Professional Documents
Culture Documents
HEMATOLOGICAL DISORDERS
• The blood and the blood forming sites, including the bone marrow and the
reticuloendothelial system
• Blood
– Plasma
– Blood cell
Blood Cells
• Erythrocyte: RBC
• Leukocyte: WBC
– Neutrophil
– Eosinophil
– Basophil
– Monocyte
– Lymphocyte:
• T lymphocyte
• B lymphocyte
• Thrombocyte: platelet
ANEMIA
Etiology:
Loss of blood
Infections
renzN405 1
Types of Anemia according morphologic characteristics of RBC
1. Normocytic/Normochromic
Hemolysis
Cancer
Aplastic anemia
Pregnancy
2. Macrocytic/Normochromic
Liver disorders
Alcoholism
Splenectomy
3. Microcytic/hypochromic
Fe deficiency anemia
Thalassemia
Lead poisoning
Hereditary spherocytosis
Manifestations
• Pallor
• Easy fatigability
• Weakness
• Shortness of breath
• Headache/dizziness
• Amenorrhea
• Cold sensitivity
• Tachycardia
• Paresthesia
renzN405 2
1. Mild anemia (hgb 10-12 g/dl)
- Usually asymptomatic
Management
– Dietary therapy
– BMT or PBSCT
– Immunosuppressive therapy
A. Fe Deficiency Anemia
Risk factors:
Impaired absorption of Fe
Clinical manifestations
• Cheilosis
• Koilonychias
• Pica
• Tinnitus
• Plummer-Vinson Syndrome
renzN405 3
Diagnostics
Absence of hemosiderin
sigmoidoscopy, colonoscopy
Management
Oral FeSO4
Take Vitamin C
Parenteral Fe
Administered as deep IM or IV
Imferon (IM)
Use Z tract
Fe Dextran
renzN405 4
Indications for parenteral Fe
Malabsorption syndrome
Compliance of patient
- Promote rest
Chronic alcoholism
Eating disorders
Pregnancy
Malabsorption condition
Clinical manifestations:
No neurological manifestations
Diagnostics:
Schilling’s test
Management:
Therapeutic trial:
renzN405 5
C. Pernicious Anemia
Pathophysiology
• RBC production
• DNA synthesis
Causes:
Gastric surgery
Clinical Manifestations:
- GI manifestations
- neurologic disorders
Diagnostics:
CBC
PBS
Serum Fe profile
Schilling test
Definitive test
renzN405 6
Management:
Cobalamin Therapy
Cyanocobalamin or hydroxycobalamin
D. Aplastic Anemia
Causes:
Acquired – 80%
Certain drugs
Autoimmune disorder
Infectious agents
Pregnancy
Idiopathic
Clinical manifestations
• Freq. infections
• Unexplained bruising
• Prolonged bleeding
Severe manifestations
Pancytopenia
Normocytic anemia
Neutropenia
Thrombocytopenia
renzN405 7
Diagnostic test
Management:
Blood transfusion
Treatment of infection
Diet adjustments
Client education
A. Hemolytic Anemia
Causes:
Acquired
- Trauma
Diagnostics:
1. CBC
2. Blood smear
3. RBC fragility
Management:
renzN405 8
Withdrawal of offending agent
Transfusion therapy
Splenectomy
Erythropoietin injection
Children are rarely symptomatic until late 1st year (r/t increase amt of fetal hgb (HgbF)
Classification:
- Heterozygous
- Milder form
- Malaria resistant
Clinical manifestations:
1. Vasoocclusive crisis
- Results from sickled cells obstructing blood vessels, causing occlusion, ischemia
&potential necrosis
S/sx:
Fever
Priapism
Arthralgia
renzN405 9
2. Sequestration crisis
- Results from sudden & massive trapping of destroyed RBC by visceral organs especially
spleen
3. Aplastic crisis
4. Hyperhemolytic crisis
6. CNS involvement
7. Overwhelming infection
Streptococcus pneumoniae
8. Chronic symptoms
• Jaundice
• Gallstones
• Growth retardation
Diagnostics:
Blood smear
renzN405 10
Management:
- Adequate oxygenation
- Adequate hydration
Treatment of crisis
- Hydration/electrolyte replacement
- Antibiotic therapy
- Blood products
Genetic counseling
C. Polycythemia Vera
Erythrocytosis, leucocytosis,thrombocytosis
Pathophysiology:
Clinical manifestations:
Ruddy complexion
Fatigue
Shortness of breath
Hepatosplenomegaly
