Hematologic Disorders

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26
Hematologic Disorders
2
Advanced EMT Education Standard

• Applies fundamental knowledge to provide basic
  and selected advanced emergency care and
  transportation based on assessment findings for
  an acutely ill patient.

3
Multimedia Directory

• Slide 39 Sickle Cell Anemia Video

4
Objectives

1. Define key terms introduced in this chapter.
2. Describe the anatomy and physiology of the
   hematologic system. 9-24
3. Describe the pathophysiology and complications of
   sickle cell disease. 38-39
4. Recognize the signs and symptoms of
   vaso-occlusive crisis. 40
5. Describe the etiologies and pathophysiology of
   anemias. 35-36

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Objectives

1. Explain the etiology and pathophysiology of
   diseases of the white blood cells, including
   leukemias and lymphomas. 41-45
2. Describe the etiology and pathophysiology of
   disorders of coagulation and hemostasis,
   including disseminated intravascular coagulation
   (DIC) and hemophilia. 46-50

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Objectives

1. Discuss the risk factors, signs and symptoms, and
   consequences of deep vein thrombosis. 49
2. Develop a list of differential diagnoses for
   patients presenting with signs and symptoms of
   hematologic disorders. 30-31
3. Provide prehospital treatment appropriate to the
   needs of patients with a variety of hematologic
   disorders. 27-31

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Introduction

• Hematology study of blood and blood-forming
  (hemopoietic) organs and tissues.
• Disorders related to red blood cells (RBCs),
  white blood cells (WBCs), platelets, or
  coagulation.

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Think About It

• How could a history of sickle cell disease relate
  to a complaint of abdominal pain?
• What additional information do Cecil and Eliza
  need to provide the patient with the best care
  possible?
• What prehospital interventions should Cecil and
  Eliza anticipate based on the information so far?

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Anatomy andPhysiology Review

• Blood liquid transport medium plasma.
• 55 blood volume 92 water
• Formed elements of blood
• Eythrocytes (RBCs)
• Leukocytes (WBCs)
• Thrombocytes (platelets)
• How many liters of blood does average adult have?

10
Anatomy andPhysiology Review

• Liver, spleen, bone marrow eliminate aged and
  damaged blood cells.
• Kidneys and liver secrete hormone that stimulates
  RBC production erythropoietin.

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Anatomy andPhysiology Review

• Plasma
• Proteins (albumin, clotting factors, antibodies).
• Carries electrolytes, nutrients, medications,
  hormones, other substances throughout body.

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Anatomy andPhysiology Review

• Figure 26-1 Hypoxia triggers increased release
  of erythropoietin.

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Anatomy andPhysiology Review

• Red Blood Cells
• Flattened disks thicker edges/thinner center.
• Provides surface area for gas exchange flexible
  to squeeze through capillaries.
• Manufactured from stem cells in bone marrow.

14
Anatomy andPhysiology Review

• Red Blood Cells
• Limited life span of 120 days.
• Erythropoietin increases to stimulate bone marrow
  to increase production of RBCs.

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Anatomy andPhysiology Review

• Red Blood Cells
• Hematocrit measure of percentage of blood volume
  composed of formed elements.
• Hemoglobin iron-containing protein that carries
  oxygen and carbon dioxide within RBCs.

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Anatomy andPhysiology Review

• What color is a molecule saturated with oxygen?
• What color is desaturated hemoglobin?

17
Anatomy andPhysiology Review

• White Blood Cells
• Produced in bone marrow.
• Signaled by chemical messengers to travel to
  areas where they are needed.
• Types neutrophils, eosinophils, basophils,
  monocytes, lymphocytes.
• Different types of WBCs respond preferentially to
  different kinds of antigens.

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Anatomy andPhysiology Review

• Figure 26-2 Clotting (coagulation) cascade.

