Hemo

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jtisby
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228579
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Hemo
Updated:
2013-07-30 11:02:04
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Hemo WWCC LPN
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Hemo_LPN_WWCC_2013
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  1. Thrombocytes, aka: platelets
    • Responds to injury
    • Begins clotting cascade
    • -plug formation
    • -coag activation
    • -clot retraction
    • Normal: 150-440 K/Mcl
    • Thrombocytopenia < 100 K/Mcl risk for bleed
    • Thrombocytosis >440 K/Mcl, risk for clotting
  2. Bone Marrow
    • Blood forming organ
    • makes: RBC, WBC, & Platelets
    • mostly in red marrow of flat bones
    • -skull
    • -sternum
    • -pelvis
    • -ends of long bones
  3. Blood cell formation:
    • Produced by stem cells in red bone marrow
    • Amount determined by body's demand
    • Requirements for RBC production:
    • -B12
    • -Folic acid
    • -Iron
  4. Components of blood
    • 46-63% plasma
    • 37-54% solids:
    • -RBC (99.9%)
    • -WBC (0.1%)
    • -Platelets (0.1%)
  5. CBC - Complete Blood Count
    • WBC: 4.5-11 K/mcL
    • RBC: 4-6.2 M/mcL
    • Hemoglobin: M - 14-16.5, F - 12-15 g/dL
    • Hemocrit: M - 42-52%, F - 35-47%
    • Platelets: 150-440 K/mcL
  6. Leukocytes (WBC)
    • Function:
    • Fight infection
    • React against foreign bodies or tissue
    • Normal Value: 4.5-11.0 K/mcL
    • Leukocytosis (elevated) > 11.0 K/mcL
    • Infection
    • Inflammation
    • Necrosis
    • Leukopenia (decreased) < 4.5 K/mcL
    • Chemotherapy
    • Leukemia
    • Viral Infections
  7. White Blood Cell Differential
    • Absolute (done by machine).
    • Counts every WBC
    • Designated absolute on printout.
    • Fast and accurate


    • Manual (done by technician)
    • Counts 100 WBCs.
    • Types counted and identified
    • Designated as percent (%)
    • Number of each type equals the percent
  8. Granulocytes: Neutrophils
    • First responders
    • -Almost all increased WBC are neutrophils
    • -Infection
    • -Tissue damage
    • -Necrosis


    • Mature =“segs
    • “Shift to the right”
    • More effective


    • Immature = “bands
    • “Shift to the left”
    • On-going infection
  9. Granulocytes: Eosinophils
    • Functions:
    • -Phagocytosis: kills foreign cells
    • -Allergy, anaphylaxis & Parasitic infections
    • -Modify antigen-antibody response
    • -Inflammatory response
  10. Granulocytes: Basophils
    • Allergic and inflammatory responses
    • Granules Contain:
    • -Platelet activating factors
    • -Histamine
    • -Serotonin
  11. Agranulocyte:
    Lymphocytes
    • Function:
    • Fight chronic bacterial & acute viral infection
    • 3 types of Lymphocytes
    • B Cells
    • -Bone marrow dependent
    • NK Cells (Humoral Immunity)
    • -Produce Antibodies
    • T Cells
    • -Thymus Dependent
    • -Respond to viruses, tumors
  12. Agranulocyte:
    Monocyte/Macrophage
    • Functions:
    • -Phagocytosis
    • -Facilitate Cellular Immune Response
  13. Red Blood Cells “Erythrocytes”
    • -Live about 120 days
    • -Formed in red bone marrow
    • -Contain Hgb & responsible for Hgb transport
    • -O2 to tissues
    • -CO2 from tissues

    • Values:
    • -Male adult: 4.5 –6.2 M/mcL
    • -Female adult: 4.0 –5.5 M/mcL
    • Decreased = Anemia and Blood Dyscrasias (multiple causes)
  14. Hemoglobin

    Function:
    • Function:
    • -Transport O2 & CO2
    • -Acid-Base Balance
    • Values:
    • -Male Adult:14-16.5 g/dL
    • -Female Adult:12-15 g/dL
    • Indications:
    • -Increased = dehydration or polycythemia
    • -Decreased = Anemia or hemorrhage
  15. Hematocrit (Hct)
    • -Measures % of RBCs per fluid volume of whole blood
    • -Evaluates % of solids vs. plasma -Important in determination of anemia or polycythemia
    • Normal: (usually 3x’s higher than the Hgb)
    • -Female –36%-48% Pregnant >33%
    • -Male–40%-54%
    • -Pediatrics:
    • -Newborn: 44%-64%
    • -6 mos. to 18yrs: 29%-43%
  16. Anemia
    “Is a deficiency in the number of erythrocytes (RBC’s), the quantity of hemoglobin, and/or the volume of packed RBC’s (hematocrit).”

