UNIT 1

Question 1

Anatomy of the Hematologic System

Answer 1

Blood: A connective tissue consisting of plasma (the liquid component) and formed elements (cells and cell fragments).

Blood Vessels: Includes arteries, veins, and capillaries, which transport blood throughout the body.

Bone Marrow: The primary site for hematopoiesis (blood cell production). It is located in the medullary cavities of bones.

Spleen: Filters blood, removes old or damaged blood cells, and plays a role in immune response.

Liver: Produces clotting factors and helps in the breakdown of old red blood cells.

Lymphatic System: Includes lymph nodes and lymphatic vessels that play a role in immune response and fluid balance.

Question 2

Physiology of the Hematologic System:

Answer 2

Hematopoiesis: The process of blood cell production, including red blood cells (erythrocytes), white blood cells (leukocytes), and platelets (thrombocytes). It occurs primarily in the bone marrow.

Red Blood Cells (RBCs): Carry oxygen from the lungs to tissues and carbon dioxide from tissues to the lungs. They contain hemoglobin.

White Blood Cells (WBCs): Part of the immune system; they protect the body against infection and foreign substances.

Platelets: Play a crucial role in blood clotting and wound repair.

Plasma: The liquid portion of blood that carries cells, hormones, nutrients, and waste products.

Question 3

Assessment of Patients with Hematologic Disorders

Answer 3

1. Patient History:

Symptoms: Assess for fatigue, pallor, bleeding tendencies, bruising, pain, or swelling.

Medical History: Include past illnesses, surgeries, or conditions affecting blood cell production.

Family History: Inquire about hereditary blood disorders or conditions.

2. Physical Examination:

Skin and Mucous Membranes: Check for pallor, jaundice, or petechiae (small red or purple spots).

Lymph Nodes: Palpate for swelling or tenderness, indicating possible lymphoma or infection.

Spleen and Liver: Assess for enlargement (hepatosplenomegaly).

Joints: Examine for swelling or pain related to bleeding disorders.

Question 4

Anemia

Answer 4

Anemia is ‘‘ Decrease in number of red blood cells (RBCs) or less than the normal quantity of Hemoglobin in the blood.

Question 5

WHO Grading of Anemia

Answer 5

❖Grade 1 (Mild Anemia): 10 g/dl

❖Grade 2 (Moderate Anemia): 7-10 g/dl

❖Grade 3 (Severe Anemia): below 7 g/dl

Question 6

Classification

Answer 6

❑On The Basis of Cause

A. Hypo proliferative (Resulting From Defective RBC Production)

B. Haemorrhagic (Resulting from RBC Loss)

C. Haemolytic Anaemia (Resulting From RBC Destruction)

❑ On the Basis of Morphology

A. Microcytic Anemia (Cells are smaller than normal under 80 fl)

B. Macrocytic Anaemia (cells are larger than normal over 100 fl)

C. Normocytic Anaemia (Cells are normal size 80–100 fl)

Question 7

1.Microcytic Anemia

Answer 7

1.Microcytic Anaemia

It Occurs in Iron Deficiency Anaemia and Ineffective RBC Production a result of Haemoglobin synthesis failure/insufficiency.

▪Cells are smaller than normal under 80 fl Heme synthesis defect

• Iron Deficiency Anaemia

▪Globin Deficiency Defect

• Thalassemia

Question 8

2. Macrocytic Anaemia

Answer 8

▪An Abnormally Large RBC, cells are larger than normal over 100 fl

▪ It Occurs as Nutritional Deficiency. E.g.Vit.B12 , Folates and Protein

▪It’s also occurs due to Drug toxicity (phenytoin), Liver Disease, Alcolism, Hypothyrodism,

Chronic Haemolytic Anaemia , Leukemia &Gastric Bypass surgery

Question 9

3. Normocytic Anaemia

Answer 9

▪Overall Haemoglobin levels are decreased but the red blood cell size(MCV)

remains normal.

▪Cells are normal size 80–100 fl

Causes

➢Acute blood loss

➢ Haemolytic Anaemia

➢ Aplastic Anaemia

Question 10

CAUSES OF ANEMIA

Answer 10

-increased requirements

menstruating females

pregnancy

lactation

growing infants and children

erythropoietin treatment

-increased loss

GI bleeding

menorrhagia
persistent hematuria

intravascular hemolytic anemias

regular blood donors

parasitic infections

-decreased intake

vegetarian diet

socioeconomic factors

-decreased absorption

upper GI pathology(celiac disease and Crohn disease )
gastrectomy
medications ( antacids, zantac )

Question 11

causes continue… ANEMIA

Answer 11

impaired rbc production ( deficiency of nutrition e.g., iron, vitamin B12 , vitamin B6, decreased erythropoietin production

increased destruction of RBC z9 hemolytic ( abnormal hemoglobin synthesis ( thalassemia )

enzymatic defect ( glucose- 6 phosphate deficiency

infection ( malaria)

antibody reaction ( RH or ABO iso immunizations

poisoning ( lead poisoning )

burns

splenomegaly

idiopathic

hereditary spherocytosis

*Due to Increased Blood Loss(Haemorrhagic) -Acute (Trauma,Epistaxis,Scurvy,Hemophilia etc.) -Chronic(Chronic Dysentry,Bleeding Piles,Haemorrhage etc.)

*Decreased RBC Production(Bone Marrow Depression)

• Hypoplasia ,Chronic Illness (Leukaemia & Nephritis)
• TB , Neoplastic Disease , Liver Disease
• Hypothyrodism

Question 12

PATHOPHYSIOLOGY OF ANEMIA

Answer 12

decrease in RBCs, HB, or HCT

diminished o2 carrying capacity

hypoxia and hypoxia induced effects on organ function

signs and symptoms of anemia

‘‘Anemia occurs when there is a decrease in red blood cells (RBCs), hemoglobin (Hb), or hematocrit (Hct), leading to a reduced oxygen-carrying capacity in the blood. This diminished oxygen supply causes tissue hypoxia, which can impair the function of various organs. A reduction in RBCs, hemoglobin, or hematocrit can result from factors such as blood loss, destruction of RBCs (hemolysis), or decreased production in the bone marrow. As oxygen delivery to tissues declines, symptoms like fatigue, weakness, dizziness, and shortness of breath arise. Organs struggle to function properly without sufficient oxygen, contributing to further symptoms like pallor, increased heart rate, and difficulty breathing

Question 13

SIGN AND SYMTPOMS

Answer 13

➢Brittle nails

➢Koilonychia (spoon shaped nails)

➢Atrophy of the papillae of the tongue

➢Angular Stomatitis

➢Brittle hair

➢Dysphagia and Glossitis

➢Plummer Vinson Syndrome /Kelly Patterson Syndrome ( Dysphagia with

Iron Deficiency Anemia)

Question 14

INVESTIGATIONS

Answer 14

CBC ( Hb, hematocrit, rbc, mcv )

stool hemoglobin test

peripheral blood smear

iron levels

ferritin

folate

vitamin B12

bilirubin

lead level

hemoglobin

reticulocyte count

LFT ( liver function test )

RFT ( renal function test )

bone marrow biopsy

Question 15

Iron deficiency anemia

Answer 15

➢Anemia associated with either Inadequate Absorption or Excessive Loss of Iron/Blood.

➢It is Chronic Microcytic Anemia.

➢The most common Cause of Anemia in Children is Iron Deficiency Anemia.

➢It’s most common cause by Microcytic Hypochromic Anemia.

Question 16

Causes of iron deficiency anemia

Answer 16

➢Insufficient Iron Supply at Birth

➢Impaired Iron Absorption

➢Blood Loss

➢Insufficient Iron Intake in Diet

➢Periods of Rapid Growth

Question 17

Sign & Symptoms of anemia iron deficiency anemia

Answer 17

➢Decreases Serum Iron Level

➢Decreased Hb Level (6 to 9mg/dl)

➢Cold Hands and Feet

➢Shortness of breath

➢Fatigue

➢Sore Tongue

➢ Brittle Nails

➢Irritability

➢Pale Skin Color

➢Dizziness

Question 18

Nursing Management of iron deficiency anemia

Answer 18

▪Oral Iron Supplements

A. Ferrous Sulphate-6 mg/kg/24 hours

B. Folic Acid – 0.4 mg/Day

C. Vitamin B12 – 30-100 mg IM/SC(5 to 10 Days)

▪Parent Education

A. The Side effects of Iron Therapy

B. The Importance of Dietary Intake of Iron

Question 19

2.Megaloblastic Anemia

Answer 19

2.Megaloblastic Anemia

▪Megaloblastic Anemia characterized by Deficiency of Vitamin B12 as well as Deficiency of Folic Acid(Folates).

▪It is a Macrocytic Anemia.

Question 20

Megaloblastic Anemia have a Two types

Answer 20

I. Pernicious Anemia(Lack of Vit B12)- Decreases in Red Blood Cells that Occurs when the Body can not Properly absorb Vit B12 from the GI tract.

▪ Vit B12 is necessary for the proper Development of Red blood Cells.

▪In this type Anaemia RBC’s are larger than normal and Die Earlier than the 120 Days Life Expectancy.

▪Red Blood cells can be Oval shaped.

II. Folate Deficiency Anemia( Lake of Folates)

Folate Deficiency Anaemia is a Decrease in RBC due to Lack of Folate OR Lower than Normal Amount of Folic Acid in Blood.

▪Folic Acid works along with Vit B12 and Vit C to help in the Create New Proteins and also helps to Form Red Blood Cells and produce DNA.

▪Folic Acid is a type of Vit B, it is Water Soluble, which means it can not be stored in the Body.
▪Water Soluble Vitamins are dissolves in Water, leftover amounts of the Vitamin leave the Body through the Urine.

Question 21

Causes of megaloblastic anemia

Answer 21

➢Lack of Intrinsic Factor( Produced by Parietal cells by Stomach) in Stomach.

➢Poor Absorption of Vit B12 in Stomach

➢Weakened Stomach Lining

➢Digestive Disorders

➢Alcohol Abuse

➢Poor Dietary Intake

➢Intestinal Dysfunction

➢Certain Medications,Such as Phenytoin

➢Complications of Hemolytic Anemia

Question 22

Sign & Symptoms of megaloblastic anemia

Answer 22

o Tingling & Numbness of Hands & Feet

o Muscles Weakness

o Neurological Problems e.g.- Dementia,Depression,Memory Loss etc.(If Severe)

o Glossitis

o Headache

o Pallor

o Forgetfulness

o Slight Jaundice

o Weight Loss

Question 23

Nursing Management of megaloblastic anemia

Answer 23

❖The Goal is to Identify and Treat the Cause of The Folate Deficiency.

❖Folic Acid Supplements orally Or through a Vein on a Short Termbasis until The Anemia has been Corrected.

❖Dietary Treatment

❖ Intake of Green Leafy Vegetables and Fruits.

❖Replacement Therapy in Case of Poor Absorption by the Intestine

Question 24

3.Aplastic Anemia

Answer 24

o Aplastic Anemia is Rare and Serious Blood Disorder in which Bone Marrow Stops making Enough New Blood Cells. This is Because The Bone Marrow’s Stem Cells are Damaged.

o The Disorder tends to get Worse over Time, Unless it’s cause is Found and Treated. Resulting Pancytopenia ( Insufficient Numbers of RBCs,WBCs and Platelets)

Question 25

Causes of aplastic anemia

Answer 25

➢ Exposure to Toxic Substances such as Arsenic, Benzene

➢Cancer Therapy

➢Use of Certain Drugs

➢Autoimmune disorder such as Rheumatoid Arthritis

➢Viral Infection such as Hepatitis, HIV etc.

➢Damage to the Stem Cells in Bone Marrow that are Responsible for Blood Cell

Production.

➢Weekend Bone Marrow (Hypoparathyroidism)

Question 26

Sign & Symptoms of aplastic anemia

Answer 26

*Pancytopenia

• Fatigue and Restlessness

*SOB *Hypoxemia

• Irregular Heartbeat

*Heart Murmur

*Pale Skin , Gums and Nail beds

*Fever and Frequent Infection due to Leukocytopenia

• Increases Bleeding Tendency and Pinpoint Red Bleeding spots on the Skin due to Thrombocytopenia

*Oral Thrush

Question 27

Nursing Management of aplastic anemia

Answer 27

▪Blood Transfusion

▪BMT OR Stem cells Transplantation

▪Medicines : ➢Erythropoietin to Stimulates The Bone Marrow ➢ Antibiotic & Anti Viral Medicines to Prevent & Treat Infection

▪Avoid Exercise

▪Avoid Contact Sports

▪Avoid Infections

Question 28

Hemolytic Anemia

Answer 28

▪The Rupture OR Destruction of Red Blood Cells is called Hemolysis. ▪Hemolytic Anemias is a Condition in Which RBCs are Destroyed and Removed from the Blood stream before their Normal Life Spam.

