Hematology
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| What is included in the hematological system | blood, bone marrow, Reticuloendothelial system (spleen, lymph system)
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| What are three fx of blood | Transportation- O2, nutrients, hormones, wastes
Regulation- F&E balance, acid/base bal, body temp
Protection- combats pathogens, hemostasis of blood coagulation
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| What are three primary cell types of blood | erythrocytes, leukocytes, thrombocytes
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| what is hematopoiesis | formation of blood cells, done in the bone marrow. Makes up 5-6L of volume in body
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| What is plasma % and what makes it up | 55% of blood volume, consists of albumin, blobulin, fibrinogen, adn other clotting factors plus serum (no clotting factors)
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| Where is blood cell formation done in the body of adults? Where is it typically aspirated from | pelvis, ribs, vertebrae, sternum
iliac crest, sternum for study or transplant, consent form
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| What are stem cells | In bone marrow and undifferentiated that can produce RBC, WBC, platelets.
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| What do RBCs do | bi-concave(lg surface area helps in )2 absorption/release) with hemoglobin contains iron. No nuclei in mature RBCs.
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| what are reticulocytes | immature RBCs that get released with some disease states or extreme demand for RBCs. Have nucleus.
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| How do RBCs transport oxygen | the hemoglobin contains iron, heme, which binds to O2 and is carried to lungs as oxyhemoglobin.
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| what is erythropoiesis | process of formation of RBCs. Requires iron, B12(need intrinsic factor in stomach), folic acid, B6, protein, takes 5 days. If spleen takes over, reticulocytes(immature RBC) released,
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| what is erythropoietin | hormone made by kidney to help myeloid cell into erythroblast
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| what is erythrocyte sedimentation rate | measures the rate of settling RBCs, high is inflammation called the "sed rate"
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| what is life span of RBC | 105-120 days(4mos)
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| Stem cells differentiate into two types | myeloid- RBC, WBC, platelets
lymphoid- T or B lymphocytes
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| What are megoblasts | abnormally lg RBCs produced when not enough B12 or folic acid and results in megaloblastic anemia, becuase get stuck and block other RBCs
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| What are two categories of WBCs | granulocytes
lymphocytes
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| what is normal count of WBC | 4,000-11,000
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| What are the three granulocytes | eosinophils-prasitic inf 2-4%
basophils- allergic, histamine <2%
neutrophils-kill bacteria 50-70%
band cell(immature neutrophil and lead to "left shift" and release of many in response to infection
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| What are the two types of agranulocytes | monocytes- 4-8%, on site, non circulating, lgst WBC, macrophages (in spleen,liver,peritoneum, alveoli)
lymphocytes- B-cells(marrow),T-cells(thymus)
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| What are three different macrophages | residents to protect body
Kupffer cells - liver
Osteoclasts- go to bone
Alveolar macrophages - sit in lung
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| Fx of macrophages | defend, remove old/damaged cells, stimulate inflammatory process, present antigen to immune system
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| what is cellular immunity | T cells kill foreign cells directly
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| what is humoral immunity | plasma cells produce antibodies called immunoglobulins that destroy
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| How is platelet production regulated | by thrombopoietin which stimulates produciton of megakaryocytes from myeloid stem cells. Lifespan of 7-10 days
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| what is fx of spleen | hematopoietic- fetal and adult PRN
filtration- RBCs, iron, hgb
immunologic- b,t-cell, IgM
storage - RBC, platelets
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| what is fx of lymph sustem | return protein/fat from GI to blood,
60% interstitial fluid to blood
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| what is a lymp system adjunct organ | liver - filters, produces pro-coagulants, stores excess iron, excretes bilirubin to common duct
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| what is hemostasis and what are two responses | preventing blood loss:
primary-vascular, platelets form plug
secondary- intrinsic/extrinsic pathway clotting with fibrin
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| Once fibrin clot is formed and injured vessel is repaired what happens? | fibrinolytic(lyse fibrin clot) system, plasminogen(protein to dissolve clots) to lyse fibrin(basis of blood clot).
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| What does hematocrit measure | % of blood volume consisting of RBCs
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| What are hematemesis, melena, polycythemia, hemarthrosis, petechiae/pupur | hematemesis: bloody vomit
melena: blood in stool
polycythemia:overproduction RBCs
Hemarthrosis: blood in joints
petechiae/purpura: red/purple hemorrhages
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| what is normal count for platelets? | 150,000-400,000
Thrombocytopenia: <100,000
Thrombocytosis: excessive platelets
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| What is normal prothrombin time? INR? | Prothrombin: 11-12.5sec
INR: 0.8-1.1 or <2.0 (want 2-3 for those on anticoagulation)
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| what is activated partial thromboplastin time (aPTT) | 30-45sec
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| What is D-dimer | fragment fibrin indicating clotting activity
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| What is anemia | Condition that is deficiency of # of RBCs, hemoglobin, or hematocrit. Most common hemotologic condition in elderly
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| Anemia is defect is these three things | loss of RBCs, decr production of RBCs, incr destruction of RBCs, blood loss, deficient iron, B12, folate, hemolytic
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| What look for in CBC for anemia | Hgb, Hct, reticulocyte county, MCV, RDW
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| what do you give for active hemorrhage? For anemia? | whole blood b/c of volume adn clotting factors
pRBCs
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| what are morphology of RBCs in anemia | normocytic, normochronmic: normal size, color
macrocytic, normochromic: lg size, normal color
microcytic, hypochromic: sm size, pale color
macrocytic, hypochromic: lg size, pale color
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| s/s of anemia | sudden = more devastating
weakness, fatique, malaise, pallor, tachy, dizzy, dyspnea, exertional dyspnea
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| tx for s/s | conserve energy....drink meals. Iron rich foods: organ meats, beans, green leafy vegs, molasses, raisins
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| What is sever anemia hct | <6
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| what are complications of severe anemia | heart failure, angina, paresthesias, delirium(no O2 to brain). Inf,inflammatory conditions can cause low iron
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| what are some findings wtih anemia | brittle hair/nails, not jaundice, smooth, pale, sore tongue, burning stomatitis
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| Where si iron normally absorbed | duodenum/upper jejunum, only 5-10% is absorbed, 1/3 is stored/recycled, .5-1mg absorbed from sm int.
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| what are nsg interventions | teach dietary sources and Vit C helps absorption, monitor bleeding, give rest, O2 therapy, give liquid iron, but use straw to get over teeth
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| What are patterns of anemia of ESRD(end stage renal disease) | Creatinine >3/100ml, hemodialysis removes folic acid and breaks RBCs, no kidney erythropoietin
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| The tongue looks different wtih iron dificiency anemia and megaloblastic anemia | iron: smooth/red
megaloblastic: beefy red/sore
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| what is aplastic anemia | decr bone marrow, lead to panyctopenia, 75% fatal
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| what is the cause of aplastic anemia | congenital, chemical toxins, meds, radiation
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| Tx for pancytopenia | transfusions, immunosuppressive therapy, bone marrow transplant, stem cell transplant
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| nsg mgmt for aplastic anemia | assess for bleeding or inf, reverse isolation, immunosuppressive reactions, manage meds
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| S/S for aplatic anemia | hemorrhage (GI), lg spleen, pupura in extremeties,
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| What is megaloblastic anemias | missing folic acid and B12 and iron, lg shape
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| s/s of folic acid deficiency differs from B12 deficiency | no neurologic s/s vs neurologic s/s
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| what is pernicious anemia | can't absorb B12 b/c lack intrinsic factor in GI, red beefy tongue, painful
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| What test is used to test for Pernicious anemia | Schillings Test(oral radiation to track B12 if absorbed- if radiation in urine, then B12 absorbed
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| what are some hemolytic anemias | break down of heme to bilirubin, decr life of RBCs, Sickle Cell, Thalassemia
