Hematological System

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Hematological System

• Joyce Smith RN BSN
• Nursing 202

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Introduction

• Blood formed in liver spleen of fetus until 3rd
  trimester
• At birth all bones
• Throughout life in flat bones

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Introduction

• Each day healthy bone marrow produces
• 2.5 billion erthrocytes, 80- 120 days
• 2.5 billion thrombocytes, 8-11 day
• 1 billion leukocytes

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Functions of Blood

• Transport of oxygen absorbed nutrients to cells
• Transport of waste production to kidney, skin
  lungs
• Transport of hormones from endocrine glands to
  other tissue
• Protection of the body from life-threatening
  microorganisms
• Regulation of body temperature by heat transfer

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Bone Marrow

• Soft organic material that fills the cavities of
  the bones
• Produces RBCs and platlets
• Majority are produced in the vertebrae, ribs,
  sternum, skull, pelvis and long bones of the legs

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Blood Components

• Plasma
• Albumin
• Globulin
• Fibroinogen
• Erythrocytes
• Leukocytes
• Platelets

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Blood Components

• Red Blood Cells (RBC)
• Largest portion of blood cells
• Normal range 4.4 to 5.5 million/mm3
• Life span 120 days
• Responsible for producing hemoglobin
• Serves as a buffer and maintains acid-base
  balance
• Eythropoiesis/erythropoietin
• Anemia

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Blood Components

• White Blood Cells (WBC)
• Formed in the bone marrow
• Provide immunity
• Protects from effects of invasion, infection,
  injury
• Types

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Blood Components

• Platelets
• Smallest of the blood cells
• Formed in the bone marrow
• Forms plugs to stop flow of blood from an injury
  site
• Maintains blood vessel integrity
• Aggregation
• Thrombopoietin
• 80 circulate, 20 stored in spleen
• Life span 1 to 2 weeks

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Spleen

• Encapsulated organ about size of fist, LUQ under
  ribs
• Blood formation
• Blood storage
• Blood filtration

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Lymph System

• System of organs, tissues, fluid that deal with
  inflammation, infection, cancer allergic
  response
• Transports lymph
• Produces lymphocytes antibodies
• Phagocytosis
• Absorption of fats fat-soluble matters from
  intestine

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Liver

• Largest organ in body next to skin
• Beneath diaphragm, most on right side of body
• 500 functions
• Reservoir 500-1000cc blood
• Filters detoxifies blood, kupffer cells

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Liver

• Stores nutrients
• Fat soluble vitamins
• A, D, E, K, B12, B1, B2, Fe, phospholipid,
  cholesterol
• Synthesizes
• bile, serum albumin, globulins, prothrombin,
  fibrogen, blood coagulation factors V, VII, VIII,
  IX, XI, XII, urea
• Converts bilirubin to bile stores extra Fe as
  ferritin

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Normal Clotting Mechanism

• Platelet Aggregation
• Activated platelets clump together to form plug
  in vessel wall damage
• Blood-clotting cascade
• Intrinsic Factor
• Extrinsic Factor

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Normal Clotting Mechanism

• Fibrin Clot Formation
• Fibrin molecules link together to form fibrin
  threads
• XIII tightens mesh
• Platelets stick to threads
• Firbrinolysis
• Breaks up fibrin clot

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Gerontological Considerations

• Hgb level fall after middle age
• Fe deficiency most frequent in older
• Reduced dietary intake of iron-rich foods
• Dont use oral Fe supplements
• By age 65 up to 50 of bodys bone marrow
  converted to inactive

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Anticoagulants

• Anticoagulants interfere with one or steps in
  blood-clotting cascade
• Heparin
• Vitamin K antagonists
• Platelet aggregation inhibitors

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Thrombolytic

• Thrombolytics degrade fibrin thread
• tPA
• SK
• Reteplase
• Anistreplase

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Key Symptoms

• Effects every system of body
• Low RBCs SOB, weakness,malaise, fatigue
• Low platelets Unusual or prolonged bleeding
• Low WBCs fever
• High lymphocytes Viral infection

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Health History

• Time of onset duration of symptoms
• Continuous or intermittent
• History of similar signs in parents or siblings
• History of jaundice or anemia in parents or
  siblings
• History of blood loss, bruising, petechiae, or
  nosebleed

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Health History

• Typical dietary pattern
• Occupational history
• Medication history
• Risk factors for hematological disorder age,
  sex, marital status, religion, race ethnic
  background, recent illnesses treatment

