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DISTURBANCES IN OXYGENATION

CARRYING MECHANISM AND TRANSPORTATION

FACILITIESJefferson C. Ramos, RMT RN

BLOOD

Circulatory fluid of the the Cardiovasclar system that is circulating constantly through a closed circuit of tubes.

PARTS OF THE BLOOD Liquid Portion

Plasma - a pale, straw colored fluid that remains if coagulation is prevented

Serum - fluid part that remains after separation of the clot

PARTS OF THE BLOOD Solid Portion

Red Blood Cells/Erythrocytes

White Blood Cells/Leukocytes

Platelets/Thrombocytes

CHARACTERISTICS OF BLOOD

Volume 5 - 6 liters or 7 - 8% of

the body weight

Color Venous blood - dark

red Arterial blood - bright

scarlet red

Viscosity Thick and sticky (5x

that of water)

Specific Gravity Between 1.055 - 1.065

Reaction Range of 7.35 - 7.45

(avg. of 7.4)

FUNCTIONS OF BLOOD Metabolic Functions

Respiration

Nutrition

Excretion

Regulation of water balance

Regulation of body temperature

Transportation of hormones

Maintenance of normal acid-base balance in the body

FUNCTIONS OF BLOOD Defensive Functions

Production of immune globulins

Functions as phagocytes

ERYTHROCYTESBiconcave discs resembling a soft

ball compressed between 2 fingersGases can easily diffuse across it

due to its very thin membraneContains HEMOGLOBIN

From matured erythrocytes; with Iron

Makes up 95% of blood massEnables the RBCs to perform its

principal function

RBC DESTRUCTION

120 days Removed by the reticuloendothelial cells in

the liver and spleen Hemoglobin is recycled

Bilirubin New hgb molecules in the bone marrow Sterco- and urobilinogen

KINDS OF WBCS

Granulocytes

Neutrophils

Eosinophils

Basophils

• Agranulocytes

• Lymphocytes

• Monocytes

NEUTROPHILS

Most abundant type of phagocyte, 50 - 60%

Responsible for neutralizing bacterial infections

They engulf pathogens coated with antibodies

Does not return to the blood

EOSINOPHILS

1 - 3%

They play a crucial part in killing parasites

Neutralize histamine

BASOPHILS

0 - 1% of the differential count

Appears in inflammatory reactions esp. those that cause allergic reations

Contains heparin & histamine

LYPMHOCYTES

About 25 - 33% of the differential

Usually abnormal results in diseases caused by viruses

Has three kinds: Natural Killer Cells T Cells B Cells

MONOCYTES

About 3 - 7%

Functions to replenish resident macrophages and dendrictic cells under noramal states

Also responds to inflammation signals

THROMBOCYTES

100,000 - 450,000 in value

Derived from the fragmentation of precursor megakaryocytes

Plays a key role in hemostasis

ASSESSMENT AND DIAGNOSTIC FINDNIGS

Hematologic StudiesComplete blood

countPeripheral blood

smearHemoglobinHematocritRBC indices

ASSESSMENT AND DIAGNOSTIC FINDNIGSBone marrow aspiration

and biopsyBone marrow

aspirationBone marrow biopsy

MANAGEMENT OF HEMATOLOGIC DISORDERS

ANEMIA

A condition in which Hemoglobin (Hgb) concentration is lower than normalHgb = 75 – 175 μg/dL or 13.5-17.5 g/dL (M)

= 65 to 165 μg/dL or 11.5-15.5 g/dL (F)

ANEMIA: CAUSESAcute or chronic blood lossInadequate dietary intake of vitamins

and mineralsIncreased demands of vitamins and

minerals for RBC productionDecreased RBC production by bone

marrowIncreased RBC destruction

ANEMIA

Hemolytic

Hypo-proliferativ

eBleeding

ANEMIA: SIGNS AND SYMPTOMS

PallorEasy

fatigabilityWeaknessWeight lossHeadacheTachycardia

SyncopeBrittle hairParesthesiaCold

sensitivityAnorexiaAmenorrhea

IRON DEFICIENCY ANEMIA Laboratory findings1. CBC- Low levels of

Hct, Hgb and RBC count

2. Low serum iron, low ferritin

3. Bone marrow aspiration- MOST definitive

Assessment1. Pallor2. Weakness &

fatigue3. Smooth & sore

tongue4. Koilonychia5. Vinson Plummer

syndrome

MEGALOBLASTIC ANEMIAS: VIT. B12 DEFICIENCY

Inadequate dietary intake

Pernicious AnemiaDue to the absence of intrinsic factor

secreted by the parietal cells Intrinsic factor binds with Vit. B12 to

promote absorption

MEGALOBLASTIC ANEMIAS: VIT. B12 DEFICIENCY

Causative factors1.Strict vegetarian diet2.Gastrointestinal malabsorption

3.Crohn's disease4.Gastrectomy

MEGALOBLASTIC ANEMIAS: MANIFIESTATIONS

1. Weakness2. Fatigue3. Listless4. Neurologic manifestations (only in

Vit. B12 deficiency)5. Jaundice – due to poor

erythropoiesis6. Red beefy tongue 7. Mild diarrhea8. Extreme pallor9. Paresthesias in the extremities

