NCLEX Deck

Hematology

NCLEX Clinical Study Booklet · 11 cards

Contents

Iron Deficiency Anemia.

Anemia
What is Iron Deficiency Anemia?
  • Insufficient iron → decreased hemoglobin.
  • The most common anemia.
What are the Causes / Risk Factors?
  • Chronic blood loss (GI, menstrual)
  • Inadequate intake
  • Malabsorption
  • Pregnancy
What are the Symptoms?
  • Fatigue, weakness, pallor
  • Tachycardia, dyspnea on exertion
  • Brittle, spoon-shaped nails (koilonychia)
  • Pica
  • Glossitis
How is it Diagnosed?
  • ↓Hgb/Hct
  • ↓ferritin, ↓serum iron
  • Microcytic, hypochromic RBCs
What is the Treatment?
  • Oral iron (with vitamin C, empty stomach)
  • Iron-rich foods (red meat, leafy greens)
  • IV iron if needed
  • Expect dark stools; use a straw for liquid iron
NCLEX TipTake oral iron with vitamin C on an empty stomach for absorption. Expect dark stools; use a straw for liquid iron.
© NCLEX Deck1 / 11

Pernicious / B12 Anemia.

Anemia
What is Pernicious / B12 Anemia?
  • Vitamin B12 deficiency (often lack of intrinsic factor).
  • Megaloblastic anemia with neuro symptoms.
What are the Causes / Risk Factors?
  • Lack of intrinsic factor (autoimmune, gastrectomy)
  • Poor intake (vegan diet)
  • Malabsorption (Crohn's)
What are the Symptoms?
  • Fatigue, pallor
  • Glossitis (beefy red tongue)
  • NEURO: paresthesias, ataxia, poor balance
  • Cognitive changes
How is it Diagnosed?
  • ↓B12
  • Macrocytic RBCs
  • Schilling test (historical)
What is the Treatment?
  • Lifelong IM B12 injections (if intrinsic factor lacking)
  • B12-rich foods / supplements
  • Safety (neuro deficits)
NCLEX TipPernicious anemia from lack of intrinsic factor needs lifelong IM B12 — oral won't be absorbed. Watch neuro symptoms.
© NCLEX Deck2 / 11

Aplastic Anemia.

Anemia
What is Aplastic Anemia?
  • Bone marrow failure → pancytopenia (↓RBCs, WBCs, platelets).
  • All cell lines are low.
What are the Causes / Risk Factors?
  • Idiopathic (autoimmune)
  • Radiation / chemo, toxins
  • Certain drugs
  • Viral infections
What are the Symptoms?
  • Fatigue, pallor (anemia)
  • Infections (↓WBC)
  • Bleeding, bruising, petechiae (↓platelets)
How is it Diagnosed?
  • Pancytopenia on CBC
  • Bone marrow biopsy (hypocellular)
What is the Treatment?
  • Remove cause; transfusions
  • Immunosuppressants
  • Bone marrow transplant
  • Neutropenic AND bleeding precautions
NCLEX TipAplastic anemia = pancytopenia. Institute neutropenic precautions (infection) AND bleeding precautions (low platelets).
© NCLEX Deck3 / 11

Sickle Cell Anemia.

Anemia
What is Sickle Cell Anemia?
  • Inherited RBC disorder — cells sickle under stress.
  • Sickled cells cause vaso-occlusive crises.
What are the Causes / Risk Factors?
  • Autosomal recessive (HgbS)
  • Crises triggered by hypoxia, dehydration, infection, stress, cold, high altitude
What are the Symptoms?
  • Severe pain (vaso-occlusive crisis)
  • Swelling of hands/feet
  • Fatigue, jaundice
  • Splenomegaly
  • Delayed growth, frequent infections
How is it Diagnosed?
  • Hemoglobin electrophoresis
  • Sickled RBCs on smear
  • ↓Hgb
What is the Treatment?
  • Crisis: HYDRATION (IV fluids), OXYGEN, pain control (opioids), rest, warmth
  • Hydroxyurea (reduces crises)
  • Avoid triggers (dehydration, hypoxia, cold)
  • Folic acid; vaccines/prophylaxis
NCLEX TipSickle cell crisis care = Hydration, Oxygen, Pain control, and rest. Avoid triggers: dehydration, hypoxia, cold, infection.
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Leukemia.

Cancer
What is Leukemia?
  • Cancer of blood-forming tissue — overproduction of abnormal WBCs.
  • Crowds out normal cells.
What are the Causes / Risk Factors?
  • Genetic factors
  • Radiation / chemical exposure
  • Prior chemotherapy
  • Down syndrome
What are the Symptoms?
  • Fatigue, pallor (anemia)
  • Frequent infections, fever
  • Bleeding, bruising, petechiae (↓platelets)
  • Bone pain, lymphadenopathy
  • Weight loss
How is it Diagnosed?
  • CBC (abnormal WBCs)
  • Bone marrow biopsy (definitive)
What is the Treatment?
  • Chemotherapy, radiation
  • Bone marrow / stem cell transplant
  • NEUTROPENIC precautions (infection = #1 cause of death)
  • Bleeding precautions; transfusions
NCLEX TipInfection is the leading cause of death in leukemia — strict neutropenic precautions. Also watch bleeding from low platelets.
© NCLEX Deck5 / 11

Lymphoma.

