chapter 41: Assessent of the Hematologic System

Question 1

Aggregation

Answer 1

Clumping together

Question 2

Erythrocytes

Answer 2

The red blood cells. The major cells in the blood and are responsible for tissue oxygenation

They have a lifespan of about 120 days. The old cells are destroyed in the spleen and liver. Iron is recycled and used to make new RBCs. They produce hemoglobin molecules.

Heme: . Once the hemoglobin is complete with iron, it can transport up to four molecules of oxygen

Globin: carries CO2. They are buffers and help maintain the acid base balance.

4.2-6.1. Decrease indicates anemia or hemorrhage. Increase indicates hypoxia or polycythemia vera.
Hemoglobin 12-18
Hematocrit 37-52%

Question 3

Erythropoiesis

Answer 3

Selective maturation of stem cells into mature erythrocytes. The trigger for red blood cell production is increased need for tissue oxygenation. The kidney produces the growth factor, erythropoietin at the same rate the red blood cells are destroyed.

˜When tissue oxygenation is less than normal ( hypoxia) , the kidney releases more erythropoietin, this growth factor stimulates the bone marrow to increase RBC production, which improves tissue oxygenation and prevents hypoxia (if you have a patient with a decreased erythropoietin level they will have a decrease in hemoglobin. Hemoglobin carries oxygen. This is a nursing priority to assess first as the client will be deficient in oxygen and will require oxygen to alleviate shortness of breath
˜When tissue oxygenation is normal or high, the kidney reduces erythropoietin levels, slowing the production of RBCs.
˜Synthetic erythropoietin (Procrit, Epogen, EPO) has the same effect on bone marrow as naturally occurring erythropoietin. The natural stimulus for continued production of erythrocytes is the presence of erythropoietin. An injection of erythropoietin will help the bone marrow increase production of erythrocytes.

Substances needed to form hemoglobin and red blood cells include iron, vitamin B12, folic acids, copper, pyridoxine cobalt, and nickel.

Question 4

Extrinsic factors

Answer 4

An event that occurs outside the blood to cause platelet plugs to form. An example is a damaged blood vessel that releases collagen which activates the platelets to cause clumping

Question 5

Fibrinolysis

Answer 5

The breakdown of a clot. Prevents over enlargement of the fibrin clot.

Question 6

Hypoxia

Answer 6

A reduction of oxygen supply to the tissues. This causes the kidneys to produce more erythropoietin

Question 7

Intrinsic factors

Answer 7

A substance normally secreted by the gastric mucosa and needed for intestinal absorption of vitamin B 12. A deficiency of intrinsic factor and the resulting failure to absorb vitamin B12 leads to pernicious anemia

Question 8

Oxygen disassociation

Answer 8

The transfer of oxygen from hemoglobin to tissues

Question 9

Petechiae

Answer 9

Pinpoint red spots on the mucous membranes, palate, conjunctiva, or skin

Question 10

Hematological system components

Answer 10

Blood, blood cells, lymph, and organs such as the lungs, heart, and blood vessels.

Question 11

Bone marrow

Answer 11

Is the blood forming organ. It produces most of the blood cells including red blood cells, white blood cells, platelets. It is also involved in the immune response.

As we age, bone marrow is replaced by fatty tissue, but still keeps some.

Stem cell: immature, unspecialized, capable of becoming different types of blood cells.

Committed stem cell: also called the precursor cell. enters one growth pathway and can differentiate into only one cell type.

Growth factor: it’s required for a committed stem cell to actively divide. An example is erythropoietin from the kidneys for red blood cells

Question 12

Plasma

Answer 12

This part of the extracellular fluid. Contains lots of protein. There are three types:

Albumin increases osmotic pressure of the blood to prevent leakage into tissues.

