Professional Documents
Culture Documents
Blood Vessels
Veins
Arteries
Capillaries
MEDICAL AND SURGICAL NURSING
Blood Forming Organs
Hematology Liver
Thymus
Lecturer: Mark Fredderick R. Abejo RN, MAN Spleen
Bone Marrow
Lymph nodes
Lymphoid organ
OVERVIEW OF THE STRUCTURE AND FUNCTION OF
THE HEMATOLOGIC SYSTEM CHARACTERISTICS:
Color
o Arterial Blood
HEMATOLOGY – the scientific study of the structure and o Venous Blood
functions of blood in health and in disease. Fraction of body weight 8%
Volume Female: 4 -5 L
BLOOD – is the circulatory fluid of the CV system which is Male: 5 - 6 L
circulating constantly through a closed circuit of tubes. Temperature 38 C ( 100.4 F )
pH 7.35 - 7.45
FUNCTIONS: Viscosity (relative to water)
► supply oxygen from the lungs and absorbed nutrients Whole blood: 4.5-5.5
from the GIT to the cells Plasma: 2.0
► remove waste products from tissues to the kidneys, Specific gravity - 1.048 to 1.066 ( 1.055 – 1.065)
skin and lungs for excretion Composition:
► transport hormones from their origin in the endocrine
glands to other parts of the body Liquid phase: PLASMA (55%)
► protect the body form dangerous microorganism
► promote Hemostasis ( to stop bleeding) ► - A light yellow substance which is one of
► regulate body temperature by heat transfer – the major fluids of the body. Major function
vasoconstriction and vasodilation is to maintain the blood volume within the
vascular compartment
Hematopoiesis
Process of blood cell production.
At birth, it is accomplished in the liver, spleen,
thymus, lymph nodes and red bone marrow.
After birth, it is confined in the red bone marrow ( but
some WBCs are still produced in the lymphatic
tissues).
During childhood, all blood cells are essentially
produced in marrow sites of the flatbones of the skull,
clavicle, sternum, ribs, vertebrae, and pelvis
After puberty, hematopoiesis becomes localized
within the flatbones of the sternum, ilium, ribs, and
vertebrae, sometimes occurring in the proximal ends
of long bones (humerus and femur)
All formed elements come from one stem cell or the ► 92% Water
HEMOCYTOBLAST. Cell differentiation gives rise ► Serum
to the cell lines with the help of growth factors. ► Plasma Proteins – all produced in the LIVER
Albumin – most abundant, maintains osmotic
pressure
Globulin
Alpha – transports bilirubin, steroids and
hormones
Beta – transports iron and copper
Gamma – transports immunoglobulins
Prothrombin – clotting factor
Fibrinogen – clotting factor
1
MS Abejo
Medical and Surgical Nursing
Hematology Lecture Notes
Prepared by: Mark Fredderick R. Abejo RN,, MAN
N = 5,000-10,000/mm3 B Cells
– Matures into Plasma Cells responsible for Antibody
Granulocytes production
1. Neutrophils – most abundant, 60-70% of total
WBCs 5 Classes of Immunoglobulins (MADGE) :
First line of defense, most common type of – Immunoglobulin M (IgM)
leukocyte but a short lifespan of only 10-12 • 1st immunoglobulin produced in an immune
hours making them ineffective in destroying responsepresent in plasma, too big to cross
infectious agents membrane barriers
Helpful in localizing the infection and in – Immunoglobulin A (IgA)
immobilizing the pathogens until other • Sound in body secretions like saliva, tears, mucus,
WBCs arrive bile, milk & colostrum
for acute inflammation – Immunoglobulin D (IgD)
• Present only in the plasma & is always attached to the
2. Eosinophils– allergic reactions B Cell
Weak phagocytic action, elevated during – Immunoglobilin G (IgG)
asthma attacks. • 80% of circulating antibodies
Usually activated during parasitic invasion • Can cross the placenta and provide passive immunity
(Schistosomes / blood flukes) • Present in all body fluids
Lifespan= hours to 3 days – Immunoglobulin E (IgE)
Modulates or reduce IgE mediated allergic • Responsible for Allergic & hypersensitivity reactions
reactions • Stimulates Mast cells & Basophils to release
Histamine which mediates inflammation & the
3. Basophils – not phagocytic in nature, they are allergic response
mediators in inflammatory process.