Cancer
What is Lymphoma?
  • Cancer of the lymphatic system.
  • Hodgkin's (Reed-Sternberg cells) vs Non-Hodgkin's.
What are the Causes / Risk Factors?
  • Epstein-Barr virus (Hodgkin's)
  • Immunosuppression
  • Autoimmune disease
What are the Symptoms?
  • Painless lymph node enlargement (neck)
  • Fever, night sweats, weight loss (B symptoms)
  • Fatigue, pruritus
  • Pain with alcohol (Hodgkin's)
How is it Diagnosed?
  • Lymph node biopsy (Reed-Sternberg = Hodgkin's)
  • CT / PET staging
  • CBC
What is the Treatment?
  • Chemotherapy, radiation
  • Immunotherapy
  • Neutropenic precautions during treatment
  • Manage side effects; support
NCLEX TipPainless lymph node swelling + fever, night sweats, weight loss (B symptoms). Reed-Sternberg cells confirm Hodgkin's.
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Thrombocytopenia / ITP.

Bleeding
What is Thrombocytopenia / ITP?
  • Low platelet count → bleeding risk.
  • ITP = immune destruction of platelets.
What are the Causes / Risk Factors?
  • Immune (ITP)
  • Chemo, radiation
  • Heparin (HIT)
  • Leukemia, DIC, splenomegaly
What are the Symptoms?
  • Petechiae, purpura, ecchymoses
  • Bleeding gums, epistaxis
  • Prolonged bleeding
  • Heavy menses
  • Internal bleeding risk (platelets <20k)
How is it Diagnosed?
  • ↓platelet count
  • CBC; bone marrow if needed
What is the Treatment?
  • Corticosteroids, IVIG (ITP)
  • Platelet transfusion (severe)
  • BLEEDING precautions (soft toothbrush, electric razor, no IM injections)
  • Avoid aspirin / NSAIDs
NCLEX TipBleeding precautions: soft toothbrush, electric razor, no IM injections, avoid aspirin/NSAIDs. Watch for internal bleeding.
© NCLEX Deck7 / 11

Hemophilia.

Bleeding
What is Hemophilia?
  • Inherited clotting factor deficiency (A = factor VIII, B = factor IX).
  • X-linked; primarily affects males.
What are the Causes / Risk Factors?
  • X-linked recessive inheritance
  • Factor VIII (A) or IX (B) deficiency
What are the Symptoms?
  • Prolonged bleeding
  • Hemarthrosis (joint bleeding → damage)
  • Easy bruising
  • Bleeding after minor injury / surgery
How is it Diagnosed?
  • Prolonged PTT
  • ↓clotting factor levels
  • Genetic testing
What is the Treatment?
  • Replace the deficient factor (VIII or IX)
  • RICE for joint bleeds; avoid aspirin/NSAIDs
  • No contact sports; safety
  • Dental / injury precautions
NCLEX TipHemophilia: replace the missing clotting factor. Avoid aspirin/NSAIDs and IM injections; protect joints from bleeds.
© NCLEX Deck8 / 11

DIC.

Emergency
What is DIC?
  • Disseminated Intravascular Coagulation — widespread clotting THEN bleeding.
  • Clotting factors and platelets are consumed.
What are the Causes / Risk Factors?
  • Sepsis (common)
  • Obstetric complications
  • Trauma, burns
  • Malignancy, shock
What are the Symptoms?
  • Simultaneous clotting AND bleeding
  • Bleeding from multiple sites (IV, gums, oozing)
  • Petechiae, purpura
  • Organ ischemia (microclots)
  • Shock
How is it Diagnosed?
  • ↓platelets, ↓fibrinogen
  • ↑PT/PTT, ↑D-dimer
  • Schistocytes on smear
What is the Treatment?
  • Treat the underlying cause (priority)
  • Replace platelets / factors (FFP, cryoprecipitate)
  • Heparin (controversial, early)
  • Monitor bleeding, perfusion, organ function
NCLEX TipDIC = clotting and bleeding at the same time. The priority is treating the underlying cause (often sepsis).
© NCLEX Deck9 / 11

Blood Transfusion.

Transfusion
Before & During
  • Verify order, consent, and type & crossmatch
  • TWO nurses verify patient & blood at the bedside
  • Use 0.9% NS only; 18–20 g IV; blood filter tubing
  • Stay with the patient the first 15 min; baseline vitals
Transfusion Reactions
  • Hemolytic (ABO mismatch): fever, chills, flank/back pain, hypotension — STOP
  • Febrile: fever, chills
  • Allergic: hives/itching; anaphylaxis: wheezing, hypotension
  • TACO (overload): dyspnea, crackles, HTN
If a Reaction Occurs
  • STOP the transfusion immediately
  • Keep the line open with 0.9% NS (new tubing)
  • Notify provider & blood bank; recheck IDs
  • Send the blood bag & a sample; treat symptoms
NCLEX TipAny transfusion reaction → STOP the blood first, then run normal saline through new tubing and notify the provider/blood bank.
© NCLEX Deck10 / 11

Polycythemia Vera.

Chronic
What is Polycythemia Vera?
  • Overproduction of RBCs → thick, viscous blood.
  • High clot risk.
What are the Causes / Risk Factors?
  • Bone marrow disorder (JAK2 mutation)
  • Chronic hypoxia (secondary)
What are the Symptoms?
  • Ruddy (reddish) complexion
  • Headache, dizziness
  • Hypertension
  • Pruritus (after a warm bath)
  • Thrombosis risk (clots)
  • Splenomegaly
How is it Diagnosed?
  • ↑RBC, Hgb, Hct
  • ↑blood viscosity
  • JAK2 testing
What is the Treatment?
  • Therapeutic phlebotomy (remove blood)
  • ↑fluids; avoid dehydration
  • Anticoagulants / aspirin (clot prevention)
  • Monitor for thrombosis / bleeding
NCLEX TipPolycythemia vera = too many RBCs → clot risk. Phlebotomy removes blood; push fluids and prevent clots.
© NCLEX Deck11 / 11
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