Globulins transport substances and protect the body against infection. They are the main protein of antibodies

Fibrinogen forms fibrin which is important in blood clotting

Question 13

Anemia

Answer 13

The result of any problem that reduces the function of a number of red blood cells to the point that tissue oxygen needs are not completely met. Substances needed to form hemoglobin and red blood cells include iron, vitamin B12, folic acids, copper, pyridoxine cobalt, and nickel.
˜Many substances are needed to form hemoglobin and RBCs, including iron, vitamin B¹², folic acid, copper, pyridoxine, cobalt, and nickel
ØVitamin B¹² deficiency impairs, cerebral, olfactory, spinal cord, and peripheral nerve function. Severe chronic deficiency may cause permanent neurologic degeneration
˜A lack of any of these substances can lead to an anemia
˜Anemia: is the result of any problem that reduces the function or the number of RBCs to the point that tissue oxygenation needs are not completely met

Question 14

White blood cells/leukocytes

Answer 14

Provide immunity and protect against invasions and infection.

˜White blood cells (WBCs) or leukocytes are important for protection through inflammation and immunity and protect against invasion and infection
ØA normal WBC is 5,000 to 10,000/mm³. A WBC below 5,000 is low and makes the patient at risk for infection. Good hand washing technique is the best way to prevent transmission of infection

Question 15

Platelets

Answer 15

Stick to the injured blood vessel and form platelet plugs. They also produce substances important to blood clotting. They repair damage to small blood vessels. The aggregate. They’re controlled by growth factor thrombopoietin. 80% circulate and 20% are stored in the spleen. The lifespan is 1 to 2 weeks

Question 16

The spleen

Answer 16

Destroy old red blood cells, breaks down hemoglobin, stores platelets, filters antigens. The patient with a splenectomy has reduced immune functions.

The white pulp is the major site of antibody production and WBCs. Red pulp = RBCS and platelets.

Located beneath the abdominal wall under the ribs on the left side. Normally not palpable

˜After a splenectomy, patients are less able to rid themselves of disease-causing organisms and are at greater risk for infection and sepsis. Important to avoid crowds.

Question 17

Liver

Answer 17

Produces prothombin and most blood clotting factors. Important in forming vitamin K. Stores whole blood and blood cells. Converts bilirubin to bile and stores extra iron.

Is found in the right upper quadrant.
˜(Vitamin K is needed to produce blood clotting factors VII, IX, and X and prothrombin)

Question 18

Hemostasis/blood clotting

Answer 18

Involves three processes. Platelet aggregation with formation of the platelet plug. The blood clotting cascade. The formation of a complete fibrin clot. Calcium and more platelets are needed in every step. The cascade requires specific clotting factors.

˜Hemostasis is the multi-step process of controlled blood clotting.
˜Localized blood clotting occurs in damaged blood vessels to prevent excessive blood loss while blood continues to circulate to all other areas.
˜This function balances blood clotting actions with anti-clotting actions.
˜Three sequential processes result in blood clotting:
1. Platelet aggregation begins forming a platelet plug by having platelets clump together which is essential for blood clotting. These platelet plugs are not clots and last only a few hours. Thus they cannot provide complete hemostasis
2. Blood clotting cascade is triggered by the formation of a platelet plug. The cascade works like a landslide.
˜A. Intrinsic factors are substances directly in the blood itself that first activate platelets and then trigger the blood clotting cascade. These conditions include circulating debris and prolonged venous stasis. Must have suficient amounts of all the different clotting factors and cofactors (see Table 41-2)
˜B. Extrinsic factors are outside of the blood that can also activate platelets. A common event is trauma that damages blood vessels and exposes the platelets to collagen.
˜Collagen then activates platelets to form a platelet plug within seconds of the trauma.
˜Other blood vessel changes that can activate platelets include inflammation, bacterial toxins, or foreign proteins
3. Fibrin clot formation is the last phase of blood clotting. Fibrinogen is an inactive protein made in the liver.
˜The enzyme thrombin removes the end portions of fibrinogen, converting it to active fibrin. Active fibrin molecules then link together to form fibrin threads. Fibrin threads make a netlike base to form a blood clot.
˜After the fibrin mesh is formed, clotting factor XIII tightens up the mesh, making it more dense and stable. More platelets stick to the threads of the mesh and attract other blood cells and proteins to form an actual blood clot. As this clot tightens (retracts) the serum is squeezed out and the clot formation is complete.

