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HEMATOLOGY . MCC NURSING BY: DIANA BLUM MSN. Blood is a type of connective tissue Transports nutrition Transports oxygen Transports hormones Immunological aspects also important Critical to body defense Maintains temperature Controls PH Removes toxins Regulates electrolytes. Anatomy .

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Hematology
HEMATOLOGY

MCC NURSING

BY: DIANA BLUM MSN


Anatomy

  • Blood is a type of connective tissue

    • Transports nutrition

    • Transports oxygen

    • Transports hormones

  • Immunological aspects also important

    • Critical to body defense

    • Maintains temperature

    • Controls PH

    • Removes toxins

    • Regulates electrolytes

Anatomy



Cell types page 1991 94

  • Plasma: straw colored liquid that suspends blood cells

  • Leukocyte: warrior cell that fights infection and invasion.

  • Reticulocyte: immature RBC

  • WBC: another name for a leukocyte

  • RBC: gives blood it color. Transports oxygen to cell and co2 to lungs

  • Erythrocyte: another name for RBC

  • Platelet: found in plasma. Works with clotting factors to help prevent bleeding.

Cell Types (page 1991-94)


Lymphatic system

Lymphatic system


Spleen

  • Stores 20-40 ml blood particles from cells

  • Removes old cells

  • Filters and destroys antigens before they enter system

  • Stores platelets (1/3 of body’s store)

Spleen


Hemostasis page 1995

Hemostasis (page 1995)


Anemia page 2008

  • Hemoglobin is low particles from cells

  • Oxygen is low

  • Not a disease but an underlying condition

  • 2 types: hypoproliferative and hemolytic

    • Hypoproliferative: marrow can’t produce adequate erythrocytes

      • Lack of factors, chemicals, marrow damage

    • Hemolytic: premature destruction of erythrocytes. Leads to tissue hypoxia

      • Abnormality like sickle cell, direct injury

Anemia (page 2008)


Erythropoiesis

Erythropoiesis


Determination between types

  • Based on: particles from cells

    • Marrow ability to respond to decreased erythrocytes

    • Manner of maturity for young erythrocytes

    • The presence or absence of end products of erythrocyte destruction within the circulation

Determination between types


Clinical manifestations pg 2010

  • Rapidity with the anemia has developed particles from cells

  • Duration of anemia

  • Metabolic requirements of patient

  • Other disorders

  • Cardio: tachycardia, hypoxia, MI symptoms

  • Respiratory: SOB in varying degrees

  • Neuro: headache, poor concentration, vertigo, irritibility, confusion

  • Compensation also may occur

Clinical manifestations (pg 2010)


Education

  • Prioritize activities particles from cells

  • Plan rest periods

  • Eats healthy foods rich in iron, vitamins, and proteins

  • Use nutrition supplements as needed

  • Report palpitations, dizziness, dyspnea

  • Monitor vitals

  • Monitor edema

  • Monitor neuro status

  • Safety techniques

Education


Iron deficiency anemia

  • Low RBC particles from cells

  • Low HGB andHCT

  • Low serum Iron level

  • Low ferritin level

  • High TIBC level

  • Results from diet low in iron

  • Results from body not absorbing enough iron from GI tract

    • Not enough hemoglobin made as result

  • s/s: sore tongue, brittle nails, fatigue, pallor, orthostatic changes (in severe cases)

  • Dx: bone marrow aspiration, lab work

  • Tx: iron supplements, iron rich foods (liver, oysters, red meat, fish, dried fruits, legumes, dark green veggies, whole grain breads and cereal)---orange juice or other vitamin C product will enhance iron absorption

    • What is the major side effect of IV iron?

