Assessment of Hematologic Function Flashcards
Hematologic System
- Blood
- Lymph nodes/nodules
- Thymus
- Accessory organs (liver, spleen)
- Bone marrow
- Lymph nodes are interconnected in our bodies by lymph vessels. Most are found in the thoracic and abdominal cavities, the neck, axilla, inguinal, and superficial areas
> Look to see if there are changes to the lymph shape or size
Lymph nodes produce Ig and IgA (immunoglobulins)
Nodules are smaller than lymph nodes but equally important
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Is an endocrine organ responsible for producing T cells
The accessory organs are the liver and spleen
Thymus
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Is the primary producer of most clotting factors; is the storage site for most blood cells
Liver
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This organ balances blood cell production and destruction; assists with immune function; iron metabolism; and restores platelets and blood cells
Spleen
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Is the major site of blood cell and stem cell formation
Produces most of the cells of the blood (RBC’s, WBC’s, platelets) and is involved in the immune response
Bone marrow
Blood Function
- Carry oxygen to cells
- Assist with acid-base balance
- Transport carbon dioxide back to the lungs
- Coagulation
- Defense against infection
- Blood volume is higher in males (5-6L) opposed to females (4-5L) [can vary based on factors]
- Blood is more viscous than water; made in the bone marrow, spleen, and liver
- Affected by age, body composition, nutrition, hydration, medications
> NSAIDs impair the hematologic system
Blood Composition
- Plasma (55%)
> Proteins (8%) [albumin, globulin, fibrinogen]
> Water (90%)
> Other solutes (2%) [nutrients, electrolytes, waste products, hormones, gases]
- Buffy coat: WBC’s and platelets (<1%)
- RBC’s (45%)
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Is the component of plasma involved in blood clotting
Fibrinogen
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Is the component of plasma that maintains osmotic pressure of the blood which prevents plasma from leaking into tissues
Albumin
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Is the component of plasma that is involved in the transportation of substances and antibiotic function
Globulin
Erythrocytes (RBC’s)
- Erythrocyte - mature RBC
- Reticulocyte - immature RBC
- Needs Vitamin B12 and folic acid for RBC maturation
- Lifespan is 120 days
- Normal: 4-6 million
- Responsible for producing hemoglobin
Hemoglobin’s main function is to carry oxygen; carry iron to tissues, lungs, and other organs
> Needs iron in order to produce hemoglobin (Hgb)
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Normal Hgb in females ?
12-16
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Normal Hgb in males ?
13-18
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Is a growth factor that stimulates RBC production in the bone marrow
> Is released by the kidneys and the bone marrow produces it
Erythropoietin
Leukocytes (WBC’s)
- Function = inflammation/immunity
- Most are formed in the bone marrow
- What is a normal count?
- What are the 2 categories?
5000 - 10,000 μL
Granulocytes, agranulocytes
What are the 3 types of granulocytes?
- Neutrophils
- Eosinophils
- Basophils
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Are responsible for allergic reactions/responses
Eosinophils
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Are involved in the allergic response; release histamine and also heparin to correct tissue damage
Basophils
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Are the primary responders to inflammation; comprise 55-70% of WBC’s
Neutrophils
- Chemotherapy patients may need an ANC level done daily
> What is their neutrophil count? - ANC determines the risk for bacterial infection; looks at immune status helps determine the need for reverse precautions
> The higher the ANC, the higher the chance to being resistant to infection; a lower # indicates being more susceptible to infection
<1000 = risk for bacterial infection
<500 - high risk
What are the 2 types of agranulocytes?
- Monocytes
- Lymphocytes
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These cells destroy bacteria
Monocytes
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These cells enhance the immune response
Lymphocytes
Leukopenia - a reduction in WBC’s
Someone with a very low ANC ⥰ Neupogen
Rx’s that affect WBC’s
Might these lower or increase the WBC count?
- Beta adrenergic agonists (i.e., albuterol)
- Corticosteroids
- Epinephrine
- Granulocyte colony stimulating factor
- Heparin
- Lithium
may INCREASE
Might these lower or increase the WBC count?