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Anatomy andPhysiology Review

• Platelets
• Fragments of thrombocytes.
• Activated by exposed tissue collagen in injured
  blood vessels.
• Become sticky and adhere to injured tissue and to
  each other, creating platelet plug.
• Hemostasis process completed by activation of
  clotting cascade.

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Anatomy andPhysiology Review

• Hemostasis process of stopping bleeding.
• Injured vessel constricts to slow flow of blood
  through it.
• Platelets attracted to the area, form platelet
  plug.

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Anatomy andPhysiology Review

• Hemostasis process of stopping bleeding.
• Coagulation formation of stable blood clot.
• Massive injury systemic formation of blood clots
  (disseminated intravascular coagulation DIC).

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Table 261 Medications That May Indicate a
Hematologic Disorder
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Table 261 (continued) Medications That May
Indicate a Hematologic Disorder
24
Anatomy andPhysiology Review

• Blood Groups
• Determined by ABO and Rh antigen systems.
• A, B, both A and B, or no (O) antigens.
• Type O can only receive type O blood.
• What blood type is the universal donor?
• What blood type is the universal recipient?

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Anatomy andPhysiology Review

• Blood Groups
• Rh-positive Rh antigen on RBCs no anti-Rh
  antibodies in blood.
• Rh-negative do not have Rh antigen on RBCs do
  not initially have anti-Rh antibodies.
• If exposed to Rh-positive blood, develop anti-Rh
  antibodies.
• Explains hemolytic disease of newborn.

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Think About It

• Patients under treatment for cancer may tell you
  their blood count or CBC.
• CBCcomplete blood count.
• Cancer or its treatments (like chemotherapy and
  radiation) can result in a dangerous fall of the
  CBC.

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General Assessment and Management of Hematologic
Emergencies

• Patient may not be aware of underlying
  hematologic problem.
• Excessive bleeding from minor MOI clue that
  patient taking medication that interferes with
  hemostasis.
• Epistaxis, excessive bleeding from injury, and
  hematoma formation interfere with airway.

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General Assessment and Management of Hematologic
Emergencies

• Figure 26-4 Purpura.

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General Assessment and Management of Hematologic
Emergencies

• Figure 26-5 Petechiae.

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General Assessment and Management of Hematologic
Emergencies

• Check for and control significant hemorrhage.
• Look for purpura, petechiae, or lymphadenopathy.
• Treatment oxygen, fluid replacement, analgesia.

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Table 262 Signs and Symptoms of Hematologic
Disorders
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Think About It

• Obtain a set of baseline vital signs and use
  monitoring devices according to the situation.
• The patients list of medications can be
  particularly helpful in determining whether the
  patient has, or is at risk for, a hematologic
  problem.

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Blood Transfusion Reactions

• Signs and Symptoms of a Transfusion Reaction
• Flushing
• Pain at infusion site
• Chest pain back or flank pain
• Restlessness or anxiety
• Nausea
• Fever chills
• Renal failure

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Think About It

• If you perform interfacility transports or work
  in the emergency department, you might care for
  patients who are receiving blood or blood
  products, or who have received them shortly
  before transport.
• What problems might occur as a result?

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Red Blood Cell Disorders

• Anemia
• Abnormally low hematocrit symptomatic when
  hematocrit drops below 30.
• Decreased production of RBCs.
• Increased destruction of RBCs.
• Loss of RBCs (hemorrhage).
• Cells do not receive enough oxygen for energy
  production.

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Red Blood Cell Disorders

• Anemia Signs and Symptoms
• Fatigue
• Pallor
• Tachycardia
• Shortness of breath, particularly on exertion
• Severe cases, chest pain/signs of heart failure
• What are the causes of anemia?

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Red Blood Cell Disorders

• Figure 26-6 Sickle cell disease.

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Red Blood Cell Disorders

• Sickle Cell Disease
• Genetic disorder.
• Common in people of African, Mediterranean,
  Middle Eastern, Caribbean, and South and Central
  American origin or descent.
• RBCs take on abnormal curved (sickle-shaped)
  appearance.
• RBCs live only 10 to 20 days.

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Sickle Cell Anemia Video

• Click here to watch a video on the topic of
  sickle cell anemia.

Back to Directory
40
Think About It

• Abnormal shape of sickle cells makes it difficult
  for them to move through capillaries.
• They are more prone to clumping together.
• When clumps of sickle cells obstruct capillary
  beds, this is called a vaso-occlusive crisis.

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White Blood Cell Disorders

• Leukemia
• Cancer causes bone marrow to rapidly produce
  large numbers of abnormal WBCs.
• Crowd out normal cells, resulting in anemia,
  bleeding, infection.

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White Blood Cell Disorders

• Leukemia
• Cells from lymphocytic or myelocytic cell lines.
• Signs and symptoms easy bruising, bone pain,
  enlarged spleen, swollen lymph nodes, repeated
  infections, fatigue.

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White Blood Cell Disorders

• Lymphoma
• Cancers of lymphocytes (B or T lymphocytes)
  localized to lymph nodes.
• Either Hodgkins or non-Hodgkins lymphoma.
• Survival rate for Hodgkins lymphoma very high
  relatively high for non-Hodgkins lymphomas.

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White Blood Cell Disorders

• Multiple Myeloma
• Cancer of cells in bone marrow.
• Abnormal cells multiply crowd out normal cells.
• Decreased production of blood cells results in
  pathologic fracture of affected bone.

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Think About It

• An increased WBC count is an indication of
  infection, inflammation, or blood cancers
  (leukemia).
• An examination of the types of WBCs responsible
  for the increase and their stage of maturity
  (differential) helps determine the type of
  infection.
• What can cause a decrease in WBCs?

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Clotting Disorders

• Platelet Disorders
• Low number of platelets (thrombocytopenia).
• Platelets reduced in number or impaired by
  leukemia or bone marrow disorders.
• Increased platelet count results in risks for
  bleeding and clotting (thrombocytosis).

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Clotting Disorders

• Hemophilia
• Inherited disease deficiencies in certain
  clotting factors.
• Treatment replacement of specific clotting
  factor.

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Clotting Disorders

• Hemophilia
• Painful, swollen joints, abnormal menstrual
  bleeding, bleeding gums, bruising, epistaxis,
  rash, purpura, petechiae, prolonged bleeding,
  gastrointestinal and urinary tract bleeding.

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Clotting Disorders

• Blood Clots and Deep Vein Thrombosis
• Deep vein thrombosis (DVT) blood clots form in
  deep, large veins of legs, pelvis, arms.
• If DVT breaks loose, can cause pulmonary
  embolism.
• Anticoagulant medications.

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Clotting Disorders

• Disseminated Intravascular Coagulation (DIC)
• Results from systemic overactivation of clotting
  mechanisms.
• Blood transfusion reactions
• Sepsis
• Surgery
• Severe trauma

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Think About It

• Has your thinking about the case study changed
  since the beginning of the chapter?

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Chapter Summary

• Hematology study of blood and blood-forming
  organs.
• Blood comprised of plasma (transport medium) and
  formed elements.
• Plasma proteins, antibodies, clotting factors,
  electrolytes, nutrients.
• RBCs carry oxygen and carbon dioxide bound to
  hemoglobin for gas exchange.

53
Chapter Summary

• Decrease in RBCs from blood loss, decreased
  production, or increased destruction can lead to
  tissue hypoxia.
• Abnormal shape of RBCs in sickle cell disease
  leads to increased hemolysis and microvascular
  occlusion.
• Antigens on RBC surface basis of blood typing.

54
Chapter Summary

• Increase in WBCs result of response to infection,
  inflammation, or pathologic process.
• Each type of WBC has specific functions.
• Hemostatic process vasospasm, platelet
  aggregation, clotting cascade.

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Chapter Summary

• Patients list of medications provides
  information.
• Abnormal localized blood clotting DVT.
• Systemic overactivation of clotting mechanisms
  DIC.