Assessment of the Hematologic System Flashcards
Responsible for blood formation
First produces blood stem cells
Red blood cells (RBCs, erythrocytes)
White blood cells (WBCs, leukocytes)
Platelets
Also has role in immune responses
Located in flat bones (sternum, skull, pelvic and shoulder girdles) and ends of long bones
Bone marrow
Stem cells (immature)are capable of becoming any type of blood cell, depending on the body’s needs
First produces blood stem cells
Composed of plasma and cells
Plasma is an extracellular fluid with plasma proteins (3 main)
Blood cells
Blood components
Albumin: maintain osmotic pressure of blood - prevents plasma from leaking into tissues
Globulins: transport of antibodies - Ig
Fibrinogen: important in clotting
Plasma is an extracellular fluid with plasma proteins (3 main)
Largest proportion of blood cells
Produce hemoglobin which carries oxygen and carbon dioxide
Iron is important component of hemoglobin - allows carry O2
RBCs - Blood cells
Role in inflammation and infection protection
WBCs - Blood cells
Smallest blood cell
Clotting and bleeding
Stick to injured vessel walls and aggregate to assist clotting
Stim IR - clump together and plug the hole
Stored in spleen
Platelets - Blood cells
Destroys old or imperfect RBCs
Breaks down the hemoglobin
Something wrong increased risk of bleeding
Stores platelets
Antibody production and filters antigens
After a splenectomy patients have reduced immune functions - increased risk for infection; decreased antibody production and ability filter them
Spleen - Accessory organs of blood formation
Produces prothrombin and other blood clotting factors
Assists in the forming of Vitamin K in the intestines - clotting
Stores all blood cells
Stores iron in the form of ferritin
Liver - Accessory organs of blood formation
Decreased blood volume
Lower levels of plasma proteins
Bone Marrow produces less blood cells
Hemoglobin levels in men and women fall after middle age
Immune responses change
Hematologic changes associated with aging
Could be related to decrease in protein intake
Higher risk for infections, bleeding, edema
Lower levels of plasma proteins - Hematologic changes associated with aging
RBC and WBC counts decrease
Platelet counts do not change with age
Bone Marrow produces less blood cells - Hematologic changes associated with aging
Could be related to decrease in iron intake
Hemoglobin levels in men and women fall after middle age - Hematologic changes associated with aging
WBC counts may be lower
WBC count does not rise as high in response to infection in older adults - not as responsive
Presentation of infection diff
Antibody levels and responses are lower and slower in older adults
Lymphocytes become less reactive to antigens
Immune responses change - Hematologic changes associated with aging
Patient history
Nutritional status - iron and vitamin B12
Environmental exposure - toxin
Family history and genetic risk
Current health problems
Assessment methods
Age - older
Gender
Liver function - symp liver disease, alcohol use
Presence of known immunologic or hematologic disorders
Drug use
Patient history
Females have lower red blood cells - H/H; worse when menstruating; worse fluid retention
Gender
Some medications can cause bone marrow suppression, hemolysis, or disrupt platelet action or clotting factors
Drug use
Many disorders are inherited
Ex. Sickle cell, hemophilia
Family history and genetic risk
Lymph node swelling
Excessive bruising or bleeding
Common symptoms with hematological disease:
Most common manifestation of anemia is fatigue as a result of decreased oxygen delivery to cells (SOB too)
Current health problems
shortness of breath on exertion
Palpitations
frequent infections
Fevers
recent weight loss
Headaches
Paresthesia - abnormal sensation
Common symptoms with hematological disease:
Skin - BIG
Head & Neck
Respiratory
Cardiovascular
Kidney & Urinary
Musculoskeletal
Abdominal
Central Nervous System
Phys assessment
Inspect skin and mucous membranes for pallor
