Hematology

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shelly_762003
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115770
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Hematology
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2011-11-11 16:24:16
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Hematology
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  1. The hematologic system consists of
    blood, blood cells, lymph and organs involved with blood formation.
  2. the hematologic system helps
    the body meet the needs for oxygen and tissue perfusion
  3. One of oxygens delivery systems is
    blood
  4. all organs depend on
    blood circulation for oxygenation
  5. bone marrow is
    the blood forming organ in the body (hematopoietic)
  6. Bone marrow produces majority of the blood cells in the body which includes
    • RBC (erythrocytes)
    • WBC
    • platelets
    • and is also involved in immune response
  7. As a person ages
    fatty tissue replaces active bone marrow
  8. the stages of blood cells include
    • stem cells undifferentiated ( not specific to one area)
    • stem cells become committed (precursor)
    • once they are exposed to a specific horomone they become committed.
  9. plasma is
    a part of the body's extracellular fluid
  10. three major types of plasma proteins are
    albumin, globulins, and fibrinogen
  11. anemia occurs when
    there are too few RBC or not enough HgB (hemoglobin)
  12. albumin is
    increases the osmotic pressure of the blood, keeps plasma from leaking into the tissues.
  13. albumin pulls
    fluid from the tissues into the vascular space and retains it in the vascular space.
  14. A person with low albumin
    • will have fluid leak out of the vascular space causing edema.
    • you want to give someone albumin so the vascular space can draw the fluid back in from the tissues.
  15. Globulins
    • transport substances
    • protect the body against infection
    • maintain proteins of antibodies
  16. fibrinogen
    forms fibrin ( blood clotting structures)
  17. erythrocytes (RBC)
    • are the largest portion of the blood cells.
    • produce hemoglobin which carries O2 to the tissues
    • last about 120 days
    • Heme carries 4 O2
    • must have iron to transport the O2
    • globin carries the CO2 out of the body.
  18. Low hemoglobin results in
    not enough oxygen getting to the tissues and the tissues begin to die.
  19. A heme molecule must contain
    an iron molecule in order to transport 4 oxygen.
  20. not enough hemoglobin results in
    lack of oxygen to the tissues
  21. what is someone with low hemoglobin going to look like
    SOB (shortness of breath), cyanosis, lethargic, restlessness, increase in BP, increase in HR, decrease in respirations, pale, diapheretic.
  22. If someone has iron deficiant anemia then they have
    not enough hemoglobin which means not enough oxygen (tissue perfusion)
  23. white blood cells
    • job is to fight infection
    • assist with inflammatory and healing response.
  24. hypoxia is
    when tissue oxygenation is less than normal.
  25. The spleen is
    • a small organ in the upper left quadrant
    • secondary lymphoid organ
    • involved with formation and storage of blood
    • circulates waste products from the blood to the macrophages and lymphocytes for destruction
    • also serves as a resrvoir for blood, which is released with low blood pressure.
    • iron defeciency can occur after a spleenectomy (blood is usually stored in the spleen)
  26. people who have had their spleen removed are
    at greater risk for a viral infection.
  27. Interventions for someone with a spleenectomy include
    flu shot and pneumoccal vaccine.
  28. after damage to an area
    platelets are drawn to it in response to exposed collagen.
  29. platelets attach to
    proteins called von Willebrand factors and release vasoactive chemicals causing vasoconstriction.
  30. the puropse of vasoconstriction is
    to reduce blood flow to the area
  31. The body releases other chemicals other then platelets to
    help limit the amount of clot formed so that an embolus does not form.
  32. activation causes the platelets to become
    sticky and allows them the clump together.
  33. The process of blood clotting includes
    • platelet aggregation
    • blood clotting cascade
    • fibrin clot formation
  34. platelet aggregation
    • with the formation of a platelet plug
    • platelets clump together to try and stop the bleeding
    • they are not clots and cannot provide homeostasis
  35. blood clotting is a cascade triggered by
    • the formation of a platelet plug
    • Once the cascade is triggered its on
  36. Intrisic factors
    happen in the blood itself
  37. extrinsic factors happen
    outside the cell.
  38. fibrin clot formation is
    • the last phase of blood clotting.
    • fribrinogen is a protein made in the liver
    • the enzyme thrombin removes the end portions of fibrinogen, converting it to active fibrin
    • active fibrin molecules link together to form fibrin threads.
    • the threads form netlike base like web creating a clot
    • Factor XIII tightens up the mesh making it more dense and stable.
  39. Many coagulation factors are produced in
    the liver thus liver disease can affect bleeding and clotting factors.
  40. vitamin K deficiency can
    impair the production of coagulation factors
  41. anemias are
    decrease in the quantity of circulating RBCs or the hemoglobin content
  42. anemias are caused by
    • disorder in RBC production
    • chronic bleeding
    • sudden hemorrhage
    • excessive cell lysis (destruction)
  43. All anemias will result in
    • decreased hemoglobin and hematocrit.
