c


 `m "


  
 Ôm Îetects characteristics of RBCs occurring with sickle
`m Whole blood consists of formed elements suspended in cell disease by exposing blood to an agent,
liquid component. depriving cells of oxygen.
À  
`m À  

`m Whole blood contains 3 types of mature blood cells: Ôm It involves measuring in minutes the time it takes
 
À for bleeding to stop after standardized skin
Ôm re biconcave disks which contains hemoglobin puncture, usually on the forearm.
Ôm c
  consist of iron containing pigment Ôm It detects disorder of platelet function
which comprises about 95% of erythrocytes `m 
 
 
mass. It has the ability to bind oxygen which is Ôm ‰easures coagulation and is used in monitoring
called ͞oxyhemoglobin͟. Coumadin therapy
Ôm c
 ë the number of hemoglobin per 100 Ôm Providing a screening test for liver disease and
ml of blood. coagulation factor deficiencies.
  
À `m  %
 
 
Ôm 5000 ë 10000 WBCs per mm3 and they live 5-9 days Ôm *sed in monitoring heparin therapy
ÿm ranulocytes Ôm åcreening for coagulation factor deficiencies.
ÿm granulocytes `m c
  
  

Ôm ranulocytes Ôm „ormal is < 6-8
ÿm „eutrophils (55-70%) Ôm Indicates blood sugar level over a 3 month
ÿm 3osinophils (1-3%) period (RBC lifespan is 109 days. lucose
ÿm Basophils (0.5-1.0%) attaches and cannot unattach)
Dm „eutrophils ë 1st to attack during Ôm *rine sugars are useless: urine output today is
infection what the blood sugar was 4 days ago. (only
-m Increases during short/ acute good for ketone check in Type 1 diabetic)
infections Ôm 5-8 weeks after treatment change, should start
Dm 3osinophils ë increases during to see improvement (decrease) in Hgb 1C
allergies and parasitic infection

Dm Basophils ë histamine releasing
Ôm granulocytes
ÿm Ñymphocytes (consist of B cells and T cells)
ÿm ‰onocytes
Dm Ñymphocytes ë circulate in the blood and lymph
systemsand make their homes in the lymphoid
organs.
. B cells- one that produces
antibodies
B. T cells ë fighting tumors and
viruses, activates B cells
`m À #% À 
Ôm  #& (mean cell volume) = 80-96
Dm (‰CH, mean cell hemoglobin, does corresponding
changes = 28-33)
Ôm (‰CHC is usually a useless index)
Ôm RBC indices used to diagnose 
, a
condition characterized by a reduction in RBCs,
which in turn decreases the oxygen-carrying
capacity of the blood. Hypoxia produces
fatigue, among other problems.
À



 

  

ë normal platelets is 150,000 ë 450,000/mm3 

Plasma ë the liquid portion of the whole blood
remaining after blood cells are removed. m
 

m c
 

m %
 

  !
 "

m "   

`m À #$ 
%  À%

Ôm 3valuates specimen of bone marrow and bone 
#' ((  condition in which the hemoglobin concentration is
Ôm übtained by introducing a needle with stylet into lower than normal
the iliac crest - is not in itself a disease, but a principal manifestation of
many abnormal conditions, such as:
Ôm To diagnose hematologic disorders
Ôm deficiency states caused by a dietary lack of iron,
Ôm To evaluate iron content vitamin B12, and folic acid
`m 
%  À  À Ôm hereditary disorders of RBCs
Ôm 3numeration of number of RBCs, WBCs and Ôm disorders involving the hematopoietic tissues (bone
platelets per mÑ of blood marrow damage or a hyperactive spleen)
Ôm Îifferential WBC count Ôm bleeding from the I tract or any organ secondary to
Ôm Respective percentage of neutrophils, basophils, cancer or trauma
lymphocytes and monocytes contributing to the Ôm a family history of anemia is common, especial in
certain racial and ethnic groups
total WBC count.
`m       

Ôm Îetects the percentage of young(1-2 days old) 1. Ñoss of RBC- occurs with bleeding
erythrocytes in the peripheral blood. 2. Îecreased RBC production
3. Increased RBC destruction
c)**'+ '& 
#' Ôm Folic acid deficiency anemia
ÿm &
 À  ,  
 % 


Ôm Inadequate dietary of vitamin B12 is a rare except in
`m ' ! ,  

strict vegetarians
Ôm Is a type of anemia wherein iron stores are depleted,
Ôm Faulty absorption of Vitamin B12 fronm the I tract
resulting in decreased supply of iron for the
occurs because of a lack of secretion of intrinsic
manufacture of hemoglobin in red blood cells.
factor
Ôm It commonly results from blood loss. Increased
Ôm Certain small intestine disorders impair absorption
metabolic demands, malabsorption, and dietary of Vitamin B12 (pernicious anemia)
inadequacy. ÿm +   ,  

