13 hema
DESCRIPTION
Credits to Mr. Jefferson Ramos :)TRANSCRIPT
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
Co
llee
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. Flo
res, R
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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
a
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)
Co
llee
n C
. Flo
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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