2 Factor VIII concentrate is a blood product. Fluid volume overload is an unlikely concern, as the factor will be given in a comparatively small volume of fluid. There is no greater a chance of emboli formation with administration of factor than with any other IV preparation. Concern as to contracting AIDS from administration of a blood product is a long-term concern related to multiple administrations. It is not a concern during the actual administration of the factor.

*correct>3 All of the injuries require nursing care; however, the child with the head injury has a potentially life-threatening injury

*4 It is not possible for parents of a hemophiliac to prevent a bleeding episode, no matter how careful they are. The nurse should reinforce this information along with methods for decreasing the chance of an injury that will lead to a bleeding episode. The other statements all indicate an appropriate understanding of hemophilia.

*Nursing Considerations*4 A client with thrombocytopenia should avoid activities that could result in injury and bleeding. For this reason, the client should avoid trimming the nails with a nail clipper, and should use a nail file instead. Option 3 indicates the safe method for shaving; straight razors should be avoided, but electric razors are acceptable. Not all clients with thrombocytopenia also experience concurrent leukopenia. Options 1 and 2 should be avoided to minimize risk of infection, or when the client's white blood cell count is low

*4, 5 Thrombocytopenia refers to a decrease in platelets. Preventing falls and bruises would be appropriate for an individual with platelet deficiencies. Fresh flowers may contain molds and fungus that can lead to infection and would be a concern for a child with neutropenia. Providing foods high in iron would be appropriate to restore red blood cells. Limiting contact with the child could affect his or her body image and self-esteem. Contact is acceptable as long as the individual is not infectious.

*correct>4 Thrombocytopenia is a decrease in circulating platelets leading to a prolonged bleeding time and disruption of the primary homeostatic plug. While a Vitamin K deficiency can lead to a prolonged prothrombin time, the patient does not exhibit petechiae and ecchymosis.

*3 ITP is an autoimmune disorder in which the body destroys platelets. In order to decrease the immune response, corticosteroids are usually administered. Platelet transfusions may be given in acute bleeding, however the body will actively destroy these as well.

*1 Cryoprecipitate, a product derived from plasma, contains von Willebrand's clotting factor. Packed red blood cells, granulocytes, and platelets do not contain von Willebrand's clotting factor (Ignatavicius and Workman, 2002).

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