Hematologic Flashcards
Main producer of blood cells/blood
Bone marrow
Components of blood
Plasma and blood cells
Types of blood cells
Erythocytes
Leukocytes
Thrombocytes
Two types of leukocytes
Granulocutes
Agranulocytes
All blood cells start as
Stem cells
Esonophils used for
Allergic reactions
Neutrophils
One of the bloods first line of defense against infection
Primary fucntion of RBC
Transport gases, O2, CO2
And to assist in acid base balance
WBC primary function
Protect body against infeciton
Platlet role
Promote blood coagulation
What does blood transport
Hormones
Metabolic waste
O2, CO2
FLuid electrolyte balance
Acid Base balance
Maintaining body temp
Maintaining hemostasis of blood coagulation
Blood makes up ___ % of total body weight
8%
How much plasma is in blood
55% plasma
7% protein
91% water
2% other solutes
45% formed elements
Mostly RBCs
Followed by Platlets
FOllwed by WBCs
- Netrophils
- Lymphocutes
- Monocytes
-Vasophils
Most common prtoein in plasma
Albumin
Pts for whom it is PARTICULARLY important to notice Albumin labs
cancer, liver dx, or on treatment for anything impacting liver9
Functions of blood
Iron metabolism
Clotting mechanism
What are clotting mechs responsible for
Vascular injury and subendothelial exposure
Platelet plug formation
Fibrin clot development
Clot retraction and dissolution
Iron deficiency is a high risk for
Marternal morbidity
What percent of iron ingested is absorbed?
5-10%
How is iron lost?
Blood lost
iron Absorption typically takes place in
Duodenum and Jejunum
Implications of Duodenum removed
So man ydrugs are absorbed there
2/3 of iron stores are found in the _____ part of the hemoglobin molecule
The Hem part
The other third of the bodys iron stores are stored as
Ferritin and hemosiderin in bone marrow, liver, spleen, macrophages
When stored iron is used and not replaced
Hemoglobin production is reduced
Transferin
Made in the liver
A carrier plasma protein for iron
Iron is recycled in body where
Liver and spleen
Primary function of spleen is to phagocotyze old RBCs
How much iron lost in urine
Very little, 3%
As platlets adhere to the collogen fibers of a wound platlet, they become
Sticky
How does aspirin act
Reducing platlet stickiness to one another
3rd phase of clotting
Fibrin clot development
Thrombin
Most powerful enzyme in coagulation process
Converts fibrin to fibrinogen
- essential component to blood clot
4th step of clot formation
Clot restrction and disillusion
Fibronolytic system initiated when palsminogen is converted to plasmin
Thrombin therefore promotes fibrinolysis
Plamin attatcks fibrin or fibrinogen by splitting molecules into smaller elements (FSPs or FDPs)
if Fibrinolysis is excessive the pt is predisposed to bleeding
The flattening out of clot to restore full blood flow
Spleens role
Produces RBCs in fetal development
Removes old/defecti e RBCs from bloodstream
Recycles iron from hemoglobin catabolism
Filters bacteria out of blood
involved in storage for platlets and RBCs (1/3)
Lympth system role
Lymph caps,ducts, fluid, nodes
transport of Fluid from interstitial spaces to the blood
Proteins and fat from GI and hormones return to circulatory system this way
Also returns interstital fluid to blood
Important in PREVENTING edema
200+ lymph nodes thart filter pathogens
Liver Role
Produces coagulants that are essential for blood clotting
When iron exceeds tissue needs, excess is stored in liver
Hepsimin protein a key regulator of iron balance
- Reduces release of stored iron
- When iron is deficient, Hepsimin decreases, releaing stored iron
4 primary structures of hem system
Bone marrow
Liver
Spleen
Lymph
Age related considerations for hem system
ANytmie older adults are out of range for normal values
when they go outside normal limits, they become ill quicker because they have less stores and less ability to resolve deficiencies
More at risk for severe clinical manifestations and dx
Assessment of hem system
Subjective
Past health history
Medications: Rx and OTC
Surgery or other treatments
Hem hx
Values and beliefs
- JWs - do not want to recieve blood or blood products
Lymph node assessment
Should include: symmetry, size, degree of fixation, tenderness and texture
Normal lymph nodes are
small (1-1.5cm), mobile, firm, non tender, firm
Abnormal lymph nodes
Hard fixed nodes are suggestive of malignancy
If liver or spleen are enlarged
Measured by cm below rib border
Enlarged livers can be palpated
Enlarged spleens CAN only be felt in conditions such as sickle cell anemia
Skin assessment
Assess H2T for rashes. If a rash is present, apply pressure to determine if it is _____ or __-_____.
