Hematology System

7/30/2019 Hematology System

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HEMATOLOGICAL SYSTEMS

I Blood forming organs1. Thymus removed myasthenia gravis2. Liver largest gland3. Lymph nodes4. Lymphoid organs payers patch5.

Bone marrow6. Spleen destroys RBC

II Blood vessels1. Veins SVC, IVC, Jugular vein blood towards the heart2. Artery carries blood away from the1. Aorta, carotid3. Capillaries

III Blood- 45% formed elements 55% plasma fluid portion of vlood. Yellow color.

Serum Plasma CHONs (Produced in Liver)1. Albumin- largest, most abundant plasma

Maintains osmotic pressure preventing edemaFXN: promotes skin integrity

2. Globulins alpha transports steroids Hormones & bilirubin - Transports iron & copperGamma transport immunoglobulins or antibodies3. Prothrombin fibrinogen clotting factor to prevent bleeding

Formed Elements:1. RBC (erythrocytes) Spleen life span = 120 days

(N) 3 6 M/mm3- Anucleated- Biconcave discs- Has molecules of Hgb (red cell pigment)

Transports & carries O2

SICKLE CELL ANEMIA

sickle shaped RBC. Should be round. Impaired circulation of RBC.

-immature cells hemolysis of RBC decreased hgb

3 NURSING PRIORITY:1. a/w avoid deoxygenating activities

- High altitude is bad2. Fluid deficit

promote hydration3. Pain & comfort

HGB ( HEMOGLOBIN)F= 12 14 gms %M = 14-16 gms %

Hct 3x hgb 12 x 3 = 36(HAMATOCRIT) F 36 42% 14 x 3 = 42

M 42 48%


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Average 42%- Red cell percentage in whole red

Substances needed for maturation of RBCa.) Folic acidb.) Ironc.) Vit Cd.) Vit B12 (cyanocobalamin)

e.) Vit B6 (Pyridoxine)f.) Intrinsic factor

Pregnant: 1st trimester- Folic acid prevent neural tube deficit3rd tri ironLife span of rbc 80 120 days. Destroyed at spleen.

WBC leucocytes 5,000 10,000/mm3GRANULOCYTES1. PolymorphonuclearneutrophilsMost abundant 60-70% WBC- fx short term phagocytosisFor acute inflammation

2. PM Basophils

-Involved in Parasitic infection- Release of chem. Mediator forinflammationSerotonin, histamine, prostaglandin,bradykinins

3. PM eosinophils- Allergic reactions

NON-GRANULOCYTES1. Monocytes (macrophage) - largest WBC- involved in long term phagocytes- For chronic inflammation- Other name macrophage

Macrophage in CNS- microgliaMacrophage in skin HistiocytesMacrophage in lungs alveolar macrophageMacrophage in Kidneys Kupffer cells

2. LymphocytesB Cell L bone marrow or bursa dependentT cell devt of immunity- target site for HIVNK cell natural killer cell

Have both antiviral & anti-tumor properties

3. Platelets (thrombocytes)N- 150,000 450, 000/ mm3it promotes hemostasis prevention of blood loss by activatingclotting- Consists of immature or baby platelets known as megakaryocytes target of virus dengue- Normal lifespan 9 12 days

Drug of choice for HIV Zidovudine (AZT or Retrovir)Standard precaution for HIV gloves, gown, goggles & mask

Malaria night biting mosquitoDengue day biting mosquito

Signs of platelet dysfunction:a.) Petecchiaeb.) Ecchemosis/ bruisesc.) Oozing or blood from venipuncture site

ANEMIA1.) IRON DEFICIENCY ANEMIA chronic normocytic, hypocromic (pale), microcytic anemia due to inadequate absorption of iron leading tohypoxemic injury.