Question 19

Hematologic aging changes

Answer 19

Decrease blood volume, decreased plasma proteins, fewer red blood cells, fewer white blood cells especially lymphocyte. Lymphocytes lose immune function. Antibody responses are slower. White blood cell count does not rise as much in response to an infection. Hemoglobin levels decrease.

ØThe lower plasma protein level may be related to low dietary intake of proteins
ØReduced protein production by the older liver
˜Bone marrow ages, and produces fewer blood cells. You will see total RBC, WBC, and lymphocyte counts lower in older adults
˜Know normal ranges! Refer to Chart 41-3
˜Platelets do not change with age.
˜Lymphocytes become less reactive to antigens and lose immune function which results in antibody levels and responses are lower and slower. The WBC does not rise as high in response to infection
˜Hgb levels fall after middle age and may be due to iron-deficient diets/

Question 20

Women’s health consideration

Answer 20

Women have lower blood cell counts than men do. The difference is greater during menstrual years because of blood loss. May also be because of a dilution caused by fluid retention from female hormones.

˜Iron deficiency anemia can be caused from heavy menses. Iron levels can be low because intake of iron is too low or there is an excessive loss of iron through bleeding

Question 21

Medications for blood clots

Answer 21

Anticoagulants: preevent new clots and limit extension, but do not break down existing clots

Fibrinolytic drugs/thrombolytic: breakdown fibrin threads already formed.
˜Fibrinolytics (thrombolytic drugs or “clot busters”)—selectively degrade fibrin threads in the formed blood clot
ØThe use of fibrinolytic drugs results in the best clot breakdown with less disruption of blood clotting.
ØAre first line therapy for problems caused by small, localized formed clots such as myocardial infarction (MI), limited arterial thrombosis, and thrombotic strokes.
ØUsually given within first 6 hours of onset of symptoms. This time limitation is not related to drug activity because fibrinolytic agents can break down clots older than 6 hours., however, the tissue that has been anoxic for more than 6 hours as a result of an acute event is not liklely to benefit from this therapy, making the risks to the patient greater than the advantages.

Platelet inhibitors: prevent platelets from becoming active or prevent them from clumping together. Aspirin, NSAIDS
ØThe most widely used drug for this effect is aspirin
ØNote: if a patient is scheduled for an invasive procedure such as surgery and is on Aspirin notify the physician as this will be rescheduled. Aspirin and other salicylates interfere with platelet aggregation, the first step in the blood clotting cascade, and decrease the ability of the blood to form a platelet plug. These effects last for more than 1 week after just the one dose of aspirin

ØComplementary therapy agents, such as St. John’s wort, inhibit platelet activity

Question 22

Alcohol

Answer 22

Causes nutritional deficiencies and liver impairment, both reduce blood clotting. The PT would be elevated.

Question 23

Vitamin K

Answer 23

Found in green leafy vegetables. Increases the rate of blood clotting.

Question 24

Anemia and fatigue

Answer 24

Fatigue most common symptom of anemia.
Oxygen delivery is decreased. Oxygen is needed to produce ATP. Without oxygen you don’t have ATP, leading to fatigue. Other symptoms include vertigo, tinnitus, a sore tongue. Systolic blood pressure tends to be lower in patients with anemia

Question 25

Leukemia

Answer 25

Caused by an overproduction of cells which creates a pressure in the bones. important sign is rib and sternal tenderness.

Question 26

PT-Prothrombin time

Answer 26

How long it takes the blood to clot. Clotting factors two, five, seven, and 10. 11 to 13 seconds or within 85 to 100% of the time needed. Warfarin therapy prolongs the PT time by 1.5 to 2 times the normal value

Increase indicates deficiency of clotting factors five and seven. Decrease time indicates vitamin K excess

Question 27

INR-International normalized ratio

Answer 27

Divide that PT by the established standard PT.
Normal is 0.7 to 1.8.
Warfarin therapy is 2.0 to 3.0

Question 28

PTT-Partial thromboplastin time

Answer 28

Assesses intrinsic clotting cascade. Factors two, five, eight, nine, 11, 12.

