Transcript Essentials of Hematology

Essentials of Hematology
Gail L. Lupica PhD, RN, CNE
Nursing 211
Hematology:
 The study of blood and blood
forming tissues (bone marrow, blood, spleen
and lymph system)
 Clinical Relevance…
Essential blood components are
necessary for clot formation (…pharm to
reverse that process).
 Oxygenation
 Immune function
 transport

WHOLE BLOOD
 Plasma- 55%
>>>
-proteins 6%-
albumins
globulins
fibrinogin
Water- 92% of plasma
other solutes 2%
 Formed elements45%
PLTS
LEUKOCYTES (WBCs)
ERYTROCYTES
Three Types of Formed Elements
 Three types of “blood cells”:
 Erythrocytes (RBCs)
 Leukocytes (WBCs)
 Thrombocytes (PLTSs)
LET’S TALK ABOUT ERYTHROCYTES
(RBC’s)_
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Disc shape
Flexible
Live 120 days
Produce Hgb
Heme component needs Fe to carry 4
O2 molecules
Erythrocytes:
 Hemoglobin is the oxygen carrying
component (protein) of the erythrocyte.
 It makes up 90% of the cell’s weight.
 A single erythrocyte can carry 300
hemoglobin molecules, which pick up O2
from the lungs, carry it to the tissues and
exchange it for the by-product of cellular
metabolism = WHAT’S THAT???
 Hgb gives blood it’s red color.
Erythrocyte/Hgb
 Clinical Relevance Administering packed red blood cells
(PRBCs) is giving the patient only the
erythrocyte portion of the blood for its O2
carrying capacity.
 Each heme site, is produced and bound
with Ferrous Iron. An Fe deficient diet
disenables these cells to bind to Fe and the
pt is ANEMIC!! WHAT KIND OF ANEMIA IS
THIS?????
Erythrocyte/Hgb
 CO (carbon monoxide) competes with
the O2 on the on the Heme molecule.
The affinity of CO is 200x greater
than O2. THIS WOULD RESULT
IN…????
 WHICH PATIENTS HAVE BEEN
EXPOSED TO CO???
 The hormone, erythropoietin,
prompts the bone marrow to form a
Red blood cell according to demands
of the body, from an immature cell.
 In fact, WBCs and platelets also develop
from that same immature stem cell
according to demands.
 Clinical Relevance…
Erythropoietin is
secreted by the kidney.
Patients in end stage
renal disease are terribly
anemic!!
Let’s Talk about Leukocytes =
White Blood Cells (WBCs)
 They’re white.
 There’s five different kinds
with very variable life spans.
(We’ll talk about that more in
the “immune” unit.)
Cont’d
 Five types of WBC:
1. Neutrophil: most common, accounts
for 50-70% of all WBCs. They are a key
player in the immune response
…responsible for phagocytosis in an
acute inflammatory response. EVER
HEARD OF NEUTROPENIC
PRECAUTIONS???
2. Eosinophils:2-4% of WBCs with some ability for
phagocytosis
3. Basophils: < 2% of WBCs
Types of WBCs cont’d
 4. Lymphocytes: 20-40% of all
WBCs, … t-lymphocytes (cell
mediated) and B-lymphocytes
(humoral immunity) form the
basis of the immune response.
 5. Monocytes: 4-8% of all WBCs. They are
phagocytes.
Thrombocytes = Platelets
 Platelets that initiate the clotting process.
 Platelet “plugs” are initiated at the site of
any break of capillary integrity.
1. WHAT HAPPENS IF THEY’RE TOO MANY???
2. WHAT HAPPENS IF THEY’RE TOO FEW??
WHAT’S THE NORMAL PLT RANGE???
Let’s look at some more
structures and functions of
the hematologic system:
Explain their
importance…
and
The Spleen
 Removes old RBCs from the circulation
 Helps to Makes RBCs (Returns the iron
component of hemoglobin to the bone
marrow for reuse)
 Filters circulating bacteria with its rich
supply of lympocytes, monocytes and
immunoglobins
 Stores RBCs and PLTS
-WHAT WOULD HAPPEN IF YOUR SPLEEN
ENLARGED??? = SPLENOMEGALY
The Liver’s Role
 manufactures prothrombin (and other clotting factors).
 manufactures albumin
 manufactures bile which is critical to the absorption of
fat soluble vitamins like vitamin K (A,E,D).
 Vitamin K in turn…. produces blood clotting factors Vll,
lX, X)
 The liver converts bilirubin to bile and stores large
quantities of blood and extra iron.
PLT aggregation
 Platelets clump and are attracted to
each other when “activated”.
 Platelet plugs begin the blood
clotting cascade.
 Substances that activate PLT
activation include ADP, Ca+,
thromboxane A2 (TXA2), and
collagen.
 These substances may come from the
PLT or from the endothelial lining.
Anti-platelet drugs
Helps prevent thrombus
formation in the arteries.
What diseases do they prevent?
THE DRUGS YOU NEED TO
KNOW!!!!!!