INCIDENCE RATE:1. Common developed country due to high cereal intakeDue to accidents common on adults

2. Common tropical countries blood sucking parasites3. Women 15 35yo reproductive yrs4. Common among the poor poor nutritional intake


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Predisposing factor:1. Chronic blood loss

a.Traumab. Mensc.GIT bleeding:

i. Hematemesis-ii. Melena upper GIT duodenal cancer

iii. Hematochezia lower GIT large intestine fresh blood from rectum

2. Inadequate intake of food rich in iron3. Inadequate absorption of iron due to :a. Chronic diarrheab. Malabsorption syndrome celiac disease-gluten free diet. Food for celiac pts- sardinesc. High cereal intake with low animal CHON ingestiond. Subtotal gastrectomy

4. Improper cooking of food

Signs & Symptoms:1. Asymptomatic2. Headache, dizziness, dyspnea, palpitations, cold sensitivity, gen body malaise, pallor3. Brittle hair, spoon shaped nails (KOILONYCHIA)=Dec O2=hypoxia=atrophy of epidermal cells4. Atropic glossitis, dysphagia, stomatitis

5. Pica abnormal craving for non edible food (caused by hypoxia=dec tissue perfusion=psychotic behavior)

Brittle hair, spoon shaped nail atrophy of epidermal cellsN = capillary refill time < 2 secsN = shape nails biconcave shape, 180 Atrophy of cells Plummer Vinsons Syndrome due to cerebral hypoxia

1. Atropic glossiti inflammation of tongue due to atrophy of pharyngeal and tongue cells2. Stomatitis mouth sores3. Dysphagia

Diagnostic Exam:1. RBC2. Hgb3. Reticulocyte4. Hct5. Iron6. Ferritin

Nursing Management:1. Monitor signs of bleeding of all hema test including urine & stool2. Complete bed rest dont overtire pt =weakness and fatigue=activity intolerance3. Encourage iron rich food2. Raisins, legumes, egg yolk4. Instruct the pt to avoid taking tea - impairs iron absorption5. Administer meds

a.) Oral iron preparationFerrous SO4Fe gluconateFe Fumarate

Nursing Management:oral iron meds:

1. Administer with meals to lessen GIT irritation2. If diluting in iron liquid prep adm with straw

Straw1. Lugols2. Tetracycline

3. Oral iron4. Macrodantine

3. Give Orange juice for iron absorption4. Monitor & inform pts S/Ea. Anorexia


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b. n/vc. Abdominal paind. Diarrhea or constipatione. Melena

If pt cant tolerate oral iron prep administer parenteral iron prep example:1. Iron dextran (IV, IM)2. Sorbitex (IM)

Nursing Management:parenteral iron prep1. Administer of use Z tract method to prevent discomfort, discoloration leakage to tissues.2. Dont massage injection site. Ambulate to facilitate absorption.3. Monitor S/E:

a.) Pain at injury siteb.) Localized abscess (nana)c.) Lymphadenopathyd.) Fever/ chillse.) Urticaria itchinessf.) Hypotension anaphylactic shock

Anaphylactic shock give epinephrine

2. PERNICIOUS ANEMIA - megaloblastic, chronic anemia due to deficiency of intrinsic factor leading to

* Hypochlorhydria decrease Hcl acid secretion.- Lifetime B12 injections . With CNS involvement .

Predisposing factor1. Subtotal gastrectomy removal stomach2. Hereditary3. Infl dse of ileum4. Autoimmune5. Strict vegetable diet

STOMACH

Parietal or ergentaffen Oxyntic cells

Fxn produce intrinsic factor Fxn secrets Hcl acid

For reabsorption of B12 Fx aids in digestion

For maturation of RBC

Diet high caloric or CHO to correct wt lossSigns & Symptoms:

1. Headache dizziness, dyspnea, palpitations, cold sensitivity, gen body malaise, pallor2. GIT changes

a. Red beefy tongue PATHOGNOMONIC mouth soresb. Dyspepsia indigestionc. Wt lossd. Jaundice

3. CNS Most dangerous anemia: pernicious due to neuroglogic involvement.

a. Tingling sensationb. Paresthesia

c. (+) Rombergs testAtaxia

d. Psychosis

Diagnostic Exam:


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- Shillings test

Nursing Management:1. Enforce CBR2. Administer B12 injections at monthly intervals for lifetime as ordered. IM- dorsogluteal or ventrogluteal .

