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MEDICATION-INDUCED BLOOD DYSCRASIAS: Diagnosis, Treatment And Prevention Jassin M. Jouria, MD Dr. Jassin M. Jouria is a medical doctor, professor of academic medicine, and medical author. He graduated from Ross University School of Medicine and has completed his clinical clerkship training in various teaching hospitals throughout New York, including King’s County Hospital Center and Brookdale Medical Center, among others. Dr. Jouria has passed all USMLE medical board exams, and has served as a test prep tutor and instructor for Kaplan. He has developed several medical courses and curricula for a variety of educational institutions. Dr. Jouria has also served on multiple levels in the academic field including faculty member and Department Chair. Dr. Jouria continues to serves as a Subject Matter Expert for several continuing education organizations covering multiple basic medical sciences. He has also developed several continuing medical education courses covering various topics in clinical medicine. Recently, Dr. Jouria has been contracted by the University of Miami/Jackson Memorial Hospital’s Department of Surgery to develop an e-module training series for trauma patient management. Dr. Jouria is currently authoring an academic textbook on Human Anatomy & Physiology. ABSTRACT Although drug-induced hematologic disorders are less common than other types of adverse reactions, they are associated with significant morbidity and mortality. Some agents, such as hemolytics, cause predictable hematologic disease, but others induce idiosyncratic reactions not directly related to the drug’s pharmacology. The most important part of managing hematologic disorders is the prompt recognition that a problem exists. The main mechanisms to manage hematologic disorders include vigilance to observe signs and symptoms indicating a blood disorder and patient education of the warning symptoms to alert them of the need to report a condition to their primary care provider or an emergency health team. nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com 1 Continuing Nursing Education Course Director & Planners William A. Cook, PhD, Director, Douglas Lawrence, MA, Webmaster, Susan DePasquale, MSN, FPMHNP-BC, Lead Nurse Planner Policy Statement This activity has been planned and implemented in accordance with the policies of NurseCe4Less.com and the continuing nursing education requirements of the American Nurses Credentialing Center's Commission on Accreditation for registered nurses. It is the policy of NurseCe4Less.com to ensure objectivity, transparency, and best practice in clinical education for all continuing nursing education (CNE) activities. Continuing Education Credit Designation This educational activity is credited for 4 hours. Nurses may only claim credit commensurate with the credit awarded for completion of this course activity. Pharmacology Content is 0.5 hour (30 minutes). Statement of Learning Need Clinicians need to know how to manage the risk of hematologic disorders induced by medication. Understanding the risk, recognizing the signs and symptoms that may indicate a blood disorder, and being skilled in how to educate the patient are essential knowledge needs of clinicians to ensure patients, caregivers and health teams are able to recognize the warning symptoms of hematologic disorders. nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com 2 Course Purpose To provide nurses and health team associates with knowledge about medication-induced dyscrasias to better recognize, treat, and educate patients, caregivers and other health team members on acute and long-term management. Target Audience Advanced Practice Registered Nurses and Registered Nurses (Interdisciplinary Health Team Members, including Vocational Nurses and Medical Assistants may obtain a Certificate of Completion) Course Author & Director Disclosures Jassin M. Jouria, MD, William S. Cook, PhD, Douglas Lawrence, MA Susan DePasquale, MSN, FPMHNP-BC – all have no disclosures Acknowledgement of Commercial Support There is no commercial support for this course. Activity Review Information Reviewed by Susan DePasquale, MSN, FPMHNP-BC Release Date: 5/21/2016 Termination Date: 5/21/2019 Please take time to complete a self-assessment of knowledge, on page 4, sample questions before reading the article. Opportunity to complete a self-assessment of knowledge learned will be provided at the end of the course. nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com 3 1. The complete blood count (CBC) is sometimes referred to as a. the cellular components test (CCT). b. the peripheral blood count (PBC). c. the EDTA test. d. the three-phase test. 2. Microscopic evaluation of a blood smear is best when the slide is prepared a. indefinitely if properly stored. b. within 8 hours of collection. c. within 3 hours of collection. d. up to 24 hours after collection. 3. True or False: Freezing of blood samples is essential to preserving the samples for a valid, complete blood count (CBC) test. a. True b. False 4. The complete blood count (CBC) analyzes a. concentration of leukocytes (white blood cells). b. volume of RBCs (red blood cells). c. weight of RBCs (red blood cells). d. All of the above 5. ___________________ provides the best morphologic preservation of blood cells and prevents coagulation of the blood specimen. a. Cold agglutination b. Dipotassium (K2) EDTA c. IgM antibodies d. Romanowsky stains nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com 4 Introduction Certain medication, such as hemolytics, cause predictable hematologic disease, but others can induce idiosyncratic reactions not directly related to the drug’s pharmacology. In the first course of this two part series, it was emphasized that the most important part of management of a hematologic disorder is the prompt recognition when a problem exists. This is done by two mechanisms: firstly, vigilance for signs and symptoms that may indicate a blood disorder; and, secondly, patient education about the warning symptoms that should alert them to the need to urgently contact their medical provider or emergency services if a prompt medical appointment is not possible. This second course focuses more specifically on the identification and management of drug-induced blood dyscrasias, including prevention through vigilant monitoring, hygiene and vitamin intake. Diagnosis Of Blood Dyscrasia: The Complete Blood Count (CBC) One of the most common tests to identify and monitor a condition of blood dyscrasia is the complete blood count (CBC) with differential. It is one of the most common laboratory tests performed, which informs clinicians about blood cell production and the ability of the red blood cells (RBC) to carry oxygen and of the white blood cells (WBC) to fight infection. Hematology medicine (concerned with the diagnosis and treatment of blood health and disease) laboratory testing helps to identify disease states that may be associated side effects of certain drugs that cause blood dyscrasias. The performance of a complete blood count (CBC) has three phases: pre- examination (before testing), examination (testing), and post-examination nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com 5 (reporting). The pre-examination phase includes the proper identification of the patient and proper collection and handling of the specimen. The specimen is analyzed in the examination phase. The CBC (sometimes referred to as the peripheral blood count (PBC)) is a primary screening test that provides information regarding the cellular components of the blood as they circulate in the peripheral blood. The concentration of leukocytes (white blood cell (WBC)), erythrocytes (red blood cell (RBC)), and platelets as well as a categorization of the different WBC subsets is included. Additional information regarding RBCs is also integrated into the CBC and includes, at minimum, the concentration of hemoglobin and the packed cell volume of RBCs, called the hematocrit. Finally, a CBC can also provide what are known as the RBC indices that are used to depict the volume and the total weight of each RBC and concentration of hemoglobin in it. The CBC can be determined by automated and/or manual methods. The post-examination phase includes reporting and interpreting the data. Based on the information collected from the CBC, the laboratory professional can provide diagnostic criteria or meaningful recommendations for any follow-up testing (reflex testing) to the medical provider to support quality patient care. The CBC report can often be submitted for medical review in an emergency situation within minutes; however, manual differentials by a trained laboratory professional will take longer. This section highlights the varied phases of the CBC test and final report for medical review, interpretation and diagnosis of a blood disorder.3,49,62-68 nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com 6 Phases of the CBC Pre-examination Patient identification Specimen collection and handling Examination Automated results Evaluation and analysis of peripheral blood smear Post-examination Interpretation of data Reporting results Pre-Examination Phase of the CBC The pre-examination phase of the CBC encompasses patient identification, blood collection, and specimen handling. Briefly, patient identification includes the patient’s name and a second identifier that can be a hospital
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