1. ASPIRIN- inhibits an enzyme needed
by PLTS to synthesize TXA2.
1. PLAVIX- blocks binding of ADP to the
PLT ADP receptor site.
2.
3.
TICLID- blocks binding of fibrinogen to the GP 11b/11a
receptor on the PLT surface. (Called GP 11b/11a
receptor antagonists)
PERSANTINE- same
The Blood Clotting Cascade
 The blood clotting cascade is
triggered by a PLT plug.
 It’s result of either an intrinsic factor
(from the blood itself—toxins, debris,
Ag-Ab) or an extrinsic factor (from
trauma to the blood vessel lining)
 Different clotting factors are involved
along the way and the two pathways
join a common clotting pathway.
The Blood Clotting Cascade
 No matter what started the cascade,
the end result is the same, A FIBRIN
CLOT. ………….IS THIS GOOD OR
BAD?????????
Thrombus arising in valve pocket at
upper end of superficial femoral vein
Anticoagulant Medications
 Inhibit clot formation in the venous
system.
 They do not dissolve but inhibit new
clot formation and inhibit growth of
existing clots.
 What would dissolve a clot???
THE DRUGS YOU NEED TO
KNOW!!!!!!
 Heparin- inhibits the conversion of
fibrinogen to fibrin.
 LMWH—LOVENOX
Have more stable responses at recommended doses so
get less risk of bleeding without needing to check PTT.
 Coumadin - Prevents the hepatic
synthesis of Vitamin K.
MEMORIZE
Hgb
12-16
14-18g/dl
Hct 37-47
42-52%
WBC 5-10,000 /uL
PLT
150-400,000
ANEMIA Anemia is the reduction in either
the number of red blood cells, or
the amount of Hgb, or Hct
Anemia is not a specific disease but a
manifestation of one of several abnormal
conditions.
ANEMIAS we’ll look at:
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Sickle cell anemia
Iron deficiency anemia
B12 deficiency anemia
Aplastic anemia
Polycythemia vera
Sickle cell anemia
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Genetic disorder
Abnormal Hgb chains
react to lower oxygen states,
change their shape and pile together.
block blood flow causing even more
hypoxia to the tissues.
Sickle cell anemia
 What triggers the sickling???--dehydration, infections, strenuous exercise,
stress!!
 Sequelae??--… Pain, disability, organ
damage, increased risk for infection, and
early death ensues.
Why is this pt in pain???
Why do the organs damage???
Why are they at risk for infection???
QUESTION
A client with sickle cell disease is
admitted with a diagnosis of Left arm
fracture. Which nursing intervention
would be the most helpful to prevent
vasocclusive pain?
1. Obtaining blood pressures every 2 hours
2. Administering pain medication every 3-4
hours as ordered
3. Monitoring arterial blood gas results
4. Administering IV fluids at an ordered rate of
200 ml/hr
Iron Deficiency Anemia
 This common type of anemia can
result from blood loss, or
inadequate diet.
Evaluate adult clients for abnormal
bleeding.
Supplemental iron is the treatment.
QUESTION
3. The nurse caring for a client with iron
deficiency has performed dietary teaching
of foods high in iron. The nurse
recognizes that teaching has been
effective when the client selects which
meal plan?
1.
2.
3.
4.
Hamburger, French fries, and orange juice
Sliced veal, spinach salad, whole-wheat roll
Vegetable lasagna, Caesar salad, toast
Bacon, lettuce, and tomato sandwich, potato
chips, and tea
Vitamin B12 Deficiency Anemia
(pernicious anemia)
 B12 is necessary to
move folic acid into
the cell where DNA
synthesis occurs and
RBC production can
take place.
 B12 deficiency
reduces folic acid
transport, inhibiting
DNA synthesis.
 Pernicious anemia
is caused by failure
to absorb vitamin
B12.
 Intrinsic factor is
secreted by the
gastric mucosa & is
needed to absorb
B12.
B12 deficiency…
Glossitis, a smooth tongue as a result of vitamin B12
deficiency anemia
QUESTION
5. Which clinical manifestation, noted in
a client with pernicious anemia, would
indicate that the client has been
noncompliant with B12 injections?
1.
2.
3.
4.
Hyperactivity in the evening hours
Weight gain of 5 pounds in one week
Paresthesia of hands and feet
Diarrhea stools several times a day
Aplastic Anemia
 Deficiency of circulating red blood cells– Failure
of Bone marrow.
 Occurs because of injury to precursor cell-long
term exposure to toxic agents, ionizing
radiation, or infection
 Usually occurs with leukopenia and
thrombocytopenia
 Pancytopenia common
 Splenectomy may be performed
NURSING DIAGNOSES…
Polycythemia Vera
 A sustained increase > production
in blood hemoglobin/RBCs
 Excessive leukocyte production
 ..HTN, thrombosis, K+
 Treat: Phlebotomy
 Treat: Increased hydration
 Treat: Anticoagulants
Nursing Diagnoses…