Caring for Clients With Hematologic and Lymphatic Disorders

1. Adult nursing Caring for Clients With Hematologic and Lymphatic Disorders

2. Anemia • Hemoglobin concentration or number of circulating RBCs decreased • Caused by • Impaired RBC formation • Excessive loss or destruction of RBCs

4. Anemia - Pathophysiology • Reduces the oxygen-carrying capacity of the blood • Causes tissue hypoxia • Body attempts to restore oxygen delivery

5. Anemia - Manifestations • Pallor • Angina • Fatigue • Dyspnea on exertion • Night cramps • Bone pain • Headache • Dizziness • Dim vision

6. Blood Loss Anemia • Acute or chronic bleeding • Both lead to anemia • RBCs normal but reduced in number

7. Nutritional Anemia • Lack of nutrients for RBC formation or development • Iron deficiency • Cheilosis (cracks at corners of mouth) • Smooth, sore tongue • Pica • Vitamin B12 • Pernicious anemia • Paresthesias

8. Nutritional Anemia (continued) • Folic acid • Chronic malnourishment • Glossitis • Cheilosis • Diarrhea

9. Anemia of Chronic Disease • Seen in AIDs, rheumatoid arthritis, inflammatory bowel disease (IBD), chronic hepatitis, chronic renal failure (CRF) • Severity depends on the severity of underlying disease • Manifestations similar to iron deficiency anemia

10. Hemolytic Anemias • Premature destruction of RBCs • Intrinsic or acquired causes • Sickle cell disorders • Abnormal Hgb, changes shape • Intense pain, chest, back, joints

12. Sickle Cell Anemia

13. Thallassemia • Inherited; caused by abnormal Hgb synthesis • Liver and spleen enlarged • Target cells

14. Acquired Hemolytic Anemias • Damage by outside factors • Mechanical trauma • Antibody reactions • Immune responses • Drugs, toxins, chemical agents, venoms

15. Aplastic Anemia • Bone marrow fails to produce RBCs • Cause unknown • Pancytopenia

16. Myelodysplastic Syndrome • Group of stem cell disorders • Seen in older adults • Anemia, enlarged spleen

17. Polycythemia • Erythrocytosis • Abnormally high RBC count, high Hct • Blood sticky • Secondary form is the most common • Develops due to chronic hypoxemia or excess erythropoietin

18. Polycythemia Vera (continued) • Primary type • Production of all blood cells increased • Cause unknown • Insidious onset • Gangrene complication

19. Leukemia • Group of malignant disorders of WBCs • Greater numbers of WBCs • Cause of most unknown • Classified by onset and duration: acute or chronic • Four types

21. Leukemia - Pathophysiology • Malignant transformation of a single stem cell • Cells proliferate slowly, nonfunctional WBCs • Bone marrow filled with leukemic cells • Leave bone marrow and infiltrate other tissues • Death from hemorrhage or infection

22. Leukemia - Manifestations • Anemia • Infection • Bleeding

23. The multisystem effects of leukemia

24. Malignant Lymphoma Cancer of lymph tissue Classified as Hodgkin or non-Hodgkin

25. Hodgkin Disease Most curable Painless progressive enlargement of one or more lymph nodes Reed-Sternberg cells Cause unknown

26. Non-Hodgkin Lymphoma More common Multiple lymph nodes involved

27. Multiple Myeloma Myeloma cells replace bone marrow, infiltrate bone Bone weakened, pathologic fractures Bone/back pain most common symptoms Kidney damage

28. Neutropenia • Disease of number of circulating neutrophils • Usually secondary to infection, hematologic disease, chronic disease, chemotherapy • Severe form is called agranulocytosis • Can result in impaired WBC formation or increased WBC destruction • Protective measures are required

29. Neutropenia - Manifestations • Fatigue • Weakness • Sore throat • Stomatitis • Dyphagia • Fever • Chills

30. Thrombocytopenia Platelet count less than 100,000 per mL Common cause of abnormal bleeding Idiopathic thrombocytopenia purpura most common form Platelets destroy more rapidly than normal Autoimmune disorder

31. Thrombocytopenia Manifestations Purpura Ecchymosis Petechiae Epistaxis Menorrhagia Hematuria

32. Hemophilia Group of hereditary clotting factor deficiencies Hemophilia A Most common type Deficiency in Factor VIII

33. Hemophilia (continued) Hemophilia B (Christmas disease) Less common Deficiency in Factor IX Transmitted from mother to son Sex-linked recessive disorder on X chromosome

34. The inheritance pattern for hemophilia A and B. Both are X-linked recessive disorders; females may carry the trait, but only males develop the disorder.

35. Hemophilia - Manifestations Hemorrhages into body tissues

36. Disseminated Intravascular Coagulation (DIC) Simultaneous blood clotting and hemorrhage Intrinsic and/or extrinsic clotting cascades activated Widespread clotting of small vessels Clotting factors depleted; leads to bleeding

37. DIC - Manifestations Bleeding most obvious Tachycardia, hypotension Mottling Abdominal distention Decreased LOC

39. Lymphangitis/Lymphedema Lymphangitis Inflammation of lymph vessel Lymphedema Obstructed lymph vessel

40. Severe lymphedema of the lower extremity. (Source: NMSB, Custom Medical Stock Photos, Inc.)

41. Infectious Mononucleosis Acute infection caused by Epstein–Barr virus Benign and self-limiting Kissing disease

42. Infectious Mononucleosis - Manifestations Headache Fatigue Fever Sore throat Enlarged and painful lymph nodes Enlarged spleen

43. Anemia – Diagnostic Tests • CBC • Iron levels • Serum ferritin • Sickle cell screening • Hemoglobin electrophoresis • Schilling’s test • Bone marrow aspiration

44. Leukemia – Diagnostic Tests • CBC with differential and platelet count • Bone marrow

45. Multiple Myeloma – Diagnostic Tests Urine samples CBC Bone marrow Bone x-rays

46. Neutropenia - Diagnosis • WBC count • Neutophil count less than 1500 cells/mm3 • May be less than 500 cells/mm3 in agranulocytosis

47. Thrombocytopenia – Diagnostic Tests CBC, platelet count Bone marrow Antinuclear antibodies

48. Hemophilia – Diagnostic Tests Platelet count Coagulation studies Clotting factors

49. DIC – Tests Clotting studies

50. Infectious Mononucleosis – Diagnostic Tests Increased lymphocytes and monocytes Increased WBC count Low platelets