    • inadequate tissue perfusion
  44. anemias that result from a disorder in RBC production occur if there is
    • inadequate or inaccessible iron (iron defficiency anemia)
    • lack of folic acid
    • lack of vitamin B12
    • lack of globulin
    • can be because of bone marrow disease (cancer, leukemia, radiation exposure)
    • lack of erythrpoietin (renal disease)
  45. what would be an intervention for someone with lack of erythropoietin?
    erythropoietin
  46. What are the signs and symptoms of anemia
    • increased heart and respiratory rate (SOB) (body attempting to deliver more O2)
    • dizziness (decreased blood flow to the brain)
    • fatigue (decreased O2 to organs and tissues)
    • skin pallor (decreased RBCs)
    • decreased hair and skin quality
    • nausea
    • decreased GI and CNS blood flow (ALOC)
  47. what are causes of anemia
    • iron deficient diet (common with vegetarians or lack of intrinisic factor with can cause decrease B12 absorption)
    • chronic alcoholism
    • malabsorption syndromes
    • gastric bypass surgery
  48. what do you teach an anemic patient
    • take iron supplements with green veggies or a source of vitamin C
    • the body can only absorb 20% of iron intake unless it has the intrinsic factor and vitamin C. Then it absorbs 80%
  49. What are some foods rick in vitamin B12
    kidney beans, spinach, and rainsins
  50. what foods ar ehigh in hemoglobin and iron
    red meat and organ meats
  51. what are sources of iron
    beans, whole wheat, bran flakes, broccoli, brussel sprouts, collard greens
  52. what blocks iron absorption
    calcium and flourquinolones (cipro)
  53. side effects of iron include
    black stools and constipation, teach your client to take a stool softener.
  54. megaloslastic anemia is
    macrocytic (large RBCs)
  55. what is the pathophysiology of megaloblastic anemia
    a B12 deficiency which doesnt allow DNA synthesis and results in large thin red blood cells
  56. symptoms of megaloblastic anemia include
    • pallor
    • jaundice
    • smooth beefy red tongue
    • weight loss
    • nerve parasthesias
  57. causes of megaloblastic anemia are
    • malabsorption of B12 from lack of intrinsic factor in the stomach mucosa = pernicious anemia
    • folic acide deficiency
  58. pernicious anemia can cause
    permanent neurological damage and the cure is B12 injections for life, weekly or monthly.
  59. surgeries that affect the absorption of B12 which causes megaloblastic anemia are
    • small bowel resection
    • gastrectomy
    • gastric bypass
  60. infections that affect the mucous lining are
    tapeworm which affects the absorption of B12 which can cause megaloblastic anemia
  61. diets poor in what can cause malabsorption of B12 which leads to megaloblastic anemia
    dairy products
  62. aplastic anemia is
    • deficiency in circulating RBCs
    • bone marrow fails to produce the cells
    • usually occurs with leukopenia (reduction of WBCs) and thrombocytopenia (reduction in platelets)
  63. pancytopenia is
    reduction in all cells and is common with aplastic anemia
  64. the cause of half the aplastic anemia cases is
    unknown
  65. aplastic anemia can be caused by
    exposure to chemicals or toxins
  66. fanconi's anemia is
    the heriditary version of aplstic anemia
  67. sickle cell anemia is
    • an autosomal genetic disorder
    • musst get one abnormal gene from each parent
    • if only one parent has the gene then they are considered a carrier
    • more common in people of african american, meditteranean decent
  68. 40% of hemoglobin contains
    an abnormality of the beta chains (hemoglobin S)
  69. changes in the O2 content in sickle cell anemics cause
    the cells to change into the sickle shape
  70. the sickle cell shape of cells cause
    clumping in the arteries which cut off the O2 supply which causes organ damage
  71. symptoms of sickle cell crisis includes
    • intense pain
    • lack of O2 to the tissues causing local or systemic hypoxia
    • priaprism (prolonged erection)
    • fatigue
    • SOB
    • jaundice (bilirubin released from lysed cells)
    • organ damage (spleen kidneys liver)
    • renal and urinary changes (acute renal failure)
    • altered level of conciousness and skin changes (ulcers)
    • folic acid deficienies
  72. what are interventions for someone in sickle cell crisis
    • pain medications ( should be IV or PO, NO IM)
    • oxygen (always)
    • fluids (possible blood transfusions, but have to watch for iron overload)
    • promote venous return
    • monitor for infection they are at greater risk for sepsis
    • elevate head of the bed 30 degrees
    • warm room temperature
    • check circulation in extremities (cap refill, pulses)
    • this is a problem of circulation oxygen and pain and they are all equally important
  73. pernicious anemia is
    a B12 deficiency
  74. B12 is essential for
    RBC function (clients develop anemia due to reduced RBC production)
  75. B12 s usually provided
    through diet