Iron Deficiency Anemia


Anemia and renal disease

  • Pts don’t become severely anemic particles from cellstilcreatinine levels exceed 3mg/100ml

  • Hematocrit decreases

  • Causes:

    • shorted RBC lifespan

    • Deficiency of erythropoietin

    • Long term hemodialysis

  • Tx: monitor serum levels of iron, hematocrit, and vitals

Anemia and Renal Disease


Anemia and chronic disease

Anemia and chronic disease


Aplastic anemia

  • Most cases are idiopathic particles from cells

  • Infection and pregnancy, medication, chemicals or radiation can trigger

    • Airplane glue, arsenic, pestisides

  • Complete failure of the bone marrow

  • Low RBC count

  • Low WBC

  • Low Platelet cts

  • S/S: pallor, fatigue, tachycardia, sob, hypotension, prolonged/spontaneous bleed, frequent infections, purpura, retinal hemorrhages are common

  • Tx: transfusion of RBC and Platelet, antibiotics, corticosteroids, bone marrow transplant, ICU setting, monitor for signs and symptoms of infection and bleeding, neutropenic precautions

Aplastic Anemia


Pernicious anemia

  • Pt does not absorb vitamin B12 from stomach particles from cells

    • Higher incidence of gastric cancer

  • Pt may lack intrinsic factor-essential for b12 absorption

  • Assess hx: gastrectomy, crohn’s, family history,etc.

  • s/s: weakness, sore tongue, numbness of hand and feet

  • Tx: B12 injections monthly, endoscopy q1-2 years---if untreated can develop heart failure and lead to death

    • Monitor oral cavity, and skin. Monitor for jaundice, monitor gait, provide small frequent bland diet

  • Dx: Obtain shilling test

Pernicious Anemia



Folic acid deficiency

  • Folate descent is in green leafy veggies and liver

  • Alcohol increases need for folic acid

  • S/S same as pernicious anemia except no neuro symptoms

  • Dx: folate level

  • Tx: replacements

Folic Acid Deficiency


Sickle cell anemia

  • RBCs normally disc shaped descent

  • In sickle cell they are sickle shaped

  • Easily rupture

  • Obstruct blood flow

  • Genetic in nature

  • Most common in African Americans

  • Sickle cell is recessive (inherit from mom and dad)

  • http://www.youtube.com/watch?v=R4-c3hUhhyc

Sickle cell anemia


Sickle cell crisis

  • 4 descenttypes:

    • sickle crisis: most common---obstructive

    • aplasic crisis---from infection from parvovirus

    • Hyperhemolytic---massive rbc destruction

    • sequestrian crisis---result from other organs pooling sickled cells

      • Spleen is most common

      • Also in liver and lungs

  • S/S: tachycardia, fever, decreased HGB, infiltrates on chest x-ray

  • Pulomary HTN is a symptom that is not usually detected until damage is irreversible

  • Monitor x-rays, CT scan, Echo, HGB level

  • Tx: treat symptoms, Bone marrow transplant, transfusions, Hydroxyurea, Arginine

  • http://www.youtube.com/watch?v=qe59ar-GZmg

Sickle Cell Crisis


Glucose 6 phospate dehydrogenase deficiency

  • This is a deficiency in the gene that is essential for membrane stability

  • Hemolysis only occurs with stressful situations

  • Mostly affects africanamericans, greek or italian decent as well as asians and jewish origins

  • Inherited on x chromosome

  • S/S: asymptomatic, or jaundice, pallor, hemoglobinuria

  • Dx: serum G-6-PD

  • Tx: stop offending med, transfusion, educate about meds to avoid, instruct to wear medic alert bracelet

Glucose -6-Phospate Dehydrogenase Deficiency


Polycythemia vera

  • Too many RBCs produced membrane stability

    • Blood more viscous

  • s/s: headache, dizziness, ringing in the ears, blurred vision, ruddy complexion, HTN, pruritis, gout problems, burning fingers and toes

  • DX: o2 sat, CBC with DIFF

  • Complications: CVA, MI, BLEED issues

  • Tx: hydroxyurea, interferon, plavix, ASA

  • Treat symptoms

  • Teach pt: don’t cross legs, quit smoking, stay active, minimal alcohol, avoid excess iron

  • TX: phlebotomize blood

Polycythemia Vera


Autoimmune hemolytic anemia

  • Enough RBCs made but they are destroyed once they are released into circulation

  • Causes: infection, drug reaction, cancer

  • s/s: pallor, fatigue, tachycardia, sob, hypotension, jaundice, high bilirubin levels