MEGALOBLASTIC ANEMIAS: LAB DATA

1. Peripheral blood smear- shows giant RBCs, WBCs with giant hypersegmented nuclei

2. Very high MCV3. Schilling’s test – determines

the cause of Vit B12 deficiency4. Intrinsic factor antibody test

MEGALOBLASTIC ANEMIAS

1. Vitamin supplementation Folic acid 1 mg daily

2. Diet supplementation Vegetarians should have

vitamin intake or fortified soy milk

3. Lifetime monthly injection of IM Vit. B12 – 1000µg (if intrinsic factor is absent)

MEGALOBLASTIC ANEMIAS

1. Monitor patient (neurologic assessment)

2. Provide assistance in ambulation

3. Oral care for sore tongue4. Explain the need for

lifetime IM injection of Vit. B12

POLYCYTHEMIA

Refers to an INCREASE volume of RBCs

The hematocrit (Hct) is ELEVATED to more than 55%

Classified as Primary or Secondary

POLYCYTHEMIA: PRIMARY

POLYCYTHEMIA VERAA proliferative disorder in which the myeloid stem cells become uncontrolled

Causative factor: unknown

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POLYCYTHEMIA: PRIMARY Uncontrollable stem cell growth

Hypercellular bone marrow

Increase in number of blood cells

Hematopoiesis in spleen

Fibrotic bone marrow

Increased RBC, WBC, platelets

Splenomegaly

Increased blood viscosity

POLYCYTHEMIA: PRIMARY

1. Ruddy skin2. Splenomegaly3. Headache4. Tinnitus5. Fatigue6. Paresthesia7. Blurred vision

1.Angina2.Claudication3.Dyspnea4.Thrombo-

phlebitis5.Pruritus6.Erythromelalgi

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POLYCYTHEMIA: PRIMARY Laboratory findings

1. CBC- shows elevated RBC mass

2. Elevated WBC and platelets

3. Elevated hematocrit4. Normal oxygen

saturation

POLYCYTHEMIA: PRIMARY

Complications1. Increased risk for

thrombophlebitis, CVA and MI

2. Bleeding due to dysfunctional platelets

POLYCYTHEMIA: PRIMARY 1. To reduce the high blood

cell mass (goal) PHLEBOTOMY

2. Allopurinol (Zyloprim) – if uric acid is increased

3. Dipyridamole (Persantine)4. Chemotherapy to

suppress bone marrow (hydroxyurea)

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POLYCYTHEMIA: PRIMARY

Patient education: Client instructions on:

1. Avoiding Iron supplements

2. Bathing with cool water (cocoa-butter based lotion and bath products)

3. Minimize bleeding Avoid Aspirin (if with bleeding

history) Minimize alcohol intake

POLYCYTHEMIA: SECONDARY

Caused by: Excessive production of

erythropoietin (hypoxic stimulus)

Hemoglobinopathies Neoplasms (renal cell

carcinoma) Treat primary problem

BLEEDING DISORDERS

Platelets

THROMBOCYTOPENIA

Low platelet level due to:1. Decreased platelet production by

bone marrow2. Increased platelet destruction (ITP)3. Increased platelet consumption

(DIC)Manifestation: bleeding and petichiae

(<20,000mm3)

IDIOPATHIC THROMBOCYTOPENIC PURPURA (ITP)

ITP Goal: safe platelet count (>30,000mm3) Immunosuppressants - block the binding

receptors on macrophages so that the platelets are not destroyed1. Prednisone2. Cyclophosphamide (Cytoxan)3. Azathioprine (Imuran)4. Dexamethasone (Decadron)

IVIG Spleenectomy Chemotherapy – Vincristine (Oncovin)

Colleen C. Flores, RN

ITP

Determine bleeding risksClient education regarding

Medication and treatmentLifestyleRefrain from vigorous

sexual intercourse (< 10,000/mm3)

Avoid client constipation

HEMOPHILIA Inherited (x-linked) bleeding disorder Deficient or defective factor VIII (A) Deficient or defective factor IX (B) Hemorrhage after minimal trauma

(joints)

HEMOPHILIA: INHERITANCE

VON WILLEBRAND’S DISEASE

Inherited (autosomal dominant) bleeding disorder; deficiency of the vWF

Common manifestationsNosebleedsHeavy menses

Lab data = normal platelet count but prolonged PTT

VON WILLEBRAND’S DISEASE: MANAGEMENT

Cryoprecipitate or FFP

Desmopressin (DDAVP) – can be used to prevent bleeding with dental/surgical procedures or manage mild post-op bleeding

DISSEMINATED INTRAVASCULAR COAGULATION (DIC)

A potentially life-threatening sign of an underlying condition

Triggered by sepsis, trauma, cancer, abruptio placenta, transfusion reactions (hemolysis)

DIC: MANIFESTATIONSMinimal occult internal bleeding to profuse hemorrhage

Lab data:Fibrin degradation products – high

PTT - highPlatelet count - lowPT - highSerum fibrinogen - low

DIC: MANAGEMENTTreat underlying disorderCorrect secondary effects of tissue ischemia

Cryoprecipitate or FFPHeparin infusion* – to interrupt thrombosis