Problem with hemophilia or disseminated intravascular coagulation is prolonged.

Heparin therapy 1.5 to 2.0 times the normal amount

Question 29

Bone marrow aspiration

Answer 29

Obtain informed consent. Feel pressure and pushing. Maybe painful while aspirating. Hip is the usual site. The sternum could be used. The patient lies in the prone or sidelying position. Takes 5 to 15 minutes. A local anesthetic or mild sedative can be used. Aspiration uses a needle. A biopsy makes a small skin incision. External pressure is applied until hemostasis is insured. Observe for bleeding and infection for 24 hours. Inspect every 2 hours. be sure no trauma happens for 48 hours.

˜Bone marrow aspiration and biopsy are similar invasive procedures to evaluate the patient’s hematologic status when other tests show persistent abnormal findings that indicate a possible problem in blood cell production or maturation.
˜Results provide information about bone marrow function, including the production of all blood cells and platelets
˜In a bone marrow aspiration, cells and fluids are suctioned from the bone marrow
˜In a bone marrow biopsy, solid tissue and cells are obtained by coring out an area of bone marrow with a large-bore needle
˜These procedures require an order from a healthcare provider and a signed informed consent because it is invasive
˜Can be performed by a physician, nurse practitioner, physician assistant, as approved by the facility or regional law
˜The procedure can be performed at the patient’s bedside, in an examination room, or in a laboratory
˜Check facility procedure manual on how to handle specimen, as heparin or other solutions may be added

Question 30

Mean corpuscular volume-MCV

Answer 30

Measures the size of a red blood cell and is useful for classifying anemias.
80 to 95 mm^3
Increase indicates macrocytic cells, possible anemia
decreased indicates microcytic cells, possible iron deficiency anemia

Question 31

MCH-Mean corpuscular hemoglobin

Answer 31

The measure of hemoglobin by weight any single red blood cell. Abnormal findings the same as MCV
27-31 pg/cell

Question 32

White blood cell count

Answer 32

5000 to 10,000/mm^3

Increase: infection, inflammation, autoimmune disorder, leukemia

Decrease: prolonged infection, bone marrow suppression

Question 33

Reticulocyte count

Answer 33

And immature RBC that still has a nucleus. The measure of bone marrow function.
.5%-.2% of RBC’s
Increase: chronic blood loss
Decrease: inadequate RBC production

ØAn elevated reticulocyte count is desirable in an anemic patient or after hemorrhage indicated bone marrow is responding appropriately
ØAn elevated reticulocyte count without a precipitating event may indicate polycythemia vera (a malignant condition in which the bone marrow over produces)

Question 34

Total iron binding capacity-TIBC

Answer 34

250-460 mcg/dL
Increase: iron deficiency
decrease: anemia, hemorrhage, hemolysis

Question 35

Iron (Fe)

Answer 35

60-180 mcg/dL

Increase: iron excess, hemochromocytosis, liver disorders, megaloblastic anemia
decreased: iron deficiency anemia, hemorrhage

Question 36

Platelet count

Answer 36

150,00-400,000/mm^3

Increased: polycythemia vera or malignancy
Decreased: bone marrow suppression, autoimmune disease, hypersplenism

• When low (thrombocytopenia, the patient is at risk for bleeding
• 40,000/mm³ - 80,000/mm³ prolonged bleeding from trauma, dental work, and surgery
• <20,000/mm³ spontaneous bleeding and difficult to stop

Question 37

Coombs test

Answer 37

Direct tests presence of antibodies against red blood cells.
Indirect detect the presence of circulating antiglobulins to determine if the patient has serum antibodies to the blood transfusion they may receive.