  • Positive direct coombsantiglobulin test

  • Tx: blood transfusions, corticosteroids, spleenectomy

  • Recovery in few days to weeks

Autoimmune Hemolytic Anemia


Leukemia

  • Defect in the WBC stem cell released into circulation

  • Abnormal reproductions

  • Unknown cause, may be from chemical or radiation exposure

  • Symptom onset is abrupt

  • http://www.youtube.com/watch?v=FJOYAaygQFE

Leukemia


Aml acute myeloid leukemia

  • Defective stem cell released into circulation

  • Incidence rises with age 60+

  • Prognosis variable

  • Younger pts may survive 5 years

  • S/S: fever, infection, weakness, fatigue, bleed tendency, pain

  • Dx: no warning, CBC

  • Complications: bleeding (petechiae, ecchymosis), infection, DIC

  • TX: chemo, transfusions, infection treatment, growth factor agents, bone marrow transplant, palliative care

AMLAcute Myeloid Leukemia


  • Uncommon in pts under 20 released into circulation

  • Life expectancy 3-5 years

  • s/s: asymptomatic, dyspnea, mild confusion, enlarged liver, wt loss, anorexia

  • Tx: tyrosine kinase inhibitor, avoid antacids and grapefruit juice, interferon, cytosine, leukopheresis, bone marrow transplant, Gleevac

CML


Acute lymphocytic leukemia all

  • Most common in young kids 4-14 released into circulation

  • Uncommon

  • s/s: decreased cbc counts, pain, enlarged liver, enlarged spleen, headache, vomiting

  • Tx: bone marrow transplant, chemo, corticosteroids

  • Complications: infection

Acute Lymphocytic LeukemiaALL


  • Common in older adults released into circulation

  • Most common form in US and Europe

  • More frequent in men

  • s/s: asymptomatic, lymphadenopathy, pain, hepatomegaly, spleenomegaly, anemia, fevers, drenching sweats, wt loss, infections

  • Tx: treat symptoms, chemo, monoclonal antibodies

CLL


Hodgkins disease

Hodgkins Disease


Non hodgkins lymphoma

  • 6 released into circulationth most common type of cancer and cancer death in US

    • Avg age of dx is 60

  • Stages

    • Low grade

    • Intermediate grade

    • High grade

  • The higher the grade the more aggressive

  • Tx: chemo, radiation, bone marrow transplant, stem cell transplant

  • 5 year survival rate is 52%

Non Hodgkins Lymphoma


Multiple myeloma

  • Cancer of the plasma cells released into circulation

  • Most common over the age of 60

  • No known cause

    • Genetics and radiation exposure play a part

  • s/s: bone pain, hyperuricemia (kidneys), anemia, hypercalcemia, fractures, spinal cord compression, renal failure

  • Diagnosis: radiographs, serum and urine protein electrophoresis, bone marrow biopsy

  • No known cure

  • Tx: chemo and radiation to treat symptoms, vertebroplasty, antiemetics, pain management

Multiple Myeloma


Bleeding disorders
Bleeding disorders released into circulation

http://www.mhhe.com/biosci/esp/2002_general/Esp/folder_structure/tr/m1/s7/trm1s7_3.htm


Thrombocytopenia

  • Too few platelets released into circulation

    • Causes: cancer treatment

  • Too many platelets being destroyed

    • Causes: idiopathic thrombocytopenic purpura, thrombic thrombocytopenic purpura

  • Dx: bone marrow bx, CBC

  • s/s: petechiae, purpura, gingival bleed, epistaxis, prolonged bleeding

  • Tx: transfusions, spleenectomy, chemo, stop med that is causing, stop ETOH, treat infection

Thrombocytopenia


Immune thrombocytopenic purpura

  • Most common among kids and young girls released into circulation

  • Usually 1-6 wks after viral infection

  • Cause unknown, h. pylori may play role

  • s/s: asymptomatic, low platelet count, petechiae, hemoptysis

  • Dx: bone marrow bx, platelet ct

  • Tx: stop med, immune globulin, chemo, prednisone, spleenectomy

  • Nsg: assess lifestyle, teach symptoms, avoid constipation, avoid valsalva, avoid teeth flossing, use only electric razors, use only soft bristled tooth brush, monitor for osteoporosis

