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Hematologic Disorders &

Nursing Priorities

Keith Rischer RN, MA, CEN

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Objectives for Today

Review pathophysiology related to hematologic cells and blood forming tissues

Interpret significance of altered hematologic lab values Review commonly used medications that alter

hematologic function Identify the patho, clinical manifestations, diagnostic

tests, nursing priorities, and client education in clients with anemia, sickle cell anemia, leukemia, lymphomas, and multiple myeloma.

Identify the nursing priorities with blood transfusion and the most common transfusion reactions.

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Blood Cells

Hematopoesis: Red bone marrow• The blood forming

tissue that produces the 3 major cell components of blood

Erythrocytes

Leukocytes

Thrombocytes

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Erythrocytes

• Function

Transport of gases (O2 & CO2)Erythropoesis

• Normal Life span: 120 days• Norms

Hgb RBC– Women: 12-16 g/dl 4.0-5.0 mm3– Men: 13.5-18n g/dl 4.5-6.0 mm3

HCT– Women: 38-47%– Men: 40-54%

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Leukocytes

• TypesGranulocytes

(Also known as polymorphonuclear leukocytes)

–Neutrophils–Eosinophils–Basophils

Leukocytes

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• Monocytes agranular)

• Lymphocytes B cells: mediate the humoral immune response

T cells: Mediate cellular immunity

Normal Blood Count of all WBC: 4,000-11,000/ul

Elderly considerations

Thrombocytes (Platelets)

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• Function: Aid in blood clotting Maintain capillary

integrity by working as “plugs” to close any openings in the capillary wall.

• Normal Blood Count: 150,000-400,000 mm3

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Anemia

Mild• Hgb 10-14 g/dl

Moderate• Hgb 6-10 g/dl

Severe• Hgb < 6 g/dl

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Anemia:Causes

Macrocytic Pernicious Anemia (B12 deficiency) Folate deficiency

Microcytic– Iron deficiency anemia

Normocytic– Blood loss– Sickle cell anemia

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Macrocytic Anemia

Megaloblastic Anemias: Presence of large RBC’s) Caused by defective DNA synthesis

Two common types:1. Cobalamin (vitamin B12 deficiency)

– Pernicious anemia =most common cause.2. Folic acid deficiency

– Poor nutrition (Anorexia)– malabsorption in small bowel– ETOH – Hemodialysis

PATIENT EDUCATION

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Microcytic Anemia: Iron Deficiency

Abnormal-small erythrocytes…decr. Hgb Most common anemia Manifestations

• Pallor• Glossitis• fatigue

Dietary sources Patient education

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Normocytic Anemia: Etiology

Blood Loss• Acute• Chronic

Extrinsic (acquired) hemolytic anemias – (damage to RBCs due to external factors)• Physical factors

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ED Case Study

88 yr women w/dk tarry stools last 5 days. c/o weakness, nausea.

Pale, cool-initial VS 80-16-124/30….2 hours later 96-20-94/49

Wbc 9.8, hgb 6.9 (was 12.7 2 weeks ago), hct 21.5, plt 176, INR 4.8 (was 2.1 2 weeks ago)

Nursing priorities

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Sickle Cell Anemia

Patho Sickle Cell Crisis Nsg Management

• Pain control• Hydration

Patient Education• Hydration• Tx infection • Psychosocial

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Thrombocytopenia

Reduction of platelets below normal range• Normal = 150,000-400,000 mm3

Etiology:• Immune Thrombocytopenic Purpura (ITP)• Heparin• Bone marrow suppression

Critical values• 50,000 or less- risk of bleeding• <20,000 spontaneous life threatening hemorrhages (brain bleed) • <10,000 transfusions recommended

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Clinical Manifestations

Petechiae Purpura Ecchymosis Bleeding

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Nursing Management

If acute care-Peripheral IV established No ASA products for pain control Prevent/control acute bleeding Platelet transfusions-assess for reaction Steroids-pt. teaching Education-signs of bleeding

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Blood Product Administration

Minimum 22 g.(blue hub) IV-prefer 20g.

(pink) or 18g. (green) Blood tubing with filter-use NS to prime/flush

• Validate pt., type of blood product, expiration date, blood tag #

• VS before, 15” after initiation, end of each• Infuse PRBC’s over 2 hours (appx 300cc/unit)

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Complications Blood Products

Circulatory OverloadAcute Hemolytic Reaction

• Chills, fever, flushing, tachycardia, SOB, hypotension, acute renal failure, shock, cardiac arrest, death

Febrile-Nonhemolytic Reaction• Sudden onset of chills, fever, temp elevation >1

degree C. headache, anxiety

Mild Allergic Reaction• Flushing, urticaria, hives

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Nursing Responsibilities

STOP transfusion Maintain IV site-disconnect from IV and

flush with NS Notify blood bank/MD Recheck ID Monitor VS Treat sx per MD orders Save bag and tubing-send to blood bank