It can be:

I. Inherited ( Parents passed the Gene for the condition on the Baby ) e.g.-Sickle Cell Anemia & Thalassemia

II. Acquired ( Baby are not Born with this condition , But Develop it due to another Disease , Condition or Factor )

Question 29

Sickle cell anemia

Answer 29

Sickle Cell Anemia is Serious Inherited Disease RBC that assume an abnormal, rigid, sickle shape.

▪ Sickling decreases the cells’ flexibility and results in a risk of various complications.

▪The sickling occurs because of a mutation in the hemoglobin gene

▪Sickle cells contain abnormal hemoglobin called sickle hemoglobin or hemoglobin S. Sickle hemoglobin causes the cells to develop a sickle, or crescent, shape.

▪Sickle cells are stiff and sticky. They tend to block blood flow in the blood vessels of the limbs and organs. Blocked blood flow can cause pain and organ damage. It can also raise the risk for infection.

Question 30

Sign & Symptoms of sickle cell anemia

Answer 30

The most common symptom of anemia is fatigue.

Other signs and symptoms of anemia include:

➢ Shortness of breath

➢Dizziness

➢Headaches

➢ Coldness in the hands and feet

➢ Paler than normal skin or mucous membranes

➢Jaundice

Question 31

Medications of sickle cell anemia

Answer 31

▪Iron

▪Vitamin supplements

▪Erythropoietin injection

Question 32

Nursing Management of sickle cell anemia

Answer 32

o The goal of treatment is to manage and control symptoms, and to limit the number of crises. People with sickle cell disease need ongoing treatment, even when not having a crisis

o People with this condition should take folic acid supplements. Folic acid helps make new red blood cells.

o Blood transfusions (may also be given regularly to prevent stroke)

o Pain medicines

o Plenty of fluids

o Antibiotics, which help prevent bacterial infections that are common in children with sickle cell disease

o Medicines reduce the amount of iron in the body

o People with sickle cell disease should have the following vaccinations to lower the risk of infection:

➢ Haemophilus influenzae vaccine (Hib)

➢Pneumococcal conjugate vaccine (PCV)

➢ Pneumococcal polysaccharide vaccine (PPV)

Question 33

Anemia Prevention

Answer 33

➢ eating a healthy diet and limiting alcohol use.

➢ seeing a doctor regularly and when problems arise routine blood work

Question 34

NURSING DIAGNOSIS of anemia

Answer 34

➢Activity intolerance related to weakness, fatigue, and general malaise

➢Altered nutritional Level, less than body requirements, related to inadequate intake of essential nutrients

➢Ineffective tissue perfusion related to inadequate blood volume or HCT

➢Ineffective Family Coping related to disabling and life-threatening disease

Question 35

Nursing Management of anemia

Answer 35

▪The goal of treatment is to manage and control symptoms, and to limit the number of crises.

People with sickle cell disease need ongoing treatment, even when not having a crisis

▪People with this condition should take folic acid supplements. Folic acid helps make new red blood cells.

▪Blood transfusions (may also be given regularly to prevent stroke)

▪Pain medicines

▪Plenty of fluids

▪ Antibiotics, which help prevent bacterial infections that are common in children with sickle cell disease

▪ Medicines reduce the amount of iron in the body

▪ People with sickle cell disease should have the following vaccinations to lower the risk of infection:

⮚ Hemophilus influenzae vaccine (Hib)

⮚Pneumococcal conjugate vaccine (PCV)

⮚ Pneumococcal polysaccharide vaccine (PPV)

Question 36

PATIENT EDUCATION of anemia

Answer 36

➢Taking Iron Supplements .Take iron on an empty stomach (1 hour before or 2 hours after a meal).

➢Start with only one tablet per day for a few days, then increase to two tablets per day, then three tablets per day

➢ Increase the intake of vitamin C (citrus fruits and juices, strawberries , tomatoes, broccoli), to enhance iron absorption.

➢Eat foods high in fiber to minimize problems with constipation.

➢Remind that stools will become dark in colour.