Not given oral due pt might have tolerance to drug3. Diet high calorie or CHO. Increase CHON, iron & Vit C4. Avoid irritating mouthwashes. Use of soft bristled toothbrush is encouraged.5. Avoid applying electric heating pads can lead to burns

3. APLASTIC ANEMIA stem cell disorder due to bone marrow depression leading to

pancytopenia all RBC are decreased

PANCYTOPENIA

Decrease RBC decrease WBC decrease platelets Anemia leukopenia thrombocytopenia

Increase WBC leukocytocysIncrease RBC polycythemia vera complication stroke, CVA, thrombosis

Predisposing factor:1. Chemicals Banzene & its derivatives2. radiation3. Immunologic injury4. Drugs cause bone marrow depression

a. Broad spectrum antibiotic - Chlorampenicol- Sulfonamides bactrim

b. Chemo therapeutic agents

Methotrexate alkylating agentsNitrogen mustard anti metabolicVincristine plant alkaloid

Signs & Symptoms:1. Anemia:

a. Weakness & fatigueb. Headache, dizziness, dyspneac. cold sensitivity, pallord. palpitations

2. Leucopenia increase susceptibility to infection3. Thrombocytopenia

Peticchiae

Oozing ofblood from venipuncture siteecchymosis

Diagnostic Exam:1. CBC pancytopenia2. Bone marrow biopsy/ aspiration at post iliac crest reveals fatty streaks in bone marrow

Nursing Management:1. Removal of underlying cause2. Blood transfusion as ordered3. Complete bed rest4. O2 inhalation5. Reverse isolation due leukopenia6. Monitor signs of infection7. Avoid SQ, IM or any venipuncture site = HEPLOCK8. Use electric razor when shaving to prevent bleeding9. Administer meds

Immunosuppresants


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Anti lymphocyte globulin (Alg) given via central venous catheter, 6 days 3 weeks to achieve maxtherapeutic effect of drug.

DISSEMINATED INTRAVASCULAR COAGULATION ( DIC )- Acute hemorrhagic syndrome char by wide spread bleeding & thrombosis due to a def of clotting factors(Prothrombin & Fibrinogen).

Predisposing factor:1. Rapid BT2. Massive trauma3. Massive burns4. Septicemia5. Hemolytic reaction6. Anaphylaxis7. Neoplasia growth of new tissue8. Pregnancy

Signs & Symptoms:1. Petechiae widespread & systemic (lungs, lower & upper trunk)2. Ecchymosis widespread3. Oozing of blood from venipunctured site

4. Hemoptysis cough blood5. Hemorrhage6. Oliguria late sx

Diagnostic Exam:1. CBC reveals decrease platelets2. Stool for occult blood (+)

Specimen stool3. Opthalmoscopic exam sub retinal hemorrhage4. ABG analysis metabolic acidosis

pH HCO3R pH PCO2 respiratory alkalosis

O ph PCO2 respiratory acidosis

M ph HCO3 metabolic alkalosis

E ph HCO3 metabolic acidosis

Diarrhea metabolic acidosisVomitting metabolic alkalosisPyloric stenosis metabolic alkalosis vomitingIleostomy or intestinal tubing metabolic acidosisCushings metabolic alkalosisDM- metabolic acidChronic bronchitis respiratory acid with hypoxemia, cyanosis

Nursing Management1. Monitor signs of bleeding hema test + urine, stool, GIT2. Administer isotonic fluid solution to prevent shock.3. Administer O2 inhalation4. Administer medsa. Vit K aquamephytonb. Pitressin or vasopressin to conserve water.5. NGT lavage

- Use iced saline lavage

6. Monitor NGT output7. Provide heplock8. Prevent complication: hypovolemic shock

Late signs of hypovolemic shock : anuria


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BLOOD TRANSFUSION Objectives :

1. To replace circulating blood volume2. To increase O2 carrying capacity of blood3. To combat infection if theres decrease WBC4. To prevent bleeding if theres platelet deficiency

Nursing Management& Principles:1. Proper refrigeration2. Proper typing & crossmatching

Type O universal donorAB universal recipient85% of people is RH (+)

3. Asceptically assemble all materials needed:a.) Filter setb.) Isotonic or PNSS or .9NaCl to prevent Hemolysis

Hypotonic sol swell or burst

Hypertonic sol will shrink or crenatec.) Needle gauge 18 - 19 or large bore needle to prevent hemolysis.d.) Instruct another RN to recheck the following .