Ôm ssessment Findings: Ôm Inadequate intake of uncooked vegetables,
1. Pallor fruits and other sources of folic acid
2. Weakness Ôm Impaired absorption of folic acid in the upper
3. Fatigue jejunum
Ôm Interventions Ôm Increased requirements of folic acids, common
1. Increase the oral intake of iron alcoholism and pregnancy
2. Instruct about the foods rich in iron to eat. Dm åå3åå‰3„T FI„ÎI„å:
m
mm
m 1. åmooth sore tongue
`m Ñean meat 2. Îiarrhea
`mÑiver 3. Paresthesias
`mreen leafy vegetables 4. Impaired coordination
`mÑegumes Dm I„T3RV3„TIü„å:
G


  





 
1. dminister prescribed medications w/c may include Vit.
DmIRü„ üRÑ form tablet
Dmastric upset ë take with full glass of water
DmCause black tarry stool- informed that it is expected
DmCü„åTIPTIü„ ë increase the 3 Fs
a. Fluids ë 2-3 liters/day
b. Fiber ë high fiber diet = fruits and vegetables
c. Fitness ë maintain consistency in exercise , best
example is 30 mins. exercise
#'
 ÑIQ*IÎ FüR‰
Dm dminister with straw
Dm astric upset ë take with full glass of water
Dm Cause black starry stool ë inform that it is expected
Dm Constipation ë increase the 3 Fs
 PR3„T3RÑ = I‰ 
Dm dminister in Z ëtrack
Dm It causes irritation to the subcutaneous fats
Dm ‰ost important is Tü T 3 WITH FüüÎ HIH I„
VIT‰I„ C (usual sample is orange juice)
`m %
 
 sickle shape, and the cell becomes rigid and
Ôm Îeficiency of circulating erythrocytes resulting from
the arrested development of red blood cells within
the bone marrow
Ôm 3tiologies are exposure to toxic agents. Viruses,
infection, autoimmune disorders and allergic states
Ôm Îefinitive diagnosis is determined by bone marrow
aspiration
Ôm ‰anagement focuses on restoring function to the
bone marrow and involves immunosuppressive
therapy and bone marrow transplant (treatment of
choice)
Ôm ssessment findings:

B12. Ñifelong Vit. B12 therapy is required
2. Vitamin supplementation Folic acid 1 mg daily
3. dvise client to consume foods high in Vitamin B12 ( organ
meats, nuts, whole grain products)
4. Provide oral care for sore tongue
c#*) ' 
`m " 

Ôm Is a group of diseases collectively termed as
hemoglobinopathies in which hemoglobin is
partly or completely replaced by abnormal sickle
hemoglobin å
Ôm It is caused by inheritance of a gene
Ôm Hemoglobin å is sensitive to changes in ü2
content of the red blood cell.
Ôm Insufficient oxygen causes the cell to assume a
clumped together, obstructing capillary blood
flow.
Ôm Precipitating factors includes fever, emotional
or physical stress or any situation that increases
the need for oxygen
Ôm The sickling response is responsible under
conditions of adequate oxygenation and
hydration
Ôm fter repeated sickling, the cell becomes
permanently sickled.
"'-  '"'"
`m &
. 


1. Pantocytopenia ë a deficiency of erythrocytes, Ôm ‰ost common type o crisis. It is caused by stasis
leukocytes and thrombocytes of blood with clumping of the cells in circulation,
- Petechiae, bleeding, pallor, weakness, tachycardia, ischemia and infarction.
fatigue `m "% 
/

Ôm Interventions: Ôm Ñife threatening crisis is caused by the pooling of
1. Prepare the client for bone marrow transplant if blood in the spleen
planned. Ôm åigns include anemia, hypovolemia and shock
2. dminister immunosuppressive medications as `m %
 


prescribed. Ôm Is caused by the diminished production and
3. dminister blood transfusions if prescribed and increase destruction of red blood cells triggered
monitor for transfusion reactions. by viral infection or depletion of folic acid
Ôm Care focuses on the prevention of (infection and
`m # 
 
 dehydration) and treatment (oxygen, hydration,
Ôm re hematologic disorders characterized by the pain management, and bed rest) of the crisis.
production of large, immature and dysfunctional '
&
'*
"0
RBCs Dm ‰aintain adequate hydration and blood flow with
Ôm Vitamin B12 deficiency anemia (pernicious anemia) intravenously administered normal saline as prescribed
and with oral fluids
 Dmdminister oxygen and blood transfusions as prescribed
to increase tissue perfusion
Dmdminister analgesics as prescribed (RTC)
administration of meperidine (Îemerol) is avoided.
Dmssist to assume a comfortable position so that the
patient keeps the extremities extended to promote
venous return.
Dm3levate the head of the bed no more than 30 degrees
Dmvoid putting strain on the painful joints
Dm3ncourage consumption of high calorie, high protein
diet with folic acid supplement
Dm‰onitor for signs of increasing anemia and shock

(mental status changes, pallor and vital signs changes)
DmInform about the hereditary aspects of the disorder


 ( is inherited disorders characterized reduced or
absent amounts of hemoglobin, the oxygen-carrying protein

