Hematology Disorders Flashcards
Slide 1 - types of anemia
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Slide 1 - types of WBC
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How much of the blood does plasma make up compared to cellular component?
Plasma - 55%
Cellular component - 45%
What does plasma consist of?
Albumin Globulin Fibrinogen Clotting factors Electrolyes Waste Products Nutrients
what does the cellular component of the blood consist of?
Erythrocytes (RBCs)
Leukocytes (WBCs)
Thrombocytes (Platlets)
Hematopoiesis
the production of blood cells and platelets, which occurs in the bone marrow.
How long do RBC, WBC and platelets live?
RBC - 120
WBC - days to years
Platelets - 7 - 10 days
Hemostasis
Balance between clotting and clot dissolution ?
the stopping of a flow of blood.
How much volume of blood do we normally have?
1.2-1.5 gallons
5 L
Describe the erythrocyte membrane
It is thin for permeability of o2 and co2
What do you call a mature erythrocyte with iron called
hemoglobin
What are reticulocytes?
immature erythrocytes
Erythropoiesis
myeloid stem cells in the bone marrow - These cells are responsible for the continual replenishment of all blood cell types in the body
the production of red blood cells.
Erythropoietin
hormone produced by kidney - stimulates red blood cell production
Iron - women
Iron is lost when females menstruate
Where is the majority of iron carried?
hemoglobin
What happens when there are low levels of iron in the blood?
hemoglobin synthesis is depressed; erythrocytes produced are small and low in hemoglobin = microcytic anemia
What are examples of granulocytes?
Eosinophils
Basophils
Neutrophils
What are examples of agranulocytes?
monocytes
lymphocytes
Eosinophils
Parasitic and allergic diseases
Basophils - things to remember
Contain heparin and histamine
Released in response to allergens
Neutrophils - things to remember
Comes from myeloid stem cell
Most abundant in body
Circulates for 6 hours then migrates into body tissues – phagocytosis (alive for 1-2 days)
Arrive within 1 hour of onset of inflammatory reaction and initiate phagocytosis
Things to remember about monocytes
Once in tissues – macrophages
Fungi and Viruses
Active in the spleen, liver, peritoneum and alveoli
— Removing debris
Things to remember about lymphocytes
produced - lymphoid stem cells or thymus
produce antibodies and identifying other cells and organisms as foreign
What is platelet formation regulated by
the hormone thrombopoietin
Platelet - role
controls bleeding; adheres to site of injury –> platelet plug
Plasma: clots
remaining is serum (?)
Plasma protein - exampels
albumin and globulins
Albumin
Maintenance of fluid balance with the vascular system
- produced in liver
- capacity to bind substance (calcium, bilirubin, hormones)
Spleen - role
Recycling iron Pooling of platelets Blood volume regulation Filter for bacteria Can restart hematopoisis - if needed
Go look at slide 11
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Gerontological considerations - hematology
Bone marrow’s response is decreased
Most susceptible to myelosuppressive effects of medications
Anemia risk
What might cause anemia in the elderly?
Iron deficiency Calorie malnutrition Inflammation Chronic disease Cardiac and pulmonary patients cannot tolerate low blood volume
Hematocrit is what?
percent of blood consisting of erythrocytes
Peripheral smear - hematology dx
shape, size of leukocytes, erythrocytes, and platelets
False elevated hematocrit can be correlated to what
fluid volume deficit patients
Low hemoglobin/hematocrit - why might someone be asymptomatic
your body has compensatory mechanisms
What are s/s of low hemoglobin/hematocrit
fatigue, poor activity tolerance, headaches, dizziness, irritability, difficulty sleeping or concentrating, progressive fatigue, poor activity tolerance, headaches, dizziness, irritability, difficulty sleeping or concentrating, tinnitus, anorexia, dyspnea, palpitations, chest pain, indigestion, abnormal menstruation in females, impotence in males, and loss of libido
Pallor – mucous membranes, nail beds, conjunctiva, palms
Tachypnea and tachycardia with activity
Patients with severe neutropenia are at a significantly increased risk for developing what?
opportunistic infections and sepsis
Low while blood cell count - Skin
Check for tenderness, erythema, edema, breaks in skin integrity, moisture, drainage, lesions (especially under breasts, axillae, groin, skin folds, bony prominences, perineum, and perirectum); check all puncture sites (e.g., IV sites) and central venous access device sites for erythema, tenderness, induration, and drainage.
Low WBC count - oral mucosa
Check for moisture, lesions, color (check palate, tongue, buccal mucosa, gums, lips, oropharynx); assess level of pain and taste changes, which may precede objective signs of mucosal damage by 3 to 5 days.
Low WBC count - respiratory
Check the presence of cough, sore throat, tachypnea, pain on inspiration; auscultate breath sounds. Note color, amount, and consistency of sputum.
Low WBC count - gastrointestinal
Check for abdominal discomfort and distention by palpating the abdomen, assess for nausea, change in bowel pattern; auscultate bowel sounds
Low WBC count - genitourinary
Check for dysuria, urgency, frequency; check urine for color, clarity, and odor
Low WBC count - Neurologic
Ask about headache, neck stiffness, visual disturbances; assess level of consciousness, orientation, and behavior
Low WBC count - temp
Check for elevation (greater than 38°C [greater than 100.4°F]).
Absolute neutrophil count (ANC) - 1,500 to 1,000
indicates mild neutropenia
Absolute neutrophil count (ANC) - 999 - 500
indicates moderate neutropenia
Absolute neutrophil count (ANC) - less than 500
indicates severe neutropenia
People with a low Absolute neutrophil count (ANC), what should they do to stay safe?
avoid large crowds
avoid sick people
Bone marrow aspiration and biopsy: why?
Used to diagnose malignancies, benign hematologic disorders, infections and storage disorders, response to treatment
Bone marrow aspiration and biopsy: risk
infection and pain
Bone marrow aspiration and biopsy: position
prone or lateral
Bone marrow aspiration and biopsy: how can a nurse help during the procedure
encourage them to take deep breaths and use relaxation techniques to help with discomfort
Bone marrow aspiration and biopsy: post-procedure care
Patients should be instructed not to submerge in a bath for 24 hours, until the site heals. A mild analgesic (e.g., acetaminophen) may be useful.
Aspirin-containing analgesics should be avoided because of the increased risk of bleeding
normal PTT
21-35 – a therapeutic range is 1.5-2 times that range
normal INR
normal = below 1.6 therapeutic = 2-3 (someone on warfarin)
What tools are used to determine if someone is at risk for bleeding
through exam
CBC / peripheral smeal
PT and INR
PTT
Slide 1/45 tells you about types of anemia
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