Immune thrombocytopenic purpura


HIT


Thrombic thrombocytopenic purpura

  • Medical emergency released into circulation

  • Causes extensive blood clots

  • TX: plasmaphoresis

  • Complication: multi organ FX

  • 95%death rate if not treated

Thrombic Thrombocytopenic Purpura


Von willebrand s disease

  • Most common inherited bleeding disorder released into circulation

  • 1-2% international population

  • s/s: Mucosal and cutaneous bleeding, porlonged bleed times

  • Tx: DDAVP, FFP, Cryoprecipitate, bleed precautions

Von Willebrand’s Disease


Hemophilia

  • Genetic released into circulation

  • Lack of blood clotting factor

  • 1-2 cases per 20,000 persons

  • Types

    • A: factor VIII is missing-higher incidence

    • B: factor IX is missing

  • Trait is carried on x chromosome

  • Rare for women to have

  • s/s: uncontrolled bleed especially in joints, skin, GI tract

  • Tx: no cure. Transfusions, pain treatment (IV morphine is common)..monitor for addiction to opiods.

  • http://www.youtube.com/watch?NR=1&feature=endscreen&v=pVHbMuBK8CI

Hemophilia


  • Not a disease released into circulation

  • Triggers: sepsis, trauma, cancer, shock, abruptioplacentae, allergic reactions

  • Life threatening condition

  • Initially coag time is normal

  • S/S: are manifested in organs with either clots or bleeding. Bleeding from all orifaces(tear ducts, gums, IV sites, rectum, urethra, etc.)

  • Dx: PT, PTT, D-Dimer

  • Tx: treat the cause, replace fluids, o2, fix electrolyte imbalances, administering vasopressors are vital, cryoprecipitate to replace factor 5 and 7, FFP, heparin

  • http://www.youtube.com/watch?v=kNSwGUqaVgs

DIC


Blood typing for transfusion

  • Universal donor= released into circulationO

    • Does not contain A, B, or Rh antigens

  • Universal recipients= AB+

    • Blood contains A, B, and RH antigens

  • Usually blood banks exactly match the ptblood

  • http://www.youtube.com/watch?v=G_-9_CF02qI

Blood typing for transfusion


Adminstration on blood

  • Pt needs 18 or 20 gauge IV needle so cells are not lysed (destroyed)

  • Prior to administration, blood needs to be checked by 2 licensed nurses. Check the expiration date, name, medical record number, type of blood, blood band id, pt birthday

    • Check vitals prior to administration

  • **blood must be initiated with in 30 minutes of arrival from lab to floor

  • Use blood tubing for administration

  • Monitor for blood reactions

  • Monitor vitals continuously during administration

adminstration on blood


Blood reactions

  • Hemolytic: fever, chills, nausea, dyspnea, chest pain, back pain, hypotension

    • Antigen/antibody rx to transfusion

    • Happens shortly after initiation

    • Tx: stop the transfusion, call md, supportive therapy to maintain HR and BP

  • Anaphylactic: urticartia, wheezing, dyspnea, hypotension

    • Type 1 hypersensitivity rx to plasma proteins

    • Occurs within 30 minutes of initiation

    • Tx: stop transfusion, call md, be ready for epi and steroids

  • Febrile: fever, chills

    • Recipients antibodies rx to donor leukocyte

    • Occurs within 30-90minutes of initiation

    • Tx: stop infusion, call md

  • Circulatory overload: cough, frothy sputum, cyanosis, decreased BP

    • cardio system is unable to manage the additional fluid load

    • Occurs anytime during transfusion and up to several hours after completion

    • Tx: stop infusion, call for help, be prepared for code, be prepared to administer oxygen and Lasix

Blood reactions


Bleeding precautions

  • Minimize the # of invasive procedure pain, hypotension

  • Avoid prolonged tourniquet use

  • Avoid IM injections

  • Instruct the client to use soft bristled tooth brush

  • No strait edge razor shaving only use electric razor

  • Avoid NSAIDS

Bleeding precautions


Any questions
ANY QUESTIONS??? pain, hypotension


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