Assess nail beds for pallor or cyanosis: Pallor of the gums, conjunctivae, and palmar creases indicates decreased hemoglobin levels and poor tissue oxygenation
Inspect for petechiae and ecchymoses
Skin - BIG
Check for pallor or ulceration of the oral mucosa
Inspect and palpate all lymph node areas
Head & Neck
Assess respirations and dyspnea at rest and on exertion - decreased RBC and Hgb
Assess for fatigue - anemia
Orthopnea
Respiratory
Assess pulses
BP
Abnormal heart sounds
Irregular rhythms
Perfusion
Cardiovascular
Assess urine for hematuria - increased risk for bleeding
CKD - EPO
Kidney & Urinary
Rib or sternal tenderness may occur with leukemia
Assess range of joint motion, document any swelling or joint pain
Musculoskeletal
Evaluate spleen
Stool specimen to check for occult blood testing
Abdominal
Normal adult spleen is usually not palpable
Enlarged spleen may occur with many hematologic problems - thing prb and enlarged not palpate because rupture
Evaluate spleen
Neurologic checks and checks of cognitive function - anemia and resp issue
Central Nervous System
4.2-6.1
Decreased: possible anemia/hemorrhage
Increased: possible chronic hypoxia/polycythmeia vera - overproduction all blood cells
Red blood cell (RBC) count - Lab profile
12-18 g/dL
Decreased: possible anemia/hemorrhage
Increased: possible chronic hypoxia/polycythmeia vera - overproduction all blood cells
Hgb - Lab profile
37-52%
Decreased: possible anemia/hemorrhage
Increased: possible chronic hypoxia/polycythmeia vera - overproduction all blood cells
Hct - Lab profile
5000-10000
Decreased: prolonged infection/bone marrow suppression
Increased: infection, inflammation, autoimmune disorders, leukemia
WBC count - Lab profile
150,000-400,000
Decreased: bone marrow suppression, autoimmune disease, hypersplenism
Increased: polycythmeia vera - overproduction all blood cells/malignancy
Platelet count - Lab profile
11-12.5 sec
Decreased: vitamin K excess
Increased: possible deficiency of clotting factors V and VII
Prothrombin time (PT) - Lab profile
60-180 mcg/dL
Decreased: iron deficiency anemia, hemorrhage
Increased: iron excess, liver disorders, hemochromatosis, megaloblastic anemia
Iron - Lab profile
10-300 ng/mL
Decreased: iron deficiency anemia, hemorrhage
Increased: iron excess, liver disorders, hemochromatosis, megaloblastic anemia
Ferritin - Lab profile
250-460 mg/dL
Increased: iron deficiency anemia - More iron binding capacity - not getting to where need be
Decreased: anemia, hemorrhage, hemolysis
Total iron-binding capacity - Lab profile
Evaluates hematologic status
Invasive procedure - not first thing; after lab work
Aspiration
Biopsy
Informed consent needed
Preparation:
Post procedure care:
Bone marrow aspiration and biopsy
Specifically for a possible problem in blood cell production or maturation
Evaluates hematologic status
cells and fluids are suctioned from the bone marrow
Aspiration
solid tissue and cells are obtained by coring out an area of bone marrow with a large-bore needle
Biopsy
Provide information and emotional support - anxious or fearful during pain - local anesthetics: some pressure experience
Explain the procedure
Positioning
Preparation:
Local anesthetic is used and may feel stinging or burning sensation
Mild tranquilizer or a rapid-acting sedative could be used
Expect a heavy sensation of pressure and pushing while the needle is being inserted
Procedure quickly
Explain the procedure
Usually use the iliac crest
Patient should be placed in the prone or side-lying position
Positioning
Hold pressure briefly to site
Cover the site with a dressing after bleeding is controlled - monitor for bleeding
Give mild analgesic for discomfort
Apply ice bag to the needle site to limit bruising - help for pain
Observe site every 2 hours for 24 hours for signs of bleeding, bruising, and infection - check sight frequently
Advise the patient to avoid contact sports or any activity that might result in trauma to the site for 48 hours
Post procedure care:
