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1
Hematologic Disorders &
Nursing Priorities
Keith Rischer RN, MA, CEN
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Objectives for Today
Review pathophysiology related to hematologic cells and blood forming tissues
Interpret significance of altered hematologic lab values Review commonly used medications that alter
hematologic function Identify the patho, clinical manifestations, diagnostic
tests, nursing priorities, and client education in clients with anemia, sickle cell anemia, leukemia, lymphomas, and multiple myeloma.
Identify the nursing priorities with blood transfusion and the most common transfusion reactions.
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Blood Cells
Hematopoesis: Red bone marrow• The blood forming
tissue that produces the 3 major cell components of blood
Erythrocytes
Leukocytes
Thrombocytes
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Erythrocytes
• Function
Transport of gases (O2 & CO2)Erythropoesis
• Normal Life span: 120 days• Norms
Hgb RBC– Women: 12-16 g/dl 4.0-5.0 mm3– Men: 13.5-18n g/dl 4.5-6.0 mm3
HCT– Women: 38-47%– Men: 40-54%
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Leukocytes
• TypesGranulocytes
(Also known as polymorphonuclear leukocytes)
–Neutrophils–Eosinophils–Basophils
Leukocytes
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• Monocytes agranular)
• Lymphocytes B cells: mediate the humoral immune response
T cells: Mediate cellular immunity
Normal Blood Count of all WBC: 4,000-11,000/ul
Elderly considerations
Thrombocytes (Platelets)
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• Function: Aid in blood clotting Maintain capillary
integrity by working as “plugs” to close any openings in the capillary wall.
• Normal Blood Count: 150,000-400,000 mm3
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Anemia
Mild• Hgb 10-14 g/dl
Moderate• Hgb 6-10 g/dl
Severe• Hgb < 6 g/dl
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Anemia:Causes
Macrocytic Pernicious Anemia (B12 deficiency) Folate deficiency
Microcytic– Iron deficiency anemia
Normocytic– Blood loss– Sickle cell anemia
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Macrocytic Anemia
Megaloblastic Anemias: Presence of large RBC’s) Caused by defective DNA synthesis
Two common types:1. Cobalamin (vitamin B12 deficiency)
– Pernicious anemia =most common cause.2. Folic acid deficiency
– Poor nutrition (Anorexia)– malabsorption in small bowel– ETOH – Hemodialysis
PATIENT EDUCATION
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Microcytic Anemia: Iron Deficiency
Abnormal-small erythrocytes…decr. Hgb Most common anemia Manifestations
• Pallor• Glossitis• fatigue
Dietary sources Patient education
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Normocytic Anemia: Etiology
Blood Loss• Acute• Chronic
Extrinsic (acquired) hemolytic anemias – (damage to RBCs due to external factors)• Physical factors
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ED Case Study
88 yr women w/dk tarry stools last 5 days. c/o weakness, nausea.
Pale, cool-initial VS 80-16-124/30….2 hours later 96-20-94/49
Wbc 9.8, hgb 6.9 (was 12.7 2 weeks ago), hct 21.5, plt 176, INR 4.8 (was 2.1 2 weeks ago)
Nursing priorities
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Sickle Cell Anemia
Patho Sickle Cell Crisis Nsg Management
• Pain control• Hydration
Patient Education• Hydration• Tx infection • Psychosocial
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Thrombocytopenia
Reduction of platelets below normal range• Normal = 150,000-400,000 mm3
Etiology:• Immune Thrombocytopenic Purpura (ITP)• Heparin• Bone marrow suppression
Critical values• 50,000 or less- risk of bleeding• <20,000 spontaneous life threatening hemorrhages (brain bleed) • <10,000 transfusions recommended
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Clinical Manifestations
Petechiae Purpura Ecchymosis Bleeding
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Nursing Management
If acute care-Peripheral IV established No ASA products for pain control Prevent/control acute bleeding Platelet transfusions-assess for reaction Steroids-pt. teaching Education-signs of bleeding
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Blood Product Administration
Minimum 22 g.(blue hub) IV-prefer 20g.
(pink) or 18g. (green) Blood tubing with filter-use NS to prime/flush
• Validate pt., type of blood product, expiration date, blood tag #
• VS before, 15” after initiation, end of each• Infuse PRBC’s over 2 hours (appx 300cc/unit)
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Complications Blood Products
Circulatory OverloadAcute Hemolytic Reaction
• Chills, fever, flushing, tachycardia, SOB, hypotension, acute renal failure, shock, cardiac arrest, death
Febrile-Nonhemolytic Reaction• Sudden onset of chills, fever, temp elevation >1
degree C. headache, anxiety
Mild Allergic Reaction• Flushing, urticaria, hives
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Nursing Responsibilities
STOP transfusion Maintain IV site-disconnect from IV and
flush with NS Notify blood bank/MD Recheck ID Monitor VS Treat sx per MD orders Save bag and tubing-send to blood bank