Hematological Problems (Exam 1 ) Flashcards
Bone Marrow
- one of the largest ORGANS in the body
- found in all bones
- primary function is hematopoiesis
- red
- yellow
Blood is used for
transportation
regulation
protection
Blood transports
oxygen, nutrients, hormones, waste products
Blood regulates
of fluid , electrolytes, and acid base balance
Blood protection
ability to clot and ability to combat infections
Eyrthrocytes (RBCs)
- function to transport O2 and CO2
- produced in red bone marrow
- life span 115-130 days
- eliminated by phagocytoisis in the spleen and liver
- Approx 5 million in the body
Leukocytes ( WBC’s )
- Approximately 5000 - 10,000
- granulocytes
- agranulocytes
- monocytes
Red bone marrow
found in the pelvis, sternum, ribs ends of long bones and vertebral
Red bone marrow purpse
hematopoiesis
Yellow bone marrow
is red marrow changed to fat (adipose)
does not contribute to hematopiesis
Blood basics
Blood is a type of connective tissue
- arterial blood - bright read
- venous blood- dark red
- visosity- 3 to 4 times thicker than water
- pH 7.35-7.45
- Volume 5-6 liters
Blood Contributing organs
- bone marrow
- spleen
- liver
- lymph nodes
bone marrow hematopiesis
forms blood cells
Spleen
- Produces RBCs during fetal formation
- Filters out old RBCs, filters iron and returns it to the marrow for re-use
- Filters out bacteria, stores WBCs and immunoglobulins
- Stores RBCs and platelets about 30% of platelets are storred in the spleen
Liver
- Functions as a filter, filters out bad things
- Produces procagulants
- Stores iron
Lymph nodes
- filter out pathogens from the blood, WBCs tend to hang out in lymph nodes, smetimes during an viral or bacterial infection lymph nodes swell
Substances needed to produce RBCs
Iron
Vitamin B12
Folic Acid
Vitamin B6
Phagocytosis
are broken RBCs and iron will be recycled out of them
Graulocytes (WBC) groups
Basoiphils
Eosinophils
Neutophils
Neutriphils
most common
Phagocytosis 70% of total WBCs
Fight bacteria by phagocytosis, primary responders in acute inflammatory states
Eosinophin
2-4% of total WBCs parasitic infections allergic reactions
basophils
2% of total WBCs inflammatory response and allergic reactions
Agranulocytes
lymphocyte
monocytes
lymphocytes
20-40% of total WBCs immune response
- B cells and T cells
- produced in lymph nodes
- produce antibodies to viral invasion
Monocytes
4-8% of total WBCs
- eats everything
- phagocytosis of red RBC & WBC
Thrombocytes (platelet)
- cell fragments
- primary function- clotting
- life span only 5-9
- 1/3 of bodies platelets are stored in the spleen
Additional testing
In addition to platelets coagulation factors are needed for coagulation
- most coagulation factors are produced by the liver
- a deficiency of either platelets or coagulation facts creates a risk for bleeding
- they would be released in a time of a large trauma
Normal Iron Metabolism
- only 5-10% of ingested iron is absorbed
- 2/3 of the bodies iron is in RBCs
- 1/3 is stored as ferritin
- transported by trasnferrin
- recycled after liver/spleen ingest old RBCs
Mechanisms
- vasoconstriction
- platelet plug
- fibrin clot
- Lysis of the clot
Vessels centrist
to minimize blood loss
plateletes
are activated and rush to the injury site, sticking together and forming a platelet plug establishing a clot
Fibrinogen is covered to fibrin by
thrombin
fibirnolysis
is when the clot dissolves
Health History
- prior hematologic problems
- hereditary disorders
- leukemia
- bleeding problems
- anemia
- any trouble with blood
- family history of hemophilia and sickle cell
Medication/ Exposures
- OTC meds
- Alcohol
- Exposure to chemicals
- exposure to radiation
OTC medications
aspirin reduces platelet aggregation which increases potential for bleeding, aspirin, ibuprofen, herbals
- toxic dose of tylenol is 15 grams
alcohol
damages liver which produces many clotting factors and dehydration
exposure to chemicals and radiation
can destroy blood cells
Symptoms of anemia
- first symptoms- weakness, fatigue and malaise
- more brusing than usual or bleeding in urine, feces and mouth
- swelling or edema ( lymph nodes in neck & groin, lower extermities)
- pain in joints, bones, or abdomen (sore tongue might mean anemia)
- skin changes0 in color texture, appearance and pruitus
- neurologic changes - headache alterations in vision numbness tingling dizziness or light headedness
- cardiovascular and resp. changes, tachycardia palpations, chestpain, shortness of breath
- GI - anorexia nausea vomiting
Physical Assessment
- Skin- color ecchymosis, pruitus
- Eyes- jaundice
- Mouth
- pallor- inadequate oxygenation
- red and smooth- perncious or iron deficiency anemia
- bleeding and oozing from gums
- lymph nodes- palpate for pain and enlargement
- heart & lung sounds
- abdomen enlarged liver and spleen
- musculoskeletal- limited ROM and pain upon movement
To palpate lymph nodes
- use the flats of your fingers and press gently
- everytime the lymph bodes swell and it goes back to normal size it never goes back to the original size due to scar tissue
- if you can palpate the liver or spleen there is a problem
- check the gum line if there is a pink tinge to the spit this may indicate bleeding along gum line
Diagnostic studies of Hematologic System
Laboratory studies
- complete blood count
- white blood cells
- platelet count
- Blood typing and Rh Factor
CBC
measures ability to carry oxygen and resist invaders
Erythrocytes measurements
hemoglobin is the main component of RBC
hematocrit is the percentage of blood occupied by RBC
leukocyte measurement
differential is distribution of various types of WBC
Coagulation studies
Platelet count 150,000- 400,000
PT used to assess effectiveness of Coumadin
PTT used to assess effectivenes of heparin
in order for heprarin to work on a thrombus
the ptt must be 1.5-2.5 times the normal value
the doctor will determine therapeutic range
type A blood
antigen A
donors A & O
Type B blood
antigen B
Donors B and O
blood type AB
antigens - neither A or B
Donors A, B ,AB and O
0
antigens - neither
O (universal donor)
type be blood is popular for
plasma transfusions
neative RH
if someone is negative they can not recieve a positive
positive rh
if someone is positive they can receive a positive or a negative
Bone Marrow Biopsy
provides information on blood cell production
aspiration biopsy
aspiration is used when a small amount is needed
local anesthesia
sterile procedure
Purpose of bone marrow biopsy
diagnoses: multiple myeloma, all types of leukemia, some lymphomas and some stages if solid tumors
nursing care of bone marrow biopsy
possible pre procedure analgesia
pressure dressing to site, bleeding is a possible complication
painful might need pre and post procedure medication