 ,
`m 

Ôm Refers to an I„CR3å3 volume of RBCs
Ôm The hematocrit is 3Ñ3VT3Î to more than 55%
Ôm Clasified as Primary or åecondary
ÿm *)) c#' &
|m Primary Polycythemia
|m  proliferative disorder in which the myeloid stem
cells become uncontrolled
|m Causative factor (unknown)
|m %
4 The stem cells grow uncontrollably
> The bone marrow becomes HYP3Rcellular and
all the blood cells are increased in number
> üvertime, the bone marrow becomes fibrotic
|m 
inside the red blood cells. It is characterized by %
 (an
abnormal decrease in the hemoglobin content of RBCs), extreme 1. åkin is ruddy




(smaller-than-normal RBCs), destruction of blood 2. åplenomegaly
elements (hemolysis), and variable degrees of anemia. 3. Headache
$ À
 1%
, 


 !
  4. dizziness, blurred vision
ͻlpha Thalassemia ë occur mainly in sia and ‰iddle 3ast, 5. ngina, dyspnea and thrombophlebitis
ͻBeta Thalassemia:  person with this disorder has two |m  ,

mutated genes 1. CBC- shows elevated RBC mass
    %
, À  


 2. „ormal oxygen saturation
ͻThalassemia ‰inor 3 3levated WBC and Platelets
ͻThalassemia Intermediate. |m 
%

ͻThalassemia ‰ajor or Cooley's nemia ë characterized by 1. Increased risk for thrombophlebitis, CV and ‰I
severe anemia, marked hemolysis, and ineffective 2. Bleeding due to dysfunctional blood cells
erythropoiesis. |m #  #

1. To reduce the high blood cell mass PHÑ3BüTü‰Y
 
 , À  


 2. llopurinol
3. Îipyridamole
ͻRegular blood transfusion helps prevent
4. Chemotherapy to suppress bone marrow
severe anemia and allows for more normal
|m

 #

growth and development 1. Primary role of the nurse is 3Î*CTüR
ͻThere are various medications that target 2. Regularly asses for the development of
the production of red blood cells (i.e.erythropoeitin) complications
3. ssist in weekly phlebotomy
4. dvise to avoid alcohol and aspirin
1
(2(%
%   
 ,  5. dvise tepid sponge bath or cool water to
Ôm is an X-linked recessive hereditary disease characterised manage pruritus
by abnormally low levels ofglucose-6-phosphate
dehydrogenase ( this gene produces an enzyme within
the RBC that is essential for membrane stability) 


Ôm Individuals with the disease may exhibit m ‰alignant disorders of blood forming cells characterized
nonimmune hemolytic anemia in response to a number by *„Cü„TRüÑÑ3Î proliferation of WHIT3 BÑüüÎ
of causes, most commonly infection or exposure to C3ÑÑå in the bone marrow- replacing marrow elements.
certain medications or chemicals The WBC can also proliferate in the liver, spleen and
lymph nodes.
""""#
+'
!'
1"0
- symptomatic and have normal hemoglobin levels and m The leukemias are named after the specific lines of
reticulocytes most of the time blood cells afffected primarily
- åeveral days after exposure to an offending medication m ‰yeloid
they may develop: m Ñymphoid
Pallor m ‰onocytic
Jaundice m The leukemias are named also according to the
Hemoglobinuria (hemoglobin in the urine)
maturation of cells
Hemolysis
Reticulocyte increases 3  - The cells are primarily immature
 #
c*
' - The cells are primarily mature or
- The treatment is to stop the offending medicastion diferentiated
- Transfussion is necessary in hemolytic state. m 3 
   


3"'
1 #
1#
m 3  
%  

The patient should be educated about the disease and given m c*
'
   

a list of medications to avoid. If hemoysis thus develop, nursing
m c*
' 
%  

interventions are the same as from other causes.
 m  '**1' + *"
Ôm *„ „üW‰
Ôm Probably exposure to radiation
Ôm Chemical agents
Ôm Infectious agents
Ôm enetic
m  c*c)"'**1) , 3   

Ôm *ncontrolled proliferation of immature cells§
suppresses bone marrow function§ severe
anemia, thrombocytopenia and granulocytopenia
m  c*c)"'**1) , c*
'  

Ôm *ncontrolled proliferation of ÎIFF3R3„TIT3Î
cells§ slow suppression of bone marrow function§
milder symptoms

""""#
+'
!'
1"

m 3  3-#'
Pallor
Fatigue
Îyspnea
Hemorrhages
ürganomegaly
Headache
Vomiting
m c*
' 3-#'
Ñess severe symptoms
organomegaly

À* *) +'

!'
1"
1. Peripheral WBC count varies widely
2. Bone marrow aspiration biopsy reveals a large
percentage of immature cells- BяåTå
3. 3rythrocytes and platelets are decreased
#  #

1.m Chemotherapy
2.m Bone marrow transplantation

  #

1. ‰anage „Î prevent infection
'm ‰onitor temperature
'm ssess for signs of infection
'm Be alert if the neutrophil count drops below 1,000
cells/mm3
2. ‰aintain skin integrity
3. Provide pain relief
4. Provide information as to therapy- chemo andbone
marrow transplantation