Involved in the release of chemical
mediators PLATELETS (Thrombocytes)
Prostaglandin
Serotonin N = 150-450 thousand mm3
Histamine
Bradykinin Promotes hemostasis prevention of blood loss
For inflammation promote clotting mechanisms
MEGAKARYOCYTES – immature/baby platelets;
target site of DHF
Normal lifespan: 9-12 days
2
MS Abejo
Medical and Surgical Nursing
Hematology Lecture Notes
Prepared by: Mark Fredderick R. Abejo RN,, MAN
b. Sex
women have lower hemoglobin and hematocrit levels,
more prevalence of agranulocytosis
hemophilia, bleeding expressed among males
because some laboratory results are sex-specific
c. Race
Blacks have lower hemoglobin levels than whites (more
prevalent sickle cell anemia)
d. Family history
Because some hematologic disorders are inherited:
– Anemia
– Thrombocytopenia
– Bleeding disorders (hemophilia and Von
Willebrand’s Dse),
– Congenital Blood Disorder (Sickle Cell
anemia)
– Jaundice, infections, delayed healing,
– Cancer
– Autoimmune dse (aplastic anemia, pernicious
anemia)
3
MS Abejo
Medical and Surgical Nursing
Hematology Lecture Notes
Prepared by: Mark Fredderick R. Abejo RN,, MAN
b. Medications- aspirin, chloramphenicol, antineoplastic drugs a. RBC count- # of RBCs/ mm3 of blood, to diagnose anemia
c. Allergies- Hx of allergies, BT and/reactions and ploycythemia
d. Family History b. Hemoglobin- # of grams of hgb/ 100ml of blood; to measure
the oxygen-carrying capacity of the blood
4. Psychosocial Hx and Lifestyle c. Hematocrit – expressed in %; measures the volume of RBCs
a. Occupation- exposure to chemicals and radiation in proportion to plasma; used also to diagnose anemia and
b. Habits- nutritional, substance abuse, alcohol abuse ploycythemia and abnormal hydration states
d. RBC indices- measure RBC size and hemoglobin content
a. MCV (mean corpuscular volume)
b. MCH (mean corpuscular hemoglobin)
Review of Systems/ Physical Examination c. MCHC (mean corpuscular hemoglobin
concentrarion)
1. SKIN e. Platelet count- # of Platelet/ mm3; to diagnose
– pallor thrombocytopenia and subsequent bleeding tendencies
– ruddy skin f. WBC count- of WBCs/ mm3 of blood; to detect infection or
– jaundice inflammation
– dry skin, brittle, spoon shaped with longitudinal ridges g. WBC Differential count- determines proportion of each
WBC in a sample of 100 WBCs; used to classify leukemias
2. EYES Normal Values
– visual disturbances (anemia and polycythemia)
– blindness (retinal hemorrhage related to RBC: Women – 4.2-5.4 million/mm3
thrombocytopenia and bleeding do) Men – 4.7-6.1 million/mm3
– scleral jaundice (hemolytic anemia) Hgb: Women – 12-16 g/dl
Men – 13-18 g/dl
3. EARS Hct : Women – 36-42%
– vertigo, tinnitus (severe anemia) Men – 42-48%
– bleeding in auditory canal WBC: 5000-10,000/mm3
– (bleeding do) Granulocytes
Neutrophils: 55-70%
Eosinophils: 1-4%
4. NOSE Basophils: 0.5-1.0%
– epistaxis (thrombocytopenia and bleeding disorders) Agranulocytes
Lymphocytes: 20-40%
5. MOUTH Monocytes: 2-8%
– smooth, glossy, bright red tongue and sore tongue Platelets: 150,000-450,000/mm3
(pernicious and Fe def. anemia)
– gingival bleeding (thrombocytopenia and bleeding
disorders)
4
MS Abejo
Medical and Surgical Nursing
Hematology Lecture Notes
Prepared by: Mark Fredderick R. Abejo RN,, MAN
To determine the variations/ abnormality in RBCs, WBCs and a. Bleeding Time – measures the ability to stop bleeding after
Platelets: normal size and shape (normocytes) and normal color small puncture wound
(normochromic) b. Partial Thromboplastin Time (PTT) – used to identify
deficiencies of coagulation factors, prothrombin and fibrinogen;
3. DIRECT ANTIGLOBULIN EST (Coomb’s Test) monitors heparin therapy.
c. Prothrombin Time (Pro-time) – determines activity and
Used in cross matching blood when transfusion reaction occurs, interaction of the Prothrombin group: factors V (preacclerin),
test umbilical cord for Erythroblastosis fetalis and diagnose VII (proconvertin), X (Stuart-Power factor), prothrombin and
acquired hemolytic anemia fibrinogen; used to determine dosages of oral anti-coagulant.