  76. pernicious anemia is
    • a slow developing disorder
    • may go unnoticed until symptoms are severe
    • found commonly in elderly, vegetarians, or gastric bypass clients
    • can be the result of an autoimmune disease where the gastric mucosa develops antibodies against parietal cells
  77. symptoms of pernicious anemia include
    • infections
    • mood swings
    • weakness
    • fatigue
    • memory changes (B12 is needed for nuerological function)
    • paresthesia of fingers or feet (tingling)
    • ataxia (staggering and unsteadiness)
    • abdominal pain
    • beefy red tongue
    • pale yellow skin
    • hepatomegaly (swelling of the liver)
    • low hemoglobin
    • can cause permanent irreversible neurological damage
  78. iron deficient anemia is
    • the most common anemia
    • about 2/3 of iron is in hemoglobin
    • the other 1/3 of iron is stored in bone marrow, spleen, liver and muscle
    • with iron deficiency the stored iron is depleted first and then the hemoglobin iron
  79. nursing assessments and interventions include
    • evaluate clients for abnormal bleeding especially from GI tract
    • assess for weakness and pallor
    • assess diet and increase amounts of foods rich in iron.(red meat, organ meat, fish, egg yolks, kidney beans, tofu, leafy green vegetables, raisins and vitamin c which promotes iron absorption)
    • oral iron supplements (ferrous sulfate: should increase hemoglobin by 2gms/dl per week)
    • if severe enough iron can be administered via Im or IV
    • labs to assess serum ferritin values
    • assess for constipation
  80. food rich in iron include
    • red meat
    • organ meat
    • fish
    • egg yolks
    • kidney beans
    • tofu
    • leafy green vegetables
    • raisins
    • vitamin c which promotes iron absorption
  81. folic acid helps
    make new red blood cells
  82. lack of folic acid results in
    anemia
  83. usually we get folic acid from
    our diet but poor nutrition, malabsorption syndomres (chrons), drugs (anticonvulsants, oral contraceptives) or alcohol abuse can inhibit absorption.
  84. floci acid deficiency does not effect what system
    nervous system
  85. what foods contain folic acid
    • dark leafy greens
    • liver
    • yeast
    • citrus fruits
    • dried beans
    • nuts
  86. primary plycythemia is
    an increase in the number of RBCs along with platelets and granulocytes
  87. signs and symptoms of primary polycythemia is
    • skin that is dark or flushed
    • intense itching
    • hypertension from increased blood viscosity
    • thrombosis formation (blood clots) or bleeding (from malformed blood cells)
    • hyperkalemia
  88. treatment for primary plycythemia is
    • phlebotomy
    • hydration
    • prevent clot formation (coumadin)
  89. secondary plycythemia is
    a result of chronic hypoxia
  90. hypoxia stimulates
    the release of erytthropoietin from the kidneys stimulating RBC production
  91. people who live at high altitudes or have COPD may have
    secondary ploycythemia because of decreased O2 to the tissues thus stimulating the bone marrow to make more RBCs.
  92. Decreased O2 to the tissues stimulates
    bone marrow to make more RBCs
  93. dehydration can cause secondary polycythemia because
    of the decrease in plasma volume
  94. any polysythemia can cause increase in
    clotting
  95. leukemia is
    • increased production of immature WBCs (blast cells)
    • which causes the bone marrow to become crowded with immaure nonfunctional cells
  96. leukemia decreases
    normal WBC production which alters the immune system, O2 transport and blood clotting abilities
  97. normal WBC range is
    4.5 to 11
  98. cancer usually occurs in
    the stem cells or precurser leukocyte cells causing excessive growth of immature leukocytes
  99. a person with leukemia
    • has no immune system defenses
    • without treatment will die from infection or bleeding
  100. causes of leukemia include
    • radiation exposure
    • chemicals and drugs
    • bone marrow hypoplasia (incomplete or underdevelopment of the bone marrow)
    • genetics
    • immunodeficiencies
    • any or all of the above
  101. signs and symptoms of leukemia
    • increased heart rate and respiratory rate to help with O2 delivery
    • murmurs and bruits in the cardiac system
    • pallor or cool extremeties related to anemia
    • petechiae or ecchymoses from reduced platelets
    • open sores or lesions on the skin
    • bleeding
    • weight loss
    • fatigue
    • headaches
    • fever
    • bone and joint pain
    • infection
  102. labs for leukemia include:
    • decreased hemoglobin and hematocrit
    • abnormal WBC count, either too high or too low
    • high WBC has a poorer prognosis
    • left shit because immature WBC are being released into the system
    • low platelet count
    • blood cultures
    • bone marrow aspiration
    • clotting times increased
    • may do other test for related symptoms such as chest xray for SOB

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