Hematologic System
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| May become tissue macrophages | Monocyte
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| 30% of volume stored in spleen | Platelet
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| Primarily responsible for immune response | Lymphocyte
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| 4% to 8% of white blood cell count (WBC) | Monocyte
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| Production stimulated by hypoxia | Erythrocyte
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| 0% to 2% of WBCs | Basophil
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| Immature cell is a band | Neutrophil
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| Increased in individuals with allergies | Eosinophil
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| Responds first at injury site | Neutrophil
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| 20% to 40% of WBC | Lymphocyte
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| Releases granules that increase allergic and inflammatory responses | Basophil
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| Arises from megakaryocyte | Platelet
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| 50% to 70% of WBCs | Neutrophils
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| Increases indicate an increased rate of erythropoiesis | Reticulocyte
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| Make up 2% to 4% of WBCs | Eosinophil
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| Also known as "segs" | Neutrophils
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| Granulocytic leukocytes include | Neutrphils, basophils and eosinophils
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| REd blood cell production is stimulated by the release of the growth factor______________ | ERYTHROPOIETIN from the kidney
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| Nutrients essential for red blood cell production include | Iron, Vitamin B12, folic acid
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| Obstruction of the lymph flow results in accumulation of lymph fluid known as | lymphedema
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| Organs of the hematologic system that have filtering functions include the | liver spleen, lymph notes
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| Iron is stored in the body in the form of | ferritin, hemosiderin
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| Thrombin converts fibrinogen to fibrin | Plasma clotting factors
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| Platelets interact wtih collagen | Platelet plug formation
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| Release of adrenosine diphosphate | Platelet plug formation
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| Thrombin catalyzes conversion of plasminogen to plasmin | Lysis of clot
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| Release of PF3, serotonin and epinephrine | Platelet plug formation
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| Fibrin split products formed with action of plasmin | Lysis of clot
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| Action of Protein C and Protein S | Lysis of clot
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| Vasoconstriction and spasm | Vascular response
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| Prothrombin converted to thrombin | Plasma clotting factors
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| Damaged vascular surface | Vascular response
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| Serum calcium activity as factor IV | Plasma clotting factors
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| Platelet agglutination | Platelet plug formation
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| An appropriate nursing action for a patient's laboratory test results which indicate increased fibrin split products (FSP) is | bleeding
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| Reason: | During fibrinolysis by plasmin, the fibrin clot is split into smaller molecules known as FSPs) or FDPs. Increased FSP impair platelet aggregation, reduce prothrombin, and prevent fibrin stabilization and lead to bleeding
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| FSP = | Fibrin Split Products
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| FDP = | Fibrin degradation Products
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| PTT = | Partial Thromboplastin Time
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| Blood test results of an 83-year old would be of major concern if the results were: | PTT of 60 seconds
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| Rationale: | In aging, the PTT is normally decr, so an abnormally high PTT of 60 secs is an indication that bleeding could readily occur. Plt are unaffected by aging, & 150k is a normal count. Serum FE levels are decr & the ESR is significantly incr with aging.
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| A patient with a bone marrow disorder with an overproduction of myeloblasts. The nurse would expect the results of a CBC to include increased | basophils, neutrophils, eosinophils
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| Rationale: | The myeloblast is a committed hematopoietic cell found in the bone marrow from which granulocytes develop. A disorder in which myeloblasts are overproduced would result in increased basophils, neutrophils, eosinophils
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| During the nursing assessment of a patient with anemia, the nurse asks the patient about a history of | stomach surgery
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| Rationale: | The parietal cells of the stomach secrete intrinsic factor, a substance necessary for the absorption of cobalamin (Vit B12), & if all or part of the stomach is removed, the lack of intrinsic factor can lead to impaired red cell prodtn & pernicious anemia.
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| Rationale continued: | Recurring infections indicate decreased WBCs and immune response, and corticosteroid therapy may cause a neutrophilia and lymphopenia. Oral contraceptive use is strongly associated wtih changes in blood coagulation.
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| Specific findings identified by the nurse during assessment of the patient's functional health patterns that indicates risk factors for hematologic problems or a patient response to actual hematologic problems are: |
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| Health perception-health management | Family history of hematologic disorders; alcohol and cigarette use
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| Nutritional Metabolic | deficiencies of iron, Vit B12, and folic acid; GI bleeding; petechiae or bruising of the skin fever, lymph node swelling
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| Elimination | frankly bloody or dark, tarry stools; dark or bloody urine
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| Activity-exercise | fatigue and weakness, change in ability to perform normal activities of daily living
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| Sleep-rest | fatigue unrelieved by sleep
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| Cognitive-perceptual | pain, especially in joints, bones, paresthesias, numbness, tingling, changes in hearing, vision, taste, mental status
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| Self-perception-self-concept | altered self-perception because of lymph node enlargement, skin changes
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| Role-relationship | home or work exposure to radiation or chemicals; military history
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| Sexuality-reproductive | menstrual history and characteristics of bleeding intrapartum or postpartum bleeding problems impotence
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| Coping-stress tolerance | lack of support to meet daily needs; methods of coping with stress
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| Value-belief | Value conflicts with treatment, especially blood products or bone marrow transplants
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| Using light pressure with index and middle fingers, the nurse cannot palpate any of the patient's superficial lymph nodes. The nurse | records this finding as normal
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| Rationale: | superficial lymph nodes are usually not palpable. It may be normal to find small (< 1.0 cm) mobile, firm, nontender nodes. Deep lymph nodes are detected radiographically.