Question 38

Anti clotting factors

Answer 38

˜Blood clotting occurs through a rapid cascade process and will keep forming clots until all the blood throughout the entire body is coagulated.
˜This widespread clotting would lead to death!
˜When the blood clotting cascade is started, anti-clotting forces are started to limit clot formation only to the damaged area so that normal blood flow is maintained everywhere else.
˜The anti-clotting forces involve two types of actions:
˜1. Ensures that activated clotting factors are present only in limited amounts
˜2. Fibrinolysis, prevents over enlargement of the fibrin clot.
˜When the blood clotting cascade is activated, certain anti-clotting substance are also activated
˜These actions prevent clots from becoming too large or forming in an area where clotting in not needed
˜Deficiency of any of these anti-clotting factors increases the risk of pulmonary embolism, myocardial infarction, and strokes

Question 39

Diet

Answer 39

˜Nutritional status: Diet can alter cell quality and affect blood clotting
ØHave patient record previous week eating habits; look for protein, mineral, or vitamin deficiencies that can contribute to anemias
ØDiets high in fat and carbohydrates and low in protein, iron, and vitamins can cause many types of anemia and decrease the functions of all blood cells
ØAlcohol consumption (chronic alcoholism) causes nutritional deficiencies and impairs the liver, both of which reduce blood clotting. The PT would be elevated
ØThe liver is the site for the production of prothrombin and most of the blood-clotting factors. Patient’s with liver failure run a high risk of having problems with bleeding.
ØDiets that enhance blood clotting that are high in vitamin K, in leafy green vegetables, may increase the rate of clotting. Assess the amount of salads and other raw vegetables and whether supplements of vitamins and calcium are used
ØAssess the ability to understand and follow instructions related to procedures, tests, drugs, and diet
ØAsk about personal resources, finances and social support. Poor income may have a diet low in iron and protein. Consider dietary consult

Question 40

Assessment

Answer 40

˜Family history and genetic risk important because many disorders affecting blood and blood clotting are inherited
ØAsk if anyone in the family has had hemophilia, frequent nosebleeds, postpartum hemorrhages, excessive bleeding after tooth extractions, or heavy bruising after relatively mild trauma
ØAsk if family member has sickle cell disease or sickle cell trait
ØAlthough sickle cell disease is seen most often among African Americans, anyone can have the trait
˜Current health problems
˜Ask about lymph node swelling, excessive bruising or bleeding, and if bleeding spontaneous or induced by trauma, a history of liver disease or liver failure
˜Dental work the amount and duration
˜Menorrhagia (excessive menstrual flow)
˜Assess for shortness of breath on exertion, palpitations, frequent infection, fevers, recent weight loss, headaches or paresthesias
˜The single most common symptom of anemia is fatigue

Question 41

Cultural awareness

Answer 41

Pallor and cyanosis are more easily detected in people with darker skin by examining the oral mucous membranes and the conjunctiva of the eye. Jaundice can be seen more easily on the roof of the mouth. Petechiae may be visible only on the palms of the hands or the soles of the feet. Bruises may be seen as darker areas of skin and palpated as slight swellings or irregular skin surfaces. Ask the patient about pain when skin surfaces are touched lightly or palpated