Blanchable rashes (blanch is better)
Non blanch are more concerning and important to pay attention to
-Petichieae
How do we diagnose disorders in hem system
Complete blood count
Red blood cells
White blood cells
Platelet count
Iron metabolism (iron, TIBC, ferritin, transferrin saturation)
PT, INR, aPTT
INR and PT tests are associated with what drug
Warfarin
PTT
Heparin
Drugs like apixaban can be tracked?
Cannot be tracked by INR, PT , or PTT
Therefore cannot be tracked until manifestations problems occur
Anemia
A deficiency in the:
Number of erythrocytes (red blood cells [RBCs])
Quantity or quality of hemoglobin
Volume of packed RBCs (hematocrit)
There are three broad causes of anemia:
Decreased RBC production
Blood loss
Increased RBC destruction
Why would RBC production be decreased
Usually iron deficiency
Average lifespan of RBC
120 days
Organs responsible for RBC recycling
Liver and spleen
Reasons for increased RBC destruction
Intrinsic (ie abnormal Hgb)
Extrinsic (ie physical trauma from dialysis; antibodies, etc)
Primary function of RBC
Transport oxygen (O2) from lungs to systemic tissues
Carry carbon dioxide from the tissues to the lungs
Is anemia a specfic disease?
No, broad manifestation of a patho process
Anemia is classified
Morphological (Most accurate)
- Cell characteristics
Etiological (Most common)
- Underlying cause
Three states of anemia
Normal Hgb range (135-180g/L)
Mild (100-12g/L)
- Mildly symptomatic
Moderate (60-100g/L)
- More tachy, palpitation, SOB
- Demand ischemia/angina
Severe (Under 60g/L)
- Related to the empirical number of Hgb and ALSO to underlying dx pt lives with
Integ manifestations of anemia
Pallor
Jaundice (Increase conc of serum bilirunin)
- Eyes
- Liver is working TOO well, bilirubin is the breakdown product OF RBCs
Pruritus - itching
- Common in iron deficiency
Cardiopulm manifestations
Increase HR
Decrease BP
Stoke volume Increase (CO maintained)
Subjective data for anemic pts
When did S/s start
- Pallor on palms
- Under eyes
- Why they are taking meds and what (antacid, Panto, NSAIDs etc.)
- Health hx
- Vomiting (coffee grounds), black stool
- Diet (iron def?)
Diagnostic checks for potential anemia
INR, PTT, as well as platlets
Nursing management of anemia
Mantain adequate nutriotn
GR and SCR
Group and screen - checking their blood type
When should someone have Gr and Scr and a crossmatch
Hgb above 80
Ideal gauge for giving blood
A 20 gauge
Pink OR green
What meds would we consider holding in anemia
Blood thinner
Maybe an EC med
Does risk of giving outweigh benefit
Do we give bolus for Anemics
NO
This would dilute their hemoglobin
Drops in BP related to blood loss, usually treat with blood vs fluid
Client teaching related to anemia
Instruct them of risks of falling
Ultimate goal in anemia
Treat cause
Iron is absorbed
Duodenum
Most common manifestations of iron def
Pallor is the most common finding.
Glossitis is the second most common –
Inflammation of the tongue
Cheilitis
Inflammation of the lips
Iron def anemia diagnostics
Laboratory findings
Hb, Hct, MCV, reticulocytes, serum iron, TIBC, transferrin, ferritin, bilirubin, serum B12, folate
Stool guaiac test/ fecal occult blood test (FOBT)
Endoscopy
Colonoscopy
Bone marrow biopsy
Why would a pt have black stool
Bleeding OR on Iron PO
- Must do FOBT to tell which
Factors to consider for PO iron
Enteric-coated or sustained-release capsules are counterproductive.
Daily dose is 150–200 mg.
Best absorbed as ferrous sulphate in an acidic environment (take 1h before meals w/ Vit C)
Liquid iron should be diluted and ingested through a straw due to possible staining of teeth w/ liquid preparations.
Adverse effects
Heartburn, constipation, diarrhea, black stool
Is iron therapy continued after Hgb is fixed?
2-3 months after
Primary complication related to acute blood loss
Hypovolemic shock due to reduced plasma volume
Diminished O2 because fewer RBCs are available
MAP <65 or Sys. <90
When do we treat pt with blood
When pt has acute symptoms and appears to be degenerating quickly
sickle cell crisis
When bone marrow is trigged, it produces exhorbinant amount of sickle cells that cannot carry O2 well and that clog up capillaries
- this is a crisis
Triggered by excess O2 demand
Major symptom of s/s crisis
Pain
Pts at risk for sickle cell anemia
Certain decents
Treating s/s of sickle cell anemia
Treat pain
Hydration
Transfusion as needed
Treating cause like infection
This is a problem of RBC destruction