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| who is affect most with sickle cell anemia | black children, low O2 bc sickle shape blocks vessels. Very painful, hemoarthrosis(blood in joints)
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| How long do sickle RBCs live | 20 days vs normal 120, jaundice in scelera
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| what are three sickle cell crises | painful sickle crisis: hypoxia/necrosis
aplastic crisis: infection with human parvovirus
Sequestration crisis: organs pool the sickled cells (spleen/liver/lungs)
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| What are some complications of sickle cell | Hand Foot syndrome: swelling bn 6mos adn 2yr
Jaundice: can lead to gallstones
Leg Ulcers, stroke, retinal damage, kidney failure, splenectomy, pneumonia, pulmonary HTN(most cause of deathm screen wtih Doplar)
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| What are nsg tx for sickle cell | conserve energy, O2, fluids, transfusion leads to chelation, Prbcs, hydroxurea(chemo)
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| What is Thalassemia | Low hgb so low O2
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| what is polycythemia Vera and what are two types | excess RBCs, primary, secondary
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| what is primary polycythemia | Male 65yr, incr Hct/WBC/blood vol, fluids, ruddy complexion, lg spleen/liver, pruritus, thrombosis
Tx: movement, blood letting
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| What is neutropenia | lack of neutrophils so decr produciton, incr destruction, risk for infection
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| What are nsg interventions for pt with infections | avoid fresh flowers, plants, litter boxes, bird cages, fresh salads, unpeeled fruit/veg, crowds
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| What is most common childhood disease that causes death | Leukemia,neoplastic proliferation of WBCs, acute/chronic, lymphoid, myeloid
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| what are 4 types of leukemia and which affects children and adults more | ALL(acute lymphocytic)- child(boys)
AML(acute myeloid) all ages, peak 60, induction therapy(aggressive chemo)
CML(chronic myeloid)
CLL(chronic lymphocytic) adult50-60, most common, gleevec tx
Complictions: tumor lysis syndrome
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| Lymphoid affects what cells myeloid affects what cells | T&B cells
monocytes, granulocytes, erythrocytes, platelets
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| What are lymphomas and what are two clssifications | cancer of lymphoid cells, start in nodes
Hodgkins - nodular, 20s/50s, painless, pruritus after alcohol, Ree-Sternberg cells
Non-Hodgkins - diffuse, all ages, B/T cell origin
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| What is multiple myeloma | malignancy of plasma cells(B lymphocytes) in bone marrow, Men after 40, bone destruction, so bone pain.
**back pain and elevated protein
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| nsg interventions for Myeloma | ambulation, bone pain, prevent fractures, fluids for hyperca
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| Bleeding disorders | Thrombocytopenia, Idiopathic Thrombocytopenia Purpura, DIC, Hemophilia, Von Willebrand's Disease
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| What is normal platelet count and counts for various bleeding | normal: 150,000-400,000
no bleeding: 50,000
petechiae, nose/gingival: 20,000
GI/CNS bleed: 5,000
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| What are signs of ITP, idiopathic thrombocytopenia purpura | bruising, petechiae, heavy menses, children/women, <20,000 count
TX: IVIG, immunosuppressive meds, splenectomy, HLS transfusions
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| What is hemophelia what is Von Willebrand's disease | inherited, X-linked, loss of factor VII or IX
taxi for VII factor
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| What is first tx for DIC | treat underlying cause, then heparin, then platelets/pRBCs
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| How are transfusions given | IV
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| What is left shift | incr of immature neutrophils, band cells from the bone marrow.
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| what is myelopoiesis | mature neutrophils formed from myeloid blast cells, depends on cytokines
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| where is albumin produced | liver, helps with fluid balance
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| What three factors can help tell if anemia is from destruction or inadequate production | 1. marrows ability to decr RBC AEB incr reticulocyte count
2. amt of immature RBC in marrow
3. end products presence/absence, bilirubin level
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