Chapter 32: Assessment of Hematologic Function and Treatment Modalities

Erythrocyte

Carries hemoglobin to provide oxygen to tissues; average lifespan is 120 days

Stroma

Component of the bone marrow not directly related to hematopoiesis but serves important supportive roles in this process

Basophil

Contains histamine; integral part of hypersensitivity reactions

Monocyte

Enters tissue as macrophage; highly phagocytic, especially against fungus; immune surveillance

Neutrophil

Essential in preventing or limiting bacterial infection via phagocytosis

Thrombocyte

Fragment of megakaryocyte; provides basis for coagulation to occur; maintains hemostasis; average lifespan is 10 days

Nucleated RBC

Immature form of RBC; portion of nucleus remains within RBC

Natural killer cells

Immune cells that accumulate in lymphoid tissue that are potent killers of virus-infected and cancer cells

Left shift, or shift to the left

Increased release of immature forms of WBCs from the bone marrow in response to need

Lymphocyte

Integral component of immune system

Hemostasis

Intricate balance between clot formation & dissolution

Eosinophil

Involved in allergic reactions (neutralizes histamine); digests foreign proteins

Hemoglobin

Iron-containing protein of RBC that delivers O2 to tissues

Hematocrit

Percentage of total blood volume consisting of RBCs

Myeloid

Pertaining to non-lymphoid blood cells that differentiate into RBCs, platelets, macrophages, mast cells, and various WBCs

Blast cell

Primitive WBC

Cytokines

Proteins produced by leukocytes that are vital to regulation of hematopoiesis, apoptosis, and immune responses

T lymphocyte

Responsible for cell-mediated immunity; recognizes material as "foreign" (surveillance system)

B lymphocytes

Responsible for humoral immunity; many mature into plasma cells to form antibodies

Plasma cell

Secretes immunoglobulin (antibody); most mature form of B lymphocytes

Reticulocytes

Slightly immature RBCs, usually only 1% of total circulating RBCs

Band cell

Slightly immature neutrophil

The nurse begins a routine blood transfusion of packed red blood cells (PRBCs) at 1100. To ensure client safety, the unit of blood should be completely transfused by what time? a) 1500 b) 1115 c) 1600 d) 1530

a) 1500 Administration time for PRBCs should not exceed 4 hours because of the increased risk of bacterial proliferation. For the first 15 minutes, the transfusion should be run slowly- no faster than 5 mL/min.

A 67-year-old client at the free clinic where you practice nursing has a history of seizures and presents with severe fatigue, frequent headaches, and a sore and beefy red tongue. Which of the following could be causing her current condition? Select all that apply. a) Intestinal disorders b) Lack of vitamin B c) Lack of meat consumption d) Alcoholism

a) Intestinal disorders d) Alcoholism Older adults and clients with alcoholism, intestinal disorders that affect food absorption, malignant disorders, and chronic illnesses often have a folic acid deficiency because of poor nutrition.

Under normal conditions, the adult bone marrow produces approximately 70 billion neutrophils. What is the major function of neutrophils? a) Rejection of foreign tissue b) Production of antibodies called immunoglobulin (Ig) c) Phagocytosis d) Destruction of tumor cells

c) Phagocytosis The major function of neutrophils is phagocytosis. T lymphocytes are responsible for rejection of foreign tissue and destruction of tumor cells. Plasma cells produce antibodies call immunoglobulin.

The physician performs a bone marrow biopsy from the posterior iliac crest on a patient with pancytopenia. What intervention should the nurse perform following the procedure? a) Pack the wound with half-inch sterile gauze b) Elevate the head of the bed to 45 degrees c) Administer a topical analgesic to control pain at the site d) Apply pressure over the site for 5-7 minutes

d) Apply pressure over the site for 5-7 minutes Hazards of either bone marrow aspiration or biopsy include bleeding and infection. The risk of bleeding is somewhat increased if the patient's platelet count is low or if the patient has been taking a medication (e.g., aspirin) that alters platelet function. After the marrow sample is obtained, pressure is applied to the site for several minutes. The site is then covered with a sterile dressing.

Granulocyte

Granulated WBC (neutrophil, eosinophil, basophil); sometimes used synonymously with neutrophil

A patient with Hodgkin's disease had a bone marrow biopsy yesterday and is complaining of aching, rated at a 5 (on a 1-10 scale), at the biopsy site. After assessing the biopsy site, which of the following nursing interventions is most appropriate? a) Administer the ordered paracetamol 500 mg po b) Notify the physician c) Administer the ordered aspirin (ASA) 325 mg po d) Reposition the patient to a high Fowler's position and continue to monitor the pain

a) Administer the ordered paracetamol 500 mg po After the marrow sample is obtained, pressure is applied to the site for several minutes. The site is then covered with a sterile dressing. Most patients have no discomfort after a bone marrow aspiration, but the site of a biopsy may ache for 1 or 2 days. Warm tub baths and a mild analgesic agent (e.g., paracetamol) may be useful. Aspirin-containing analgesic agents should be avoided it the immediate post-procedure period because they can aggravate or potentiate bleeding.

The charge nurse should intervene when observing a new nurse perform which action after a client has suffered a possible hemolytic blood transfusion reaction? a) Disposing of the blood container and tubing in biohazard waste. b) Notifying the blood bank of the reaction. c) Documenting the reaction in the client's medical record. d) Informing the client to leave a urine sample after the client's next void.

a) Disposing of the blood container and tubing in biohazard waste. The blood container and tubing should be returned to the blood bank for repeat typing and culture, and the blood bank should be notified of the reaction. A urine sample is collected as soon as possible to detect hemoglobin in the urine. Documenting the client's reaction in the medical record is an appropriate action.

A client is receiving platelets. In order to decreased the risk of circulatory overload in this client, the nurse should do which of the following? a) Infuse each unit over 30-60 minutes per client tolerance. b) Flush the intravenous line with a liter of saline between units. c) Monitor vital signs closely before transfusion and once per shift. d) Administer each unit slowly over 3-4 hours.

a) Infuse each unit over 30-60 minutes per client tolerance. Infuse each unit of FFP over 30-60 minutes per client tolerance. Platelet clumping will occur if administered too slowly. Vital signs should be monitored before and throughout the transfusion, not just once per shift. A liter of saline is too large an amount to flush the intravenous line and would contribute to fluid overload.

A client receiving a blood transfusion complains of shortness of breath, appears anxious, and has a pulse of 125 beats/minute. What is the best action for the nurse to take after stopping the transfusion and awaiting further instruction from the healthcare provider? a) Ensure there is an oxygen delivery device at the bedside. b) Place the client in a recumbent position with legs elevated. c) Remove the intravenous line. d) Administer prescribed PRN anti-anxiety agent.

a) Ensure there is an oxygen delivery device at the bedside. The client is exhibiting signs of circulatory overload. After stopping the transfusion and notifying the healthcare provider, the nurse should place the client in a more upright position with the legs dependent to decrease workload on the heart. The IV line is kept patent in case emergency medications are needed. Oxygen and morphine may be needed to treat severe dyspnea. Administering an anti-anxiety agent is not a priority action over ensuring oxygen is available.

G-CSF (filgrastim [Neupogen]) is prescribed for a client with bone marrow suppression. What medication administration teaching should the nurse provide to the client? a) Neupogen is taken intramuscularly on a weekly basis. b) Assist the client in identifying appropriate subcutaneous injection sites. c) Do not eat before arriving to receive the intravenous administration of Neupogen. d) Take this medication by mouth at bedtime each night.

b) Assist the client in identifying appropriate subcutaneous injection sites. Neupogen is administered subcutaneously on a daily basis.

A client tells the nurse that he would like to donate blood before his abdominal surgery next week. What should be the nurse's first action? a) Tell the client that 2 units of blood will be needed. b) Explain the time frame needed for autologous donation. c) Provide the client with a list of the nearest donation centers. d) Remind the client to take supplemental iron before donation.

b) Explain the time frame needed for autologous donation. Preoperative autologous donations are ideally collected 4 to 6 weeks before surgery. The nurse should first explain that time frame to this client. Surgery is scheduled in one week which means that autologous blood donation may not be an option for this client. A list of donation centers can be provided to the client; and even though iron is recommended and 2 units of blood may be suggested, the first action is to tell the client about the needed time frame for donation.