Hematological and Immune Alterations Flashcards
Primary Site of Cell Production
Bone Marrow Production
Secondary Site of Cell production
Spleen
Liver
Thymus
Lymphatic system
Erythrocytes
RBC
stim by kidney
Thrombocytes
Platelets
Clotting
Leukocytes
WBC
Fight infection
Granular Leukocytes
Neutrophils
Eosinophils
Basophils
Neutrophils
Bacterial Infections
Eosinophils
Allergens
Parasites
Basophils
Allergic response
Inflammatory response
Active immunity
actively produces cells to fight antigens
Passive immunity
Passed on
Humoral Immunity
Immunoglobins
IgG
IgM - first
IgA
IgE - allergies
IgD
Cell medicated immunity
T lymphocytes
Initiated by macrophages
for viral, fungal, intracellular infections
Intrinsic factor
Injury to blood factor 12
Extrinsic factor
Injury to tissue factor 7
Fibrinolysis
breakdown of clot
thrombin released
cues to hematological or immunological problems
altered oxygenation
bleeding
infection
Anemia causes
Blood loss
Impaired production
Increased RBC destruction
Combination of three
Types of anemia (7)
Marrow failure – bone marrow disorder on RBC precursors
* Aplastic – disorder hematopoietic stem cells (RBC, WBC,
PLT)
* Hemolytic – extrasplenic destruction of RBC
* Sickle cell – abnormal Hbg
* B12 deficiency – decreased HCl and intrinsic factor
(pernicious anemia)
* Folic acid deficiency – malabsorption of folic acid
* Iron deficiency—(most common) decreased iron stores
Tx of anemia
- Erythropoietin used to stimulate RBC production – marrow
failure - Bone marrow stimulants – aplastic
- Staphylococcal protein A – hemolytic
- IV fluids/oxygen – sickle cell
- Vitamin B 12 injections – B12 deficiency
- Folic acid – folic acid deficiency
- Ferrous sulfate – iron deficiency
Immunocompromised
Lack of inflammatory, phagocytic, antibodies, and cytokine responses
fever may be the only sign. Pain without inflammation may be a cue.
Neutropenia
- Mild – 1000 – 1500 cells/microliter
- Moderate – 500 – 1000 cells/microliter
- Severe – < 500 cells/microliter
Neutropenia causes
- Overwhelming infection
- Radiation
- Inadequate production
- Exposure to chemicals and drugs
Malignant WBC disorders
Leukemia - large number of immature cells
Lymphoma - affects lymphocytes
Multiple myeloma - abnormal immunoglobulins
AIDS
- Infection with human immunodeficiency virus (HIV) (retrovirus)
- Depletes helper T cells, CD4 cells, and macrophages
- Increased risk for opportunistic infections
- Transmitted via body fluids, blood, or blood products
Bleeding Disorders
Abnormality in stages of clotting
* Vasoconstriction
* Creation of platelet plug
* Development of clot
* Fibrinolysis
Nursing Management Bleeding
- Assess blood loss
- Assess vital signs, hemodynamics, and perfusion
- Assess for signs and symptoms of hypovolemia
- Administer blood products and fluids
- Administer topical agents as needed
Thrombocytopenia
- Decreased platelets (less than 100,000 cells/microliter)
- Decreased production in the bone marrow
- Increased destruction of platelets
- Abnormal distribution of platelets
Tx: Platelet infusion
RF bleeding
Disseminated Intravascular Coagulation
triggered by vessel injury
hemastasis
lots of mini clots form
no clotting factors left
BLEEDING
DIC causes
- Sepsis
- Infection
- Trauma (e.g., burns, crush)
- Obstetric conditions (e.g., abruptio placentae, amniotic fluid
embolus, retained dead fetus) - Hematological disorders
- Oncological disorders
- Other: shock and acute respiratory distress syndrome
S/S DIC
Decreased perfusion to organs
* Changes in mental status
* Infarction of tissue in digits and nose
- Overt bleeding or oozing
- Occult bleeding
Signs of platelet deficiency
* Gingival bleeding
* Petechiae
* Ecchymosis
Tx DIC
Adm blood - pplatelets, ffp, etc.
Stop abnormal coagulation - heparin
Myeloma
Cancer of plasma cells
Bone pain
Test for DIC
D dimer
Primary Immuno deficency
Born with it
Autoimmunity
Sometimes the immune system makes a mistake and attacks the body’s own tissues or organs.
humoral and cell mediated immunity
work together
Increased Bleeding in Critically Ill
Trauma
Meds - GI bleed
Decreased Production of RBC
lack of nutrition
chronic conditions- anemia
fluid overload (dilution of RBC)
Destruction RBC
genetic
autoimmunity (hemolytics)
DIC
What does a shift left mean (bacterial infection)
Increase number of band neutrophils compared to mature neutrophils
Bands
Immature neutrophils
Decrease neutrophils causes
Cancer
Cancer Tx
Immunotherapy
Viral Infection
AIDS
T cells for
Viral Infection
RF for GVHD (graft versus host)
old age
aplastic anemia
prior GVHD
GVHD priority care
prevent infection
S/S GVHD - THINK TRANSPLANT
mucositis
rash
weight loss
xerostomia
photosensitivity
joint pain
