Hematological System Flashcards
RBC
Carry Oxygen
Platelets (thrombocytes)
Platelet plug formation
Neutrophils - Granulocyte
Phagocytic & secrete toxins to fight all pathogens
Eosinophils - Granulocyte
Fight eukaryotic pathogens, especially parasitic worms
Basophils - Granulocyte
Release histamine to inc inflammatory response. Very similar to mast cells
Lymphocytes - Agranulocyte
- Adaptive immune response cells
- T cells: coordinate attack and/or directly kill pathogens
- B cells: produce antibodies
- Memory cells circulate to patrol for repeat threats
Monocytes - Agranulocytes
Extremely phagocytic, antigen-presenting cells
Polycythemia vera
What
○ Loss of cellular regulation
○ Excessive number of erythrocytes, leukocytes, and thrombocytes
○ This causes the blood to become hyper viscous
○ Hemoglobin > 18 in men and >16.5 in women
○ Hematocrit > 55%
○ The thicker the blood, the more problems with perfusion the client can have
Assessment
○ Skin
○ Dark purple, cyanotic appearance
○ CV
○ Distended veins: Causes intense itching
○ Hypertension
○ Thrombosis
○ Poor gas exchange: Hypoxia
Treatment
○ Apheresis
○ Withdrawal of whole blood
○ Removal of the excessive components (erythrocytes)
○ Reinfusion of the plasma back to the client
○ Anticoagulation
○ Hydration
Client education
○ Prevent clots
○ Drink at least 3 liters of liquids each day
○ Avoid tight or constrictive clothing
○ Wear gloves when outdoors in cold temperatures
○ Wear compression stockings when up
○ Elevate feed when seated
○ No smoking
Stop activity at the first sign of chest pain
Anemia
What
* Reduction in the number of erythrocytes
* Can occur with many different disease processes
* Several types and causes
Iron deficiency anemia
Inadequate iron intake caused by:
* Iron-deficient diet
* Chronic alcoholism
* Malabsorption syndromes
* Partial gastrectomy
* Rapid metabolic (anabolic) activity caused by:
○ Pregnancy
○ Adolescence
○ Infection
* Most common!
Vitamin B12 deficiency anemia
Dietary deficiency
* Failure to absorb vitamin B12 from intestinal tract as a result of:
○ Partial gastrectomy
○ Pernicious anemia
○ Malabsorption syndromes
Aplastic anemia
What
* Body stops producing enough new blood cells
Causes
* Include exposure to myelotoxic agents:
○ Radiation
○ Benzene
○ Chloramphenicol
○ Alkylating agents
○ Antimetabolites
○ Sulfonamides
○ Insecticides
Assessment findings
* CV
○ Tachycardia
○ Orthostatic hypotension
* Respiratory
○ Dyspnea on exertion
○ Decreased SpO2
* Neuro
○ Fatigue
○ Increased need for sleep
* Skin
○ Pallor
○ Cool
○ Mottled
○ Delayed capillary refill
○ Unable to tolerate the cold
Treatment
* Depends on the specific type of anemia
○ Iron deficiency anemia →
§ Increased iron in the diet and iron supplements
○ Vitamin B12 deficiency anemia →
§ Increased B12 in diet and supplements.
○ Aplastic anemia →
§ Depends on cause
§ Discontinue causative drug/exposure if possible
§ Blood transfusions
Sickle Cell Anemia
What
* A disorder that causes the red blood cells to ‘sickle’ and break down Autosomal recessive
Pathophysiology
* Autosomal recessive
* Those with the trait have ‘sickled’ RBCs
* The sickled cells are not able to carry oxygen like they should
○ Decreased perfusion
Due to their shape, they can get caught in vessels and cause obstruction
Sickle Cell Crisis
What
○ The decreased blood flow to the tissues leads to hypoxia, ischemia, and infarction
○ There is severe joint pain
○ Sequestration
○ Blood pools
○ Often in the spleen
○ Splenomegaly and tenderness
○ Acute exacerbation can be caused by hypoxia, exercise, high altitude (due to low oxygen), and fever
Assessment
* Pallor
* Pain
* Fatigue
* Arthralgia
* Chest pain
* Respiratory distress
Treatment
* IV Fluids
○ This helps dilute the blood so that the sickled cells are not so concentrated
○ Provides hydration
* Blood transfusion
○ Provides normal RBCs
○ Helps optimize oxygenation and better perfusion
* Oxygen
○ Increase oxygen to the tissues if the client is hypoxic
* Medications
○ Pain management - Analgesics often necessary
○ Hydroxyurea
§ Increases production of fetal hemoglobin to reduce crises
Disseminated Intravascular Coagulation (DIC)
What
* A serious disorder in which the proteins that control blood clotting become overactive
Triggers
* Blood transfusion
* Cancer
* Pancreatitis
* Liver disease
* Severe tissue injury
○ Burns
○ Head injury
* Pregnancy complication
Assessment
* Bleeding
○ Ecchymosis
○ Hematoma
○ Hemoptysis
○ Melena
○ Pallor
○ Hematuria
* Where the clot goes
○ Lungs/heart
§ Chest pain
§ Dyspnea
§ SOB
○ Legs
§ Pain
§ Redness
§ Warmth
§ Swelling
○ Brain
§ Headache
§ Speech changes
§ Paralysis
§ Dizziness
Lab Findings
* Platelet count: dec
* Fibrinogen: dec
* Pt/INR: inc
* PTT: inc
* D-dimer: inc
Treatment
* Determine underlying cause and TREAT
* Administer clotting factors
* Administer platelets
* Bleeding precautions
Lab: Hemoglobin (Hgb)
CBC
* F: 12 - 16
* M: 14 - 18
Transports Oxygen to Lungs and Tissues
Lab: Hematocrit
CBC
* F: 37 - 47 %
* M: 42 - 52 %
* % of RBC in the body
○ Inc = dehydrated
Dec = bleeding, Anemic or Hemorrhage
Lab: White Blood Cells (WBC)
CBC
* 5000 - 1000
* Fights infections
* Inc = infections
* Dec = immunocompromised
Lab: Red Blood Cells (RBC)
CBC
* 4.5 - 5.5 million
* Carries oxygen
* Dec = Anemia
Lab: Platelets
CBC
* 150 000 - 400 000
* Clump together to form clot and cause hemostasis
* Inc = excessive clotting (DVT, thrombus)
Dec = Bleeding
Lab: Partial Thromboplastin Time (PTT)
- 20 - 30 sec
- How long it takes for a clot to form
- Heparin: 1.5 - 2.5 times normal
Lab: Prothrombin Time (PT)
10 - 12 seconds
Lab: International Normalized Ratio (INR)
- 0.9 - 1.2
- Calculated from PT to monitor Warfarin
Warfarin: 2 - 3
- Calculated from PT to monitor Warfarin
Lab: Sodium (Na)
135 - 145