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| During physical assessment of a patient with thrombocytopenia, the nurse would expect to find | petechia and purpura
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| Rationale: | Petechiae are small, flat, red or reddish brown pinpoint microhemorrhages that occur on the skin when platelet levels are low; when they are numerous, they group, causing reddish bruises known as purpura. Jaundice occurs when anemias are of a hemolytic
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| Rationale continued: ... | origin, resulting in accumulation of bile pigments from RBCs. Enlarged, tender lymph nodes are associated with infection, and sternal tenderness is associated with leukemias
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| A patient with a hematologic disorder has a smooth, shiny red tongue. The nurse would expect the patient's laboratory results to include | Hb: 9.6 g/dL (96 g/L)
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| Rationale: | A smooth, shiny, reddened tongue is an indication of iron-deficiency anemia or pernicous anemia that would be reflected by a decr hgb level. Incr WBC could be indicative of an infection; the decr neutrophils, or a neutropenia; & incr RBC, or polycythemia.
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| A ptient is being treated with chemotherapeutic agents. The nurse revises teh patient's care polan based on the CBC results of | Platelets: 50,000/ul
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| Rationale: | Plt ct < 150k/ul is considered thrombocytopenia & could place the pt at risk for bleeding, necessitating consideration in nursing care. CHemo may cause bone marrow suppression & a depletion of all blood cells. Other factors are all w/in normal range.
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| Identify the type of condition indicated by the following laboratory study results |
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| Serum Iron: 40 mcg/dL (7 umol/L) | iron deficiency anemia
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| ESR: 30 mm/hr | inflammatory conditions of any kind
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| Increased band neutrophils | infection
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| Activated partial thromboplastin time: 60 secs | heparin therapy
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| Indirect bilirubin: 2.0 mg/dl (34 umol/L) | hemolysis of RBCs
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| Urine Bence-Jones protein | multiple myeloma
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| If a patient with blood type O Rh+ is given AB Rh- blood, the nurse would expect | The anti-A and Anti-B antibodies in the patient's blood to hemolyze the donor blood
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| Rationale: A pateint with O Rh+ blood has no A or B antigens on the red cell but does have anti-A or anti-B antibodies in the blood & has an Rh antigen. AB Rh- blood has both A & B antaigens on red cell but no Rh antigen & no Anti-A or Anti-B antibodies | If the AB Rh-
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| A patient is undergoing a contrast CT of the spleen. Before this test, it is important for the nurse to ask the patient about |
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| To prepare the patient for a bone marrow aspiration from the most common site for adults, the nurse positions the patient |
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| When teacing a patient about a bone marrow examination, the nurse explains that |
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| A lymph node biopsy is most often performed to diagnose |
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| Hematology | The study of blood and blood-forming tissues. This includes bone marrow, blood, spleen and lymph system. Evaluate the patients ability to transport Oxygen and Carbon dioxide, coagulate blood and combat infections
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| Hematopoiesis (Blood cell production) | Occurs within the bone marrow.
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| Bone Marrow | the soft material that fills the central core of bones.
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| All three types of blood cells (RBC, WBC and platelets) | develop from a common hematopoietic stem cell within the bone marrow.
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| Hematopoietic stem cell | nondifferentiated immature blood cell found in the bone marrow;
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| Three types of Blood Cells | As the cells mature and differentiate, several different types of blood cells are formed
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| Blood: A type of connective tissue that performs three major functions | Transportation, regulation, and protection.
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| Blood is responsible for | transportation of oxygen, nutrients, hormones, and waste products around the body. Blood also plays a role in the regulation of fluid, electrolyte, and acid-base balance.
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| Blood's role | protective in its ability to clot and combat infections.
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| Two major components to blood: | Plasma and blood cells
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| Plasma is 55% of blood; composed primarily of water | It contains proteins, electrolytes, gases, nutrients and waste
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| Serum | Plasma minus its clotting factors
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| Plasma Protein | Albumin, Globulin, Clotting factors, mostly fibrinogen
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| Blood Cells are 45% of the blood | Is comosed of formed elements or blood cells
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| Three types of blood cells | Erythrocytes (RBCs), leukocytes (WBCs), and thrombocytes (Platelets).
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| Primary function of erythrocytes is | Oxygen transportation,
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| Leukocytes are | involved in protection of the body from infection.
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| Platelets function | promote blood coagulation
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| Erythrocytes (RBC) | the primary functions of RBCs include transport of gases (both O2 and CO2) and assistance in maintaining acid-base balance.
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| Composition of Erythrocyte | it is a flexible cell with a unique biconcave shape
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| Hemoglobin | A complex protein-iron compound composed of heme (an iron compound) and globin ( a simple protein). functions to bind with O2 & CO2.
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| Erythropoiesis (the process of RBC production) | stimulated by hypoxia and controlled by erythropoietin, a glycoprotein growth facdtor sythesized and released by the kidney.
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| Erythropoietin | stimulates the bone marrow to increase erythrocyte production
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| Erythropoietin production | normally the bone marrow releases 3x10 to the 9th RBCs/kg of body wt/day. Erythropoiesis is also influenced by the availability of nutrients.
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| Essential nutrients necssaray for erythropoiesis are | protein, iron, folate (folic acid), cobalamin (vit b12), riboflavin (vit b2) and pyridoxine (vit b6) Erythrocyte production is also affected by endocrine hormones, such as thyroxine, corticosteroids, & testosterone.
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| Example of microcytic anemia | hypothyroidism can be the cause of microcytic anemia
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| Reticulocyte | an immature erythrocyte. It measures the rate at which new RBCs appear in the circulation. They can develop into mature RBCs w/in 48hrs of release into circulation. assessing # of retic is a useful means of eval the rate & adequacy of erythrocyte prodctn
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| Hemolysis (destruction of RBCs) | by monocytes and macrophages removes abnormal, defective, damaged and old RBCs from circulatiaon. This usually occurs in teh bone marrow, liver & spleen.
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| Hemolysis of RBCs | results in increased bilirubin to be processed by the body. When hemolysis occurs via normal mechanism, the liver is able to conjugate ane excrete all bili that is released
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| Normal lifespan of erythrocyte | 120 days
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| Leukocytes (WBC) | appear white when separated from blood. they originate from stem cells within the bone marrow
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| Five different tyepes of leukocytes, each with a different function | Granulocytes, Agranulocytes, neutrophil, monocytes,
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| Granulocytes: | neutrophils, basophils and eosinophils
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| Leukocytes without granules within the cytoplasm are called | agranulocytes and include lymphocytes and monocytes.
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| Lymphocytes and monocytes | are also referred to as mononuclear cells because they have only one discrete nucleus.
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| Leukocytes | have a widely variable life span.
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| Granulocytes | may only live for hours, yet some T-lymphocytes may live for years.
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| Primary function of the granulocytes | phagocytosis which is a process by which WBCs ingest or engulf any unwanted organism and tehn digest and kill it.
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| Neutrophil | the most common type of granulocyte - 50 to 70% of all WBCs.
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| Neutrophils | primary phagocytic cells involved in acute inflammatory responses
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| Mature neutrophil | called segmented neutrophil or seg or polysemented neutrophil because the nucleus is segmented into two to five loves connected by strands.
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| A Band | Immature neutrophil. Also capable of phagocytosis, but the mature neutrophil is much more effective
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| Eosinophils | account for only 2 to 4% of all WBCs. they have a similar but reduced ability for phagocytosis. One of their primary functions is to engulf antigen-antibody complexes formed during an allegic response.
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| Which cells are able to defend against parasitic infections | Eosinophils
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| Basophils make up less than 2% of all leukocytes | They have a limited role in phagocytosis. They have cytoplasmic granules that contain heparin, serotonin, and histamine.
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| The response seen in allergic and inflammatory reactions is | when a basophil is stimulated by an antigen or by tissue injury.
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| Examples of Nticoagulants are | Protein C and Protein S, Antithrombins and fibrinolysis. Endogenous heparin is an example of an anticoagulant.
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| Fibrinolysis | A process resulting in the dissolution of the fibrin clot.
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| Spleen | Located in the upper left quadrant of the abdomen.
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| Functions of the Spleen | Hematopoietic, filtration, immunologic and storage.
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| Hematopoietic function | manifested by the spleen's ability to produce RBCs during fetal development.
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| Filtration Function | demonstrated by teh spleen's ability to remove old and defective RBCs from the circulation by the mononuclear phagocyte system It also involves the reuse of iron.
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| The spleen also | plays a role in filtering circulating bacteria, especially encapsulated organisms such as gram-positive cocci.
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| The spleen as storage | About 30% of the platelet mass is stored in the spleen.
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| The Lymph System | consists of lymph fluid, lymphatic capillaries, ducts, & lymph nodes.
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| The Lymph System | It carries fluid from the interstitial spaces to the blood. It is by means of the lymph that proteins & fat from the GI tract & certain hormones are able to return to the circulatory system. It also returns excess interstitial fluid to the blood.
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| Returning excess interstitial fluid to the blood | is important in preventing the development of edema.
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| Primary function of lymph nodes | filtration of pathogens and foreign particles that are carried by lymph to the nodes.
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