04.01 Hematology for CCRN Review

Nursing Points

General

1. Hematology
   1. Disseminated intravascular coagulation (DIC)
      1. Clotting cascade
         1. Intrinsic -> Injury of endothelium in vessels
         2. Extrinsic -> Injury of tissue/muscle
         3. Prothrombin -> thrombin
         4. Fibrinogen (level is low) -> fibrin (split product level high)
         5. Plasmin -> clot -> FSP
         6. PT & PTT high
      2. Treatment
         1. Heparin (EXCEPT in OB emergencies)
            1. Halts the intrinsic pathway
            2. Prevents thrombin
            3. Prevents fibrin
            4. Stops current thrombin
         2. FFP
         3. Treat cause
   2. Heparin-induced thrombocytopenia
      1. Person doesn’t have anti-thrombin 3 (opposite effect occurs due to issues in metabolism)
      2. Blood clots
      3. Treatment -> Argatrobon (ACOVA)
         1. Anti-thrombin 3 isn’t needed to work
   3. Idiopathic (Immune) Thrombocytopenic Purpura
      1. Low platelets from destruction by antibodies
      2. Causes
         1. Bone marrow issue
         2. Platelets stuck in spleen
         3. Something causing platelet breakdown
            1. HIV
            2. Medications
               1. Heparin
               2. Quinidine
               3. Oral diabetic drugs
            3. DIC
            4. Septicemia
      3. Symptoms
         1. < 50,000 platelets
         2. Fibrin split product 0
         3. Low hemoglobin and hematocrit
         4. Pallor
         5. Bleeding
         6. Skin changes
            1. Petechiae
            2. Purpura
            3. Bruising