- Antibiotics, anticonvulsants
- Anti-thyroid, arsenicals
- Captopril
- Chemotherapy drugs, Chlorpromazine
- Clozapine, diuretics
- Histamine-2 blockers
- Sulfonamides
- Quinidine, terbinafine, ticlopidine
may LOWER
Thrombocytes (Platelets)
- Smallest cell
! Controls bleeding
Normal count is ?
Lifespan of 1-2 weeks
! Thrombocytopenia is a deficiency in platelets
150,000 - 400,000 μL
Thrombocytes (Platelets)
- Formed in the bone marrow; stored in the spleen; and released as needed. Used to control bleeding
- Stick to an injured vessel wall and form platelet plugs; helps to repair damage to small cells to control bleed
<50,000 μL = huge risk for bleeding
Bleeding & Coagulation Measurements
- PT
- INR
- PTT or aPTT
- Platelet agglutination/aggregation
What is a normal PT?
10-13
What is a normal INR?
0.8-1.2
What is a normal PTT/aPTT?
20-36
- INR can be used with PT for those on warfarin
- Therapeutic INR for coumadin is 2.0-3.0
- PTT - looks at how long it takes the blood to clot and evaluates clotting factors II, V, VII, and IX
- PTT usually drawn on patients receiving heparin therapy; ranges can differ based on patient complication (cardiac issue vs DVT)
Which hematological measurement is looked at for warfarin?
PT/INR
Which hematological measurement is looked at for heparin?
PTT
Age-Related Changes to the Hematological System
> As the body ages, the # of cells are gradually reduced
Lean body mass decreases
Fat tissue increases until around 60
Bone mass and intracellular fluids also tend to decrease
Normal aging causes a decrease in total body water
- Blood volume decreases with age; bone marrow activity production to make RBCs and WBCs may be decreased
- Circulating Hgb and Hct levels may be lower, leading to fatigue in the older individual
- Reduction in lymphocyte count leads to decreased ability to fight infection
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- An insufficient supply of healthy RBCs
- Common causes = nutritional, hereditary, bone marrow disease, or bleeding
Anemia
! Is a clinical sign; NOT a specific disease; can be referred to as a disease
These patients have an insufficient amount of RBCs; decreased Hgb, Hct
! Hgb (g/dL) will determine how severe the anemia is
Mild anemia: 10-14 g/dL
Moderate: 6-10 g/dL
Severe: <6 g/dL
Hematocrit - the % of RBCs
Normal % in males is __-__%; is slightly higher than females __-__%
! Hct is 3x the Hgb
Males: 42-52%
Females: 37-47%
Clinical Manifestations of Anemia
- Pallor, fatigue
- Intolerance to cold, cold to touch
- Nails brittle/ridged “spoon shaped”
- Tachycardia
- Weakness, palpitations
- Orthostatic hypotension, headache
Types of Anemia
> Iron deficiency
Vitamin B12 deficiency
Folic acid deficiency
Aplastic
- Iron deficiency anemia lacking iron as opposed to aplastic anemia where the bone marrow doesn’t make enough new blood cells
Iron Deficiency Anemia
- Most common
- Causes - insufficient dietary intake, blood loss, impaired absorption
- Common in women, menstruating women, childbearing or pregnant women, older adults, and people with poor dietary habits
- Type tends to be chronic and dietary intake is a big factor
- Another source is from blood loss (i.e., from the GI tract [coffee-ground emesis, black tarry stools] or menstruation)
> Also, the patient with impaired intestinal absorption or someone who’s had gastric bypass surgery - Increase dietary intake - red meat, organ meat, egg yolks, leafy green vegetables
> May need iron supplements [! Constipation = offset with fiber or increased water intake] or IM injections
Vitamin B12 Deficiency
- Lack of B12 in the diet
- Poor absorption
- Diagnosed: CBC, MMA (methylmalonic acid), or Schilling Test
- Treatment = dietary, B12 injections, nasal inhalation
- Increase intake through animal protein, meat, seafood, eggs, and dairy
- Psychiatric and neurological dysfunction; glossitis and paresthesia
- Someone who is unable to absorb vitamin B12 may be lacking the intrinsic factor needed to absorb B12; known as pernicious anemia (glossitis)
- Identifying the cause and whether the patient is able to absorb it or not will help determine treatment
Folic Acid Deficiency Causes (Water-Soluble B9)