Identifies antibodies to RBC antigens in the serum of clients Reticulocytes: 25-75 x 10 9/L
who have greater than normal chance of developing transfusion Bleeding Time: 2.75-8 min
reactions. Partial Thromboplastin Time (PTT): 20-35 sec.
Prothrombin Time (PT): 12-14 sec.
5. RETICULOCYTE COUNT
Used to determine the responsiveness of the bone marrow to the BLOOD DISORDERS
depletion of circulating RBCs (probably due to hemolytic
anemia or hemorrhage) I. IRON DEFICIENCY ANEMIA (IDA) – chronic
microcytic anemia due to inadequate absorption of iron
6. BONE MARROW ASPIRATION and BIOPSY leading to hypoxemic tissue injury
Used to determine size and shape of RBCs, WBCs and platelet A. INCIDENT RATE
precursors and to examine various maturational abnormalities. 1. Developed countries (d/t high intake of cereals
and milk)
2. Accidents (adults)
3. Tropical areas (blood sucking parasites)
4. Women 15-35 (reproductive age)
5. Common among the poor (poor nutrition)
B. PREDISPOSING FACTORS
1. Chronic blood loss
Trauma
Menstruation
GIT bleeding
Hematemesis
Melena (UGIB)
Hematochezia (LGIB) (d/t E.
histolytica DOC: metronidazole)
2. Inadequate intake of iron rich food
3. Inadequate absorption of iron due to
Chronic diarrhea
R/t increased cereal intake with decreased
animal CHON ingestion, related to subtotal
gastrectomy
Malabsorption syndrome
4. Improper cooking of foods
5
MS Abejo
Medical and Surgical Nursing
Hematology Lecture Notes
Prepared by: Mark Fredderick R. Abejo RN,, MAN
6
MS Abejo
Medical and Surgical Nursing
Hematology Lecture Notes
Prepared by: Mark Fredderick R. Abejo RN,, MAN
IV. SICKLED CELL ANEMIA - is a life-long blood disorder 2. Patients will take a 1 mg dose of folic acid daily
characterized by red blood cells that assume an abnormal, for life.
rigid, sickle shape 3. From birth to five years of age, they will also
have to take penicillin daily due to the immature
immune system that makes them more prone to
early childhood illnesses.
4. Painful crises are treated symptomatically with
analgesics; pain management requires opioid
administration at regular intervals until the crisis
has settled
5. The first approved drug for the causative
treatment of sickle-cell anaemia, hydroxyurea,
was shown to decrease the number and severity
of attacks
6. Bone marrow transplants have proven to be
effective in children
F. NURSING MANAGEMENT
7
MS Abejo
Medical and Surgical Nursing
Hematology Lecture Notes
Prepared by: Mark Fredderick R. Abejo RN,, MAN
A. ASSESSMENT
1. Reddish purple hue of skin & mucosa,
pruritus
2. Splenomegaly, hepatomegaly
3. Epigastric discomfort, abdominal discomfort
4. Painful fingers & toes from paresthesias
5. Altered mentation
6. Weakness, fatigue, night sweats, bleeding
tendency
7. Hyperuricemia – from increased RBD
formation and destruction
B. DX TESTS
1. CBC
2. BONE MARROW ASPIRATION & Biopsy
C. MANAGEMENT
1. HYPERVISCOSITY
= phlebotomy @ intervals determined by CBC A. ASSESSMENT
results to decrease RBC mass 1. Abnormal bleeding in response to trauma or
=generally 250-500ml removal @ a time surgery. (muscles/joints)
2. HYPERPLASIA 2. Joint bleeding causing pain, tenderness,
= myelosuppressive therapy, swelling, and limited range of motion.
= generally using hydroxyurea or IV radioactive 3. Tendency to bruise easily.
phosphorus (32P), biologic response 4. Epistaxis
modifier, ie alpha interferon 5. Hemarthrosis (bleeding in joints causing pain,
3. HYPERURICEMIA= allupurinol swelling and limited movement)
(Zyloprim)
4. PRURITUS = antihistamines (cimitidine), B. IMPLEMENTATION
low dose acetyl salicylic acid; certain anti- 1. Administer factor VIII concentrate.
depressants (paroxetin), phototherapy, 2. Monitor for bleeding and maintain bleeding
cholestyramine precautions.
3. Monitor for joint pain; IMMOBILIZE the
affected extremity if joint pains occur.