    -Anemia is not a specific disease but a manifestation of a pathologic problem.
  17. Anemia - Symptomatology
    • R/T generalized tissue hypoxia
    • -Fatigue
    • -Headache
    • -Weakness
    • -Dizziness/Orthostatic hypotension
    • -Pallor/cool skin
    • -Tachycardia/tachypnea
    • -Decreased RBC, Hgb and/or Hct on lab
  18. Anemia –Types
    • -Iron Deficiency
    • -Folic Acid Deficiency
    • -Pernicious Anemia
    • -Aplastic Anemia
    • -Thalassemia
    • -Sickle Cell Disease
  19. Anemia –Iron Deficiency

    Most commonly affected
    • Most Common Type of Anemia
    • Affects:
    • -Children/Adolescents
    • -Pregnant & menstruating women
    • -Elderly (>65 years)
    • -MCV, MCH, and MCHC all decreased
  20. Red Blood Cell Indices -

    Mean Corpuscular Volume (MCV)
    • Mean Corpuscular Volume (MCV): average RBC size& Hgb content
    • -76-100 microm3
    • -Normocytic (average size)
    • -Microcytic (small) <76
    • -Macrocytic (large) >100
  21. Red Blood Cell Indices -

    Mean Corpuscular Hemoglobin (MCH)
    • Mean Corpuscular Hemoglobin (MCH):
    • -average amt of Hgb per RBC by weight
    • -27-33 picto-grams
  22. Red Blood Cell Indices -
    Mean Corpuscular Hemoglobin Concentration (MCHC)
    • Mean Corpuscular Hemoglobin Concentration (MCHC): average % of RBC occupied by Hgb
    • -32-36 g/dL of packed RBCs
    • -Normochromic (average color)
    • -Hypochromic (less than average)
    • -Hyperchromic (more than average)
  23. Anemia –Iron Deficiency

    Causes
    • Low serum iron
    • -Inadequate dietary intake 
    • -Blood loss 
    • -Malabsorption of iron
    • -Intravascular hemolysis(Pregnancy/Dialysis)
  24. Anemia-Iron Deficiency

    Clinical Manifestations:
    • -Pallor
    • -Weakness/Fatigue
    • -Irritability/Palpitations
    • -Headache
    • -Dyspnea
    • -Glossitis/stomatitis/cheilitis
    • -Brittle nails
  25. Anemia - Iron Deficiency

    Diagnostic Tests
    • Labs:
    • -CBC with RBC indices
    • -Radiographic studies: GI tract series
    • -Stool guiac
    • -Sigmoidoscopy/EGD
  26. Anemia –Iron deficiency

    Prevention/Treatment
    • -Foods high in iron
    • -Box 37-2, p. 433
    • -Vitamin C take with foods
    • -Increase absorption
    • -Oral Iron Supplements
    • -Ferrous sulfate, gluconate
    • -Best absorbed on empty stomach
    • -May cause GI upset –take with food
  27. Anemia –Iron Deficiency

    Treatment
    • -No response to oral or malabsorption
    • -Iron –Given IM or IV
    • -May stain skin=Give deep IM –Z track
    • -Therapy may be required for up to one year
    • -Liquid iron For children
    • -Can stain teeth=Use a straw
  28. Anemia-Iron Deficiency

    Teaching
    • Instruct patient and family about iron rich foods.
    • -Do not give iron with milk or antacids R/T decreased absorption
    • -Discuss side effects
  29. Anemia –Pernicious Anemia
    Vitamin B12 and/or intrinsic factor deficiency

    Necessary for synthesis of DNA & RBC maturation
  30. Anemia –Pernicious Anemia

    Causes
    • Causes:
    • Inadequate intake –vegetarians
    • Drugs that impede absorption:
    • -Anticonvulsants, oral contraceptives, metformin, nitrous oxide => M.O.N.A.
    • Decreased absorption from GI tract
    • -Loss of intrinsic factor
    • Macrocytic and normochromic
    • MCH and MCHC –normal to high
    • MCV -increased
  31. Pernicious Anemia

    Symptomatology
    • Smooth, sore, beefy red tongue
    • Parasthesia of hands & feet
    • Difficulty with balance
    • Impaired memory
    • Confusion
    • GI manifestations (weight loss, anorexia, nausea, diarrhea)
  32. Anemia –Pernicious Anemia

    Diagnostic studies
    • Lab tests:
    • -Schilling test (definitive test for PA)
    • -CBC
    • -serum iron level
    • -Total iron-binding capacity
    • -Serum ferritin
  33. Anemia –Pernicious Anemia

    Treatment
    • Treatment 
    • -Dietary ( Box 46-8, p. 593)
    • -Parental Vitamin B12
    • -Teaching: life long admin
    • -Oral or IV Iron Supplements
    • -Digestants
    • -High doses of folate, cobalamine & pyridoxine
  34. Anemia - Folic Acid

    Causes
    • Disruption in DNA synthesis of blast cells-forms megablasts
    • Causes:
    • -Malnutrition
    • -Alcohol abuse 
    • -Anorexia
    • -Hemodialysis
    • -Drugs: Methotrexate, anticonvulsants
    • -Malabsorption syndromes
    • -Pregnancy and growth spurts
  35. Anemia - Folic Acid

    Labs
    • -RBC, H&H, WBC, and Platelets are all low
    • -MCV and MCH are high
    • -MCHC is normal
  36. Anemia –Folic Acid

    Symptoms
    • Irritability
    • Depression
    • Sleep deprivation
    • GI disturbances -dyspepsia
  37. Anemia –Folic Acid

    Treatment and Teaching
    • Consume foods rich in folic acid:
    • -Dark green leafy vegetables
    • -Fortified cereals and breads
    • -Folic acid supplement (oral or IM) and Vit. C
    • -Pregnant women need 1mg/day
  38. Anemia –Folic Acid

    Diagnostic Studies
    • Blood smear
    • Bone marrow examination
    • Serum folate (normal: 7 to 20 ng/mL)

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