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Hematological System

Hematological System . Joyce Smith RN BSN Nursing 202. Introduction. Blood formed in liver & spleen of fetus until 3 rd trimester At birth all bones Throughout life in flat bones. Introduction. Each day healthy bone marrow produces 2.5 billion erthrocytes, 80- 120 days

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Hematological System

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  1. Hematological System Joyce Smith RN BSN Nursing 202

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

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

  4. 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

  5. Bone Marrow • Soft organic material that fills the cavities of the bones • Produces RBC’s and platlets • Majority are produced in the vertebrae, ribs, sternum, skull, pelvis and long bones of the legs

  6. Blood Components • Plasma • Albumin • Globulin • Fibroinogen • Erythrocytes • Leukocytes • Platelets

  7. 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

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

  9. 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

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

  11. 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

  12. 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

  13. 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

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

  15. 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

  16. Gerontological Considerations • Hgb level fall after middle age • Fe deficiency most frequent in older • Reduced dietary intake of iron-rich foods • Don’t use oral Fe supplements • By age 65 up to 50% of body’s bone marrow converted to inactive

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

  18. Thrombolytic • Thrombolytics: degrade fibrin thread • tPA • SK • Reteplase • Anistreplase

  19. 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

  20. 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

  21. 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

  22. Health History • Family history of illnesses both living & deceased realities as well as cause of death • Sexual habits: promiscuity, male homosexuality & bisexuality, & partner’s sexual habits • Drug abuse history • Medical history, including malignancies

  23. Physical Assessment • Skin • Head & neck • Respiratory • Cardiovascular • Renal & Urinary • Muscloskeletal • Abdominal • CNS • Psychosocial

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

  25. Head & Neck • Sclera • Jaundice • Oral mucosal ulceration • Fissures at corner of mouth • Lymph enlargement or pain • Smooth red tongue

  26. Respiratory • Rate • Depth • Rest & activity • 10 word sentences • Easily fatigued • SOB at rest or exertion • # of pillows

  27. 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

  28. Renal & Urinary • Overt bleeding • Occult bleeding • Hematuria • Proteinuria

  29. Musculoskeletal • Rib tenderness • Sternal tenderness

  30. CNS • Cranial nerve assessment • Neurological function • Mental status • GCS • Neuromuscular evaluation

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

  32. 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

  33. Reticulocyte Count • Immature RBCs • 2% for circulating RBCs normally •  indicates increased production of RBC by bone marrow

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

  35. Coombs’ Test • Direct & indirect • Used for blood typing • Direct presence of antibodies against RBCs • Certain disease associated with production of antibodies against body’s own RBCs, causes hemolytic anemia • Indirect presence of circulating antiglobins • Determines presence of serum antibodies to type of RBCs in blood transfusion

  36. 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

  37. 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.

  38. 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

  39. International Normalized Ratio • INR same as PT but standardized • 0.7 – 1.8 • Warfarin therapy 2.0-3.0

  40. 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

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

  42. Bone Marrow Aspiration • Nursing considerations • Signed informed consent • Lasts 5 to 15 min • Anesthesia or sedation • Local anesthetic or rapid acting sedative

  43. Bone Marrow Aspiration • Complications • Soreness at site • Bleeding • Infection

  44. 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 

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