Question 42

Physical assessment

Answer 42

˜Skin and mucous membranes inspect for:
ØPallor or jaundice
ØAssess nail beds for pallor or cyanosis
ØPallor of the gums, conjunctivae, and palmar creases (when the palm is stretched) indicates decreased hemoglobin levels and poor tissue oxygenation.
ØAssess gums for active bleeding in response to light pressure or brushing the teeth with a soft bristle tooth brush, any lesions or draining areas
ØInspect for petechiae and bruising
•Hospitalized patient look for bleeding from sites such as around the naso-gastric tube, endotracheal tube, central lines, peripheral IV sites, and Foley catheter
•Petechiae are the only finding that is not a result aging and may represent an inability to clot appropriately
ØCheck skin turgor, dry and itching skin can indicate hematologic disease
˜Head and neck
ØCheck for pallor ulceration of the mouth mucosa
ØTongue may be completely smooth in pernicious anemia and iron deficiency and smooth and beefy red in nutritional deficiencies
ØAssess for jaundice of the sclera
ØInspect and palpate lymph node areas
˜Respiratory (blood problems reduce oxygen delivery)
ØAssess the rate and depth of respiration at rest and mild physical activity. See is they can complete a 10 word sentence without stopping
ØAssess if fatigues easily
˜Cardiovascular (reduction in oxygen delivery, the heart works harder to maintain tissue perfusion)
ØAssess pulse as they become weak and thready
ØObserve for distended neck veins, edema, or signs of phlebitis, listen for murmurs, gallops, irregular rhythms, and abnormal BP
ØNote BP tends to be lower than normal in patients with anemia and higher than normal when patients have excessive red blood cells
˜Renal and urinary (the kidneys have many blood vessels and bleeding problems may cause gross hematuria)
ØCheck and test urine for hematuria, and proteins in the urine. Blood contains protein, and blood in the urine increases protein content. Liver failure risk for bleeding in bladder, check urine
˜Musculoskeletal
ØRib or sternal tenderness may occur with leukemia (cancer of the blood) the bone marrow overproduces cells, increasing the pressure in the bones
˜Abdominal
ØThe normal adult spleen is usually not palpable. An enlarged spleen occurs with many hematologic problems.
ØPalpate gently and cautiously because an enlarged spleen may be tender and easily ruptured
ØA common cause of anemia among older adults is a chronically bleeding GI ulcer or polyp. If ulcer in the stomach or small intestine may not see in stool. Obtain occult blood testing.
˜Central nervous system
ØExamine cranial nerves hematologic issues can cause specific changes such as Vitamin B¹² deficiency impairs cerebral, olfactory, spinal cord, and peripheral nerve function, and severe chronic deficiency may cause permanent neurologic degeneration
ØLeukemia can cause bleeding, infection, or tumor spread with the brain
ØA patient with a bleeding disorder and head trauma, include frequent neurologic checks and mental status examinations

Question 43

Labs

Answer 43

ØPlatelet count (normal 150,000 to 400,000/mm³
•When low (thrombocytopenia, the patient is at risk for bleeding
•40,000/mm³ - 80,000/mm³ prolonged bleeding from trauma, dental work, and surgery
•<20,000/mm³ spontaneous bleeding and difficult to stop
ØHemoglobin electrophoresis
•Detects abnormal forms of hemoglobin such as hemoglobin S in sickle cell disease
ØLeukocyte alkaline phosphatase (LAP)
•Elevated LAP occur during episodes of infection or stress
•An elevated neutrophil count without an elevation in LAP level occurs with some types of leukemia
ØCoombs’ test direct and indirect used for blood typing
•The direct test detects antibodies against RBCs. The presence of these antibodies can cause hemolytic anemia
•The indirect test detects the presence of circulating antiglobulins. This test detrmines whether the patietn has serum antibodies to the type of RBCs before receiving a blood transfusion
ØSerum ferritin, transferrin, and total iron-binding capacity (TIBC)
•Measures iron levels and abnormal levels of iron and TIBC