Pts name, blood typing & cross typing expiration date, serial number.e.) Check blood unit for presence of bubbles, cloudiness, dark in color & sediments indicatesbacterial contamination. Dont dispose. Return to blood bank.f.) Never warm blood products may destroy vital factors in blood.

- Warming is done if with warming device only in EMERGENCY! For multiple BT.- Within 30 mins room temp only!

g.) Blood transfusion should be completed < 4hrs because blood that is exposed at room temp for > 2hcauses blood deterioration.

h.) Avoid mixing or administering drug at BT line leads to hemolysisi.) Regulate BT 10 15 gtts/min KVO or 100cc/hr to prevent circulatory overload

j.) Monitor VS before, during & after BT especially q15 mins(local board) for 1st hour.NCLEX-q5min for 1 st 15min .- Majority of BT reaction occurs within 1h.

BLOOD TRANSFUSION REACTIONS

H hemolytic ReactionA allergic ReactionP pyrogenic ReactionC circulatory overloadA air embolismT - thrombocytopeniaC citrate intoxication expired blood =hyperkalemiaH hyperkalemia

1.HEMOLYTIC REACTION

Signs & Symptoms:HeadacheDizzinessDyspnea

PalpitationLumbar/ sterna/ flank painhypotension, flushed skin , (red) port wine urine.


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Nursing Management:1. Stop BT2. Notify Doc3. Flush with plain NSS4. Administer isotonic fluid sol to prevent acute tubular necrosis & conteract shock5. Send blood unit to blood bank for reexamination6. Obtain urine & blood samples of pt & send to lab for reexamination7. Monitor VS & Allergic Rxn

2.ALLERGIC REACTION

Signs & Symptoms:1. Fever/ chills2. Urticaria/ pruritus3. Dyspnea4. Laryngospasm/ bronchospasm5. Bronchial wheezing

Nursing Management:1. Stop BT2. Notify Doc3. Flush with PNSS4. Administer antihistamine diphenhydramine Hcl (Benadryl). Give bedtime.SE-Adult-drowsiness. Child-

hyperactiveIf (+) Hypotension anaphylactic shock administer epinephrine

5. Send blood unit to blood bank6. Obtain urine & blood samples send to lab7. Monitor VS & IO8. Adm. Antihistamine as ordered for AllergicRxn, if (+) to hypotension indicates anaphylactic shock3. administer epinephrine9. Adm antipyretic & antibiotic for pyrogenic Rxn & TSB

3.PYROGENIC REACTION Signs & Symptoms:

a.) Fever/ chills d. tachycardiab.) Headache e. palpitationsc.) Dyspnea f. diaphoresis

Nursing Management:1. Stop BT2. Notify Doc3. Flush with PNSS4. Administer antipyretics, antibiotics

5. Send blood unit to blood bank6. Obtain urine & blood samples send to lab7. Monitor VS & IO8. Tepid sponge bath offer hypothermic blanket

4. CIRCULATORY OVERLOAD

Signs & Symptoms:b. Dyspneac. Orthopnead. Rales or cracklese. Exertional discomfort

Nursing Management:1. Stop BT2. Notify Doc. Dont flush due pt has circulatory overload.3. Administer diuretics


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PRIORITY CASES Hemolytic Rxn 1 st due to hypotension 1st priority attend to destruction of Hgb O2 brain damage Allergic 3 rd

Pyrogenic 4 th

Circulatory 2 nd Hemolytic 2 nd

Anaphylitic 1st priority

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Hematology System