Chapter 30 and 31: Hematologic System and Hematologic Problems Flashcards
Gerontologic considerations
Very few changes. May drop slightly, but remain in normal limits. Have a diminished reserve capacity. Have less reserve so harder to fight back after illness esp. with clotting, oxygen transport, and fighting infection. Anemia is NOT an expected finding!
Hgb is only decreased slightly. Need to look for other causes if low. Anemia causes in older adults: 1/3 is nutritional, 1/3 is renal insufficiency or chronic inflammation, 1/3 is unexplained.
Decreased samt red marrow=decreased reserve capacity=harder to fight back.
Heredity
Hemophilia, sickle cell disease, thalassemia, hemochromatosis; also possibly leukemia, pernicious anemia, and clotting disorders
Medications
Salicylates (i.e. ASA)- platelet function; NSAIDs=- inhibit platelet aggregation; Herbs- MANY herbs affect coagulation; Oral contraceptives- increased clotting risks; Immunosuppressants- affects WBCs; chemo- affects all cells
Past surgical procedures
Splenectomy: spleen holds 300 mL of blood, 1/3 of platelets. WBC storage=protective agent. removed=higher circulating platelet level, decreased RBC storage and destruction, decreased immune functioning
Duodenal or ileal surgeries: interferes with iron absorption (B12 absorbed in the ileum, iron absorbed in the duodenum)
Partial or total gastrectomy or ileal resection: affects intrinsic factor (made by parietal cells) and B12 absorption (ileum)
Gastric bypass: interferes with iron absorption (intrinsic factor)
Ileal resection: affects intrinsic factor-B12 absorption
Ethnic Decent
African Americans (sickle cell disease), northern Europeans (pernicious anemia), mediterranean’s (thalassemia)
Alcohol or cigarette use
GI bleeding, vitamin deficiencies, damages the liver where clotting factors are made Smoking leads to hypoxia, affects platelets (promotes platelet aggregation=increased Hct. Increased viscosity d/t interference with oxygenation [promotion of secondary polycythemia-more RBCs to accommodate decreased O2 binding)
Nutritional History
Inadequate intake could lead to anemia’s
Must have iron, cobalamin, folic acid to develop RBCs. Liver, meat, eggs, whole-grain, potatoes, leafy green veggies, dried fruits, legumes, citrus fruits
Joint Pain
Autoimmune disorder, gout from uric acid from breakdown of cells (hemolytic anemia). Bleeding into the joints, pain from leukemia. Achy bones can happen from pressure of expanding bone marrow in leukemia. Parathesias, numbness, tingling can happen with pernicious anemia
Cobalamin
B12
Lymph nodes
Should be
Pallor and cyanosis
Pallor in mild anemia, cyanosis in severe
Clubbing
Chronic anemia (i.e. SCD [Sickle cell disease]). High CO2 associated with hypoxemia. CO2 dilates vessels in fingers=hypertrophy over time
Petechiae, bruising, purpura
=platelets. Signs of bleeding; usually a platelet disorder (bleeding into joints or muscles is more likely to be a coagulation factor problem)
Splenomegaly
Spleen’s function is to filter the blood, clear microorganisms and antigens, remove abnormal and old RBCs, and store platelets and WBCs, fights the bacteria of meningitis and pneumonia. Can trap all the blood cells, stores 30% of the boy’s platelets (will have a higher circulating level of platelets and potential clotting problems once the spleen is removed). When enlarged it doesn’t work as well and can lead to a decrease in blood cells, increased risk for rupture (s/s: may be asymptomatic, may have abd pain, early satiety, anemia, thrombocytopenia, leukopenia). Splenectomy is done to increase blood cell count or for splenic rupture. Post splenectomy can have immunologic deficiencies leading to a lifelong risk for infection; recommend pneumovax, influenza vaccine
Recycles everything from RBCs. Chronic anemic issue=bad RBC=spleen destroys them. take spleen out to stop it
Assess the 3 major blood cells formed in the bone marrow.
CBC
Think 12-16. Decreases in anemia, hemorrhage, fluid overload(hemedilution). Increases in polycythemia, dehydration (hemeconcentration).
Hemoglobin
Percentage of RBCs in the total blood volume. Affected by the same things as Hgb. Think 35-45. (Hgbx3)
Hematocrit
Total RBCs (think 4-5) and types
MCV- Mean corpuscular volume=size (low is small)
MCH Mean corpuscular hemoglobin=weight (low is hypochromia)
MCHC Mean corpuscular hemoglobin concentration=saturation with Hgb (how much of the RBC is saturation with Hgb)
Indicates infection/inflammation/leukemia. Total count and differential count which tells the percentage of each type. If lots of bands is called “shift to the left.” Can have a normal ___ but abnormal differential like with neutropenia (multiply the total ___ by the percentage of neutrophils). Should be 4,000-11,000
WBCs
Basophils=allergic response, histamine
Eosinophils=antigen immune response, allergic reactions
Neutrophils=70%, phagocytic, main warriors
Elevated bands=sign of infection. (seg+band)total WBC
Absolute neutrophil count should be 1500-7000. @1000, cautious.
Below 100,000 is thrombocytopenia. Thrombocytosis would be >400,000 and cause excessive clotting.
Should be 150,000-400,000
Platelets
Indicates the presence of abnormal or immature cells. Looks more closely at the types of cells, shapes of cells, maturity of cells. May also be performed when a person has s/s that suggest a condition affecting blood cell or lifespan.
Peripheral smear
Measures clotting time. Normal is 25-35 seconds, but up to 70 if on anticoagulant. Focuses on the intrinsic pathway in the blood clotting process. Monitors the effects of heparin
aPTT/PTT (activated partial thromboplastin time)
PTT (3)+ heparin (7)=10
Measures clotting time. Normal 11-13 seconds. Focuses on extrinsic pathway in the blood clotting process. Monitors effects of coumadin.
PT (prothrombin time)
Standardized way of reporting the PT. Normal 0.9-1.1 but 2-3 if on anticoagulation. Monitors effects of coumadin
INR (international normalized ratio)
