6.3 Hematopoietic and Immune Blood Cells

Question 1

Hematopoietic and Immune Blood Cells

Answer 1

• Immature cells that evolve develop into different BC’s
• Originate in stem cells of blood marrow
• Found in the peripheral blood and bone marrow
• Failure in maturation of these blood cells can result in different consequences
  Aplastic - Deficient Cell Production
  Anemia - Reduced Circulating RBC’s
  Functional Iron Deficiency
  Abnormalities in WBC count
  Thrombocytopenia - Low Platelet Count

Question 2

Treatment Options

Answer 2

• Uses hematopoietic growth factors (protein)

- Cannot be given orally due to being destroyed in GI tract

Question 3

Erythropoiesis Stimulants

Answer 3

• Exogenous replacement of endogenous erythropoietin (EPO)
• Treatment of anemia associated with Chronic Renal Failure (CRF).
• Treatment of anemia due to zidovudine therapy, chemo-therapy, patients with anemia at high risk of substantial blood loss during surgery
• Stimulates RBC Production
• IV or SQ Administration (excreted via Kidneys)

Question 4

Erythropoiesis Stimilants

Answer 4

CONTRAINDICATIONS - Hypertension, avoid if hemoglobin is greater than 12/dL
ADVERSE EFFECTS - Hypertension, vascular disease, anemia, iron, folate deficiency.
- Look at reticulocyte count within 10 days to check effectiveness.
- Increased RBC and Hgb in 2-6 weeks.
PATIENT INFORMATION - maintain adequate iron intake, with chronic kidney disease maintain diet, teach how to do self SQ injections.

Question 5

Colony-Stimulating Factors

Answer 5

Filgrastim

• Increases neutrophil count for cancer patients.
• Stimulates and mobilizes cells that are progenitor cells for neutrophils.

Question 6

Interleukins

Answer 6

• Prevention of severe thrombocytopenia and reduced need to platelet transfusions in adult patients with non-myeloid malignancy
• Stimulates production of Megakaryocyte progenitor cells and thrombopoietin.
  CONTRAINDICATIONS - Hypersensitivity during and after cytotoxic chemotherapy

Question 7

Interleukins

Answer 7

Precautions - Patient with pre-exiting cardiomyopathy (disease of heart muscle making it harder to pump), congestive heart failure, history of atrial arrhythmia.
ADVERSE EFFECTS - Severe allergic reactions with anaphylaxis, fluid retention with weight gain, cardiac dysrhythmias, atrial fibrillation.
ASSESSMENT - Monitor platelet count and CBC. Monitor fluid and electrolyte balance. Assess for signs of bleeding.

Question 8

ABO Blood Groups

Answer 8

• Only OO blood is O. AO is A and BO is B
  O - Universal Donor (No antigens)
  AB - Universal Receiver (No antibodies)

Question 9

Blood Transfusion Reactions (Febrile - Nonhemolytic)

Answer 9

Febrile - Recipients antibodies react with WBC Antigens or WBC Fragments in the blood.
- Could also be cytokines (immune cells) that accumulate in the blood product during storage
SIGNS AND SYMTOMS
- Fever, Chills
- Febrile reactions are common, occurring in 2% of transfusions. Can be reduced by using leukocyte-reduced blood.

Question 10

Allergic Reaction to Blood Transfusion

Answer 10

• Occurs due to antigens in donors blood or transfusion of antibodies from a donor who has allergies with a subsequent antigen exposure
• Can be minimized by washing RBC’s
  SIGNS/SYMPTOMS
• Urticaria (Hives), Itching

Question 11

Reaction to Blood Transfusion (Hemolytic)

Answer 11

Hemolytic - ABO Incompatibility
- Can be fatal
SIGNS/SYMPTOMS
- BACKACHE*, headache, fever, tachycardia, hypotension, dyspnea, RBC hemolysis, sensation of heat in the vein, abdominal cramping, constricting chest pain, nausea, vomiting, facial flushing.
- STOP TRANSFUSION IMMEDIATELY. Maintain IV Access, save blood for evaluation, notify provider and the blood bank.

Question 12

Rhesus Factor (Rh) Types

Answer 12

• Presence or absence of RhD Antigen
• RhD+ has antigen
• RhD- does not have antigen
• RhD- person exposed to RhD+ blood will develop antibodies for the antigen posing issues for subsequent exposures. (Pregnancy, Transfusion)
• If second exposure baby may develop HEMOLYTIC DISEASE, or ERYTHROBLASTOSIS FETALIS.
• This happens in Rh+ babies inside Rh- Mothers

Question 13

Hemolytic Disease of Newborn

Answer 13

Pathophysiology - First baby is not affected but second baby will have their blood attacked by mother causing hemolysis
Clinical Manifestation - Severe anemia, jaundice, splenomegaly, impaired liver function, decrease albumin leading to massive edema, severe brain damage
- Rh immune globin (Rhogam) is provided at 28 weeks gestation and within 72 hours of delivery to block maternal sensitization to antigen.