D. NURSING INTERVENTION
1. Encourage/assist ambulation 4. Monitor urine for hematuria.
8
MS Abejo
Medical and Surgical Nursing
Hematology Lecture Notes
Prepared by: Mark Fredderick R. Abejo RN,, MAN
B. MEDICAL MANAGEMENT:
Drug therapy:
1. Prednisone – decreases anti-platelet antibodies
(monitor for infection)
2. IVIG (Intravenous Immune Globulin) – helps
to effectively increase platelet count
3. Anti-D Antibody – one dose treatment
Given to pt’s 1 year but less than 19 years
old
Normal WBC and hemoglobin
no active bleeding present
no concurrent infection
Diphenhydramine and hydrocortisine are
made ready for possible allergic reactions
to the medication
Platelet transfusion
Splenectomy
C. NURSING MANAGEMENT
1. Prevent, control and minimize bleeding.
A. ASSESSMENT 2. Prevent bruising
1. purpura on lower extremities & abdomen 3. Provide support to client and be sensitive to
2. hemorrhagic bullae, acral cyanosis, focal change in body image.
gangrene in skin 4. Protect from infection.
5. Administer analgesics (acetaminophen) as
ordered; avoid aspirin.
6. administer meds orally, rectally, or I.V. rather
than I.M.
9
MS Abejo
Medical and Surgical Nursing
Hematology Lecture Notes
Prepared by: Mark Fredderick R. Abejo RN,, MAN
2. Allergic reactions
BLOOD TRANSFUSIONS Signs and symptoms
Fever, chills, dyspnea, Laryngospasm,
I. OBJECTIVES bronchospasm, Bronchial wheezing,
A. To replace circulating blood volume Urticaria, pruritus, skin rashes
B. Increase oxygen carrying capacity of the blood Nursing Management
C. Combat infections if decreased WBCs Stop BT, Notify MD, Flush with PNSS
D. Prevent bleeding if decreased PLT Diphenhydramine administration as
ordered
II. NURSING MANAGEMENT/PRINCIPLES If (+) to hypotension, it indicates
A. Proper refrigeration anaphylactic shock
B. Proper blood typing and cross-matching Return blood unit to blood bank for re-
examination
Obtain urine and blood sample of client
for re-examination
Monitor VS and IO
3. Pyrogenic reactions
Signs and symptoms
Fever and chills
Headache
Dyspnea
1. Type O – universal donor Tachycardia and palpitations
2. Type AB – universal receipient Diaphoresis
3. 85% of general population is Rh (+) Nursing Management
Blood expiration: Stop BT
Platelets : 5 days Notify MD
RBC: 5-7 days, 250 cc Flush with PNSS
C. Aseptically assemble all materials needed for BT Administer antipyretics and antibiotics
1. Filter set (BT set) as ordered
2. PNSS to prevent hemolysis Provide hypothermic blanket
3. 18-19 gauge large bore needle to prevent Return blood unit to blood bank for re-
hemolysis examination
D. Instruct another RN to re-check the following: Obtain urine and blood sample of client
1. Name of patient for re-examination
2. Bt and ct Monitor VS and IO
3. Expiration date 4. Circulatory overload
4. Serial number Signs and symptoms
E. Check blood unit for presence of bubbles, cloudiness, Dyspnea
sediments and dark color as it may indicate Rales/crackles
contamination Orthopnea
F. NEVER WARM BLOOD PRODUCTS! ROOM Nursing Management
TEMPERATURE ONLY Stop BT
1. Warming only done if you have dewarming devise Notify MD
2. Warming only done during emergency situations if
there is massive blood loss massive transfusion
Administer loop diuretics as ordered
G. Transfusion should be completed in 4 HOURS NO FLUSHING!
because blood exposed to room temperature more than Monitor VS and IO
2 hours causes blood deterioration 5. Air embolism
H. Avoid mixing or administering drug at BT line to 6. Thrombocytopenia
prevent hemolysis 7. Citrate intoxication
I. Regulate at KVO (10-15 gtts/min) at 100 cc/hour to 8. Hyperkalemia arrhythmia
prevent circulatory overload
J. MONITOR VS BEFORE, DURING, & AFTER
TRANSFUSION ESPECIALLY EVERY 15 MINUTES
FOR THE FIRST HOUR. Majority of BT reactions occurs
at these times
K. SIGNS OF BT REACTION (HAPCATCH)
1. Hemolytic reactions life threatening.
PRIORITY
Signs and symptoms
Dizziness, Headache, Dyspnea,
Hypotension, Flushed skin, Lumbar,
flank and sternal pain, diarrhea or
constipation, Portwine urine (red urine)
Nursing Management
Stop BT, Notify MD, Flush with PNSS
Administer Isotonic Solution to
counteract shock and prevent acute
tubular necrosis
Return blood unit to blood bank for re-
examination
Obtain urine and blood sample of client
for re-examination and send to lab
Monitor VS and IO
10
MS Abejo