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Health History

• Family history of illnesses both living
  deceased realities as well as cause of death
• Sexual habits promiscuity, male homosexuality
  bisexuality, partners sexual habits
• Drug abuse history
• Medical history, including malignancies

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Physical Assessment

• Skin
• Head neck
• Respiratory
• Cardiovascular
• Renal Urinary
• Muscloskeletal
• Abdominal
• CNS
• Psychosocial

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Skin

• Pallor
• Jaundice
• Mucous membranes
• Nail beds
• Bleeding
• Ecchymosis
• Petechiae
• Bleeding from invasive sites

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Head Neck

• Sclera
• Jaundice
• Oral mucosal ulceration
• Fissures at corner of mouth
• Lymph enlargement or pain
• Smooth red tongue

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Respiratory

• Rate
• Depth
• Rest activity
• 10 word sentences
• Easily fatigued
• SOB at rest or exertion
• of pillows

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Cardiovascular

• JVD
• Edema
• Phlebitis
• Murmurs
• Gallops
• Irregular rhythm

• Abnormal B/P
• S V anemia
• B/P ? hypercellular conditions
• Severe anemia
• R vent. Hypertrophy
• Heart disease

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Renal Urinary

• Overt bleeding
• Occult bleeding
• Hematuria
• Proteinuria

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Musculoskeletal

• Rib tenderness
• Sternal tenderness

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CNS

• Cranial nerve assessment
• Neurological function
• Mental status
• GCS
• Neuromuscular evaluation

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Psychosocial

• Chronic illness acute exacerbation of chronic
  disease
• Social support network
• Community resources
• Financial health
• Compliance with therapy

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Complete Blood Count (CBC)

• Measures circulating RBCs WBCs in 1 mm venous
  blood
• of different leukocytes
• Hct - of RBCs in total blood volume, total
  amount of Hct in peripheral blood
• MCV- average volume or size of single RBC
• MCH- weight Hgb in average RBC
• MCHC- concentration of Hgb in each RBC

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Reticulocyte Count

• Immature RBCs
• 2 for circulating RBCs normally
• ? indicates increased production of RBC by bone
  marrow

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Hemoglobin Electrophoresis

• Hemoglobin A normal
• Abnormal form of hemoglobin
• Hemoglobin S in sickle cell

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Coombs Test

• Direct indirect
• Used for blood typing
• Direct presence of antibodies against RBCs
• Certain disease associated with production of
  antibodies against bodys own RBCs, causes
  hemolytic anemia
• Indirect presence of circulating antiglobins
• Determines presence of serum antibodies to type
  of RBCs in blood transfusion

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Serum Ferritin

• Measures quantity of Fe present as free Fe in
  plasma reflects total body Fe stores
• Transferrin protein that transports Fe from GI
• Test is TIBC
• 30 of transferrin is bound to iron in blood
• Total Fe-binding capacity of saturation of
  transferrin, varies according to intake,
  reflects livers function

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Bleeding Time

• Evaluates vascular platelet activity
• Use lancet, small incision in forearm with B/P
  cuff inflated 40 mm Hg
• Blood blotted 30 sec. Intervals timed until
  bleeding stops
• Normal 1-9 min.

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Prothrombin Time

• Measures time for blood to clot
• Normal 11 to 13 sec.
• Clotting factors
• II, V, VII, X
• ? when one or more clotting factor deficient or
  with liver disease
• Warfarin therapy 1.5 to 2. X normal
• Not used often currently except when weaning
  Heparin

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International Normalized Ratio

• INR same as PT but standardized
• 0.7 1.8
• Warfarin therapy 2.0-3.0

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Partial Thromboplastin Time

• PTT
• Evaluates factors
• II, V, VIII, IX, X, XII
• Intrinsic coagulation cascade
• Evaluates Heparin therapy 1.5 to 2.5 times normal

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Bone Marrow Aspiration

• Aspiration
• Needle
• Needle biopsy
• Small incision coring, needle used
• Site
• Posterior superior iliac crest
• Spinous process of vertebrae
• Tibia
• Sternum

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Bone Marrow Aspiration

• Nursing considerations
• Signed informed consent
• Lasts 5 to 15 min
• Anesthesia or sedation
• Local anesthetic or rapid acting sedative

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Bone Marrow Aspiration

• Complications
• Soreness at site
• Bleeding
• Infection

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Nursing Responsibilities

• Cover site with drg.
• Monitor for bleeding q 2 X 24 hours
• Monitor P, B/P, T
• Ice pack, mild aspirin-free analgesic
• Instruct pt to keep site dry for 24 hours
• Avoid trauma 48 hours
• Watch for redness, swelling, T ?