Question 44

Tests for bleeding and coagulation

Answer 44

Tests that measure bleeding and coagulation provide information that reflects the effectiveness of different aspects of the blood clotting. These tests diagnose specific hematologic health problems, determine drug therapy effectiveness, and identify risk for excessive bleeding or clotting
˜Capillary fragility test *not tested
˜Bleeding time test *not tested
˜Prothrombin time (PT)
ØMeasures how long blood takes to clot (between 11 and 12.5 seconds)
ØPT is prolonged when one or more clotting factors are deficient. Warfarin (Coumadin, Warfiline) therapy) is also monitored using PT levels. Usually warfarin therapy is considered appropriate with the PT is prolonged by 1.5 to 2 times the patient’s normal PT value, depending on the specific reason for the warfarin therapy
ØAn increased prothrombin time would be most indicative of a problem with the clotting system component of the hematologic system
˜International normalized ratio (INR)
ØMeasures the same process as the PT by establishing a normal mean or standard for PT. A normal INR ranges between 0.7 and 1.8. INR with warfarin therapy, the desired outcome is usually to maintain the patient’s INR between 2.0 and 3.0. Outside of this range is not therapeutic
˜Partial thromboplastin time (PTT)
ØAssesses the intrinsic clotting cascade and the action of factors II, V, VIII, IX, XI, and XII. The PTT is prolonged whenever any of these factors is deficient, such as hemophilia or disseminated intravascular coagulation (DIC).
ØIf a patient is on heparin therapy the PTT assesses the intrinsic clotting cascade. Heparin therapy is monitored by the PTT
˜Platelet agglutination/aggregation is the ability to clump, is tested by mixing the patient’s plasma with an agonist substance that should cause clumping. The degree of clumping is noted. Aggregation can be impaired in von Willebrand’s disease and by ddrugs such as aspirin, antiinflammatory agents, psychotropics, and platelet inhibitors.

Question 45

Other tests

Answer 45

˜Radiographic examinations for suspected hematologic problems can include radioisotopic imaging.
˜Isotopes are used to evaluate the bone marrow for sites of active blood cell formation and sites of iron storage.
˜Radioactive colloids are used to determine organ size and liver and spleen function
ØThe patient is given a radiostope by IV about 3 hours before the procedure. Once in nuclear medicine department, the patient will lie still for about 1 hour during the scan. No special patient preparation or follow-up care is needed for these tests

Question 46

Patient prep bone marrow aspiration

Answer 46

˜Bone marrow aspiration and biopsy are similar invasive procedures to evaluate the patient’s hematologic status when other tests show persistent abnormal findings that indicate a possible problem in blood cell production or maturation.
˜Results provide information about bone marrow function, including the production of all blood cells and platelets
˜In a bone marrow aspiration, cells and fluids are suctioned from the bone marrow
˜In a bone marrow biopsy, solid tissue and cells are obtained by coring out an area of bone marrow with a large-bore needle
˜These procedures require an order from a healthcare provider and a signed informed consent because it is invasive
˜Can be performed by a physician, nurse practitioner, physician assistant, as approved by the facility or regional law
˜The procedure can be performed at the patient’s bedside, in an examination room, or in a laboratory
˜Check facility procedure manual on how to handle specimen, as heparin or other solutions may be added

Question 47

Bone marrow aspiration procedure

Answer 47

ØThe procedure lasts from 5 to 15 minutes
ØThe type and amount of anesthesia or sedation will depend on physician preference, the patient’s preference
ØA local anesthetic is injected into the skin around the site. Lidocaine can reduce the discomfort of the local anesthetic
ØThe patient may receive a mild tranquilizer or rapid-acting sedative such as Versed, ativan, or Amidate
ØAspiration or biopsy procedures are invasive, and sterile precaution are observed!
ØThe skin over the site is cleaned with a disinfectant.
ØAspiration biopsy the needle is inserted
ØFor a biopsy, a small skin incision is made and the biopsy needle is inserted through the skin opening. Apply external pressure to the site until hemostasis is ensured. A pressure dressing or sandbags may be applied to reduce bleeding at the site

Question 48

Post bone marrow biopsy

Answer 48

˜Follow-up care
˜The nursing priority after a bone marrow aspiration or biopsy is prevention of excessive bleeding!
˜Cover the site with a dressing after bleeding is controlled, observe closely for 24 hours for signs of bleeding and infection.
˜A mild analgesic (aspirin-free) may be given for discomfort, and ice packs can be placed over the site to limit bruising
˜Instruct the patient to inspect the site every 2 hours for the first 24 hours and note the presence of active bleeding or bruising
˜Advise to avoid contact sports or any activity that might result in trauma to the site for 48 hours
˜Bone marrow results will reflect the degree and quality of bone marrow activity and can confirm the spread of cancer cells from other tumor sites