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Hematologic Disorders & Nursing Priorities

Understand hematologic cells, interpret lab values, learn about medications, and prioritize nursing care for anemia, sickle cell anemia, leukemia, and more. Includes information on blood transfusions and reactions.

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Hematologic Disorders & Nursing Priorities

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  1. Hematologic Disorders &Nursing Priorities Keith Rischer RN, MA, CEN

  2. Objectives for Today • Review pathophysiology related to hematologic cells and blood forming tissues • Interpret significance of altered hematologic lab values • Review commonly used medications that alter hematologic function • Identify the patho, clinical manifestations, diagnostic tests, nursing priorities, and client education in clients with anemia, sickle cell anemia, leukemia, lymphomas, and multiple myeloma. • Identify the nursing priorities with blood transfusion and the most common transfusion reactions.

  3. Blood Cells • Hematopoesis: Red bone marrow • The blood forming tissue that produces the 3 major cell components of blood • Erythrocytes • Leukocytes • Thrombocytes

  4. Erythrocytes • Function • Transport of gases (O2 & CO2) • Erythropoesis • Normal Life span: 120 days • Norms • Hgb RBC • Women: 12-16 g/dl 4.0-5.0 mm3 • Men: 13.5-18n g/dl 4.5-6.0 mm3 • HCT • Women: 38-47% • Men: 40-54%

  5. Leukocytes • Types • Granulocytes (Also known as polymorphonuclearleukocytes) • Neutrophils • Eosinophils • Basophils

  6. Leukocytes • Monocytes agranular) • Lymphocytes B cells: mediate the humoral immune response • T cells: Mediate cellular immunity • Normal Blood Count of all WBC: 4,000-11,000/ul • Elderly considerations

  7. Thrombocytes (Platelets) • Function: • Aid in blood clotting • Maintain capillary integrity by working as “plugs” to close any openings in the capillary wall. • Normal Blood Count: 150,000-400,000 mm3

  8. Anemia • Mild • Hgb 10-14 g/dl • Moderate • Hgb 6-10 g/dl • Severe • Hgb < 6 g/dl

  9. Anemia:Causes Macrocytic • Pernicious Anemia (B12 deficiency) • Folate deficiency Microcytic • Iron deficiency anemia Normocytic • Blood loss • Sickle cell anemia

  10. Macrocytic Anemia Megaloblastic Anemias: Presence of large RBC’s) • Caused by defective DNA synthesis Two common types: 1. Cobalamin (vitamin B12 deficiency) • Pernicious anemia =most common cause. 2. Folic acid deficiency • Poor nutrition (Anorexia) • malabsorption in small bowel • ETOH • Hemodialysis PATIENT EDUCATION

  11. Microcytic Anemia: Iron Deficiency • Abnormal-small erythrocytes…decr. Hgb • Most common anemia • Manifestations • Pallor • Glossitis • fatigue • Dietary sources • Patient education

  12. Normocytic Anemia: Etiology Blood Loss • Acute • Chronic Extrinsic (acquired) hemolytic anemias – (damage to RBCs due to external factors) • Physical factors

  13. ED Case Study • 88 yr women w/dk tarry stools last 5 days. c/o weakness, nausea. • Pale, cool-initial VS 80-16-124/30….2 hours later 96-20-94/49 • Wbc 9.8, hgb 6.9 (was 12.7 2 weeks ago), hct 21.5, plt 176, INR 4.8 (was 2.1 2 weeks ago) • Nursing priorities

  14. Sickle Cell Anemia • Patho • Sickle Cell Crisis • Nsg Management • Pain control • Hydration • Patient Education • Hydration • Tx infection • Psychosocial

  15. Thrombocytopenia • Reduction of platelets below normal range • Normal = 150,000-400,000 mm3 • Etiology: • Immune Thrombocytopenic Purpura (ITP) • Heparin • Bone marrow suppression • Critical values • 50,000 or less- risk of bleeding • <20,000 spontaneous life threatening hemorrhages (brain bleed) • <10,000 transfusions recommended

  16. Clinical Manifestations • Petechiae • Purpura • Ecchymosis • Bleeding

  17. Nursing Management • If acute care-Peripheral IV established • No ASA products for pain control • Prevent/control acute bleeding • Platelet transfusions-assess for reaction • Steroids-pt. teaching • Education-signs of bleeding

  18. Blood Product Administration • Minimum 22 g.(blue hub) IV-prefer 20g. (pink) or 18g. (green) • Blood tubing with filter-use NS to prime/flush • Validate pt., type of blood product, expiration date, blood tag # • VS before, 15” after initiation, end of each • Infuse PRBC’s over 2 hours (appx 300cc/unit)

  19. Complications Blood Products • Circulatory Overload Acute Hemolytic Reaction • Chills, fever, flushing, tachycardia, SOB, hypotension, acute renal failure, shock, cardiac arrest, death Febrile-Nonhemolytic Reaction • Sudden onset of chills,fever, temp elevation >1 degree C. headache, anxiety Mild Allergic Reaction • Flushing, urticaria, hives

  20. Nursing Responsibilities • STOP transfusion • Maintain IV site-disconnect from IV and flush with NS • Notify blood bank/MD • Recheck ID • Monitor VS • Treat sx per MD orders • Save bag and tubing-send to blood bank

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