- Dietary
- Malabsorption
- Medications
- Affects the elderly, chronic illness, chronic ETOH abuse
- Occurs in those who don’t eat vegetables or go on extreme diets
- Also, malabsorption due to Crohn’s or gastric bypass; chronic illness; chronic alcohol abuse
- Rx’s - oral contraceptives, metformin, anticonvulsants, chemotherapeutic agents (methotrexate)
! Increase intake of fortified cereals, grains, green vegetables, yeast extracts, nuts, and folic acid supplements
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! Rare
- Deficiency in circulating RBCs
- Chronic exposure to toxic agents, congenital
- Accompanied by decreased leukocytes, platelets
Aplastic anemia
- Can cause heart arrythmias
- Can be caused by chronic exposure to toxic agents like pesticides or insecticides, radiation, autoimmune disease, chemotherapy, and other medications. Can also be idiopathic
- Treatment with blood transfusions or immunosuppressive therapy
Anemia Management
- Early identification of those at risk
- Dietary modification
- Supplements/rx’s
- Blood transfusion
Transfusion Therapy
- Verify prescription
- Test donor’s and recipient’s blood for compatibility (type and screen/cross-match)
- Examine blood bag for identification
- Check expiration date
- Inspect blood for discoloration, gas bubbles, or cloudiness
Transfusion Responsibilities
- Provide patient education
> Obtain informed consent - Assess VS
> May need to pre-medicate with Tylenol or Benadryl - Begin transfusion slowly and stay with the patient for the first 15-30 minutes
- Ask patient to report unusual sensations such as chills, SOB, hives, or itching
- Administer blood products per protocol
- Assess for hyperkalemia
! Occurs due to cellular damage and release of potassium into the blood; can occur from units of blood that are too old or too cold [a blood warmer may be used]
Transfusion Reactions
- Febrile transfusion reaction
> Chills, fever, tachycardia, HTN, tachypnea - Hemolytic transfusion reactions
> When the blood type or blood antigens are incompatible
> Fever, chills, headache, tachycardia, tachypnea, chest pain, HTN
- Allergic transfusion reaction
> Itching, bronchospasm, anaphylaxis
- Bacterial transfusion reaction
> Can be caused by contaminated blood
> Tachycardia, HTN, fever, chills, and in severe cases, shock
- Circulatory overload
> Happens when blood is infused too quickly
> HTN, bounding pulse, distended neck veins, dyspnea, restlessness, confusion
Autologous Blood Transfusion
- Collection and infusion of patient’s own blood
- Eliminates compatibility problems; reduces risk for transmission of bloodborne disease
- Also a way to minimize transfusion reactions
- Useful for a surgery; need to be infection-free; Hgb >11 g/dL; and by a provider’s prescription
Sickle Cell Disease (Anemia)
- Increased RBC destruction
- Genetic disorder
- Sickle-shaped RBCs
- Painful
- RBCs cannot effectively transport oxygen and deliver oxygen to tissues, organs, etc.
- Those with the disease go into times of crisis
> Crisis can be caused by hypoxia, dehydration, infection, pregnancy, high altitudes, stress, alcohol, and strenuous activities
- Pain is the first and most severe symptom
- Blood is not getting to the tissue and there is poor oxygenation from the obstructed blood flow
- We give these patients more oxygen, analgesics to help with the pain, rehydration, and blood transfusions
> Typically need opiate rx’s to ease their pain
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- A greater than normal RBC count
- Temporary or permanent
- Treatment = phlebotomy, hydration, anticoagulants
Polycythemia vera
Hgb >18 g/dL
Hct >48-52 in men
Massive production of RBCs, WBCs, and platelets
! A dark, flushed appearance, intense itching, HTN, poor tissue oxygenation (the greater viscosity of blood slows down oxygen exchange to the tissues)
> Are at a high risk for clotting
- 2-3x/week for phlebotomy isn’t unusual
- Give radiation or Interferon
! Complications of this disorder are thrombosis, or blood clotting, and hemorrhage; bone marrow scarring; development of AML; HF from the heart being overtaxed; PE concern
- May get hypoxic
