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Nursing management of patients with hematologic dysfunction. Nursing 210 Fluid and Cells. Laurie Brown RN, MSN, MPA-HA, CCRN. Development of Blood Cells. Hemoglobin and Hematacrit. Hb: Women: 12-16 Men: 13.5-18. Hct: Women: 38-47% Men: 40-54%. Complete Blood Count.

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Nursing 210 Fluid and Cells

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Nursing 210 fluid and cells

Nursing management of patients with hematologic dysfunction

Nursing 210

Fluid and Cells

Laurie Brown RN, MSN, MPA-HA, CCRN

Nursing 210 fluid and cells

Development of Blood Cells

Hemoglobin and hematacrit

Hemoglobin and Hematacrit

Hb: Women: 12-16

Men: 13.5-18

Hct: Women: 38-47%

Men: 40-54%

Complete blood count

Complete Blood Count

White Blood Cells (WBC) 5,000-10,000

Wbc differential












Nursing 210 fluid and cells


Platelet Count


Nursing 210 fluid and cells

Red Cells

  • Mean Corpuscular Hemoglobin (MCH)

  • Mean Corpuscular Volume (MCV)

  • Mean Corpuscular Hemoglobin Concentration (MCHC)



  • Extrinsic

  • Intrinsic

Nursing 210 fluid and cells





Vitamin K

Protamine sulfate

Drugs impairing the hematologic system

Drugs Impairing the Hematologic System

  • Drugs causing bone marrow suppression

  • Drugs causing hemolysis

  • Drugs that disrupt platelet action

  • Drugs that disrupt clotting action



  • “Can Not Make”

  • “Lost”

  • “Destroyed”


Iron Deficiency

Pernicious Anemia

Folic Acid Deficiency


Chronic loss

Sickle Cell

Infectious Agents


Aplastic Anemia

G6PD Deficiency


Sickle cell anemia

Sickle Cell Anemia

  • Pain Control

  • Sickle cell crisis

  • Rational for orders

  • Nursing orders

Pernicious anemia

Pernicious Anemia

  • Vitamin B 12

  • Intrinsic Factor

  • Cells mutate and become large

  • Development of Neurological problems

Clotting problems

Clotting Problems

  • Thrombocytopenia

  • Hemophilia

  • Von Willebrand

  • Disseminated Intravascular Coagulation (DIC)

Nursing 210 fluid and cells


“Imbalance between the process of coagulation and anticoagulation”

Nursing 210 fluid and cells


Heparin administration

Heparin Administration

  • Heparin loading dose

  • Initial Maintenance Infusion

  • Dosage calculation often by patients weight

Transfusion administration


Lab values

Drs order verify

Pt assessment

IV site assessment


Verify with 2nd RN

Monitor VS

Remain with the patient


Nursing 210 fluid and cells

  • Automatic IV infuser pump

  • Flow rate calculation

  • Blood/Blood product w/tag

  • 150 cc NS

  • Blood Administration Set

  • Gloves

Blood bank

Blood Bank

  • Patient name and I.D. number

  • Unit number and ABO/Rh type on bag with blood bag compatibility tag & bag unit/type

  • Verify expiration date on blood bag

Autologous blood transfusions

Autologous Blood Transfusions

  • Preoperative autologous blood donation

  • Acute normovolemic hemodilution

  • Intraoperative autologous transfusion

  • Postoperative blood salvage

Characteristics of normal cells

Characteristics of Normal Cells

  • Limited Cell Division

  • Specific Morphology

  • Small Nuclear-Cytoplasmic Ratio

  • Perform Specific Differentiated Functions

  • Adhere tightly together…

  • Are nonmigratory

  • Grow in an orderly and well differentiated manner

  • Are contact inhibited

Characteristics of malignant cells

Characteristics of Malignant Cells

  • Demonstrate rapid or continuous cellular division.

  • Show anaplastic morphology

  • Have alargenuclear-cytoplasmic ratio

  • Lose some or all differentiated functions

  • Adhere loosely together

  • Are able to migrate

  • Grow by invasion

  • Are not contact-inhibited



  • AML - Acute Myelogenous

  • ALL - Acute Lymphocytic

  • CML - Chronic Myelogenous

  • CLL - Chronic Lymphocytic

Fab leukemia classification

FAB Leukemia Classification

  • French American British Classification

  • Historically distinguishing AML from ALL was a major clinical problem

  • Chemotherapy dependent on tissue type

Acute leukemia nccn guidelines

Acute Leukemia NCCN Guidelines

  • National Comprehensive Cancer Network (NCCN) has issued guidelines for treatment of many cancers including Leukemia as well as other hematological malignancies

Bone marrow aspiration

Bone Marrow Aspiration

  • Bone marrow biopsy

  • Bone marrow aspiration



  • Hodgkin’s lymphoma

  • Non-Hodgkin’s lymphoma

Multiple myeloma

Multiple Myeloma

  • Gammopathy

  • “M” Protein

    • called a tumor marker

History of myeloma

History of Myeloma

  • Skeletal evidence of myeloma obtained from Egyptian mummies

  • First case described in 1844

  • 1845 Dr Henry Bence Jones detected heat properties of urinary light chains

  • 1929 Bone marrow aspiration

  • 1937 serum protein electrophoresis

  • 1960 Alkeran and prednisone- first treatment

What is multiple myeloma

What is Multiple Myeloma?

  • A cancer of the bone marrow

    • The location where cells are produced

  • The affected cells are plasma cells

  • Plasma cells produce antibodies (proteins that fight off infection)

To many harmful plasma cells

To Many Harmful Plasma Cells

  • Abnormal Plasma Cells are called Myeloma Cells and develop without warning

  • Myeloma cells collect in bones and cause “soft spots” where the cell is damaged

Effects of the blood

Normal cells are not being produced in the bone marrow

Bones are damaged

Bone demineralization (soft spots)

Effects of the blood

Symptomatic multiple myeloma

Symptomatic Multiple Myeloma

  • Calcium

  • Renal

  • Anemia

  • Bone

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