Skeletal gout
renzN405 11
Diagnostics:
CBC
Platelet count
ABG
Management:
No permanent cure
Therapeutic phlebotomy
Chemotherapy
D. Hemochromatosis (HH)
Clinical manifestations:
Depression
Fatigue
Impotence
Arthritis
renzN405 12
Diagnostics:
Management:
Phlebotomy
Classification:
1. Alpha Thalassemia
- Most common
- Heterozygous
- Insidious onset
3.BetaThalassemiamajor
- Homozygous
Clinical manifestations: (s/sx noted toward the end of the 1st year)
Severe anemia
renzN405 13
Failure to thrive
Diagnostics:
1. Amniocentesis
3. Hgb electrophoresis
Management:
Splenectomy
Dietary intervention
- Vitamin C intake
Genetic counseling
- Hemorrhagic autoimmune disease that results in platelet destruction upon reaching liver &
spleen
Clinical manifestations:
Petechiae
epistaxis
Ecchymosis
Easy bruising
Bleeding gums
Diagnostics:
renzN405 14
Complications:
Management:
Surgery
IV gamma globulin
Splenectomy
Immunosuppressive therapy
COAGULATION DISORDERS
A. Hemophilia
Females – carriers
Classification:
Autosomal dominant
renzN405 15
Clinical manifestations:
Prolonged bleeding
Hemarthrosis – hallmark
Intracranial hemorrhage
Severity of Bleeding:
Diagnostics:
1. Platelet count
2. Bleeding time
3. PT
4. PTT – prolonged
Management:
1. Control of bleeding
Factor IX concentrate
Adjunctive measures
Corticosteroids
Loss of balance between the clotting and lysing systems in the body
renzN405 16
Causes:
1. Infection
Pathophysiology:
Clinical manifestations:
Restlessness
Anxiety
Dyspnea
Coolness of extremities
Diagnostic findings:
Low fibrinogen
Prolonged PT
Pronged PTT
Reduced platelets
Management:
- Platelet transfusion
- Cryoprecipitate
Supportive measures
Heparin (controversial)
Prevent injury
renzN405 17
Leukemia
Types:
Defect in the stem cells that differentiate into all myeloid cells:
- Prognosis is variable
Manifestations:
Bleeding tendencies
Hyperplasia of gums
Bone pain
Treatment:
- Aggressive chemotherapy
- Induction therapy
- BMT
Stages
A. Chronic phase
B. Transformational phase
C. Blast crisis
renzN405 18
CML
Malaise
Anorexia
Weight loss
Confusion
Enlarged liver
Treatment:
Manifestations:
Treatment:
Chemotherapy,
Malignant B lymphocytes, most of which are mature, may escape apoptosis, resulting in
excessive accumulation of cells
renzN405 19
Most common form of leukemia
Manifestations:
Lymphadenopathy
Hepatosplenomegaly
Chemotherapy
Laboratory tests
• Imbalanced nutrition
• Acute pain
• Hyperthermia
• Diarrhea
• Self-care deficit
• Anxiety
• Grieving diagnoses
• Deficient knowledge
renzN405 20
Potential Complications:
• Infection
• Bleeding
• Renal dysfunction
• Nutritional depletion
• Mucositis
• Depression
- Absence of complications
- Activity tolerance
Interventions
1. Mucositis
2. Improving Nutrition
- Provide small, frequent feedings with soft foods that are moderate in temperature
renzN405 21
Lymphoma
Hodgkin’s lymphoma
Non-Hodgkin’s lymphoma
Hodgkin’s Disease
Unicentric origin
Reed–Sternberg cell
Familial pattern
Manifestations:
2. Pruritus
3. Fever
4. Sweats
5. Weight loss
Chemotherapy
Radiation therapy
Lymphoid tissues become infiltrated with malignant cells that spread unpredictably;
localized disease is rare
Interferon
Chemotherapy
Radiation therapy
renzN405 22
Multiple Myeloma
Malignant disease of plasma cells in the bone marrow with destruction of bone
Manifestations:
1. Bone pain
2. Osteoporosis
3. Fractures
5. hypocalcemia
6. Renal damage
7. Renal failure
8. Symptoms of anemia
9. Fatigue
10. Weakness
Treatment:
Chemotherapy
Corticosteroids
Radiation therapy
Biphosphonates
Prepared by:
NCM104 Instructors
HAUCON
renzN405 23